Key result
Metformin significantly reduces intracranial aneurysm wall enhancement vs. placebo, driven by lower volume ratio and index.
Why the study?
Metformin has anti-inflammatory properties, but its potential role in modifying aneurysm wall inflammation in unruptured vertebrobasilar dissecting aneurysms remained unclear.
Does metformin 250 mg twice daily for 6 months reduce aneurysm wall enhancement (WEVR and WEI) in patients with unruptured vertebrobasilar dissecting aneurysms showing wall enhancement on HR-VWI?
RCT (n=60)
Double-blind
1:1
Yes
Does metformin 250 mg twice daily for 6 months reduce aneurysm wall enhancement (WEVR and WEI) in patients with unruptured vertebrobasilar dissecting aneurysms showing wall enhancement on HR-VWI?
Six months of metformin therapy significantly reduced MRI markers of aneurysm wall inflammation, attenuated intramural hematoma progression, and lowered systemic inflammatory biomarkers in patients with unruptured vertebrobasilar dissecting aneurysms.
Answers are grounded in this paper and cite their sources.
Metformin may reduce wall inflammation in unruptured VBDAs; leaves open whether it alters rupture risk or clinical outcomes.
Background Vertebrobasilar dissecting aneurysms (VBDAs) are an important cause of ischemic stroke in young and middle-aged adults. High-resolution vessel wall imaging (HR-VWI) enables non-invasive assessment of aneurysm wall inflammation. Metformin has anti-inflammatory properties, but its potential role in unruptured VBDAs remains unclear. We evaluated the effect of 6 months of metformin therapy on aneurysm wall enhancement in unruptured VBDAs. Methods In this multicenter, prospective, randomized, double-blind, placebo-controlled trial, patients with unruptured VBDAs showing wall enhancement on HR-VWI between May 2024 and September 2025 were assigned 1:1 to receive metformin 250 mg twice daily or placebo for 6 months. The co-primary outcomes were changes in wall enhancement volume ratio (WEVR) and wall enhancement index (WEI) from baseline to 6 months. Secondary outcomes included changes in total outer aneurysm diameter, luminal diameter, intramural hematoma volume (IHV), and circulating inflammatory biomarkers. Results A total of 60 patients were included in the final analysis (30 per group). After 6 months, reductions in WEVR and WEI were significantly greater in the metformin group than in the placebo group (ΔWEVR: −8.91% vs 6.71%, P<0.001; ΔWEI: −0.16 vs 0.09, P<0.001). In patients with intramural hematoma, the increase in IHV was significantly smaller in the metformin group (ΔIHV: 145.60 mm³ vs 245.30 mm³, P=0.025). Additionally, C-reactive protein, tumor necrosis factor α, and interleukin 1β levels showed significantly greater reductions with metformin than with placebo (P<0.05). Conclusion Metformin significantly reduced aneurysm wall enhancement in patients with unruptured VBDAs, was associated with less progression of intramural hematoma, and reduced selected circulating inflammatory biomarker levels. Trial registration number NCT06405971.
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Dong et al. (2026) conducted an RCT in Unruptured vertebrobasilar dissecting aneurysms (VBDAs) (n=60). Metformin vs. Placebo was evaluated on Co-primary changes in wall enhancement volume ratio (WEVR) and wall enhancement index (WEI) from baseline to 6 months (p=<0.001). Metformin 250 mg twice daily for 6 months significantly reduced aneurysm wall enhancement compared to placebo (ΔWEVR -8.91% vs 6.71%, P<0.001; ΔWEI -0.16 vs 0.09, P<0.001).
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