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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">H. Oishi</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">October 2012,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">33 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(9) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">E121; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A3335 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-12092--61349661686" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">H. Oishi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>Department of Neurosurgery Juntendo University School of Medicine Tokyo, Japan</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=H.%2BOishi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Oishi%20H&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AH.%2BOishi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div>  </div>

  
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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><p id="p-1">In the International Study of Unruptured Intracranial Aneurysms (ISUIA),<sup><a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a></sup> the natural risk of bleeding in patients without a history of subarachnoid hemorrhage strongly depended on the size of the aneurysm. Aneurysms (&lt;7 mm) located in the internal carotid artery, anterior communicating artery, middle cerebral artery, and aneurysms (&lt;7 mm) located in the posterior circulation or the posterior communicating artery showed an annual bleeding risk of 0% and 0.5%, respectively. On the other hand, Sonobe et al<sup><a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a></sup> reported that the annual bleeding risk of unruptured intracranial aneurysms (UIAs) &lt;5 mm in the Japanese population was 0.54%. In their meta-analyses of the rupture risk of UIAs, Wermer et al<sup><a id="xref-ref-3-2" class="xref-bibr" href="#ref-3">3</a></sup> reported that the risks of the aneurysms measuring ≤5 mm and 5–10 mm were 0.5% and 1.2%, respectively. Japanese and Finnish populations have a relatively high risk of aneurysm rupture. In the latest prospective study regarding the natural course of UIAs in the Japanese population, the annual rupture risks of UIAs measuring 3–4 mm, 5–6 mm, and 7–9 mm were 0.36%, 0.50%, and 1.69%, respectively.<sup><a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a></sup> Therefore, the patient's race should be taken into consideration regarding the rupture risk of asymptomatic small UIAs.</p><p id="p-2">We believe that UIAs that are incompletely embolized with a coil can be protected from bleeding in short-to-midterm periods. Patients with incompletely embolized UIAs receive certain benefits from endosaccular coil embolization. However, a large-scale prospective cohort study with long-term follow-up is warranted.</p><p id="p-3">With increasing experience and the development of endovascular devices, aneurysms that are difficult to treat with endosaccular coil embolization, probably resulting in failure in the early period, have become treatable, resulting in a residual neck or residual aneurysm.</p><p id="p-4">We reported that the patients in our series were not representative of the whole Japanese population of patients with small asymptomatic UIAs because surgically treated or untreated UIAs were not included in this study. Therefore, a large-scale prospective cohort study is warranted. We discovered that experienced interventionalists can perform the endosaccular coil embolization of asymptomatic small UIAs with very low morbidity and mortality rates.</p><div class="section ref-list" id="ref-list-1"><h2>References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.9.E121.1" data-doi="10.1056/NEJM199812103392401"><div class="cit-metadata"><cite><span class="cit-article-title">Unruptured intracranial aneurysms: risk of rupture and risks of surgical intervention—International Study of Unruptured Intracranial Aneurysms Investigators</span>. 
<abbr class="cit-jnl-abbrev">N Engl J Med</abbr> 
<span class="cit-pub-date">1998</span>;
<span class="cit-vol">339</span>:
<span class="cit-fpage">1725</span>–
<span class="cit-lpage">33</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1056/NEJM199812103392401&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=9867550&amp;link_type=MED&amp;atom=%2Fajnr%2F33%2F9%2FE121.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">2.</span>

<div class="cit ref-cit ref-journal no-rev-xref" id="cit-33.9.E121.2" data-doi="10.1161/STROKEAHA.110.585059"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Sonobe</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Yamazaki</span>  <span class="cit-name-given-names">T</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Yonekura</span>  <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. 
<span class="cit-article-title">Small unruptured intracranial aneurysm verification study: SUAVe study, Japan</span>. 
<abbr class="cit-jnl-abbrev">Stroke</abbr> 
<span class="cit-pub-date">2010</span>;
<span class="cit-vol">41</span>:
<span class="cit-fpage">1969</span>–
<span class="cit-lpage">77</span></cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToic3Ryb2tlYWhhIjtzOjU6InJlc2lkIjtzOjk6IjQxLzkvMTk2OSI7czo0OiJhdG9tIjtzOjIwOiIvYWpuci8zMy85L0UxMjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.9.E121.3" data-doi="10.1161/01.STR.0000260955.51401.cd"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Werner</span>  <span class="cit-name-given-names">MJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">van der Schaaf</span>  <span class="cit-name-given-names">IC</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Algra</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. 
<span class="cit-article-title">Risk of rupture of unruptured intracranial aneurysms in relation to patient and aneurysm characteristics: an updated meta-analysis</span>. 
<abbr class="cit-jnl-abbrev">Stroke</abbr> 
<span class="cit-pub-date">2007</span>;
<span class="cit-vol">38</span>:
<span class="cit-fpage">1404</span>–
<span class="cit-lpage">10</span>.</cite></div><div class="cit-extra"><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6OToic3Ryb2tlYWhhIjtzOjU6InJlc2lkIjtzOjk6IjM4LzQvMTQwNCI7czo0OiJhdG9tIjtzOjIwOiIvYWpuci8zMy85L0UxMjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a>

<div class="cit ref-cit ref-journal" id="cit-33.9.E121.4" data-doi="10.1056/NEJMoa1113260"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Morita</span>  <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kirino</span>  <span class="cit-name-given-names">T</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Hashi</span>  <span class="cit-name-given-names">K</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. 
<span class="cit-article-title">The natural course of unruptured cerebral aneurysms in a Japanese cohort</span>. 
<abbr class="cit-jnl-abbrev">N Engl J Med</abbr> 
<span class="cit-pub-date">2012</span>;
<span class="cit-vol">366</span>:
<span class="cit-fpage">2474</span>–
<span class="cit-lpage">82</span></cite></div><div class="cit-extra"><a href="/lookup/external-ref?access_num=10.1056/NEJMoa1113260&amp;link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=22738097&amp;link_type=MED&amp;atom=%2Fajnr%2F33%2F9%2FE121.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li></ol></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2012 by American Journal of Neuroradiology</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 33</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 9 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Oct 2012 </div></div>
      
      
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