Long-term survival after treatment of unruptured intracranial aneurysms: A population-based perspective.

Introduction: Unruptured intracranial aneurysms (UIAs) affect 2-3% of the general population. While treatment decisions focus on balancing procedural risks with the long-term rupture risk, little is known about the overall life expectancy and long-term mortality in this patient group. Research question: This study aimed to evaluate survival, causes of death, and cardiovascular risk factors in UIA patients compared to the general population. Material and methods: In this observational study, 382 patients with UIAs were identified from a single-center cohort of 1107 treated intracranial aneurysms (2006-2022). Patients were matched 1:100 by age and sex to individuals from the general population. Survival and cause-of-death data were obtained from national records, with WHO-based classification. Cardiovascular risk factors were extracted from hospital records and compared to national health survey data. Results: Patients with UIAs (median age 59, 36% male) had a significantly higher mortality risk than the matched population (hazard ratio 3.116; CI 2.291-4.239; p < 0.001). Median life expectancy was 73.9 years [69.9, 79.1], 13 years shorter than the matched cohort (87.0 years [86.4, 87.4]). Cardiovascular disease was a more frequent cause of death in UIA patients (34.3% vs. 21.3%), and cardiovascular risk factors were highly prevalent. Discussion and conclusions: Patients with UIAs experience markedly reduced life expectancy and excess cardiovascular mortality. These findings emphasize the importance of integrating aggressive cardiovascular risk management into UIA care and call for cautious selection of preventive treatment, particularly in patients with significant comorbidities.