Unruptured intracranial aneurysms (UIA) have a high prevalence (3.2%) and are increasingly diagnosed with modern imaging tools. The main risk of UIA is their rupture associated with intracranial bleeding with often severe clinical consequences. Areas covered: This review discusses the management strategy of UIAs, based on the large series of the literature (ISUIA, ATENA, UCAS, …), knowing that no randomized controlled trial is available to compare different strategies. The different endovascular treatments are described. Expert commentary: Due to the relatively scarce data regarding the risk of rupture of UIAs, the strategy of management is often difficult to define. It has to be multidisciplinary and has to take into account several factors related to the patient and the aneurysm. Beside the surgical approach, several endovascular tools are available to treat UIAs, that includes standard coiling, balloon-assisted coiling, stent-assisted coiling, flow diversion, and flow disruption.
Keywords: Unruptured intracranial aneurysm; balloon-assisted coiling; coiling; endovascular treatment; flow disruption; flow diversion; stent-assisted coiling.