American Board of Internal Medicine (ABIM) Certification Practice Exam

In which cases is surgical treatment such as clipping or coiling considered for aneurysms?

1. 7 mm or greater in the anterior circulation

2. 5 mm or greater in the posterior circulation

3. 7 mm or greater in the posterior circulation and 12 mm or greater in the anterior circulation

4. 10 mm or greater in either circulation

The correct answer is: 7 mm or greater in the posterior circulation and 12 mm or greater in the anterior circulation

Surgical treatment, such as clipping or coiling, is often considered for aneurysms based on their size and location due to the increased risk of rupture associated with larger aneurysms. When evaluating the management of aneurysms, key factors include not just their size but also their anatomical location, as the risk profiles vary significantly between the anterior and posterior circulation. In the case of the anterior circulation, aneurysms 12 mm or greater are associated with a notably higher risk of rupture, making surgical intervention more compelling. This size threshold stems from clinical studies that indicate larger anterior circulation aneurysms are more likely to rupture and can lead to significant morbidity and mortality. For posterior circulation aneurysms, the threshold for considering surgical intervention is lower, typically at 7 mm or greater. These aneurysms have a different risk profile; hence, they often require intervention at a smaller size compared to anterior circulation aneurysms. The other size criteria, such as 5 mm in the posterior circulation or 10 mm in either circulation, do not align with current clinical recommendations which advocate for more proactive surgical measures at the specified sizes in option C. Therefore, the guidelines reflect a targeted approach that aims to minimize potential complications and optimize patient outcomes, just