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The conclusions of the International Study of Unruptured Intracranial Aneurysms (ISUIA) demonstrating that anterior circulation aneurysms less than 7 mm in maximal diameter have a 0% risk of rupture continue to be widely cited despite discordance with the anecdotal observation that the majority of ruptured cerebral aneurysms are less than 7 mm. The leading hypothesis to reconcile this discrepancy...