Should Intracranial Aneurysms Be Treated before They Rupture?

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Abstract
Modern diagnostic techniques allow the detection of many potentially dangerous conditions before patients get sick, often before symptoms occur. The ability to detect four such conditions — asymptomatic carotid-artery stenosis,1 atrial fibrillation without brain embolism,2 vascular malformations in the brain,3,4 and cerebral aneurysms57 — has led to controversy about preventive treatment. All four are serious disorders that can cause disabling or fatal brain infarction or hemorrhage. Treatment of these conditions — surgery in patients with carotid artery disease, aneurysms, or vascular malformations and anticoagulant therapy in elderly persons with atrial fibrillation — carries considerable risks as well as . . .