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Kanning JP, Abtahi S, Schnier C, Klungel OH, Geerlings MI, Ruigrok YM. Prescribed Drug Use and Aneurysmal Subarachnoid Hemorrhage Incidence: A Drug-Wide Association Study. Neurology 2024; 102:e209479. [PMID: 38838229 DOI: 10.1212/wnl.0000000000209479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Current benefits of invasive intracranial aneurysm treatment to prevent aneurysmal subarachnoid hemorrhage (aSAH) rarely outweigh treatment risks. Most intracranial aneurysms thus remain untreated. Commonly prescribed drugs reducing aSAH incidence may provide leads for drug repurposing. We performed a drug-wide association study (DWAS) to systematically investigate the association between commonly prescribed drugs and aSAH incidence. METHODS We defined all aSAH cases between 2000 and 2020 using International Classification of Diseases codes from the Secure Anonymised Information Linkage databank. Each case was matched with 9 controls based on age, sex, and year of database entry. We investigated commonly prescribed drugs (>2% in study population) and defined 3 exposure windows relative to the most recent prescription before index date (i.e., occurrence of aSAH): current (within 3 months), recent (3-12 months), and past (>12 months). A logistic regression model was fitted to compare drug use across these exposure windows vs never use, controlling for age, sex, known aSAH risk factors, and health care utilization. The family-wise error rate was kept at p < 0.05 through Bonferroni correction. RESULTS We investigated exposure to 205 commonly prescribed drugs between 4,879 aSAH cases (mean age 61.4, 61.2% women) and 43,911 matched controls. We found similar trends for lisinopril and amlodipine, with a decreased aSAH risk for current use (lisinopril odds ratio [OR] 0.63, 95% CI 0.44-0.90, amlodipine OR 0.82, 95% CI 0.65-1.04) and an increased aSAH risk for recent use (lisinopril OR 1.30, 95% CI 0.61-2.78, amlodipine OR 1.61, 95% CI 1.04-2.48). A decreased aSAH risk in current use was also found for simvastatin (OR 0.78, 95% CI 0.64-0.96), metformin (OR 0.58, 95% CI 0.43-0.78), and tamsulosin (OR 0.55, 95% CI 0.32-0.93). By contrast, an increased aSAH risk was found for current use of warfarin (OR 1.35, 95% CI 1.02-1.79), venlafaxine (OR 1.67, 95% CI 1.01-2.75), prochlorperazine (OR 2.15, 95% CI 1.45-3.18), and co-codamol (OR 1.31, 95% CI 1.10-1.56). DISCUSSION We identified several drugs associated with aSAH, of which 5 drugs (lisinopril and possibly amlodipine, simvastatin, metformin, and tamsulosin) showed a decreased aSAH risk. Future research should build on these signals to further assess the effectiveness of these drugs in reducing aSAH incidence. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that some commonly prescribed drugs are associated with subsequent development of aSAH.
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Affiliation(s)
- Jos P Kanning
- From the UMC Utrecht Brain Center (J.P.K., Y.M.R.), Department of Neurology and Neurosurgery, University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care (J.P.K., O.H.K., M.I.G.), University Medical Center Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology (S.A., O.H.K.), Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands; Infection Medicine (C.S.), Edinburgh Medical School, The University of Edinburgh, United Kingdom; Department of General Practice (M.I.G.), Amsterdam UMC, location University of Amsterdam; Amsterdam Public Health, Aging & Later Life, and Personalized Medicine (M.I.G.); and Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep (M.I.G.), the Netherlands
| | - Shahab Abtahi
- From the UMC Utrecht Brain Center (J.P.K., Y.M.R.), Department of Neurology and Neurosurgery, University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care (J.P.K., O.H.K., M.I.G.), University Medical Center Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology (S.A., O.H.K.), Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands; Infection Medicine (C.S.), Edinburgh Medical School, The University of Edinburgh, United Kingdom; Department of General Practice (M.I.G.), Amsterdam UMC, location University of Amsterdam; Amsterdam Public Health, Aging & Later Life, and Personalized Medicine (M.I.G.); and Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep (M.I.G.), the Netherlands
| | - Christian Schnier
- From the UMC Utrecht Brain Center (J.P.K., Y.M.R.), Department of Neurology and Neurosurgery, University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care (J.P.K., O.H.K., M.I.G.), University Medical Center Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology (S.A., O.H.K.), Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands; Infection Medicine (C.S.), Edinburgh Medical School, The University of Edinburgh, United Kingdom; Department of General Practice (M.I.G.), Amsterdam UMC, location University of Amsterdam; Amsterdam Public Health, Aging & Later Life, and Personalized Medicine (M.I.G.); and Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep (M.I.G.), the Netherlands
| | - Olaf H Klungel
- From the UMC Utrecht Brain Center (J.P.K., Y.M.R.), Department of Neurology and Neurosurgery, University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care (J.P.K., O.H.K., M.I.G.), University Medical Center Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology (S.A., O.H.K.), Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands; Infection Medicine (C.S.), Edinburgh Medical School, The University of Edinburgh, United Kingdom; Department of General Practice (M.I.G.), Amsterdam UMC, location University of Amsterdam; Amsterdam Public Health, Aging & Later Life, and Personalized Medicine (M.I.G.); and Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep (M.I.G.), the Netherlands
| | - Mirjam I Geerlings
- From the UMC Utrecht Brain Center (J.P.K., Y.M.R.), Department of Neurology and Neurosurgery, University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care (J.P.K., O.H.K., M.I.G.), University Medical Center Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology (S.A., O.H.K.), Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands; Infection Medicine (C.S.), Edinburgh Medical School, The University of Edinburgh, United Kingdom; Department of General Practice (M.I.G.), Amsterdam UMC, location University of Amsterdam; Amsterdam Public Health, Aging & Later Life, and Personalized Medicine (M.I.G.); and Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep (M.I.G.), the Netherlands
| | - Ynte M Ruigrok
- From the UMC Utrecht Brain Center (J.P.K., Y.M.R.), Department of Neurology and Neurosurgery, University Medical Center Utrecht; Julius Center for Health Sciences and Primary Care (J.P.K., O.H.K., M.I.G.), University Medical Center Utrecht, and Division of Pharmacoepidemiology and Clinical Pharmacology (S.A., O.H.K.), Utrecht Institute for Pharmaceutical Sciences, Utrecht University, the Netherlands; Infection Medicine (C.S.), Edinburgh Medical School, The University of Edinburgh, United Kingdom; Department of General Practice (M.I.G.), Amsterdam UMC, location University of Amsterdam; Amsterdam Public Health, Aging & Later Life, and Personalized Medicine (M.I.G.); and Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep (M.I.G.), the Netherlands
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Crane A, Shanahan RM, Hudson JS, Nowicki KW, Gersey ZC, Agarwal P, Jacobs RC, Lang MJ, Gross B. Pharmaceutical Modulation of Intracranial Aneurysm Development and Rupture. J Clin Med 2024; 13:3324. [PMID: 38893035 PMCID: PMC11173282 DOI: 10.3390/jcm13113324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024] Open
Abstract
Management of intracranial aneurysms (IAs) is determined by patient age, risk of rupture, and comorbid conditions. While endovascular and microsurgical interventions offer solutions to mitigate the risk of rupture, pharmacological management strategies may complement these approaches or serve as alternatives in appropriate cases. The pathophysiology of IAs allows for the targeting of inflammation to prevent the development and rupture of IAs. The aim of this review is to provide an updated summary of different pharmaceutical management strategies for IAs. Acetylsalicylic acid and renin-angiotensin-aldosterone system (RAAS) inhibitor antihypertensives have some evidence supporting their protective effect. Studies of selective cyclooxygenase-2 (COX-2) inhibitors, statins, ADP inhibitors, and other metabolism-affecting drugs have demonstrated inconclusive findings regarding their association with aneurysm growth or rupture. In this manuscript, we highlight the evidence supporting each drug's effectiveness.
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Affiliation(s)
- Alex Crane
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Regan M. Shanahan
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Joseph S. Hudson
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Kamil W. Nowicki
- Department of Neurosurgery, Yale School of Medicine, New Haven, CT 06510, USA;
| | - Zachary C. Gersey
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Prateek Agarwal
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Rachel C. Jacobs
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Michael J. Lang
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
| | - Bradley Gross
- Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15213, USA (Z.C.G.); (M.J.L.)
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Feng Y, Zhang H, Dai S, Li X. Aspirin treatment for unruptured intracranial aneurysms: Focusing on its anti-inflammatory role. Heliyon 2024; 10:e29119. [PMID: 38617958 PMCID: PMC11015424 DOI: 10.1016/j.heliyon.2024.e29119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/07/2024] [Accepted: 04/01/2024] [Indexed: 04/16/2024] Open
Abstract
Intracranial aneurysms (IAs), as a common cerebrovascular disease, claims a worldwide morbidity rate of 3.2%. Inflammation, pivotal in the pathogenesis of IAs, influences their formation, growth, and rupture. This review investigates aspirin's modulation of inflammatory pathways within this context. With IAs carrying significant morbidity and mortality upon IAs rupture and current interventions limited to surgical clipping and endovascular coiling, the quest for pharmacological options is imperative. Aspirin's role in cardiovascular prevention, due to its anti-inflammatory effects, presents a potential therapeutic avenue for IAs. In this review, we examine aspirin's efficacy in experimental models and clinical settings, highlighting its impact on the progression and rupture risks of unruptured IAs. The underlying mechanisms of aspirin's impact on IAs are explored, with its ability examined to attenuate endothelial dysfunction and vascular injury. This review may provide a theoretical basis for the use of aspirin, suggesting a promising strategy for IAs management. However, the optimal dosing, safety, and long-term efficacy remain to be established. The implications of aspirin therapy are significant in light of current surgical and endovascular treatments. Further research is encouraged to refine aspirin's clinical application in the management of unruptured IAs, with the ultimate aim of reducing the incidence of aneurysms rupture.
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Affiliation(s)
- Yuan Feng
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Hongchen Zhang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Shuhui Dai
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
- National Translational Science Center for Molecular Medicine and Department of Cell Biology, Fourth Military Medical University, Xi'an, China
| | - Xia Li
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Liu H, Zuo H, Johanna O, Zhao R, Yang P, Chen W, Li Q, Lin X, Zhou Y, Liu J. Genetically determined blood pressure, antihypertensive medications, and risk of intracranial aneurysms and aneurysmal subarachnoid hemorrhage: A Mendelian randomization study. Eur Stroke J 2024; 9:244-250. [PMID: 37800876 PMCID: PMC10916827 DOI: 10.1177/23969873231204420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Observational studies suggest that different classes of antihypertensive drugs may have different effects on the occurrence of intracranial aneurysms (IA) and subarachnoid hemorrhage (SAH). However, the reported results in previous studies are inconsistent, and randomized data are absent. We performed a two-sample Mendelian randomization (MR) analysis to study the causal effects of genetically determined blood pressure (BP) and genetic proxies for antihypertensive drug classes on the risk of IA and SAH. MATERIALS AND METHODS Genetic instruments and outcome data were obtained from independent genome-wide association studies (GWAS) or published data, which were exclusively restricted to European ancestry. Causal relationships were identified using inverse-variance weighted MR analyses and a series of statistical sensitivity analyses. The FinnGen consortium was used for repeated analysis to verify results obtained from the above GWAS. RESULTS Two-sample MR analysis showed that genetically determined Systolic BP, Dystolic BP, and Pulse Pressure were related to a higher risk of IA and SAH. Based on identified single nucleotide polymorphisms (SNPs) that influence the effect of calcium channel blockers (CCB, 42 SNPs), beta-blockers (BB, 8 SNPs), angiotensin-converting enzyme inhibitors (ACEI, 2 SNPs), angiotensin receptor blockers (ARB, 1 SNPs), and thiazides (5 SNPs), genetically determined effect of CCBs was associated with a higher risk of IA (OR, 1.07 [95% CI, 1.03-1.10], p = 5.02 × 10-5) and SAH (OR, 1.06 [95% CI, 1.03-1.09], p = 1.84 × 10-3). No associations were found between other antihypertensive drugs and the risk of IA or SAH. The effect of CCBs on SAH was confirmed in FinnGenconsortium samples (OR, 1.04 [95% CI, 1.00-1.08], p = 0.042). DISCUSSION AND CONCLUSION This MR analysis supports the role of elevated blood pressure in the occurrence of intracranial aneurysms and subarachnoid hemorrhage. However, genetic proxies for calcium channel blockers were associated with an increased risk of intracranial aneurysms and subarachnoid hemorrhage. Further studies are required to confirm these findings and investigate the underlying mechanisms.
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Affiliation(s)
- Hanchen Liu
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Huiqin Zuo
- Huamu Community Center of Pudong, Shanghai, China
| | - Ospel Johanna
- Department of Radiology, University Hospital Basel, Basel, Switzerland
| | - Rui Zhao
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Pengfei Yang
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | | | - Qiang Li
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Xiaolei Lin
- School of Data Science, Fudan University, Shanghai, China
| | - Yu Zhou
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
| | - Jianmin Liu
- Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China
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Joerger AK, Albrecht C, Rothhammer V, Neuhaus K, Wagner A, Meyer B, Wostrack M. The Role of Gut and Oral Microbiota in the Formation and Rupture of Intracranial Aneurysms: A Literature Review. Int J Mol Sci 2023; 25:48. [PMID: 38203219 PMCID: PMC10779325 DOI: 10.3390/ijms25010048] [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: 11/12/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
In recent years, there has been a growing interest in the role of the microbiome in cardiovascular and cerebrovascular diseases. Emerging research highlights the potential role of the microbiome in intracranial aneurysm (IA) formation and rupture, particularly in relation to inflammation. In this review, we aim to explore the existing literature regarding the influence of the gut and oral microbiome on IA formation and rupture. In the first section, we provide background information, elucidating the connection between inflammation and aneurysm formation and presenting potential mechanisms of gut-brain interaction. Additionally, we explain the methods for microbiome analysis. The second section reviews existing studies that investigate the relationship between the gut and oral microbiome and IAs. We conclude with a prospective overview, highlighting the extent to which the microbiome is already therapeutically utilized in other fields. Furthermore, we address the challenges associated with the context of IAs that still need to be overcome.
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Affiliation(s)
- Ann-Kathrin Joerger
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany; (A.-K.J.); (B.M.)
| | - Carolin Albrecht
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany; (A.-K.J.); (B.M.)
| | - Veit Rothhammer
- Department of Neurology, University Hospital Erlangen, Friedrich-Alexander University Erlangen Nuremberg, 91054 Erlangen, Germany;
| | - Klaus Neuhaus
- Core Facility Microbiom, ZIEL Institute for Food & Health, Technical University of Munich, 85354 Freising, Germany;
| | - Arthur Wagner
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany; (A.-K.J.); (B.M.)
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany; (A.-K.J.); (B.M.)
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany; (A.-K.J.); (B.M.)
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Ma J, Zheng Y, Li P, Zhou T, Sun Z, Ju T, Li A. Risk factors for the rupture of intracranial aneurysms: a systematic review and meta-analysis. Front Neurol 2023; 14:1268438. [PMID: 38146438 PMCID: PMC10749344 DOI: 10.3389/fneur.2023.1268438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/09/2023] [Indexed: 12/27/2023] Open
Abstract
Purpose The study aimed to identify potential risk factors for aneurysm rupture by performing a systematic review and meta-analysis. Materials and methods We systematically searched the PubMed, Embase, and Cochrane Library electronic databases for eligible studies from their inception until June 2023. Results Eighteen studies involving 17,069 patients with unruptured intracranial aneurysm (UIA) and 2,699 aneurysm ruptures were selected for the meta-analysis. Hyperlipidemia [odds ratio (OR): 0.47; 95% confidence interval (CI): 0.39-0.56; p < 0.001] and a family history of subarachnoid hemorrhage (SAH) (OR: 0.81; 95% CI: 0.71-0.91; p = 0.001) were associated with a reduced risk of aneurysm rupture. In contrast, a large-size aneurysm (OR: 4.49; 95% CI: 2.46-8.17; p < 0.001), ACA (OR: 3.34; 95% CI: 1.94-5.76; p < 0.001), MCA (OR: 2.16; 95% CI: 1.73-2.69; p < 0.001), and VABA (OR: 2.20; 95% CI: 1.24-3.91; p = 0.007) were associated with an increased risk of aneurysm rupture. Furthermore, the risk of aneurysm rupture was not affected by age, sex, current smoking, hypertension, diabetes mellitus, a history of SAH, and multiple aneurysms. Conclusion This study identified the predictors of aneurysm rupture in patients with UIAs, including hyperlipidemia, a family history of SAH, a large-size aneurysm, ACA, MCA, and VABA; patients at high risk for aneurysm rupture should be carefully monitored. Systematic Review Registration Our study was registered in the INPLASY platform (INPLASY202360062).
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Affiliation(s)
- Jinyuan Ma
- Department of Neurosurgery, Qingdao Binhai University Affiliated Hospital, Qingdao, China
| | - Yuehua Zheng
- Department of Neurosurgery, Weifang People’s Hospital Shandong Province, Weifang, China
| | - Puxian Li
- Department of Neurosurgery, Qingdao Binhai University Affiliated Hospital, Qingdao, China
| | - Tao Zhou
- Department of Neurosurgery, Weifang People’s Hospital Shandong Province, Weifang, China
| | - Zhen Sun
- Department of Neurosurgery, Qingdao Binhai University Affiliated Hospital, Qingdao, China
| | - Tongze Ju
- Department of Neurosurgery, Qingdao Binhai University Affiliated Hospital, Qingdao, China
| | - Aijun Li
- Department of Neurosurgery, Qingdao Binhai University Affiliated Hospital, Qingdao, China
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Shimizu K, Aoki T, Etminan N, Hackenberg KAM, Tani S, Imamura H, Kataoka H, Sakai N. Associations Between Drug Treatments and the Risk of Aneurysmal Subarachnoid Hemorrhage: a Systematic Review and Meta-analysis. Transl Stroke Res 2023; 14:833-841. [PMID: 36242746 DOI: 10.1007/s12975-022-01097-2] [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: 05/07/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022]
Abstract
There is increasing interest in drug therapy for preventing aneurysmal subarachnoid hemorrhage (aSAH). We aimed to comprehensively evaluate the association between drug use and the risk of aSAH. We searched PubMed and Scopus from the databases' inception until December 2021. Observational studies reporting the association between any drug therapy and aSAH were included. The odds ratios (ORs) for each drug used in aSAH were meta-analyzed with a random-effect model. According to the systematic review, 25 observational studies were eligible for the present study. Four therapeutic purpose-based classes (e.g., lipid-lowering agents) and 14 mechanism-based classes (e.g., statins) were meta-analyzed. Anti-hypertensive agents (OR, 0.50; 95% confidence interval [95% CI], 0.33-0.74), statins (OR, 0.55; 95% CI, 0.35-0.85), biguanides (OR, 0.57; 95% CI, 0.34-0.96), and acetylsalicylic acid (ASA) (OR, 0.62; 95% CI, 0.41-0.94) were inversely associated with the risk of aSAH. Non-ASA non-steroidal anti-inflammatory drugs (OR, 1.73; 95% CI, 1.07-2.79), selective cyclooxygenase-2 inhibitors (OR, 2.04; 95% CI, 1.24-3.35), vitamin K antagonists (OR, 1.50; 95% CI, 1.18-1.91), and dipyridamole (OR, 1.77; 95% CI, 1.23-2.54) were positively associated with the incidence of aSAH. There was also a trend toward a positive association between glucocorticoids (OR, 1.38; 95% CI, 0.97-1.94) and aSAH. The present study suggests that anti-hypertensive agents, statins, biguanides, and ASA are candidate drugs for preventing aSAH. By contrast, several drugs (e.g., anti-thrombotic drugs) may increase the risk of aSAH. Thus, the indications of these drugs in patients with intracranial aneurysms should be carefully determined.
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Affiliation(s)
- Kampei Shimizu
- Department of Neurosurgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan.
- Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Tomohiro Aoki
- Department of Molecular Pharmacology, Research Institute, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Katharina A M Hackenberg
- Department of Neurosurgery, University Hospital Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Shoichi Tani
- Department of Neurosurgery, Tenri Hospital, 200 Mishima-cho, Tenri, Nara, 632-8552, Japan
| | - Hirotoshi Imamura
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Ewbank F, Birks J, Bulters D. The association between acetylsalicylic acid and subarachnoid haemorrhage: the Framingham Heart Study. Sci Rep 2023; 13:6533. [PMID: 37085588 PMCID: PMC10121705 DOI: 10.1038/s41598-023-33570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 04/14/2023] [Indexed: 04/23/2023] Open
Abstract
Studies investigating the association between acetylsalicylic acid (ASA) use and spontaneous subarachnoid haemorrhage (SAH) in the general population have produced conflicting results. The aim of this study is to clarify the relationship between SAH and ASA. We included all participants who reported on ASA use during interim examinations of the Framingham Heart Study Cohorts. Using Cox proportional-hazards regression modelling, we estimated the hazard ratio (HR) associated with ASA use. 7692 participants were included in this study. There were 30 cases of SAH during follow up, with an estimated incidence of 10.0 per 100,000 person- years (CI 6.90-14.15). Univariate analysis showed no association between regular ASA use and SAH (HR, 0.33 [0.08-1.41]; p = 0.14). This was similar when accounting for smoking (HR, 0.35 [0.08-1.51]; p = 0.16). Using a large longitudinal dataset from the Framingham Heart Study, we observed some evidence suggesting fewer SAH in those participants taking regular ASA. However, multivariate statistical analysis showed no significant association between ASA use and SAH. Due to the low incidence of SAH in the general population, the absolute number of SAH events was low and it remains uncertain if a significant effect would become apparent with more follow up.
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Affiliation(s)
- Frederick Ewbank
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK.
| | - Jacqueline Birks
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Diederik Bulters
- Department of Neurosurgery, University Hospital Southampton, Southampton, UK
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Zhou Z, Liu Z, Yang H, Zhang C, Zhang C, Chen J, Wang Y. A nomogram for predicting the risk of poor prognosis in patients with poor-grade aneurysmal subarachnoid hemorrhage following microsurgical clipping. Front Neurol 2023; 14:1146106. [PMID: 37034089 PMCID: PMC10073426 DOI: 10.3389/fneur.2023.1146106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/06/2023] [Indexed: 04/11/2023] Open
Abstract
Objective Aneurysmal subarachnoid hemorrhage (aSAH) is a common and potentially fatal cerebrovascular disease. Poor-grade aSAH (Hunt-Hess grades IV and V) accounts for 20-30% of patients with aSAH, with most patients having a poor prognosis. This study aimed to develop a stable nomogram model for predicting adverse outcomes at 6 months in patients with aSAH, and thus, aid in improving the prognosis. Method The clinical data and imaging findings of 150 patients with poor-grade aSAH treated with microsurgical clipping of intracranial aneurysms on admission from December 2015 to October 2021 were retrospectively analyzed. Least absolute shrinkage and selection operator (LASSO), logistic regression analyses, and a nomogram were used to develop the prognostic models. Receiver operating characteristic (ROC) curves and Hosmer-Lemeshow tests were used to assess discrimination and calibration. The bootstrap method (1,000 repetitions) was used for internal validation. Decision curve analysis (DCA) was performed to evaluate the clinical validity of the nomogram model. Result LASSO regression analysis showed that age, Hunt-Hess grade, Glasgow Coma Scale (GCS), aneurysm size, and refractory hyperpyrexia were potential predictors for poor-grade aSAH. Logistic regression analyses revealed that age (OR: 1.107, 95% CI: 1.056-1.116, P < 0.001), Hunt-Hess grade (OR: 8.832, 95% CI: 2.312-33.736, P = 0.001), aneurysm size (OR: 6.871, 95% CI: 1.907-24.754, P = 0.003) and refractory fever (OR: 3.610, 95% CI: 1.301-10.018, P < 0.001) were independent predictors of poor outcome. The area under the ROC curve (AUC) was 0.909. The calibration curve and Hosmer-Lemeshow tests showed that the nomogram had good calibration ability. Furthermore, the DCA curve showed better clinical utilization of the nomogram. Conclusion This study provides a reliable and valuable nomogram that can accurately predict the risk of poor prognosis in patients with poor-grade aSAH after microsurgical clipping. This tool is easy to use and can help physicians make appropriate clinical decisions to significantly improve patient prognosis.
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10
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Xu WD, Chen RD, Hu SQ, Hou YY, Yu JS. Morphological evaluation of the risk of posterior communicating artery aneurysm rupture: a mirror aneurysm model. J Neurosurg 2023; 138:185-190. [PMID: 36067385 DOI: 10.3171/2022.4.jns22490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/20/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The aim of this study was to use morphological parameters of mirror posterior communicating artery (PCoA) aneurysms to evaluate aneurysm rupture risk. METHODS The morphological parameters of 45 pairs of ruptured mirror PCoA aneurysms were analyzed. Conditional univariate and multivariate logistic regression of the following paired morphological parameters was performed: aneurysm with a daughter sac, aneurysm height, aneurysm width, neck width, internal carotid artery diameter, PCoA diameter, flow angle, PCoA angle, aspect ratio, bottleneck factor, size ratio, height/width ratio, fetal posterior cerebral artery, and aneurysm with height > width. A scoring system was established according to the odds ratios (ORs). The receiver operating characteristic was used to test the prediction accuracy of this scoring system in the authors' database of 523 PCoA aneurysms and the threshold value was used to define higher risk. RESULTS Aneurysm width (OR 1.676, p = 0.014), aneurysm with daughter sac (OR 7.775, p = 0.016), and aneurysm with height > width (OR 9.067, p = 0.012) were independent risk factors for rupture. The scoring system consisted of aneurysm width (1 point per mm), aneurysm with a daughter sac (5 points), and aneurysm with height > width (5 points). The area under the curve (AUC) of the scoring system was 0.842, and its threshold value was 7.97. A score ≥ 8 points was defined as higher risk. The AUC using this definition was 0.802. CONCLUSIONS Aneurysm width, aneurysms with height > width, and aneurysms with a daughter sac were independent risk factors for PCoA aneurysm rupture. The scoring system devised in this study accurately predicts rupture risk.
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11
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Ewbank F, Birks J, Gaastra B, Hall S, Galea I, Bulters D. Aspirin and Subarachnoid Haemorrhage in the UK Biobank. Transl Stroke Res 2022:10.1007/s12975-022-01060-1. [PMID: 35809217 DOI: 10.1007/s12975-022-01060-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022]
Abstract
Previous studies investigating the relationship between aspirin use and subarachnoid haemorrhage (SAH) have yielded conflicting results. In this study, we aimed to clarify the association between aspirin and SAH in the general population. The UK Biobank is a prospective population-based cohort study. Sex, age, smoking, alcohol, medication use, hypertension, blood pressure, ischaemic heart disease and stroke were recorded at baseline assessments. Follow-up is conducted through linkages to National Health Service data including electronic, coded death certificate, hospital and primary care data. Cox proportional hazards modelling was used to analyse the association between aspirin use and SAH. Of the 501,060 participants included in the analysis, a total of 579 suffered from spontaneous SAH after their baseline assessment. There was no relationship between aspirin and SAH of all causes (HR, 1.16 [0.92-1.46]), aneurysmal SAH (HR, 1.15 [0.91-1.47]) or non-aneurysmal SAH (HR, 1.29 [0.54-3.09]). Aspirin use was associated with SAH resulting in death (HR, 1.69 [1.14-2.51]), especially out of hospital death (HR, 2.10 [1.13-3.91]). Despite reports of a protective association between aspirin and SAH in patients with known unruptured aneurysms, this study has not demonstrated the same effect in the general population. However, aspirin users were more likely to suffer SAH resulting in death, especially out of hospital.
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Affiliation(s)
- Frederick Ewbank
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| | - Jacqueline Birks
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Benjamin Gaastra
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
| | - Samuel Hall
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ian Galea
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Diederik Bulters
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, University of Southampton, Southampton, UK
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12
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Zhong P, Lu Z, Li Z, Li T, Lan Q, Liu J, Wang Z, Chen S, Huang Q. Effect of Renin-Angiotensin-Aldosterone System Inhibitors on the Rupture Risk Among Hypertensive Patients With Intracranial Aneurysms. Hypertension 2022; 79:1475-1486. [PMID: 35656813 DOI: 10.1161/hypertensionaha.122.18970] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Mounting experimental evidence supports the concept that the RAAS (renin-angiotensin-aldosterone system) is involved in the pathogenesis of intracranial aneurysm rupture. However, whether RAAS inhibitors could reduce the rupture risk of intracranial aneurysms remains unclear. METHODS We performed a chart review of a multicenter, prospectively maintained database of 3044 hypertensive patients with intracranial aneurysms from 20 medical centers in China. The patients were separated into ruptured and unruptured groups. Univariable and multivariable logistical regression analyses were performed to determine the association between the use of RAAS inhibitors and the rupture risk. Sensitivity analyses and subgroup analyses were performed to verify the robustness of the results. RESULTS In multivariable analyses, female sex, passive smoking, uncontrolled, or unmonitored hypertension, use of over 2 antihypertensive medications, RAAS inhibitors use, antihyperglycemic agents use, hyperlipidemia, ischemic stroke, and aneurysmal location were independently associated with the rupture risk. The use of RAAS inhibitors was significantly associated with a reduced rupture risk compared with the use of non-RAAS inhibitors (odds ratio, 0.490 [95% CI, 0.402-0.597]; P=0.000). Compared with the use of non-RAAS inhibitors, the use of ACE (angiotensin-converting enzyme) inhibitors (odds ratio, 0.559 [95% CI, 0.442-0.709]; P=0.000) and use of ARBs (angiotensin receptor blockers; odds ratio, 0.414 [95% CI, 0.315-0.542]; P=0.000) were both significantly associated with a reduced rupture risk. The negative association of the rupture risk with RAAS inhibitors was consistent across 3 analyzed data and the predefined subgroups (including controlled hypertension). CONCLUSIONS The use of RAAS inhibitors was significantly associated with a decreased rupture risk independent of blood pressure control among hypertensive patients with intracranial aneurysms.
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Affiliation(s)
- Ping Zhong
- Department of Neurosurgery (P.Z., Z. Li, S.C.), School of Medicine, Xiamen University, China.,BE and Phase I Clinical Trial Center (P.Z.), School of Medicine, Xiamen University, China
| | - Zhiwen Lu
- Neurovascular Center, Changhai Hospital, Second Military Medical University, Shanghai, China (Z. Lu, J.L., Q.H)
| | - Zhangyu Li
- Department of Neurosurgery (P.Z., Z. Li, S.C.), School of Medicine, Xiamen University, China
| | - Tianxiao Li
- Neurovascular Center, Henan Provincial People's Hospital, Zhengzhou, China (T.L.)
| | - Qing Lan
- Department of Neurosurgery, Second Affiliated Hospital of Soochow University, Suzhou, China (Q.L.)
| | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Second Military Medical University, Shanghai, China (Z. Lu, J.L., Q.H)
| | - Zhanxiang Wang
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center (Z.W.), School of Medicine, Xiamen University, China.,The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University and Department of Neuroscience, Institute of Neurosurgery (Z.W.), School of Medicine, Xiamen University, China
| | - Sifang Chen
- Department of Neurosurgery (P.Z., Z. Li, S.C.), School of Medicine, Xiamen University, China
| | - Qinghai Huang
- Neurovascular Center, Changhai Hospital, Second Military Medical University, Shanghai, China (Z. Lu, J.L., Q.H)
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13
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Kawada T. Letter to the Editor Regarding "Morphologic Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries". World Neurosurg 2022; 161:208. [PMID: 35505527 DOI: 10.1016/j.wneu.2022.01.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Tomoyuki Kawada
- Department of Hygiene and Public Health, Nippon Medical School, Bunkyo-ku, Japan.
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14
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Narsinh KH, Narsinh K, McCoy DB, Sun Z, Halabi C, Meisel K, Tihan T, Chaganti K, Amans MR, Halbach VV, Higashida RT, Hetts SW, Dowd CF, Winkler EA, Abla AA, Nowakowski TJ, Cooke DL. Endovascular Biopsy of Vertebrobasilar Aneurysm in Patient With Polyarteritis Nodosa. Front Neurol 2021; 12:697105. [PMID: 34887823 PMCID: PMC8650719 DOI: 10.3389/fneur.2021.697105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 10/08/2021] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose: The management of unruptured intracranial aneurysms remains controversial. The decisions to treat are heavily informed by estimated risk of bleeding. However, these estimates are imprecise, and better methods for stratifying the risk or tailoring treatment strategy are badly needed. Here, we demonstrate an initial proof-of-principle concept for endovascular biopsy to identify the key molecular pathways and gene expression changes associated with aneurysm formation. We couple this technique with single cell RNA sequencing (scRNAseq) to develop a roadmap of the pathogenic changes of a dolichoectatic vertebrobasilar aneurysm in a patient with polyarteritis nodosa. Methods: Endovascular biopsy and fluorescence activated cell sorting was used to isolate the viable endothelial cells (ECs) using the established techniques. A single cell RNA sequencing (scRNAseq) was then performed on 24 aneurysmal ECs and 23 patient-matched non-aneurysmal ECs. An integrated panel of bioinformatic tools was applied to determine the differential gene expression, enriched signaling pathways, and cell subpopulations hypothesized to drive disease pathogenesis. Results: We identify a subset of 7 (29%) aneurysm-specific ECs with a distinct gene expression signature not found in the patient-matched control ECs. A gene set enrichment analysis identified these ECs to have increased the expression of genes regulating the leukocyte-endothelial cell adhesion, major histocompatibility complex (MHC) class I, T cell receptor recycling, tumor necrosis factor alpha (TNFα) response, and interferon gamma signaling. A histopathologic analysis of a different intracranial aneurysm that was later resected yielded a diagnosis of polyarteritis nodosa and positive staining for TNFα. Conclusions: We demonstrate feasibility of applying scRNAseq to the endovascular biopsy samples and identify a subpopulation of ECs associated with cerebral aneurysm in polyarteritis nodosa. Endovascular biopsy may be a safe method for deriving insight into the disease pathogenesis and tailoring the personalized treatment approaches to intracranial aneurysms.
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Affiliation(s)
- Kazim H Narsinh
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Kamileh Narsinh
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - David B McCoy
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Zhengda Sun
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Cathra Halabi
- Division of Neurovascular Neurology, Department of Neurology, University of California, San Francisco, San Francisco, CA, United States.,Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Karl Meisel
- Division of Neurovascular Neurology, Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Tarik Tihan
- Division of Neuropathology, Department of Pathology, University of California, San Francisco, San Francisco, CA, United States
| | - Krishna Chaganti
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Matthew R Amans
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Van V Halbach
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Randall T Higashida
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Steven W Hetts
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher F Dowd
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Ethan A Winkler
- Cerebrovascular Disorders Program, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Adib A Abla
- Cerebrovascular Disorders Program, Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Tomasz J Nowakowski
- Department of Anatomy, Chan Zuckerberg Biohub, University of California, San Francisco, San Francisco, CA, United States
| | - Daniel L Cooke
- Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
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15
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Guo Y, Guo XM, Zhao K, Yang MF. Aspirin and growth, rupture of unruptured intracranial aneurysms: A systematic review and meta-analysis. Clin Neurol Neurosurg 2021; 209:106949. [PMID: 34562772 DOI: 10.1016/j.clineuro.2021.106949] [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] [Received: 08/13/2021] [Revised: 09/10/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Aspirin has been suggested as a potential therapeutic strategy to prevent the growth and rupture of unruptured intracranial aneurysms (UIAs), but there is still controversy. The aim of this systematic review and meta-analysis is to determine the association between aspirin use and growth, rupture of UIAs. METHODS We performed a systematic literature search of electronic databases to identify cohort and case-control studies investigating the relationship between aspirin use and growth or rupture of UIAs. Pooled odds ratio (OR) with corresponding 95% confidence interval (CI) were calculated using a random effects model. Heterogeneity among studies was quantified using the I2 statistic, and potential publication bias was assessed using funnel plots. Sensitivity analysis was performed to verify the robustness of the intention-to-treat results. Subgroup analysis was conducted according to the frequency of aspirin use. RESULTS We identified 8 studies comprising 10,518 participants. The risk of bias was low to moderate. The pooled estimate showed that aspirin use was associated with a lower likelihood of growth of UIAs (OR = 0.25, 95% CI = 0.11-0.55; p = 0.0005) without statistical heterogeneity (p for Cochran Q statistic = 0.62, I2 = 0%). Likewise, aspirin intake also significant decreased 58% risk of intracranial aneurysms rupture (OR = 0.42, 95% CI = 0.29-0.60; p < 0.00001) with moderate heterogeneity (p for Cochran Q statistic = 0.005, I2 = 66%). Similar results were observed in the sensitivity analysis. Pooled OR of aspirin frequency subgroup analysis for less than or equal to 2 times per week was 0.82 (95%CI = 0.40-1.72; I2 = 0%), for at least 3 times per week to daily was 0.25 (95%CI = 0.12-053; I2 = 0%), for daily was 0.59 (95%CI: 0.47-0.74; I2 = 0%), and for unknown was 0.26 (95%CI: 0.15-0.45; I2 = 51%). CONCLUSIONS The results of this systematic review and meta-analysis indicates a beneficial effect of aspirin on growth and rupture of UIAs.
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Affiliation(s)
- Yu Guo
- Graduate School, Qinghai University, Xining, Qinghai, China
| | - Xin-Mei Guo
- Biomedical Engineering Research Center, Kunming Medical University, Kunming, Yunnan, China
| | - Kai Zhao
- Graduate School, Qinghai University, Xining, Qinghai, China
| | - Ming-Fei Yang
- Department of Neurosurgery, Qinghai Provincial People's Hospital, Xining, Qinghai, China.
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16
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Sebök M, Hostettler IC, Keller E, Rautalin IM, Coert BA, Vandertop WP, Post R, Sardeha A, Tjerkstra MA, Regli L, Verbaan D, Germans MR. Prehemorrhage antiplatelet use in aneurysmal subarachnoid hemorrhage and impact on clinical outcome. Int J Stroke 2021; 17:545-552. [PMID: 34282988 PMCID: PMC9150139 DOI: 10.1177/17474930211035647] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background Literature is inconclusive regarding the association between antiplatelet agents use and outcome after aneurysmal subarachnoid hemorrhage. Aims To investigate the association between clinical outcome and prehemorrhage use in aneurysmal subarachnoid hemorrhage patients as well as the impact of thrombocyte transfusion on rebleed and clinical outcome. Methods Data were collected from prospective databases of two European tertiary reference centers for aneurysmal subarachnoid hemorrhage patients. Patients were divided into “antiplatelet-user” and “non-user” according to the use of acetylsalicylic acid prior to the hemorrhage. Primary outcome was poor clinical outcome at six months (Glasgow Outcome Scale score 1–3). Secondary outcomes were in-hospital mortality and impact of thrombocyte transfusion. Results Of the 1033 patients, 161 (15.6%) were antiplatelet users. The antiplatelet users were older with higher incidence of cardiovascular risk factors. Antiplatelet use was associated with poor outcome and in-hospital mortality. After correction for age, sex, World Federation of Neurosurgical Societies score, infarction and heart disorder, pre-hemorrhage acetylsalicylic acid use was only associated with poor clinical outcome at six months (adjusted OR 1.80, 95% CI 1.08–3.02). Thrombocyte transfusion was not associated with a reduction in rebleed or poor clinical outcome. Conclusion In this multicenter study, the prehemorrhage acetylsalicylic acid use in aneurysmal subarachnoid hemorrhage patients was independently associated with poor clinical outcome at six months. Thrombocyte transfusion was not associated with the rebleed rate or poor clinical outcome at six months.
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Affiliation(s)
- Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Isabel C Hostettler
- Stroke Research Centre, University College London, Institute of Neurology, London, UK.,Department of Neurosurgery, Klinikum rechts der Isar, Munich, Germany
| | - Emanuela Keller
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Neurosurgical Intensive Care Unit, Department of Neurosurgery and Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Ilari M Rautalin
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Bert A Coert
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - William P Vandertop
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - René Post
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ali Sardeha
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Maud A Tjerkstra
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Dagmar Verbaan
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Menno R Germans
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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17
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Wu X, Duan Z, Liu Y, Zhou C, Jiao Z, Zhao Y, Tang T. Incidental Unruptured Intracranial Aneurysms Do Not Impact Outcome in Patients With Acute Cerebral Infarction. Front Neurol 2021; 12:613027. [PMID: 33981282 PMCID: PMC8107683 DOI: 10.3389/fneur.2021.613027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 03/11/2021] [Indexed: 01/01/2023] Open
Abstract
Background: This study was to examine the patients with acute cerebral infarction (ACI) treated at a single center over 9 years and who underwent Unruptured intracranial aneurysm (UIA) screening by three-dimensional time-of-flight magnetic resonance angiography (3D-TOF-MRA), and to explore the factors associated with outcomes. Methods: The outcome was the modified Rankin scale (mRS) score at 90 days after stroke onset. The outcome was classified into a good outcome (mRS score of 0–2 points) and poor outcome (mRS score of 3–6 points). Results: UIAs were found in 260 (6.5%) of 4,033 patients with ACI; 2,543 (63.1%) had a good outcome, and 1,490 (36.9%) had a poor outcome. There was no difference in outcomes between the two groups (P = 0.785). The multivariable analysis showed that age (OR = 1.009, 95%CI: 1.003–1.014, P = 0.003), diabetes (OR = 1.179, 95%CI: 1.035–1.342, P = 0.013), ischemic stroke history (OR = 1.451, 95%CI: 1.256–1.677, P < 0.001), and baseline NIHSS score (OR = 1.034, 95%CI: 1.018–1.050, P < 0.001) were independently associated with the 90-day outcomes in patients with ACI. The presence of incidental UIA was not associated with outcomes after ACI. Conclusions: Age, diabetes, ischemic stroke history, and baseline NIHSS score were independently associated with the early outcomes of patients with ACI.
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Affiliation(s)
- Xuan Wu
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Zuowei Duan
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Yihui Liu
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Changwu Zhou
- Department of Medical Imaging, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Zhiyun Jiao
- Department of Medical Imaging, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Yi Zhao
- Department of Medical Imaging, Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Tieyu Tang
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
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18
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Ewbank F, Birks J, Bulters D. A meta-analysis of aspirin and subarachnoid hemorrhage in patients with intracranial aneurysms yields different results to the general population. Int J Stroke 2021; 17:341-353. [PMID: 33705214 DOI: 10.1177/17474930211004888] [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: 12/18/2022]
Abstract
BACKGROUND Some studies have shown a protective association between aspirin use and subarachnoid hemorrhage. Other studies have found no relationship or the reverse. These studies differ in their study populations and definitions of subarachnoid hemorrhage. AIMS Our aim was to establish (1) if there is an association between aspirin and subarachnoid hemorrhage, (2) how this differs between the general population and those with intracranial aneurysms. SUMMARY OF REVIEW Studies reporting aspirin use and the occurrence of subarachnoid hemorrhage were included and grouped based on population (general population vs. aneurysm population). Odds ratios, hazard ratios, and confidence intervals were combined in random-effects models. Eleven studies were included. Overall, there was an association between aspirin and subarachnoid hemorrhage (OR 0.68 [0.48, 0.96]). However, populations were diverse and heterogeneity between studies high (p < 0.00001), questioning the validity of combining these studies and justifying analysis by population. In the general population, there was no difference in aspirin use between individuals with and without subarachnoid hemorrhage (OR 1.15 [0.96, 1.38]). In patients with intracranial aneurysms, aspirin use was greater in patients without subarachnoid hemorrhage (OR 0.37 [0.24, 0.58]), although these studies were at higher risk of bias. CONCLUSIONS There is an association between aspirin use and subarachnoid hemorrhage in patients with intracranial aneurysms. This apparent protective relationship is not seen in the general population. Prospective randomized studies are required to further investigate the effect of aspirin on unruptured intracranial aneurysms.
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19
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Yang S, Liu T, Wu Y, Xu N, Xia L, Yu X. The Role of Aspirin in the Management of Intracranial Aneurysms: A Systematic Review and Meta-Analyses. Front Neurol 2021; 12:646613. [PMID: 33859609 PMCID: PMC8042149 DOI: 10.3389/fneur.2021.646613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/08/2021] [Indexed: 01/19/2023] Open
Abstract
Objective: To evaluate the association between aspirin use and the risks of unruptured intracranial aneurysm (UIA) growth and aneurysmal subarachnoid hemorrhage (aSAH). Methods: We searched PubMed and Scopus from inception to 1 September 2020. Studies evaluating the associations between aspirin prescription and the risk of UIA growth or the risk of aSAH were included. The study only included patients with intracranial aneurysms. We assessed the quality of included studies using the Newcastle-Ottawa scale. Random-effects meta-analysis was conducted to pool the estimates of effect size quantitatively. Sensitivity analyses using the leave-one-out strategy were performed to identify any potential source of heterogeneity. Results: After a review of 2,226 citations, five cohort studies, two case-control studies, and one nested case-control study involving 8,898 participants were included. Pooled analyses showed that aspirin use, regardless of frequency and duration, was associated with a statistically significantly lower risk of UIA growth (OR 0.25, 95% CI 0.11–0.54; I2 = 0.0%, p = 0.604) and aSAH (OR, 0.37, 95% CI, 0.23–0.58; I2 = 79.3%, p = 0.001) in patients presented with intracranial aneurysms. The results did not significantly change in sensitivity analyses. Conclusions: Summarizing available evidence in the literature, our findings indicate that aspirin use, regardless of frequency and duration, was associated with a statistically significantly lower risk of UIA growth and aSAH in patients with UIA. Well-designed and large-scale clinical trials are needed to help define the role of aspirin as a protective pharmaceutical for UIAs.
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Affiliation(s)
- Shuwen Yang
- Department of Neurosurgery, People's Hospital of Huangpi District, Jianghan University, Wuhan, China
| | - Tianyu Liu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuehui Wu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nina Xu
- Department of Neurosurgery, Union 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
| | - Xinyu Yu
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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20
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Løvik K, Laupsa-Borge J, Logallo N, Helland CA. Dyslipidemia and rupture risk of intracranial aneurysms-a systematic review. Neurosurg Rev 2021; 44:3143-3150. [PMID: 33704595 PMCID: PMC8593048 DOI: 10.1007/s10143-021-01515-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 01/09/2023]
Abstract
Dyslipidemia is a well-established risk factor for coronary artery disease. However, the effect on cerebral artery disease, and more specifically the rupture risk of intracranial aneurysms, is unclear and has not yet been reviewed. We therefore performed a systematic review to investigate associations between different types of dyslipidemia and incidence of aneurysmal subarachnoid hemorrhage (aSAH). We used the MEDLINE, Embase, and Web of Science databases to identify clinical trials that compared the rupture risk among SAH patients with or without dyslipidemia. The risk of bias in each included study was evaluated using the Critical Appraisal Skills Program (CASP). Of 149 unique citations from the initial literature search, five clinical trials with a case-control design met our eligibility criteria. These studies compared aSAH patients to patients with unruptured aneurysms and found an overall inverse relationship between hypercholesterolemia and rupture risk of intracranial aneurysms. The quality assessment classified all included studies as high risk of bias. The evidence indicates that hypercholesterolemia is associated with a reduced rupture risk of intracranial aneurysms. However, it is not clear whether this relation is due to the dyslipidemic condition itself or the use of antihyperlipidemic medication.
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Affiliation(s)
- Katja Løvik
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | - Nicola Logallo
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Christian A Helland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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21
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Golnari P, Nazari P, Garcia RM, Weiss H, Shaibani A, Hurley MC, Ansari SA, Potts MB, Jahromi BS. Volumes, outcomes, and complications after surgical versus endovascular treatment of aneurysms in the United States (1993–2015): continued evolution versus steady-state after more than 2 decades of practice. J Neurosurg 2021; 134:848-861. [DOI: 10.3171/2019.12.jns192755] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/02/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEAdoption of endovascular treatment (EVT) and other advances in aneurysm care have shifted practice patterns of cerebral aneurysm treatment over the past 2 decades in the US. The objective of this study was to determine whether resulting trends in volumes, outcomes, and complications have matured in general practice or continue to evolve.METHODSData were obtained from the National Inpatient Sample from 1993 to 2015. ICD-9 codes were used to estimate annual volumes, outcomes, and complications following treatment of ruptured and unruptured aneurysms. Univariate and multivariate analyses were used to estimate risk ratios for complications and outcomes. Trends in time were assessed utilizing annual percentage change (APC).RESULTSThe authors found a nearly 5-fold increase in annual admissions with diagnoses of unruptured aneurysms, whereas SAH volume increased less than 50%. Clipping ruptured aneurysms steadily declined (APC −0.86%, p = 0.69 until 1999, then −6.22%, p < 0.001 thereafter), whereas clipping unruptured aneurysms slightly increased (APC 2.02%, p < 0.001). EVT tripled in 2002–2004 and steadily increased thereafter (APC 7.22%, p < 0.001 and 5.85%, p = 0.01 for unruptured and ruptured aneurysms, respectively). Despite a 3-fold increase in both diagnosis and treatment of unruptured aneurysms, the incidence of SAH remained steady at 12 per 100,000 persons per year (APC 0.04%, p = 0.83). In contrast, SAH severity increased over time, as did patient age and comorbidities (all p < 0.001). SAH led to nonroutine discharge more frequently over time after both EVT and clipping (APC 1.24% and 1.10%, respectively), although mortality decreased during the same time (APC −2.48% and −1.44%, respectively). Complications were more frequent after clipping than EVT, but this differential risk diminished during the study period and was less perceptible in ruptured aneurysms. The proportion of patients discharged home after treatment of unruptured aneurysms was significantly lower (p < 0.001) after clipping (69.3%–79.5%) than EVT (88.3%–93.3%); both proportions changed minimally since 1998 (APC −0.39%, p = 0.02, and APC −0.11%, p = 0.14, respectively).CONCLUSIONSEVT volume markedly increased for ruptured and unruptured aneurysms from 1993 to 2015, whereas clipping decreased for ruptured and slightly increased for unruptured aneurysms. The incidence of SAH remained unchanged despite increased diagnosis and treatment of unruptured aneurysms. In ruptured aneurysms, SAH severity has increased over time, as have age, comorbidities, and nonroutine discharges. In contrast, routine discharge after treatment of unruptured aneurysms remains largely unchanged since 1998 and remains lower with clipping.
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Affiliation(s)
- Pedram Golnari
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pouya Nazari
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Ali Shaibani
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael C. Hurley
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sameer A. Ansari
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew B. Potts
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Babak S. Jahromi
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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22
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Effect of combined acetylsalicylic acid and statins treatment on intracranial aneurysm rupture. PLoS One 2021; 16:e0247153. [PMID: 33600491 PMCID: PMC7891751 DOI: 10.1371/journal.pone.0247153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/03/2021] [Indexed: 01/20/2023] Open
Abstract
Background Acetylsalicylic acid (ASA) and statins have been identified as potentially reducing the risk of intracranial aneurysms (IA) rupture. We aim to determine the effect of this drugs on the risk of rupture of IA. Patients and methods We performed a retrospective cohort study from a prospective database of patients with IA treated in our institution between January 2013 and December 2018. Demographics, previous oral treatments, presence of multiple aneurysms, size of aneurysm, lobulation, location and morphology of the aneurysms were recorded. Patients were dichotomized as ruptured and unruptured IA. Results A total of 408 IA were treated, of which 283 (68.6%) were in women. The median age was 53, 194 (47.5%) were ruptured IA. 38 patients (9.3%) were receiving ASA and 84 (20.6%) were receiving statins at the moment of the IA diagnosis. In the multivariable regression analysis, ASA plus statin use and multiple aneurysms were independently associated with unruptured IA (OR 5.01, 95% CI, 1.37–18.33, P = 0.015 and OR 2.72, 95% CI 1.68–4.27, P<0.001, respectively). Whereas, lobulated wall aneurysm and PComA/AComA location were inversely and independently associated with unruptured IA condition (OR 0.34, 95% CI 0.21–0.55, P<0.001 and OR 0.37, 95% CI 0.23–0.60, P<0.001, respectively). However, ASA and statins in monotherapy were not independently associated with unruptured IA condition. Conclusions In our study population ASA plus statins treatment is independently associated with unruptured IA. Larger and prospective studies are required to explore this potential protective effect against IA rupture.
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23
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Rousseau O, Karakachoff M, Gaignard A, Bellanger L, Bijlenga P, Constant Dit Beaufils P, L'Allinec V, Levrier O, Aguettaz P, Desilles JP, Michelozzi C, Marnat G, Vion AC, Loirand G, Desal H, Redon R, Gourraud PA, Bourcier R. Location of intracranial aneurysms is the main factor associated with rupture in the ICAN population. J Neurol Neurosurg Psychiatry 2021; 92:122-128. [PMID: 33097563 DOI: 10.1136/jnnp-2020-324371] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE The ever-growing availability of imaging led to increasing incidentally discovered unruptured intracranial aneurysms (UIAs). We leveraged machine-learning techniques and advanced statistical methods to provide new insights into rupture intracranial aneurysm (RIA) risks. METHODS We analysed the characteristics of 2505 patients with intracranial aneurysms (IA) discovered between 2016 and 2019. Baseline characteristics, familial history of IA, tobacco and alcohol consumption, pharmacological treatments before the IA diagnosis, cardiovascular risk factors and comorbidities, headaches, allergy and atopy, IA location, absolute IA size and adjusted size ratio (aSR) were analysed with a multivariable logistic regression (MLR) model. A random forest (RF) method globally assessed the risk factors and evaluated the predictive capacity of a multivariate model. RESULTS Among 994 patients with RIA (39.7%) and 1511 patients with UIA (60.3 %), the MLR showed that IA location appeared to be the most significant factor associated with RIA (OR, 95% CI: internal carotid artery, reference; middle cerebral artery, 2.72, 2.02-3.58; anterior cerebral artery, 4.99, 3.61-6.92; posterior circulation arteries, 6.05, 4.41-8.33). Size and aSR were not significant factors associated with RIA in the MLR model and antiplatelet-treatment intake patients were less likely to have RIA (OR: 0.74; 95% CI: 0.55-0.98). IA location, age, following by aSR were the best predictors of RIA using the RF model. CONCLUSIONS The location of IA is the most consistent parameter associated with RIA. The use of 'artificial intelligence' RF helps to re-evaluate the contribution and selection of each risk factor in the multivariate model.
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Affiliation(s)
- Olivia Rousseau
- INSERM, CIC 1413, Clinique des données, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
| | - Matilde Karakachoff
- INSERM, CIC 1413, Clinique des données, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
| | - Alban Gaignard
- CNRS, INSERM, L'institut du thorax, University of Nantes, Nantes, Pays de la Loire, France
| | - Lise Bellanger
- Laboratoire de Mathématiques Jean Leray, University of Nantes, Nantes, Pays de la Loire, France
| | - Philippe Bijlenga
- Department of Clinical Neurosciences, University of Geneva, Geneva, Switzerland
| | | | - Vincent L'Allinec
- Department Neuroradiology, University Hospital Centre Angers, Angers, Pays de la Loire, France
| | - Olivier Levrier
- Department of Neuroradiology, Hôpital Clairval - Ramsay-Générale de santé, Marseille, France
| | - Pierre Aguettaz
- Department of Neuroradiology, Hospital Clairval, Marseille, Provence-Alpes-Côte d'Azu, France
| | - Jean-Philippe Desilles
- Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Caterina Michelozzi
- Department of Neuroradiology, Hopital Pierre Paul Riquet, CHU de Toulouse, Toulouse, France
| | - Gaultier Marnat
- Department of Neuroradiology, University Hospital of Bordeaux, Bordeaux, France
| | - Anne-Clémence Vion
- CNRS, INSERM, L'institut du thorax, University of Nantes, Nantes, Pays de la Loire, France
| | - Gervaise Loirand
- CNRS, INSERM, L'institut du thorax, University of Nantes, Nantes, Pays de la Loire, France
| | - Hubert Desal
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, UNIV Nantes, Nantes, Pays de la Loire, FR, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
| | - Richard Redon
- CNRS, INSERM, L'institut du thorax, University of Nantes, Nantes, Pays de la Loire, France
| | - Pierre-Antoine Gourraud
- INSERM, CIC 1413, Clinique des données, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
| | - Romain Bourcier
- Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L'institut du thorax, Inserm 1087, CNRS, UNIV Nantes, Nantes, Pays de la Loire, FR, University Hospital Centre Nantes, Nantes, Pays de la Loire, France
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24
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Neurovascular disease, diagnosis, and therapy: Brain aneurysms. HANDBOOK OF CLINICAL NEUROLOGY 2020; 176:121-134. [PMID: 33272392 DOI: 10.1016/b978-0-444-64034-5.00001-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Unruptured intracranial aneurysms (UIAs) have a prevalence of 3% in the adult population worldwide. The majority of UIAs are incidental findings, but some UIAs cause cranial nerve palsies, brainstem compression, ischemic events, or epileptic seizures. The most frequent clinical presentation of intracranial aneurysms is, however, rupture and thereby subarachnoid hemorrhage (SAH). To avoid SAH with its fatal consequences, patients with UIAs require counseling by dedicated and interdisciplinary neurovascular specialists. For the purpose of assessment and decision-making for the management of patients with UIAs, numerous aspects have to be considered: radiological characteristics, clinical symptoms, estimated rupture risk of an individual aneurysm as well as patient- and aneurysm-related risks of preventive repair. Generally, two management options exist: observation with follow-up imaging or preventive repair. This chapter discusses current data on pathogenesis, clinical presentation, diagnostics, risk factors for rupture and preventive repair, and guidance tools for the management of patients with UIAs according to current evidence.
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25
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Hostettler IC, O'Callaghan B, Bugiardini E, O'Connor E, Vandrovcova J, Davagnanam I, Alg V, Bonner S, Walsh D, Bulters D, Kitchen N, Brown MM, Grieve J, Werring DJ, Houlden H. ANGPTL6 Genetic Variants Are an Underlying Cause of Familial Intracranial Aneurysms. Neurology 2020; 96:e947-e955. [PMID: 33106390 PMCID: PMC8105901 DOI: 10.1212/wnl.0000000000011125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 10/08/2020] [Indexed: 01/16/2023] Open
Abstract
Purpose To understand the role of the angiopoietin-like 6 gene (ANGPTL6) in intracranial aneurysms (IAs), we investigated its role in a large cohort of familial IAs. Methods Individuals with family history of IA were recruited to the Genetic and Observational Subarachnoid Haemorrhage (GOSH) study. The ANGPTL6 gene was sequenced using Sanger sequencing. Identified genetic variants were compared to a control population. Results We found 6 rare ANGPTL6 genetic variants in 9/275 individuals with a family history of IA (3.3%) (5 missense mutations and 1 nonsense mutation leading to a premature stop codon), none present in controls. One of these had been previously reported: c.392A>T (p.Glu131Val) on exon 2; another was very close: c.332G>A (p.Arg111His). Two further genetic variants lie within the fibrinogen-like domain of the ANGPTL6 gene, which may influence function or level of the ANGPTL6 protein. The last 2 missense mutations lie within the coiled-coil domain of the ANGPTL6 protein. All genetic variants were well conserved across species. Conclusion ANGPTL6 genetic variants are an important cause of IA. Defective or lack of ANGPTL6 protein is therefore an important factor in blood vessel proliferation leading to IA; dysfunction of this protein is likely to cause abnormal proliferation or weakness of vessel walls. With these data, not only do we emphasize the importance of screening familial IA cases for ANGPTL6 and other genes involved in IA, but also highlight the ANGPTL6 pathway as a potential therapeutic target. Classification of Evidence This is a Class III study showing some specificity of presence of the ANGPTL6 gene variant as a marker of familial intracranial aneurysms in a small subset of individuals with familial aneurysms.
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Affiliation(s)
- Isabel C Hostettler
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Benjamin O'Callaghan
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Enrico Bugiardini
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Emer O'Connor
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Jana Vandrovcova
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Indran Davagnanam
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Varinder Alg
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Stephen Bonner
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Daniel Walsh
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Diederik Bulters
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Neil Kitchen
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Martin M Brown
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Joan Grieve
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - David J Werring
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust
| | - Henry Houlden
- From the Stroke Research Centre (I.C.H., V.A., M.M.B., D.J.W.), MRC Centre for Neuromuscular Diseases (B.O., E.B.), and Department of Neuromuscular Disorders (E.B., J.V.), UCL Queen Square Institute of Neurology; Neurogenetics Laboratory (I.C.H., B.O., E.O., H.H.) and Departments of Neuroradiology (I.D.) and Neurosurgery (N.K., J.G.), the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London; Department of Anaesthesia (S.B.), the James Cook University Hospital, Middlesbrough; Department of Neurosurgery (D.W.), King's College Hospital NHS Foundation Trust, London; and Department of Neurosurgery (D.B.), University Hospital Southampton NHS Foundation Trust.
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Florez WA, García-Ballestas E, Maeda F, Joaquim A, Pavlov O, Moscote-Salazar LR, Tsimpas A, Martinez-Perez R. Relationship between aspirin use and subarachnoid hemorrhage: A systematic Review and meta-analysis. Clin Neurol Neurosurg 2020; 200:106320. [PMID: 33268193 DOI: 10.1016/j.clineuro.2020.106320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Aspirin has been associated with a decreasing risk of subarachnoid hemorrhage due to its anti-inflammatory mechanism of action and potential protective properties against aneurysm growth. OBJECTIVE To determine the association between aneurysmal subarachnoid hemorrhage and aspirin use. METHODS A systematic review of the literature and a meta-analysis were performed across the PubMed database. The following keywords were used: "aspirin, acetylsalicylic acid, 2-acetyloxy-benzoic acid, ruptured intracranial aneurysm, aneurysmal subarachnoid hemorrhage, spontaneous subarachnoid hemorrhage, intracerebral hemorrhage, spontaneous aneurysmal hemorrhage, spontaneous intracerebral bleeding". Studies that were performed with animals or analyzed patients with traumatic brain injury were excluded. A total of five studies were included in our meta-analysis, with a total of 19,222 patients evaluated. Statistical analysis was performed to determine the association between the use of aspirin and the risk of subarachnoid hemorrhage. RESULTS Aspirin use reduce the risk of subarachnoid hemorrhage (odds ratio [OR] 0.51, 95 % confidence interval [CI] 0.34-0.76). CONCLUSION Although some previous studies suggested that aspirin may potentially reduce the risk of subarachnoid hemorrhage, our meta-analysis found an association between the reduction of risk of aneurysmal subarachnoid hemorrhage.
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Affiliation(s)
- William A Florez
- Latinoamerican Council of Neurocritical Care, Cartagena, Colombia; Faculty of Health, Programa Medicina, Universidad Surcolombiana, Neiva, Huila, Colombia.
| | - Ezequiel García-Ballestas
- Latinoamerican Council of Neurocritical Care, Cartagena, Colombia; Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Fernando Maeda
- Department of Neurosurgery, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Andrei Joaquim
- Department of Neurosurgery, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Orlin Pavlov
- Departament of Neurosurgery, Klinikum Fulda gAG, Fulda, Germany
| | - Luis Rafael Moscote-Salazar
- Latinoamerican Council of Neurocritical Care, Cartagena, Colombia; Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Asterios Tsimpas
- Section of Neurosurgery, Department of Surgery, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
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Qian C, He Y, Li Y, Chen C, Zhang B. Association Between Aspirin Use and Risk of Aneurysmal Subarachnoid Hemorrhage: A Meta-analysis. World Neurosurg 2020; 138:299-308. [DOI: 10.1016/j.wneu.2020.01.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/13/2020] [Accepted: 01/16/2020] [Indexed: 12/18/2022]
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Huckhagel T, Klinger R, Schmidt NO, Regelsberger J, Westphal M, Czorlich P. The burden of headache following aneurysmal subarachnoid hemorrhage: a prospective single-center cross-sectional analysis. Acta Neurochir (Wien) 2020; 162:893-903. [PMID: 32016589 PMCID: PMC7066282 DOI: 10.1007/s00701-020-04235-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/18/2020] [Indexed: 12/17/2022]
Abstract
Background Aneurysmal subarachnoid hemorrhage (SAH) as a serious type of stroke is frequently accompanied by a so-called initial thunderclap headache. However, the occurrence of burdensome long-term headache following SAH has never been studied in detail so far. The aim of this study was to determine the prevalence and characteristics of long-term burdensome headache in good-grade SAH patients as well as its relation to health-related quality of life (HR-QOL). Methods All SAH cases treated between January 2014 and December 2016 with preserved consciousness at hospital discharge were prospectively interviewed regarding burdensome headache in 2018. Study participants were subsequently scrutinized by means of a standardized postal survey comprising validated pain and HR-QOL questionnaires. A retrospective chart review provided data on the initial treatment. Results A total of 93 out of 145 eligible SAH patients participated in the study (62 females). A total of 41% (38/93) of subjects indicated burdensome headache at follow-up (mean 32.6 ± 9.3 months). Comparison between patients with (HA+) and without long-term headache (HA-) revealed significantly younger mean age (47.9 ± 11.8 vs. 55.6 ± 10.3 years; p < .01) as well as more favorable neurological conditions (WFNS I/II: 95% vs. 75%; p = .03) in HA+ cases. The mean average headache of the HA+ group was 3.7 ± 2.3 (10-point numeric rating scale), and the mean maximum headache intensity was 5.7 ± 2.9. Pain and HR-QOL scores demonstrated profound alterations in HA+ compared to HA- patients. Conclusions Our results suggest that a considerable proportion of SAH patients suffers from burdensome headache even years after the hemorrhage. Moreover, long-term headache is associated with reduced HR-QOL in these cases. Electronic supplementary material The online version of this article (10.1007/s00701-020-04235-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Torge Huckhagel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Regine Klinger
- Department of Anesthesiology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Nils Ole Schmidt
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jan Regelsberger
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Roa JA, Zanaty M, Ishii D, Lu Y, Kung DK, Starke RM, Torner JC, Jabbour PM, Samaniego EA, Hasan DM. Decreased contrast enhancement on high-resolution vessel wall imaging of unruptured intracranial aneurysms in patients taking aspirin. J Neurosurg 2020; 134:902-908. [PMID: 32114538 DOI: 10.3171/2019.12.jns193023] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/30/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Inflammation plays an integral role in the formation, growth, and progression to rupture of unruptured intracranial aneurysms (UIAs). Animal and human studies have suggested that, due to its antiinflammatory effect, aspirin (ASA) may decrease the risks of growth and rupture of UIAs. High-resolution vessel wall imaging (HR-VWI) has emerged as a noninvasive method to assess vessel wall inflammation and UIA instability. To the authors' knowledge, to date no studies have found a significant correlation between patient use of ASA and contrast enhancement of UIAs on HR-VWI. METHODS The University of Iowa HR-VWI Project database was analyzed. This database is a compilation of data on patients with UIAs who prospectively underwent HR-VWI on a 3T Siemens MRI scanner. The presence of aneurysmal wall enhancement was objectively defined using the aneurysm-to-pituitary stalk contrast ratio (CRstalk). This ratio was calculated by measuring the maximal signal intensity in the aneurysmal wall and the pituitary stalk on postcontrast T1-weighted images. Data on aneurysm size, morphology, and location and patient demographics and comorbidities were collected. Use of ASA was defined as daily intake of ≥ 81 mg during the previous 6 months or longer. Univariate and multivariate logistic regression analyses were performed to determine factors independently associated with increased contrast enhancement of UIAs on HR-VWI. RESULTS In total, 74 patients harboring 96 UIAs were included in the study. The mean patient age was 64.7 ± 12.4 years, and 60 patients (81%) were women. Multivariate analysis showed that age (OR 1.12, 95% CI 1.05-1.19), aneurysm size ≥ 7 mm (OR 21.3, 95% CI 4.88-92.8), and location in the anterior communicating, posterior communicating, and basilar arteries (OR 10.7, 95% CI 2.45-46.5) were significantly associated with increased wall enhancement on HR-VWI. On the other hand, use of ASA was significantly associated with decreased aneurysmal wall enhancement on HR-VWI (OR 0.22, 95% CI 0.06-0.83, p = 0.026). CONCLUSIONS The study results establish a correlation between use of ASA daily for ≥ 6 months and significant decreases in wall enhancement of UIAs on HR-VWI. The findings also demonstrate that detection of wall enhancement using HR-MRI may be a valuable noninvasive method for assessing aneurysmal wall inflammation and UIA instability.
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Affiliation(s)
- Jorge A Roa
- Departments of1Neurology and.,2Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Mario Zanaty
- 2Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Daizo Ishii
- 2Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Yongjun Lu
- 2Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - David K Kung
- 3Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert M Starke
- 4Department of Neurosurgery and Radiology, University of Miami, Florida
| | - James C Torner
- 5Department of Biostatistics and Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Pascal M Jabbour
- 6Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania; and
| | - Edgar A Samaniego
- Departments of1Neurology and.,2Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa.,7Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - David M Hasan
- 2Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Morton MJ, Hostettler IC, Kazmi N, Alg VS, Bonner S, Brown MM, Durnford A, Gaastra B, Garland P, Grieve J, Kitchen N, Walsh D, Zolnourian A, Houlden H, Gaunt TR, Bulters DO, Werring DJ, Galea I. Haptoglobin genotype and outcome after aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 2020; 91:305-313. [PMID: 31937585 PMCID: PMC7116595 DOI: 10.1136/jnnp-2019-321697] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/30/2019] [Accepted: 12/11/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE After aneurysmal subarachnoid haemorrhage (aSAH), extracellular haemoglobin (Hb) in the subarachnoid space is bound by haptoglobin, neutralising Hb toxicity and helping its clearance. Two exons in the HP gene (encoding haptoglobin) exhibit copy number variation (CNV), giving rise to HP1 and HP2 alleles, which influence haptoglobin expression level and possibly haptoglobin function. We hypothesised that the HP CNV associates with long-term outcome beyond the first year after aSAH. METHODS The HP CNV was typed using quantitative PCR in 1299 aSAH survivors in the Genetics and Observational Subarachnoid Haemorrhage (GOSH) Study, a retrospective multicentre cohort study with a median follow-up of 18 months. To investigate mediation of the HP CNV effect by haptoglobin expression level, as opposed to functional differences, we used rs2000999, a single nucleotide polymorphism associated with haptoglobin expression independent of the HP CNV. Outcome was assessed using modified Rankin and Glasgow Outcome Scores. SAH volume was dichotomised on the Fisher grade. Haemoglobin-haptoglobin complexes were measured in cerebrospinal fluid (CSF) of 44 patients with aSAH and related to the HP CNV. RESULTS The HP2 allele associated with a favourable long-term outcome after high-volume but not low-volume aSAH (multivariable logistic regression). However rs2000999 did not predict outcome. The HP2 allele associated with lower CSF haemoglobin-haptoglobin complex levels. The CSF Hb concentration after high-volume and low-volume aSAH was, respectively, higher and lower than the Hb-binding capacity of CSF haptoglobin. CONCLUSION The HP2 allele carries a favourable long-term prognosis after high-volume aSAH. Haptoglobin and the Hb clearance pathway are therapeutic targets after aSAH.
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Affiliation(s)
- Matthew J Morton
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - Isabel C Hostettler
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Nabila Kazmi
- MRC Integrative Epidemiology Unit (IEU), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Varinder S Alg
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Stephen Bonner
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - Martin M Brown
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Andrew Durnford
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Benjamin Gaastra
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Patrick Garland
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - Joan Grieve
- Department of Neurosurgery, The National Hospital of Neurology and Neurosurgery, London, UK
| | - Neil Kitchen
- Department of Neurosurgery, The National Hospital of Neurology and Neurosurgery, London, UK
| | - Daniel Walsh
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Ardalan Zolnourian
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Henry Houlden
- Neurogenetics Laboratory, The National Hospital of Neurology and Neurosurgery, London, UK
| | - Tom R Gaunt
- MRC Integrative Epidemiology Unit (IEU), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Diederik O Bulters
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - David J Werring
- Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Ian Galea
- Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
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Xu WD, Wang H, Wu Q, Wen LL, You ZQ, Yuan B, Chen SJ, Wang HD, Zhang X. Morphology parameters for rupture in middle cerebral artery mirror aneurysms. J Neurointerv Surg 2020; 12:858-861. [DOI: 10.1136/neurintsurg-2019-015620] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/06/2020] [Accepted: 02/08/2020] [Indexed: 12/25/2022]
Abstract
ObjectiveTo identify the morphological parameters correlated with the rupture of middle cerebral artery (MCA) aneurysms.MethodsWe retrospectively analyzed the digital subtraction angiography (DSA) data of 48 patients with ruptured mirror MCA aneurysms. Morphological parameters included aneurysm with wall protrusion, maximum diameter (Dmax), height, neck width, aneurysm width, dome projection, parent artery average diameter (Dp), aspect ratio (AR), bottleneck factor (BNF), size ratio (SR), M1/M2 ratio, and height/width (H/W) ratio. These paired parameters were analyzed by conditional univariate and multivariate logistic regressions to screen out the independent risk factors. We established a score based on the independent risk factors. Receiver operating characteristics (ROC) were generated to estimate the prediction performance of the score in our large database of 763 aneurysms.ResultsIn the univariate regressions, Dmax, height, aneurysm width, neck width, AR, BNF, H/W ratio, SR, anterior dome projection and aneurysm with wall protrusion were significant risk factors. Aneurysm width (OR 3.296, p=0.015), AR (OR 11.594, p=0.014) and anterior dome projection (OR 9.385, p=0.016) were independent risk factors in multivariate regression. The area under the curve (AUC) value of the score based on the three independent risk factors was 0.829.ConclusionAneurysm width, AR and anterior dome projection were independent risks factors of rupture.
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Young CC, Bonow RH, Barros G, Mossa-Basha M, Kim LJ, Levitt MR. Magnetic resonance vessel wall imaging in cerebrovascular diseases. Neurosurg Focus 2019; 47:E4. [DOI: 10.3171/2019.9.focus19599] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebrovascular diseases manifest as abnormalities of and disruption to the intracranial vasculature and its capacity to carry blood to the brain. However, the pathogenesis of many cerebrovascular diseases begins in the vessel wall. Traditional luminal and perfusion imaging techniques do not provide adequate information regarding the differentiation, onset, or progression of disease. Intracranial high-resolution MR vessel wall imaging (VWI) has emerged as an invaluable technique for understanding and evaluating cerebrovascular diseases. The location and pattern of contrast enhancement in intracranial VWI provides new insight into the inflammatory etiology of cerebrovascular diseases and has potential to permit earlier diagnosis and treatment. In this report, technical considerations of VWI are discussed and current applications of VWI in vascular malformations, blunt cerebrovascular injury/dissection, and steno-occlusive cerebrovascular vasculopathies are reviewed.
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Affiliation(s)
| | | | | | | | - Louis J. Kim
- Departments of 1Neurological Surgery,
- 2Radiology, and
- 4Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
| | - Michael R. Levitt
- Departments of 1Neurological Surgery,
- 2Radiology, and
- 3Mechanical Engineering, and
- 4Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
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Zanaty M, Roa JA, Nakagawa D, Chalouhi N, Allan L, Al Kasab S, Limaye K, Ishii D, Samaniego EA, Jabbour P, Torner JC, Hasan DM. Aspirin associated with decreased rate of intracranial aneurysm growth. J Neurosurg 2019; 133:1478-1485. [PMID: 31662579 DOI: 10.3171/2019.6.jns191273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 06/04/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Aspirin has emerged as a potential agent in the prevention of rupture of intracranial aneurysms (IAs). In this study, the authors' goal was to test if aspirin is protective against aneurysm growth in patients harboring multiple IAs ≤ 5 mm. METHODS The authors performed a retrospective review of a prospectively maintained database covering the period July 2009 through January 2019. Patients' data were included if the following criteria were met: 1) the patient harbored multiple IAs; 2) designated primary aneurysms were treated by surgical/endovascular means; 3) the remaining aneurysms were observed for growth; and 4) a follow-up period of at least 5 years after the initial treatment was available. Demographics, earlier medical history, the rupture status of designated primary aneurysms, aneurysms' angiographic features, and treatment modalities were gathered. RESULTS The authors identified 146 patients harboring a total of 375 IAs. At the initial encounter, 146 aneurysms were treated and the remaining 229 aneurysms (2-5 mm) were observed. During the follow-up period, 24 (10.48%) of 229 aneurysms grew. All aneurysms observed to grow later underwent treatment. None of the observed aneurysms ruptured. Multivariate analysis showed that aspirin was significantly associated with a decreased rate of growth (odds ratio [OR] 0.19, 95% confidence interval [CI] 0.05-0.63). Variables associated with an increased rate of growth included hypertension (OR 14.38, 95% CI 3.83-53.94), drug abuse (OR 11.26, 95% CI 1.21-104.65), history of polycystic kidney disease (OR 9.48, 95% CI 1.51-59.35), and subarachnoid hemorrhage at presentation (OR 5.91, 95% CI 1.83-19.09). CONCLUSIONS In patients with multiple IAs, aspirin significantly decreased the rate of aneurysm growth over time. Additional prospective interventional studies are needed to validate these findings.
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Affiliation(s)
| | | | - Daichi Nakagawa
- 3Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Nohra Chalouhi
- 4Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | | | | | | | - Daizo Ishii
- 6Department of Neurosurgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | | | - Pascal Jabbour
- 4Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania; and
| | - James C Torner
- 8Epidemiology and Public Health, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Hudson JS, Marincovich AJ, Roa JA, Zanaty M, Samaniego EA, Hasan DM. Aspirin and Intracranial Aneurysms. Stroke 2019; 50:2591-2596. [DOI: 10.1161/strokeaha.119.026094] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Joseph S. Hudson
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
| | - Anthony J. Marincovich
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
| | - Jorge A. Roa
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
- Department of Neurology (J.A.R., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City
| | - Mario Zanaty
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
| | - Edgar A. Samaniego
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
- Department of Neurology (J.A.R., E.A.S.), University of Iowa Hospitals and Clinics, Iowa City
- Department of Radiology (E.A.S.), University of Iowa Hospitals and Clinics, Iowa City
| | - David M. Hasan
- From the Department of Neurosurgery (J.S.H., A.J.M., J.A.R., M.Z., E.A.S., D.M.H.), University of Iowa Hospitals and Clinics, Iowa City
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Juvela S. Reader response: Association between aspirin dose and subarachnoid hemorrhage from saccular aneurysms: A case-control study. Neurology 2019; 92:1024-1025. [DOI: 10.1212/wnl.0000000000007550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ikawa F, Morita A, Tominari S, Nakayama T, Shiokawa Y, Date I, Nozaki K, Miyamoto S, Kayama T, Arai H. Rupture risk of small unruptured cerebral aneurysms. J Neurosurg 2019; 132:69-78. [PMID: 30684948 DOI: 10.3171/2018.9.jns181736] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/13/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The annual rupture rate of small (3-4 mm) unruptured cerebral aneurysms (UCAs) is 0.36% per year, however, the proportion of small ruptured aneurysms < 5 mm is 35%. This discrepancy is explained by the hypothesis that most acute subarachnoid hemorrhage (SAH) is from recently formed, unscreened aneurysms, but this hypothesis is without definitive proof. The authors aimed to clarify the actual number of screened, ruptured small aneurysms and risk factors for rupture. METHODS The Unruptured Cerebral Aneurysm Study Japan, a project of the Japan Neurosurgical Society, was designed to clarify the natural course of UCAs. From January 2001 through March 2004, 6697 UCAs among 5720 patients were prospectively registered. At registration, 2839 patients (49.6%) had 3132 (46.8%) small UCAs of 3-4 mm. The registered, treated, and rupture numbers of these small aneurysms and the annual rupture rate were investigated. The rate was assessed per aneurysm. The characteristics of patients and aneurysms were compared to those of larger unruptured aneurysms (≥ 5 mm). Cumulative rates of SAH were estimated per aneurysm. Risk factors underwent univariate and multivariate analysis. RESULTS Treatment and rupture numbers of small UCAs were 1132 (37.1% of all treated aneurysms) and 23 (20.7% of all ruptured aneurysms), respectively. The registered, treated, rupture number, and annual rupture rates were 1658 (24.8%), 495 (16.2%), 11 (9.9%), and 0.30%, respectively, among 3-mm aneurysms, and 1474 (22.0%), 637 (20.9%), 12 (10.8%), and 0.45%, respectively, among 4-mm aneurysms. Multivariate risk-factor analysis revealed that a screening brain checkup (hazard ratio [HR] 4.1, 95% confidence interval [CI] 1.2-14.4), history of SAH (HR 10.8, 95% CI 2.3-51.1), uncontrolled hypertension (HR 5.2, 95% CI 1.8-15.3), and location on the anterior communicating artery (ACoA; HR 5.0, 95% CI 1.6-15.5) were independent predictors of rupture. CONCLUSIONS Although the annual rupture rate of small aneurysms was low, the actual number of ruptures was not low. Small aneurysms that ruptured during follow-up could be detected, screened, and managed based on each risk factor. Possible selection criteria for treating small UCAs include a history of SAH, uncontrolled hypertension, location on the ACoA, and young patients. Further large prospective and longitudinal trials are needed.Clinical trial registration no.: C000000418 (https://www.umin.ac.jp/ctr).
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Affiliation(s)
- Fusao Ikawa
- 1Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima
| | - Akio Morita
- 2Department of Neurological Surgery, Nippon Medical School, Tokyo
| | - Shinjiro Tominari
- 3Department of Health Informatics, Kyoto University School of Public Health, Kyoto
| | - Takeo Nakayama
- 4Graduate School of Medicine and Faculty of Medicine, Kyoto University, Kyoto
| | - Yoshiaki Shiokawa
- 5Department of Neurosurgery, Kyorin University School of Medicine, Tokyo
| | - Isao Date
- 6Department of Neurological Surgery, Okayama University Graduate School of Medicine, Okayama
| | - Kazuhiko Nozaki
- 7Department of Neurosurgery, Shiga University of Medical Science, Shiga
| | - Susumu Miyamoto
- 8Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto
| | - Takamasa Kayama
- 9Department of Advanced Medicine, Yamagata University School of Medicine, Yamagata; and
| | - Hajime Arai
- 10Department of Neurosurgery, Juntendo University, Tokyo, Japan
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