Background: Subarachnoid hemorrhage from rupture of an intracranial aneurysm (aneurysmal subarachnoid hemorrhage, ASAH) is a devastating subset of stroke. Since brain damage from the initial hemorrhage is a major cause for the poor outcome after ASAH, prevention of ASAH has the highest potential to prevent poor outcome from ASAH.

Aim: In this review, we describe the groups at high risk of ASAH who may benefit from preventive screening for unruptured intracranial aneurysms (UIA) followed by preventive treatment of UIAs found. Furthermore, we describe the advantages and disadvantages of screening and advise how to perform counseling on screening.

Summary of review: Modelling studies show that persons with two or more affected first-degree relatives with ASAH and patients with autosomal dominant polycystic kidney disease (ADPKD) are candidates for screening for UIAs. One modelling study also suggest that persons with only one affected first-degree relative with ASAH are also likely candidates for screening. Another group who may benefit from screening are persons ≥35 years who smoke(d) and are hypertensive, given their high lifetime risk of ASAH of up to 7%, but the prevalence of UIAs in such persons, and thus the efficiency and cost-effectiveness of screening in this group are not yet known. The ultimate goal of screening is to increase the number of quality years of life of the screening candidates, and therefore the benefits but also many downsides of screening –such as risk of incidental findings, very small UIAs that require regular follow-up, preventive treatment with inherent risk of complications and anxiety- should be discussed with the candidate so that an informed decision can be made before intracranial vessels are imaged.

Conclusions: Several groups of persons who may benefit from screening have been identified, but since these constitute only a minority of all ASAH patients, additional high-risk groups still need to be identified. Further research is also needed to identify persons at low or high risk of aneurysmal development and rupture within the groups identified thus far to improve the efficiency of screening. Moreover, if new medical treatment strategies that can reduce the risk of rupture of UIA become available, the groups of persons who may benefit from screening could increase considerably.

背景：颅内动脉瘤破裂引起的蛛网膜下腔出血（动脉瘤性蛛网膜下腔出血，ASAH）是中风的破坏性亚型。由于最初出血引起的脑损伤是导致 ASAH 后不良结果的主要原因，因此预防 ASAH 最有可能防止 ASAH 不良结果。

目的：在这篇综述中，我们描述了可能受益于未破裂颅内动脉瘤 (UIA) 的预防性筛查和发现的 UIA 的预防性治疗的 ASAH 高风险人群。此外，我们描述了筛查的优点和缺点，并建议如何进行筛查咨询。

综述总结：建模研究表明，有两个或更多受累的一级亲属患有 ASAH 和常染色体显性遗传多囊肾病 (ADPKD) 患者是筛查 UIA 的候选人。一项建模研究还表明，只有一个受 ASAH 影响的一级亲属也可能是筛查的候选人。另一组可能受益于筛查的人群是 35 岁以上吸烟 (d) 且患有高血压的人，因为他们一生中发生 ASAH 的风险高达 7%，但这些人中 UIA 的患病率，因此效率该组筛查的成本效益和成本效益尚不清楚。筛选的最终目标是增加筛选候选人的优质生命年数，

结论：已经确定了几组可能从筛查中受益的人群，但由于这些人群仅占所有 ASAH 患者的一小部分，因此仍需要确定其他高危人群。还需要进一步的研究来确定迄今为止确定的组中动脉瘤发展和破裂风险低或高的人，以提高筛查效率。此外，如果可以使用可以降低 UIA 破裂风险的新医疗策略，那么可能从筛查中受益的人群可能会大大增加。