Integrated review of intracranial aneurysms in autosomal dominant polycystic kidney disease (ADPKD) — novel approaches and emerging perspectives

Introduction: Intracranial aneurysms (ICAs) are a clinically significant yet underrecognized com-plication of autosomal dominant polycystic kidney disease (ADPKD). Despite their often-asymptomatic course, ICAs carry a high risk of subarachnoid hem-orrhage (SAH), particularly at younger ages, and with smaller aneurysm sizes than in the general population. This review integrates recent literature (2020–2025) to reassess the epidemiology, pathogenesis, screen-ing strategies, management, and clinical implications of ICAs in ADPKD. Material and methods: A systematic search of PubMed was conducted in April 2025 for stud-ies published from January 2020 to April 2, 2025. Inclusion criteria limited results to original human research published in English that addressed ICAs in ADPKD. After screening 99 articles, 23 met the inclusion criteria for detailed analysis. Results: Intracranial aneurysms are found in 5–12% of ADPKD patients, with a predilection for the an-terior circulation and a higher frequency of multiple aneurysms. Although current guidelines prioritize screening in patients with a family history of ICA or SAH, recent studies reveal that up to 70% of affected individuals lack these risk factors. Novel PKD1 vari-ants, such as c.G10086T/p.Q3362H, suggest a ge-netic predisposition to vascular wall fragility. Screen-ing with magnetic resonance angiography (MRA) every 5 years has demonstrated cost-effectiveness in selected high-risk patients. Endovascular coiling is the preferred treatment modality, especially in pa-tients with renal impairment, although individualized care remains critical. Excessive screening and inter-vention, however, may expose patients to unneces-sary risks and psychological burdens. Conclusions: The traditional reliance on family his-tory and vascular risk factors for ICA screening in ADPKD may overlook a significant proportion of at-risk individuals. Emerging genetic insights and population-based data support a more nuanced, personalized screening strategy. A multidisciplinary approach — including nephrology, neurology, genet-ics, and interventional radiology — is essential for optimal patient care. Future research should focus on refining risk prediction models, evaluating broader screening protocols, and developing evidence-based guidelines for long-term surveillance and treatment.