There seems to be a pathogenetic link between hemodynamics and inflammatory arterial wall alteration leading to the development and rupture of intracranial aneurysms (IAs). Noninvasive assessment of the inflammatory status of the aneurysm wall may guide the management of unruptured IAs by identifying reliable markers for increased rupture risk. We conducted a qualitative systematic review following the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) framework. A search was made in MEDLINE/PubMed, Embase, and CINAHL from database inception to October 2017 using the terms “intracranial aneurysm” and “cerebral aneurysm” linked with the following key words: inflammation, hemodynamic(s), remodeling, macrophages, neutrophils, lymphocytes, complement system, vascular smooth muscle cells, mast cells, cytokines, and inflammatory biomarkers. One hundred and twenty-three articles were included in the review. In this systematic review, we explore the relationship between hemodynamic stress, inflammation, vascular remodeling, and the formation and rupture of IAs to develop novel strategies to predict the individual risk of aneurysmal rupture. •Hemodynamic changes cause infiltration of inflammatory cells into arterial wall.•Simultaneously mechanisms of arterial wall protection are activated.•Imbalance in favor of arterial wall degradation promote IA formation and rupture.•Regulation of endothelial NF-κB expression is a key event in keeping the balance.•Noninvasive test of IA wall inflammation may predict the individual rupture risk.