Time to Consider Pharmacologic Management of Unruptured Intracranial Aneurysms?

The increasing detection rate of unruptured intracranial aneurysms (UIAs) using advanced imaging underscores the need for alternative management strategies beyond surgical and endovascular interventions. Although these procedures have improved substantially, they still carry procedural risks, high costs, and psychological burdens related to continuous surveillance. This review aimed to suggest the potential role of pharmacological therapy in mitigating aneurysm progression and the risk of rupture. We first reviewed the key pathophysiological mechanisms-endothelial dysfunction, hemodynamic stress, inflammation, and thrombosis-contributing to UIA growth and instability. We then listed and examined a range of pharmacological agents, including antihypertensives, lipidlowering drugs, anti-inflammatory compounds, antioxidants, and novel candidates, summarizing both the preclinical and observational evidence supporting their use. While these findings are encouraging, current clinical data do not support broad, standardized treatment guidelines. Further prospective or randomized studies are required to clarify the safety, efficacy, and feasibility of using these agents in routine practice. By highlighting the rationale for pharmacological interventions and identifying key knowledge gaps, this review underscores the importance of an integrative management approach, encompassing medication, lifestyle modification, and vigilant monitoring, to better address patient needs and ultimately improve outcomes in UIA care.