1
|
Laczynski DJ, Dong S, Kalahasti V, Kirksey L, Rowse JW, Quatromoni JG, Lyden SP, Caputo FJ. Prevalence of intracranial aneurysms in Marfan syndrome. J Vasc Surg 2023; 78:633-637. [PMID: 37182816 DOI: 10.1016/j.jvs.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/30/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Aneurysmal pathology of the aorta is well-defined in the Marfan syndrome (MFS) population. Owing in part to the rarity of pathologies, the prevalence of intracranial aneurysms (IA) in MFS is poorly defined. There is debate as to whether or not there is an association between the two. The aim of this study was to evaluate the prevalence of IA in a population of patients with MFS who underwent intracranial imaging. METHODS This was a single-center retrospective review of patients with MFS. Between 1995 and 2021, 983 patients were reviewed. We identified 198 patients with MFS who had intracranial imaging. Imaging consisted of CTA and/or MRA, and was read by an attending radiologist. Details of the aneurysm, patient demographics, and aortic characteristics were collected. RESULTS The prevalence of IA was 7.1% (14/198). Age of patients with IA (55.0 ± 15.1 years) was not significantly different than those without IA (52.6 ± 16.0 years) (P = .58). The most common location of IA was the internal carotid artery. The mean diameter of the IA was 7 ± 5.8 mm. No ruptures of the internal carotid artery were identified. One patient (0.5%) underwent intervention for the IA. There were no significant differences found in aortic characteristic including dimensions, history of dissection, or aneurysm. CONCLUSIONS In a large, single-center experience over 20 years, we identified patients with confirmed MFS who underwent intracranial imaging. The prevalence of IA in our experience was 7.1%. There were no patient or aortic characteristics found to be significantly associated with IA; however, this finding may be due to the small number of aneurysms. Although this number is higher than the historically reported prevalence in the general population, a collection of experiences from multiple institutions will likely be required to truly define the risk of IA in MFS and to determine whether screening is warranted.
Collapse
Affiliation(s)
- David J Laczynski
- Cleveland Clinic Foundation, Department of Vascular Surgery, Cleveland, OH
| | - Siwei Dong
- Cleveland Clinic Foundation, Department of Vascular Surgery, Cleveland, OH
| | - Vidyasagar Kalahasti
- Cleveland Clinic Foundation, Department of Cardiovascular Medicine, Cleveland, OH
| | - Levester Kirksey
- Cleveland Clinic Foundation, Department of Vascular Surgery, Cleveland, OH
| | - Jarrad W Rowse
- Cleveland Clinic Foundation, Department of Vascular Surgery, Cleveland, OH
| | - Jon G Quatromoni
- Cleveland Clinic Foundation, Department of Vascular Surgery, Cleveland, OH
| | - Sean P Lyden
- Cleveland Clinic Foundation, Department of Vascular Surgery, Cleveland, OH
| | - Francis J Caputo
- Cleveland Clinic Foundation, Department of Vascular Surgery, Cleveland, OH.
| |
Collapse
|
2
|
Lin JY, Tung CS, Wang JC, Chien WC, Chung CH, Lin CY, Tsai SH. The Association between Migraine and Abdominal Aortic Aneurysms: A Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084389. [PMID: 33924263 PMCID: PMC8074774 DOI: 10.3390/ijerph18084389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 12/18/2022]
Abstract
Previous studies have indicated that patients with migraine have a higher prevalence of risk factors known to be associated with cardiovascular diseases. There are also shared epidemiology and molecular mechanisms between migraine and abdominal aortic aneurysm (AAA). We hypothesized that patients with migraine could have an increased risk of AAA. To test this hypothesis, we used the National Health Insurance Research Database (NHIRD) to evaluate whether associations exist between migraine and AAA. The data for this nationwide population-based retrospective cohort study were obtained from the NHIRD in Taiwan. The assessed study outcome was the cumulative incidence of AAA in patients with migraine during a 15-year follow-up period. Among the 1,936,512 patients from the NHIRD, 53,668 (2.77%) patients were identified as having been diagnosed with migraine. The patients with migraine had a significantly higher cumulative risk of 3.558 of developing an AAA 5 years after the index date compared with the patients without migraine. At the end of the 15-year follow-up period, a significantly higher incidence of AAA (0.98%) was observed in the patients with migraine than in those without migraine (0.24%). We revealed an association between the development of migraine and AAA.
Collapse
Affiliation(s)
- Jou-Yu Lin
- Department of Rehabilitation, Cheng Hsin General Hospital, Taipei 11220, Taiwan;
| | - Che-Se Tung
- Division of Medical Research & Education, Cheng Hsin General Hospital, Taipei 11220, Taiwan;
| | - Jen-Chun Wang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei 11490, Taiwan
- Correspondence: (W.-C.C.); (S.-H.T.); Tel.: +886-2-87923311-16877 (W.-C.C. & S.-H.T.)
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
- School of Public Health, National Defense Medical Center, Taipei 11490, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei 11490, Taiwan
| | - Chih-Yuan Lin
- Department of Surgery, Division of Cardiovascular Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 11490, Taiwan;
- Department of Physiology and Biophysics, Graduate Institute of Physiology, National Defense Medical Center, Taipei 11490, Taiwan
- Correspondence: (W.-C.C.); (S.-H.T.); Tel.: +886-2-87923311-16877 (W.-C.C. & S.-H.T.)
| |
Collapse
|
3
|
Erben Y, Da Rocha-Franco JA, Ball CT, Barrett KM, Freeman WD, Lin M, Tawk R, Huang JF, Vibhute P, Oderich G, Miller DA, Farres H, Davila V, Money SR, Meltzer AJ, Hakaim AG, Brott TG, Meschia JF. Prevalence of Intracranial Aneurysms in Patients with Infrarenal Abdominal Aortic Aneurysms: A Multicenter Experience. Int J Angiol 2020; 29:229-236. [PMID: 33268973 DOI: 10.1055/s-0040-1713139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Prior studies suggest high prevalence of intracranial aneurysms (IA) in patients with infrarenal abdominal aortic aneurysms (AAA). We reviewed our multicenter experience in clinical detection/treatment of IAs in AAA patients and estimated the risk of IA in patients with AAA relative to patients without AAA. We reviewed cases of vascular surgery infrarenal AAA repairs at three Mayo Clinic sites from January 1998 to December 2018. Concurrent controls were randomly matched in a 1:1 ratio by age, sex, smoking history, and head imaging characteristics. Conditional logistic regression was used to calculate odds ratios. We reviewed 2,300 infrarenal AAA repairs. Mean size of AAA at repair was 56.9 ± 11.4 mm; mean age at repair, 75.8 ± 8.0 years. 87.5% of the cases ( n = 2014) were men. Head imaging was available in 421 patients. Thirty-seven patients were found to have 45 IAs for a prevalence of 8.8%. Mean size of IA was 4.6 ± 3.5 mm; mean age at IA detection, 72.0 ± 10.8 years. Thirty (81%) out of 37 patients were men. Six patients underwent treatment for IA: four for ruptured IAs and two for unruptured IAs. All were diagnosed before AAA repair. Treatment included five clippings and one coil-assisted stenting. Time from IA diagnosis to AAA repair was 16.4 ± 11.0 years. Two of these patients presented with ruptured AAA, one with successful repair and a second one that resulted in death. Odds of IA were higher for patients with AAA versus those without AAA (8.8% [37/421] vs. 3.1% [13/421]; OR 3.18; 95% confidence interval, 1.62-6.27, p < 0.001). Co-prevalence of IA among patients with AAA was 8.8% and is more than three times the rate seen in patients without AAA. All IAs were diagnosed prior to AAA repair. Surveillance for AAA after IA treatment could have prevented two AAA ruptures and one death.
Collapse
Affiliation(s)
- Young Erben
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | | | - Colleen T Ball
- Department of Health Sciences Research, Mayo Clinic Florida, Jacksonville, Florida
| | | | - William D Freeman
- Department of Neurology, Mayo Clinic, Jacksonville, Florida.,Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | - Michelle Lin
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
| | - Rabih Tawk
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, Florida
| | | | | | - Gustavo Oderich
- Division of Vascular and Endovascular Surgery, Rochester, Minnesota
| | - David A Miller
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Houssam Farres
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - Victor Davila
- Divsion of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, Arizona
| | - Samuel R Money
- Divsion of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, Arizona
| | - Andrew J Meltzer
- Divsion of Vascular and Endovascular Surgery, Mayo Clinic, Scottsdale, Arizona
| | - Albert G Hakaim
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Jacksonville, Florida
| | - T G Brott
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
| | | |
Collapse
|
4
|
Moughal S, Bashir M. Correlation of intracranial and aortic aneurysms: current trends and evidence. Asian Cardiovasc Thorac Ann 2020; 28:250-257. [PMID: 32486829 DOI: 10.1177/0218492320930848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The correlation between intracranial and aortic aneurysms remains elusive. Data in the literature are scattered, and outcome reporting is swamped with heterogeneity and single-center bias. This calamity is adding to confusion on decision-making and delays the instigation of appropriate clinical applications. This literature review delves into the abyss of the lack of clinically driven scientific input, and highlights the trends explored thus far.
Collapse
Affiliation(s)
- Saad Moughal
- Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Mohamad Bashir
- Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
| |
Collapse
|
5
|
Wang JC, Tsai SH. Reply. J Vasc Surg 2020; 71:1074. [DOI: 10.1016/j.jvs.2019.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/12/2019] [Indexed: 11/26/2022]
|
6
|
Prevalence of intracranial aneurysm in patients with aortic aneurysm. J Vasc Surg 2020; 71:1073-1074. [PMID: 32089206 DOI: 10.1016/j.jvs.2019.10.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/04/2019] [Indexed: 11/21/2022]
|
7
|
Yu X, Xia L, Jiang Q, Wei Y, Wei X, Cao S. Prevalence of Intracranial Aneurysm in Patients with Aortopathy: A Systematic Review with Meta-Analyses. J Stroke 2020; 22:76-86. [PMID: 32027793 PMCID: PMC7005354 DOI: 10.5853/jos.2019.01312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/21/2019] [Accepted: 10/15/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND PURPOSE Patients with aortic disease might have an increased risk of intracranial aneurysm (IA). We conducted this research to assess the prevalence of IA in patients with aortopathy, considering the impact of gender, age, and cardiovascular risk factors. METHODS We searched PubMed and Scopus from inception to August 2019 for epidemiological studies reporting the prevalence of IA in patients with aortopathy. Random-effect meta-analyses were performed to calculate the overall prevalence, and the effect of risk factors on the prevalence was also evaluated. Anatomical location of IAs in patients suffered from distinct aortic disease was extracted and further analyzed. RESULTS Thirteen cross-sectional studies involving 4,041 participants were included in this systematic review. We reported an estimated prevalence of 12% (95% confidence interval [CI], 9% to 14%) of IA in patients with aortopathy. The pooled prevalence of IA in patients with bicuspid aortic valve, coarctation of the aorta, aortic aneurysm, and aortic dissection was 8% (95% CI, 6% to 10%), 10% (95% CI, 7% to 14%), 12% (95% CI, 9% to 15%), and 23% (95% CI, 12% to 34%), respectively. Gender (female) and smoking are risk factors related to an increased risk of IA. The anatomical distribution of IAs was heterogeneously between participants with different aortic disease. CONCLUSIONS According to current epidemiological evidence, the prevalence of IA in patients with aortic disease is quadrupled compared to that in the general population, which suggests that an early IA screening should be considered among patients with aortic disease for timely diagnosis and treatment of IA.
Collapse
Affiliation(s)
- Xinyu Yu
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liangtao Xia
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingqing Jiang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yupeng Wei
- Biological Science Department, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- NHC Key Laboratory of Organ Transplantation, Wuhan, China
- Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|