Brain aneurysm bleeding is associated with high rates of fatality or permanent neurological impairment. Despite the low risk of bleeding of an unruptured cerebral aneurysm (UCA) [1,2], the dismal outcome of aneurysmal rupture has led to the aggressive treatment of these aneurysms. In 2008, approximately 60,000 UCAs were treated in the USA [3]. The rate of morbidity and mortality from treatment is high: approximately 5 and 14% for coil embolization and surgical clipping, respectively [3]. The risk-benefit analysis does not support treatment of all UCAs and in an era of significant attention to healthcare economics, considerable expense for treatment of unruptured aneurysms may not be justified. Thus, there is a strong clinical need to identify asymptomatic patients with UCA who would benefit from preventative interventional or surgical procedures.

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