Specific interventions to prevent intracranial hemorrhage

This chapter deals with patients who have not yet had a stroke but who do have a vascular lesion that might give rise to a stroke in the future, namely unruptured intracranial aneurysms (UIAs) or brain arteriovenous malformations (bAVMs). Aneurysmal subarachnoid hemorrhage (SAH) is common in patients with autosomal dominant polycystic kidney disease (ADPKD) and causes a large proportion of deaths in these patients. A newer technique for treating UIAs involves a flow diversion device (FDD) in which a specialized stent is deployed within the parent artery across the aneurysm neck to disrupt aneurysmal flow, promoting intra‐aneurysmal thrombosis. The primary goal of treating bAVMs is to reduce death and long‐term disability due to hemorrhage. Neurosurgical excision is the most effective treatment for eliminating future hemorrhage risk. Given the existing uncertainties, patients with unruptured bAVMs for whom treatment is considered should be entered into a randomized controlled trial.