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Advance in knowledge and clinical implications To the best of our knowledge, this is the first report investigating clinical and morphological characteristics of atherosclerotic lesions in IAs and the first attempt to identify factors associated with aneurysm stabilization. Age (P = 0.002; OR, 1.105) showed a positive trend with atherosclerotic aneurysm walls and DM (P = 0.027; OR, 29.435) was CB-839 manufacturer the only factor predicting stabilized aneurysms in older patients. The positive association of age and atherosclerotic aneurysm walls suggest the aneurysm may progress with atherosclerotic changes over time and may help to predict the natural history of the aneurysm. The suggested parameters for predicting aneurysm stabilization can help in determining treatment strategy when an unruptured aneurysm is found incidentally. First, the parameters can help in deciding whether to treat or not, especially in elderly patients who have a short life expectancy Ritipenem and usually a higher morbidity rate under general anesthesia. Second, the parameters can help estimate the potential risk of treatment because atherosclerotic aneurysms usually have a higher risk of intraoperative ischemia[10] during clipping surgery or may have a higher risk of perioperative embolic complications with endovascular treatment. Limitations The first limitation of this study is the uncertainty whether aneurysms with atherosclerotic walls are stabilized in terms of rupture because the natural history or the rupture mechanism of the aneurysm is unknown. Moreover, there are no large and prospective data showing aneurysm wall morphology and rupture risk. Instead, there are studies that thin portion of aneurysm dome correlated with the point of rupture.[37] An aneurysm ruptures when the local hemodynamic stresses exceed vascular wall strength and aneurysms with hypertrophied atherosclerotic walls[29] appear more resistant Volasertib research buy to hemodynamic pressure than aneurysms with a thin wall. To support our hypothesis, we evaluated the intraoperative videos of 31 ruptured aneurysms and only one patient was suspected to have an atherosclerotic wall and did not have a transparent wall. The second limitation is that this analysis was based on intraoperative findings and included only surgical cases. Unclippable, very small-sized aneurysms were excluded and the study mainly included aneurysms involving anterior circulation, particularly the middle cerebral artery. Third, intraoperative microscopy did not allow circumferential visualization of the entire aneurysm dome in some cases. Translucent portions on the opposite side may be neglected. To minimize this possibility, we excluded the aneurysm which did not exposed