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September 3, 2026The Lancet NeurologyOpen Access

Prevalence of unruptured intracranial aneurysms according to comorbidities, risk factors, country, and time period: a systematic review and meta-analysis

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Authors

JDJudith DremelHeidelberg UniversityVRViktoria RückerUniversity of WürzburgCBCamilo BadelUniversity of Atlántico

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Implication

Systematic review and meta-analysis shows increasing prevalence of unruptured intracranial aneurysms over time, suggesting potential benefits of targeted screening in high-risk groups.

Key Points

  • To determine whether the historical decline in subarachnoid hemorrhage incidence is paralleled by decreases in the prevalence of unruptured intracranial aneurysms (UIAs) across comorbidities, risk factors, countries, and time periods.
  • Systematic review and meta-analysis searching Embase, PubMed, and Web of Science (2011 to 2025) alongside 68 reassessed articles published before March 2011.
  • Included cross-sectional or case–control studies reporting crude counts of UIA in 10 or more participants, registered with PROSPERO (CRD420261296728).
  • Estimated adjusted prevalence ratios (PRs) and risk ratios (RRs) relative to a reference population (age 50, 50% women, no comorbidities) using generalized linear mixed models and binomial meta-regression.
  • Analyzed 162 articles covering 316,131 participants and 11,822 UIAs; baseline prevalence in the reference population was 3.9% (95% CI 3.0–5.1).
  • Prevalence was markedly elevated in autosomal dominant polycystic kidney disease (12.8%; adjusted PR 4.4, 95% CI 1.5–12.6), connective-tissue disorders (10.3%; adjusted PR 3.9, 95% CI 2.0–7.6), and family history of aneurysm/hemorrhage (7.9%; adjusted PR 2.4, 95% CI 0.5–11.2).
  • Risk of UIA was increased with female sex (RR 1.9, 95% CI 1.8–2.0), hypertension (RR 1.6, 95% CI 1.5–1.7), and current smoking (RR 1.4, 95% CI 1.2–1.6); prevalence in healthy cohorts using angiography rose from 2002–2015 to 2016–2022 (adjusted PR 1.8, 95% CI 1.1–2.8).

Cite This Study

Dremel et al. (2026) studied this question.

synapsesocial.com/papers/6a993592636c6408cfa7dee5https://doi.org/10.1016/s1474-4422(26)00276-0
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Some Observations on the Natural History of Intracranial Aneurysms1965 · 144 citations
  2. 2The risk of intravenous thrombolysis-induced intracranial hemorrhage in Taiwanese patients with unruptured intracranial aneurysm2017 · 8 citations
  3. 3The risk of endovascular thrombectomy in acute ischemic stroke patients with large vessel occlusions harboring unruptured intracranial aneurysms2025 · 3 citations
  4. 4Screening for brain aneurysm in the Familial Intracranial Aneurysm study: frequency and predictors of lesion detection2008 · 124 citations
  5. 5Factors associated with early-onset intracranial aneurysms in patients with autosomal dominant polycystic kidney disease2024 · 9 citations