Introduction: Actuality to deeply understand the underlying mechanisms in the aneurysm wall launching the progression and potentially rupture may be helpful to optimize the clinical decision making process among patients with unruptured cranial aneurysms (totally fast 18 million in Europe), especially asymptomatic with low score according to specific scales such as PHASES und UIATS.

Aim of the study was to gather and analyze the current relevant scientific achievements describing the pathophysiology of inflammatory remodeling of aneu rysm wall resulting in the degeneration und poor clinical outcome.

Material and methods: 529 patients with unruptured saccular intracranial aneurysms are being observed and treated during 2013-2023. 19.1% have already been operated (98% endovascular, 2% transcranial approach). Among them 19.8% had multiple, 4.95% – mirror intracranial aneurysms. Primarily we used PHASES and in the last years UIATS Score to estimate and individualize the risk of aneurysm rupture. We conducted also the literature review using the PubMed service.

Results and discussion: Our findings correlate with literature data confirming the thickening of aneurysm wall, myointimal hyperplasia und hypocellularity with accelerated collagen breakdown. The high wall shear stress activates pro-inflammatory signaling thorough macrophage chemoattractant protein 1 (MCP1) promoting the smooth muscle cell proliferation being thus a promising target for drug therapy. This process increases the aneurysm wall permeability, which can be detected using the dynamic contrast-enhanced MR perfusion.

Conclusions: The detection of biochemical markers of aneurysm wall remodeling with modern radiological correlates looks promising to improve the early diagnosis, treatment and prevention of rupture of the cerebral aneurysms.