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Abualnaja SY, Rehman U, Roy H, McKenna G. A narrative review of the screening protocols investigating intracranial aneurysms in polycystic kidney disease. Br J Neurosurg 2024:1-6. [PMID: 39126353 DOI: 10.1080/02688697.2024.2389844] [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: 03/29/2023] [Revised: 07/03/2024] [Accepted: 08/04/2024] [Indexed: 08/12/2024]
Abstract
INTRODUCTION Intracranial aneurysms (IA) are a common complication of autosomal dominant polycystic kidney disease (ADPKD). Screening protocols that exist for IA in ADPKD patients are an important component of disease monitoring to enable appropriate preventative measures and precautions to avoid IA rupture with its associated morbidly and mortality. AIMS The aims of this review are to analyse the different types of screening protocols that exist by referencing the lead time between IA diagnosis and rupture in ADPKD patients, the purpose and importance of screening, the types of imaging modalities used, and patient outcomes. We will also consider cost-effectiveness and its relation in establishing a screening protocol as this is an important factor. METHODOLOGY A literature search was conducted in April 2022 using PubMed, BMJ electronic databases, Dynamed, NICE guidelines and Cochrane databases for articles published between 1990 and 2022 with special interest in IA, ADPKD and screening protocols. The only exclusion criteria were patients who were diagnosed with ADPKD <30 years of age. RESULTS Our findings suggest that if a patient with ADPKD presents with either a positive family history of IA and/or cerebrovascular events and/or is above 40 years of age, then they should have a magnetic resonance angiography (MRA) scan every 5 years to monitor IA formation and growth with annual follow-ups. This may contribute to decreased patient morbidity and mortality in ADPKD-positive patients. CONCLUSION While there is some evidence proving that screening protocols decrease the morbidity and mortality of ADPKD patients, none have been recommended. The screening protocol suggested in this review should be used as a guideline for future studies that will try and establish a national or international guidelines that can be used by nephrologists and neurosurgeons worldwide.
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Affiliation(s)
| | - Umar Rehman
- Core Surgical Trainee, Department of Paediatric Surgery, Chelsea and Westminster Hospital, London, UK
| | - Holly Roy
- Academic Clinical Fellow in Neurosurgery, University of Plymouth, Plymouth, UK
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Tjoumakaris SI, Hanel R, Mocco J, Ali-Aziz Sultan M, Froehler M, Lieber BB, Coon A, Tateshima S, Altschul DJ, Narayanan S, El Naamani K, Taussky P, Hoh BL, Meyers P, Gounis MJ, Liebeskind DS, Volovici V, Toth G, Arthur A, Wakhloo AK. ARISE I Consensus Review on the Management of Intracranial Aneurysms. Stroke 2024; 55:1428-1437. [PMID: 38648283 DOI: 10.1161/strokeaha.123.046208] [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: 10/24/2023] [Accepted: 03/19/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Intracranial aneurysms (IAs) remain a challenging neurological diagnosis associated with significant morbidity and mortality. There is a plethora of microsurgical and endovascular techniques for the treatment of both ruptured and unruptured aneurysms. There is no definitive consensus as to the best treatment option for this cerebrovascular pathology. The Aneurysm, Arteriovenous Malformation, and Chronic Subdural Hematoma Roundtable Discussion With Industry and Stroke Experts discussed best practices and the most promising approaches to improve the management of brain aneurysms. METHODS A group of experts from academia, industry, and federal regulators convened to discuss updated clinical trials, scientific research on preclinical system models, management options, screening and monitoring, and promising novel device technologies, aiming to improve the outcomes of patients with IA. RESULTS Aneurysm, Arteriovenous Malformation, and Chronic Subdural Hematoma Roundtable Discussion With Industry and Stroke Experts suggested the incorporation of artificial intelligence to capture sequential aneurysm growth, identify predictors of rupture, and predict the risk of rupture to guide treatment options. The consensus strongly recommended nationwide systemic data collection of unruptured IA radiographic images for the analysis and development of machine learning algorithms for rupture risk. The consensus supported centers of excellence for preclinical multicenter trials in areas such as genetics, cellular composition, and radiogenomics. Optical coherence tomography and magnetic resonance imaging contrast-enhanced 3T vessel wall imaging are promising technologies; however, more data are needed to define their role in IA management. Ruptured aneurysms are best managed at large volume centers, which should include comprehensive patient management with expertise in microsurgery, endovascular surgery, neurology, and neurocritical care. CONCLUSIONS Clinical and preclinical studies and scientific research on IA should engage high-volume centers and be conducted in multicenter collaborative efforts. The future of IA diagnosis and monitoring could be enhanced by the incorporation of artificial intelligence and national radiographic and biologic registries. A collaborative effort between academic centers, government regulators, and the device industry is paramount for the adequate management of IA and the advancement of the field.
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Affiliation(s)
- Stavropoula I Tjoumakaris
- Department of Neurosurgery, Thomas Jefferson University at Sidney Kimmel Medical College, Philadelphia, PA (S.I.T., K.E.N.)
| | - Ricardo Hanel
- Baptist Neurological Institute, Jacksonville, FL (R.H.)
| | - J Mocco
- Department of Neurosurgery, Mount Sinai University Hospital, New York, NY (J.M.)
| | - M Ali-Aziz Sultan
- Department of Neurosurgery, Harvard Medical School, Boston, MA (M.A.-A.S.)
| | - Michael Froehler
- Department of Neurology, Vanderbilt University, Nashville, TN (M.F.)
| | - Barry B Lieber
- Department of Neurology, Tufts School of Medicine, Boston, MA (B.B.L.)
| | - Alexander Coon
- Department of Neurosurgery, Carondelet Neurological Institute of St. Joseph's and St. Mary's Hospitals in Tucson, AZ (A.C.)
| | - Satoshi Tateshima
- Department of Radiology (S.T.), University of California, Los Angeles
| | - David J Altschul
- Department of Neurological Surgery, Einstein Montefiore Medical Center, Bronx, NY (D.J.A.)
| | - Sandra Narayanan
- Department of Neurology, Pacific Neuroscience Institute, Santa Monica, CA (S.N.)
| | - Kareem El Naamani
- Department of Neurosurgery, Thomas Jefferson University at Sidney Kimmel Medical College, Philadelphia, PA (S.I.T., K.E.N.)
| | - Phil Taussky
- Department of Neurosurgery, Beth Israel Deaconess Medical Center, Boston, MA (P.T.)
| | - Brian L Hoh
- Department of Neurosurgery, University of Florida, Gainesville (B.L.H.)
| | - Philip Meyers
- Department of Radiology, Saint Luke's Clinic, Boise, ID (P.M.)
| | - Matthew J Gounis
- Department of Radiology, University of Massachusetts, Worcester (M.J.G.)
| | | | - Victor Volovici
- Department of Neurosurgery, Erasmus MC Stroke Center, Erasmus MC University Medical Center, Rotterdam, the Netherlands (V.V.)
| | - Gabor Toth
- Department of Neurosurgery, Cleveland Clinic, OH (G.T.)
| | - Adam Arthur
- Department of Neurosurgery, Semmes Murphey Clinic, Memphis, TN (A.A.)
| | - Ajay K Wakhloo
- Department of Radiology, Tufts University School of Medicine, Boston, MA (A.K.W.)
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Kivelev J, Saarenpää I, Karlsson A, Crisafulli P, Musciotto F, Piilo J, Mantegna RN. Complex networks approach to study comorbidities in patients with unruptured intracranial aneurysms. Sci Rep 2024; 14:9175. [PMID: 38649696 PMCID: PMC11035559 DOI: 10.1038/s41598-024-59919-2] [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: 09/12/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
The role of complex network analysis in patients with diagnosis of unruptured intracranial aneurysm is unexplored. The objective of this study is to assess the applicability of this methodology in aneurysm patients. We retrospectively analyze comprehensive unbiased local digital data of a large number of patients treated for any reason between January 2004 and July 2019. We apply an age-cohort approach to a total of 628,831 patients and construct the diagnostic history of each patient-and include the information how old the patient was when diagnosed for the first time with each diagnosis coded according to International Classification of Diseases. For each cohort of age within a 10 year interval and for each gender, we construct a statistically validated comorbidity network and focused on crucial comorbidity links that the aneurysm code has to other disease codes within the whole network. For all cohorts of different age and gender, the analysis shows that 267 diagnose codes have nearest neighbour statistically validated links to unruptured aneurysm ICD code. Among the 267 comorbidities, 204 (76%) were found in patients aged from 40 to 69-years old. Patterns of connectivity with aneurysms were found for smoking, hypertension, chronic obstructive pulmonary disease, dyslipidemia, and mood disorders. A few uncommon connections are also detected in cohorts of female patients. Our study explored the applicability of network analysis and statistical validation in aneurysm observational study.
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Affiliation(s)
- Juri Kivelev
- Department of Neurosurgery, Turku University Hospital, Turku, Finland.
| | - Ilkka Saarenpää
- Department of Neurosurgery, Turku University Hospital, Turku, Finland
| | | | - Paride Crisafulli
- Dipartimento di Fisica e Chimica, Università degli Studi di Palermo, Palermo, Italy
- Instituto de Fısica Interdisciplinar y Sistemas Complejos IFISC (CSIC-UIB), 07122, Palma de Mallorca, Spain
| | - Federico Musciotto
- Dipartimento di Fisica e Chimica, Università degli Studi di Palermo, Palermo, Italy
| | - Jyrki Piilo
- Department of Physics and Astronomy, University of Turku, Turku, Finland
| | - Rosario N Mantegna
- Dipartimento di Fisica e Chimica, Università degli Studi di Palermo, Palermo, Italy
- Complexity Science Hub, Vienna, Austria
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4
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Chebib FT, Tawk RG. All Patients with ADPKD Should Undergo Screening for Intracranial Aneurysms: CON. KIDNEY360 2024; 5:495-498. [PMID: 37990377 PMCID: PMC11093549 DOI: 10.34067/kid.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/15/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Fouad T. Chebib
- Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, Florida
- Mayo Clinic Florida PKD Center of Excellence, Jacksonville, Florida
| | - Rabih G. Tawk
- Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida
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5
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Righini M, Mancini R, Busutti M, Buscaroli A. Autosomal Dominant Polycystic Kidney Disease: Extrarenal Involvement. Int J Mol Sci 2024; 25:2554. [PMID: 38473800 DOI: 10.3390/ijms25052554] [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: 01/03/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common hereditary kidney disorder, but kidneys are not the only organs involved in this systemic disorder. Individuals with the condition may display additional manifestations beyond the renal system, involving the liver, pancreas, and brain in the context of cystic manifestations, while involving the vascular system, gastrointestinal tract, bones, and cardiac valves in the context of non-cystic manifestations. Despite kidney involvement remaining the main feature of the disease, thanks to longer survival, early diagnosis, and better management of kidney-related problems, a new wave of complications must be faced by clinicians who treated patients with ADPKD. Involvement of the liver represents the most prevalent extrarenal manifestation and has growing importance in the symptom burden and quality of life. Vascular abnormalities are a key factor for patients' life expectancy and there is still debate whether to screen or not to screen all patients. Arterial hypertension is often the earliest onset symptom among ADPKD patients, leading to frequent cardiovascular complications. Although cardiac valvular abnormalities are a frequent complication, they rarely lead to relevant problems in the clinical history of polycystic patients. One of the newest relevant aspects concerns bone disorders that can exert a considerable influence on the clinical course of these patients. This review aims to provide the "state of the art" among the extrarenal manifestation of ADPKD.
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Affiliation(s)
- Matteo Righini
- Nephrology and Dialysis Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
- Nephrology, Dialysis and Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Raul Mancini
- Nephrology, Dialysis and Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Marco Busutti
- Nephrology, Dialysis and Transplantation Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy
| | - Andrea Buscaroli
- Nephrology and Dialysis Unit, Santa Maria delle Croci Hospital, AUSL Romagna, 48121 Ravenna, Italy
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Zhu J, Liu F, Mao J. Clinical findings, underlying pathogenetic processes and treatment of vascular dysfunction in autosomal dominant polycystic kidney disease. Ren Fail 2023; 45:2282027. [PMID: 37970664 PMCID: PMC11001366 DOI: 10.1080/0886022x.2023.2282027] [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: 04/13/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is an inherited disorder characterized by the development of fluid-filled cysts in the kidneys. The primary cause of ADPKD is mutations in the PKD1 (polycystic kidney disease 1) or PKD2 (polycystic kidney disease 2) gene. Patients with ADPKD often develop a variety of vascular abnormalities, which have a major impact on the structure and function of the blood vessels and can lead to complications such as hypertension, intracranial aneurysm (ICAN), and atherosclerosis. The progression of ADPKD involves intricate molecular and cellular processes that lead to the development of these vascular abnormalities. Our understanding of these processes remains incomplete, and available treatment options are limited. The aim of this review is to delve into the underlying mechanisms of these vascular abnormalities and to explore potential interventions.
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Affiliation(s)
- Jinjun Zhu
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Fei Liu
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Jianhua Mao
- Department of Nephrology, Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Li Y, Huan L, Lu W, Li J, Wang H, Wang B, Song Y, Peng C, Wang J, Yang X, Hao J. Integrate prediction of machine learning for single ACoA rupture risk: a multicenter retrospective analysis. Front Neurol 2023; 14:1126640. [PMID: 37920830 PMCID: PMC10619904 DOI: 10.3389/fneur.2023.1126640] [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: 12/18/2022] [Accepted: 09/11/2023] [Indexed: 11/04/2023] Open
Abstract
Background Statistically, Anterior communicating aneurysm (ACoA) accounts for 30 to 35% of intracranial aneurysms. ACoA, once ruptured, will have an acute onset and cause severe neurological dysfunction and even death. Therefore, clinical analysis of risk factors related to ACoA and the establishment of prediction model are the benefits to the primary prevention of ACoA. Methods Among 1,436 cases of single ACoA patients, we screened 1,325 valid cases, classified risk factors of 1,124 cases in the ruptured group and 201 cases in the unruptured group, and assessed the risk factors, respectively, and predicted the risk of single ACoA rupture by using the logistic regression and the machine learning. Results In the ruptured group (84.8%) of 1,124 cases and the unruptured group (15.2%) of 201 cases, the multivariable logistic regression (MLR) model shows hemorrhagic stroke history (OR 95%CI, p:0.233 (0.120-0.454),<0.001) and the age stratification of 60-69 years (OR 95%CI, p:0.425 (0.271-0.668),<0.001) has a significant statistic difference. In the RandomForest (RF) model, hemorrhagic stroke history and age are the best predictive factors. Conclusion We combined the analysis of MLR, RF, and PCA models to conclude that hemorrhagic stroke history and gender affect single ACoA rupture. The RF model with web dynamic nomogram, allows for real-time personalized analysis based on different patients' conditions, which is a tremendous advantage for the primary prevention of single ACoA rupture. Clinical trial registration https://www.chictr.org.cn/showproj.html?proj=178501.
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Affiliation(s)
- Yang Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Linchun Huan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Department of Neurosurgery, Linyi People's Hospital of Shandong Province, Linyi, Shandong, China
| | - Wenpeng Lu
- Department of Neurosurgery, The First People's Hospital of Jining, Jining, Shandong, China
| | - Jian Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Hongping Wang
- Department of Neurosurgery, Tangshan Workers Hospital, Tangshan, Hebei, China
| | - Bangyue Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Yunfei Song
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Peng
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiyue Wang
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Xinyu Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiheng Hao
- Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, Shandong, China
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Steele CN, Oh ES, Wang W, Farmer-Bailey H, Gitomer BY, Chonchol M, Nowak KL. Cerebrovascular Pulsatility Index Is Reduced in Autosomal Dominant Polycystic Kidney Disease. Am J Nephrol 2023; 54:165-174. [PMID: 37231790 PMCID: PMC10529076 DOI: 10.1159/000530583] [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: 02/06/2023] [Accepted: 03/17/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Cerebrovascular dysfunction, characterized by increased brain pulsatile flow, reduced cerebrovascular reactivity, and cerebral hypoperfusion precedes the onset of dementia and is linked to cognitive dysfunction. Autosomal dominant polycystic kidney disease (ADPKD) may increase the risk of dementia, and intracranial aneurysms are more prevalent in ADPKD patients. However, cerebrovascular function has not been previously characterized in patients with ADPKD. METHODS Using transcranial Doppler, we compared middle cerebral artery (MCA) pulsatility index (PI, cerebrovascular stiffness) and MCA blood velocity response to hypercapnia (normalized for blood pressure and end-tidal CO2, cerebrovascular reactivity) in patients with early-stage ADPKD versus age-matched healthy controls. We also administered the NIH cognitive toolbox (cognitive function) and measured carotid-femoral pulse-wave velocity (PWV, aortic stiffness). RESULTS Fifteen participants with ADPKD (9F, 27 ± 4 yrs, eGFR: 106 ± 22 mL/min/1.73 m2) were compared to 15 healthy controls (8F, 29 ± 4 yrs, eGFR: 109 ± 14 mL/min/1.73 m2). MCA PI was unexpectedly lower in ADPKD (0.71 ± 0.07) versus controls (0.82 ± 0.09 AU; p < 0.001); however, normalized MCA blood velocity in response to hypercapnia did not differ between groups (2.0 ± 1.2 vs. 2.1 ± 0.8 %Δ/mm Hg; p = 0.85). Lower MCA PI was associated with a lower crystalized composite score (cognition), which persisted after adjustment for age, sex, eGFR, and education (β = 0.58, p = 0.007). There was no association of MCA PI with carotid-femoral PWV (r = 0.01, p = 0.96), despite greater carotid-femoral PWV in ADPKD, suggesting MCA PI reflects vascular properties other than arterial stiffness (such as low wall shear stress) in ADPKD. DISCUSSION/CONCLUSION MCA PI is lower in patients with ADPKD. Follow-up research on this observation is merited as low PI has been associated with intracranial aneurysm in other populations.
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Affiliation(s)
- Cortney N Steele
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ester S Oh
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Wei Wang
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Heather Farmer-Bailey
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Berenice Y Gitomer
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michel Chonchol
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kristen L Nowak
- Division of Renal Diseases and Hypertension, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Javed K, Ahmad S, Qin J, Mowrey W, Kadaba D, Liriano G, Fortunel A, Holland R, Khatri D, Haranhalli N, Altschul D. Higher Incidence of Unruptured Intracranial Aneurysms among Black and Hispanic Women on Screening MRA in Large Urban Populations. AJNR Am J Neuroradiol 2023; 44:574-579. [PMID: 37105681 PMCID: PMC10171375 DOI: 10.3174/ajnr.a7856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms have a reported prevalence of 1%-2% in the general population. Currently, only patients with a strong family history or autosomal dominant polycystic kidney disease are screened for intracranial aneurysms using MRA. The purpose of this study was to determine whether there are other specific patient populations at risk that should be offered screening for intracranial aneurysms. MATERIALS AND METHODS This is a retrospective case-control study of adult patients who underwent a screening MRA of their brain at our comprehensive stroke center from 2011 to 2020. Patients with a history of a known brain aneurysm were excluded. Data were extracted on patient demographics and medical comorbidities. Bivariate analyses were performed, followed by multivariable logistic regression, to identify factors associated with a positive MRA screen for incidental aneurysms. RESULTS Of 24,397 patients eligible for this study, 2084 screened positive for a possible intracranial aneurysm. On bivariate analysis, significant differences were present in the following categories: age, sex, race and ethnicity, chronic constipation, and hyperlipidemia. On logistic regression analysis, older age (+10 years: OR = 10.01; 95% CI, 10.01-10.02; P = .001), female sex (OR = 1.37; 95% CI, 1.24-1.51; P = .001), non-Hispanic Black (OR = 1.19; 95% CI, 1.02-1.40; P = .031), and Hispanic ethnicity (OR = 1.35; 95% CI, 1.16-1.58; P = .001) versus non-Hispanic White remained significant when adjusted for other factors. CONCLUSIONS Targeted screening for high-risk elderly women of Black or Hispanic descent will yield higher positive findings for brain aneurysms, which may mitigate the risk of rupture. Whether this is a cost-effective approach has yet to be determined.
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Affiliation(s)
- K Javed
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - S Ahmad
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - J Qin
- Epidemiology & Population Health (J.Q., W.M.), Montefiore Medical Center, Bronx, New York
| | - W Mowrey
- Epidemiology & Population Health (J.Q., W.M.), Montefiore Medical Center, Bronx, New York
| | - D Kadaba
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - G Liriano
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - A Fortunel
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - R Holland
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - D Khatri
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - N Haranhalli
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
| | - D Altschul
- From the Departments of Neurological Surgery (K.J., S.A., D.K., G.L., A.F., R.H., D.K., N.H., D.A.)
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10
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Lupescu IC, Iacob S, Lupascu N, Lupescu IG, Pietrareanu C, Gheorghe L. The Prevalence of Cerebral Aneurysms in Patients with Polycystic Liver Disease. ROMANIAN JOURNAL OF MILITARY MEDICINE 2023. [DOI: 10.55453/rjmm.2023.126.3.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
"Background: It is well known that patients with polycystic kidney disease (PKD) are at increased risk of developing cerebral aneurysms, however, this association has not been well studied for patients with polycystic liver disease (PLD). Material and methods: Cross-sectional descriptive study, which included 15 adult patients diagnosed with polycystic liver disease at the Gastroenterology and Hepatology Department of Fundeni Clinical Institute. Standard neurological exam and brain MRI were performed in all patients on a 1.5 Tesla MRI. Brain imaging protocol included T1/T2, T1SE, T2-FLAIR, DWI, SWI, 2D-TOF, 3D-TOF. Results: The majority of patients (93%) were females. The mean age was 53 ± 5 years old. Patients with AD-PKD and polycystic hepatic disease predominated (60%). Aneurysms were found in only one patient diagnosed with AD-PKD (in whom three aneurysms were described). The overall prevalence of cerebral aneurysms in our patient group was 7%. However, none of the patients with isolated PLD was found to have intracranial aneurysms. Other brain imaging abnormalities were frequent but nonspecific (mostly attributable to vascular-degenerative changes). Conclusions: Given these results, and due to the small number of patients in our study, it is hard to appreciate if polycystic liver disease is indeed associated with an increased risk of cerebral aneurysms. "
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11
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Ars E, Bernis C, Fraga G, Furlano M, Martínez V, Martins J, Ortiz A, Pérez-Gómez MV, Rodríguez-Pérez JC, Sans L, Torra R. Consensus document on autosomal dominant polycystic kindey disease from the Spanish Working Group on Inherited Kindey Diseases. Review 2020. Nefrologia 2022; 42:367-389. [PMID: 36404270 DOI: 10.1016/j.nefroe.2022.11.011] [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: 06/17/2020] [Accepted: 05/02/2021] [Indexed: 06/16/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent cause of genetic renal disease and accounts for 6-10% of patients on kidney replacement therapy (KRT). Very few prospective, randomized trials or clinical studies address the diagnosis and management of this relatively frequent disorder. No clinical guidelines are available to date. This is a revised consensus statement from the previous 2014 version, presenting the recommendations of the Spanish Working Group on Inherited Kidney Diseases, which were agreed to following a literature search and discussions. Levels of evidence mostly are C and D according to the Centre for Evidence-Based Medicine (University of Oxford). The recommendations relate to, among other topics, the use of imaging and genetic diagnosis, management of hypertension, pain, cyst infections and bleeding, extra-renal involvement including polycystic liver disease and cranial aneurysms, management of chronic kidney disease (CKD) and KRT and management of children with ADPKD. Recommendations on specific ADPKD therapies are provided as well as the recommendation to assess rapid progression.
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Affiliation(s)
- Elisabet Ars
- Laboratorio de Biología Molecular, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Carmen Bernis
- Servicio de Nefrología, Hospital de la Princesa, REDinREN, Instituto de Investigación Carlos III, Madrid, Spain
| | - Gloria Fraga
- Sección de Nefrología Pediátrica, Hospital de la Santa Creu i Sant Pau, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Mónica Furlano
- Enfermedades Renales Hereditarias, Servicio de Nefrología, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universidad Autónoma de Barcelona (Departamento de Medicina), REDinREN, Barcelona, Spain
| | - Víctor Martínez
- Servicio de Nefrología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Judith Martins
- Servicio de Nefrología, Hospital Universitario de Getafe, Universidad Europea de Madrid, Getafe, Madrid, Spain
| | - Alberto Ortiz
- Servicio de Nefrología, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, IRSIN, REDinREN, Madrid, Spain
| | - Maria Vanessa Pérez-Gómez
- Servicio de Nefrología, IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, IRSIN, REDinREN, Madrid, Spain
| | - José Carlos Rodríguez-Pérez
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Laia Sans
- Servicio de Nefrología, REDinREN, Instituto de Investigación Carlos III, Hospital del Mar, Barcelona, Spain
| | - Roser Torra
- Enfermedades Renales Hereditarias, Servicio de Nefrología, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universidad Autónoma de Barcelona (Departamento de Medicina), REDinREN, Barcelona, Spain.
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12
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Documento de consenso de poliquistosis renal autosómica dominante del grupo de trabajo de enfermedades hereditarias de la Sociedad Española de Nefrología. Revisión 2020. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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López Del Moral Cuesta C, Mazón Ruiz J, Fernández Fresnedo G. Should all patients with polycystic kidney disease be screened for intracraneal aneurysms? Nefrologia 2021; 41:702-703. [PMID: 36165161 DOI: 10.1016/j.nefroe.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/25/2020] [Indexed: 06/16/2023] Open
Affiliation(s)
| | - Jaime Mazón Ruiz
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Cantabria, Spain
| | - Gema Fernández Fresnedo
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Cantabria, Spain
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14
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Capelli I, Zoli M, Righini M, Faccioli L, Aiello V, Spinardi L, Gori D, Friso F, Rustici A, Bortolotti C, Graziano C, Mantovani V, Sciascia N, Mazzatenta D, Seri M, Pastore Trossello M, La Manna G. MR Brain Screening in ADPKD Patients : To Screen or not to Screen? Clin Neuroradiol 2021; 32:69-78. [PMID: 34586427 PMCID: PMC8894296 DOI: 10.1007/s00062-021-01050-0] [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: 02/17/2021] [Accepted: 05/31/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Adult polycystic kidney disease (ADPKD) still represents a major cause of renal failure and intracranial aneurisms (IA) have a higher prevalence in ADPKD than in the general population. Current guidelines suggest performing brain MRI only in the subjects with a positive familiar history of IAs or subarachnoid hemorrhage (SAH). This is a retrospective case-control analysis to evaluate the usefulness of a MR screening program in ADPKD patients. METHODS We retrospectively analyzed all ADPKD patients followed in our outpatient clinic between 2016 and 2019 who underwent a brain MRI screening. We evaluated the presence of IAs and others brain abnormalities and compared our results with a non-ADPKD population (n = 300). We performed univariate and multivariate regression analysis to evaluate if general and demographic features, laboratory findings, clinical parameters and genetic test results correlated with IAs or other brain abnormalities presence. RESULTS Among the patients evaluated 17 out of 156 (13.6%) ADPKD patients had IAs, compared to 16 out of 300 (5.3%) non-ADPKD controls (p < 0.005). Considering ADPKD patients presenting IAs, 12 (70.6%) had no family history for IAs or SAH. Genetic analysis was available for 97 patients: in the sub-population with IAs, 13 (76.5%) presented a PKD1 mutation and none a PKD2 mutation. We found that arachnoid cysts (AC) (p < 0.001) and arterial anatomical variants (p < 0.04) were significantly more frequent in ADPKD patients. CONCLUSION In our population ADPKD patients showed a higher prevalence of IAs, AC and arterial variants compared to non-ADPKD. Most of the IAs were found in patients presenting a PKD1 mutation. We found a significant number of alterations even in those patients without a family history of IAs or SAH. The practice of submitting only patients with familial IAs or kidney transplantation candidates to MRI scan should be re-evaluated.
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Affiliation(s)
- I Capelli
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero Universitaria di Bologna, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Zoli
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - M Righini
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero Universitaria di Bologna, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - L Faccioli
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - V Aiello
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero Universitaria di Bologna, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - L Spinardi
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - D Gori
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - F Friso
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - A Rustici
- Department of Neuroradiology, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - C Bortolotti
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - C Graziano
- Medical Genetics Unit, Sant'Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - V Mantovani
- Medical Genetics Unit, Sant'Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research (CRBA), University of Bologna, Bologna, Italy
| | - N Sciascia
- Radiology Unit, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - D Mazzatenta
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - M Seri
- Medical Genetics Unit, Sant'Orsola-Malpighi University Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - M Pastore Trossello
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Bologna, Italy
| | - G La Manna
- Nephrology, Dialysis and Renal Transplant Unit, IRCCS - Azienda Ospedaliero Universitaria di Bologna, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
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15
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Abstract
Rupture of an intracranial aneurysm leads to aneurysmal subarachnoid hemorrhage, a severe type of stroke which is, in part, driven by genetic variation. In the past 10 years, genetic studies of IA have boosted the number of known genetic risk factors and improved our understanding of the disease. In this review, we provide an overview of the current status of the field and highlight the latest findings of family based, sequencing, and genome-wide association studies. We further describe opportunities of genetic analyses for understanding, prevention, and treatment of the disease.
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Affiliation(s)
- Mark K Bakker
- University Medical Center Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands
| | - Ynte M Ruigrok
- University Medical Center Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands
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16
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Abstract
Background Subarachnoid hemorrhage from rupture of an intracranial aneurysm (aneurysmal subarachnoid hemorrhage) is a devastating subset of stroke. Since brain damage from the initial hemorrhage is a major cause for the poor outcome after aneurysmal subarachnoid hemorrhage, prevention of aneurysmal subarachnoid hemorrhage has the highest potential to prevent poor outcome from aneurysmal subarachnoid hemorrhage. Aim In this review, we describe the groups at high risk of aneurysmal subarachnoid hemorrhage who may benefit from preventive screening for unruptured intracranial aneurysms followed by preventive treatment of unruptured intracranial aneurysms found. Furthermore, we describe the advantages and disadvantages of screening and advise how to perform counseling on screening. Summary of review Modeling studies show that persons with two or more affected first-degree relatives with aneurysmal subarachnoid hemorrhage and patients with autosomal dominant polycystic kidney disease (ADPKD) are candidates for screening for unruptured intracranial aneurysms. One modeling study also suggests that persons with only one affected first-degree relative with aneurysmal subarachnoid hemorrhage are also likely candidates for screening. Another group who may benefit from screening are persons ≥35 years who smoke(d) and are hypertensive, given their high lifetime risk of aneurysmal subarachnoid hemorrhage of up to 7%, but the prevalence of unruptured intracranial aneurysms in such persons and the efficiency and cost-effectiveness of screening in this group are not yet known. The ultimate goal of screening is to increase the number of quality years of life of the screening candidates, and therefore the benefits but also many downsides of screening –such as risk of incidental findings, very small unruptured intracranial aneurysms that require regular follow-up, preventive treatment with inherent risk of complications and anxiety – should be discussed with the candidate so that an informed decision can be made before intracranial vessels are imaged. Conclusions Several groups of persons who may benefit from screening have been identified, but since these constitute only a minority of all aneurysmal subarachnoid hemorrhage patients, additional high-risk groups still need to be identified. Further research is also needed to identify persons at low or high risk of aneurysmal development and rupture within the groups identified thus far to improve the efficiency of screening. Moreover, if new medical treatment strategies that can reduce the risk of rupture of unruptured intracranial aneurysm become available, the groups of persons who may benefit from screening could increase considerably.
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Affiliation(s)
- Gabriel Je Rinkel
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
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17
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Nurmonen HJ, Huttunen T, Huttunen J, Kurtelius A, Kotikoski S, Junkkari A, Koivisto T, von Und Zu Fraunberg M, Kämäräinen OP, Lång M, Isoniemi H, Jääskeläinen JE, Lindgren AE. Lack of impact of polycystic kidney disease on the outcome of aneurysmal subarachnoid hemorrhage: a matched case-control study. J Neurosurg 2021; 134:1871-1878. [PMID: 32619983 DOI: 10.3171/2020.4.jns20544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors set out to study whether autosomal dominant polycystic kidney disease (ADPKD), an established risk factor for intracranial aneurysms (IAs), affects the acute course and long-term outcome of aneurysmal subarachnoid hemorrhage (aSAH). METHODS The outcomes of 32 ADPKD patients with aSAH between 1980 and 2015 (median age 43 years; 50% women) were compared with 160 matched (age, sex, and year of aSAH) non-ADPKD aSAH patients in the prospectively collected Kuopio Intracranial Aneurysm Patient and Family Database. RESULTS At 12 months, 75% of the aSAH patients with ADPKD versus 71% of the matched-control aSAH patients without ADPKD had good outcomes (Glasgow Outcome Scale score 4 or 5). There was no significant difference in condition at admission. Hypertension had been diagnosed before aSAH in 69% of the ADPKD patients versus 27% of controls (p < 0.001). Multiple IAs were present in 44% of patients in the ADPKD group versus 25% in the control group (p = 0.03). The most common sites of ruptured IAs were the anterior communicating artery (47% vs 29%, p = 0.05) and the middle cerebral artery bifurcation (28% vs 31%), and the median size was 6.0 mm versus 8.0 mm (p = 0.02). During the median follow-up of 11 years, a second aSAH occurred in 3 of 29 (10%) ADPKD patients and in 4 of 131 (3%) controls (p = 0.11). A fatal second aSAH due to a confirmed de novo aneurysm occurred in 2 (6%) of the ADPKD patients but in none of the controls (p = 0.027). CONCLUSIONS The outcomes of ADPKD patients with aSAH did not differ significantly from those of matched non-ADPKD aSAH patients. ADPKD patients had an increased risk of second aSAH from a de novo aneurysm, warranting long-term angiographic follow-up.
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Affiliation(s)
- Heidi J Nurmonen
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
- 2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
- 3Kuopio Health Center, Kuopio
| | - Terhi Huttunen
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
| | - Jukka Huttunen
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
| | - Arttu Kurtelius
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
- 2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
| | - Satu Kotikoski
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
- 2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
| | - Antti Junkkari
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
| | - Timo Koivisto
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
- 2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
| | - Mikael von Und Zu Fraunberg
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
- 2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
| | - Olli-Pekka Kämäräinen
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
- 2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
| | - Maarit Lång
- 2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
- 4Neurointensive Care and
| | - Helena Isoniemi
- 6Transplantation and Liver Surgery Clinic, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Juha E Jääskeläinen
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
- 2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
| | - Antti E Lindgren
- 1Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio
- 2School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio
- 5Department of Clinical Radiology, Kuopio University Hospital, Kuopio; and
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18
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Inaba Y, Osako M, Aoki M, Kasai M, Yamabe K. Aortic Dissection in Familial Patients with Autosomal Dominant Polycystic Kidney Disease. Ann Vasc Dis 2021; 14:68-70. [PMID: 33786104 PMCID: PMC7991707 DOI: 10.3400/avd.cr.20-00149] [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] [Indexed: 12/02/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common congenital kidney disease. However, reports on occasional cases of aortic dissection in PKD familial patients remain scarce. Herein, we describe rare aortic dissection cases in PKD familial patients (i.e., mother and daughter) and our successful treatment experience. The mother (84 years old) and daughter (53 years old) had a referral to us to treat type A acute aortic dissection. We performed emergency surgery and successfully treated the patients with an artificial graft. For comprehensive evaluation and treatment, ADPKD patients and their families should be screened for aortic diseases.
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Affiliation(s)
- Yu Inaba
- Department of Cardiovascular Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Motohiko Osako
- Department of Cardiovascular Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Michiko Aoki
- Department of Cardiovascular Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Mio Kasai
- Department of Cardiovascular Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kentaro Yamabe
- Department of Cardiovascular Surgery, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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19
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Lee CH, Ahn C, Ryu H, Kang HS, Jeong SK, Jung KH. Clinical Factors Associated with the Risk of Intracranial Aneurysm Rupture in Autosomal Dominant Polycystic Kidney Disease. Cerebrovasc Dis 2021; 50:339-346. [PMID: 33706308 DOI: 10.1159/000513709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/01/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The occurrence of intracranial aneurysms is higher in patients with autosomal dominant polycystic kidney disease (ADPKD) than in the healthy population. However, research concerning the factors related to the risk of intracranial aneurysm rupture in patients with ADPKD is still insufficient. OBJECTIVES The aim of the study was to investigate the prevalence of intracranial aneurysms and aneurysmal subarachnoid hemorrhage (SAH) and to analyze the systemic factors associated with high-risk aneurysms in patients with ADPKD. METHODS We screened patients who underwent cerebral angiography between January 2007 and May 2017 in the ADPKD registry. Patients were examined for the presence of intracranial aneurysms and subsequently reclassified into 3 groups based on the risk of aneurysmal rupture: the aneurysm-negative (group 1), low-risk aneurysm (group 2), or high-risk aneurysm (group 3). Various systemic factors were compared, and independent factors associated with high-risk aneurysms were analyzed. RESULTS Among the 926 patients, 148 (16.0%) had intracranial aneurysms and 11 (1.2%) had previous aneurysmal SAH. Patients with intracranial aneurysms were further classified into group 2 (low-risk aneurysms, 15.5%) or group 3 (high-risk aneurysms, 84.5%). Age (odds ratio [OR] 1.03, 95% confidence interval [CI] 1.01-1.05, p = 0.004), female sex (OR 3.13, 95% CI 1.94-5.0 6, p < 0.001), dolichoectasia (OR 8.57, 95% CI 1.53-48.17, p = 0.015), and mitral inflow deceleration time (DT) (OR 1.01, 95% CI 1.00-1.01, p = 0.046) were independently associated with high-risk aneurysms, whereas hypercholesterolemia (OR 0.46, 95% CI 0.29-0.72, p = 0.001) was negatively associated. CONCLUSION In the present study among patients with ADPKD, the prevalence of intracranial aneurysms and aneurysmal SAH was 16 and 1.2%, respectively. Age, female sex, dolichoectasia, and mitral inflow DT were positively associated with high-risk aneurysms, whereas hypercholesterolemia was negatively associated. A subsequent large-scaled longitudinal study is needed to define the plausibility of the clinical parameters.
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Affiliation(s)
- Chan-Hyuk Lee
- Department of Neurology, Jeonbuk National University Hospital and Medical School, Jeonju, Republic of Korea.,Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Curie Ahn
- Department of Nephrology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyunjin Ryu
- Department of Nephrology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seul-Ki Jeong
- Visual Intelligence Laboratory, Seul-Ki Jeong Neurology Clinic, Seoul, Republic of Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea,
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20
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Neyazi B, Swiatek VM, Skalej M, Beuing O, Stein KP, Hattingen J, Preim B, Berg P, Saalfeld S, Sandalcioglu IE. Rupture risk assessment for multiple intracranial aneurysms: why there is no need for dozens of clinical, morphological and hemodynamic parameters. Ther Adv Neurol Disord 2020; 13:1756286420966159. [PMID: 33403004 PMCID: PMC7739206 DOI: 10.1177/1756286420966159] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/21/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction: A multitude of approaches have been postulated for assessing the risk of intracranial aneurysm rupture. However, the amount of potential predictive factors is not applicable in clinical practice and they are rejected in favor of the more practical PHASES score. For the subgroup of multiple intracranial aneurysms (MIAs), the PHASES score might severely underestimate the rupture risk, as only the aneurysm with the largest diameter is considered for risk evaluation. Methods: In this study, we investigated 38 patients harboring a total number of 87 MIAs with respect to their morphological and hemodynamical characteristics. For the determination of the best suited parameters regarding their predictive power for aneurysm rupture, we conducted three phases of statistical evaluation. The statistical analysis aimed to identify parameters that differ significantly between ruptured and unruptured aneurysms, show smallest possible correlations among each other and have a high impact on rupture risk prediction. Results: Significant differences between ruptured and unruptured aneurysms were found in 16 out of 49 parameters. The lowest correlation were found for gamma, aspect ratio (AR1), aneurysm maximal relative residence time (Aneurysm_RRT_max) and aneurysm mean relative residence time. The data-driven parameter selection yielded a significant correlation of only two parameters (AR1 and the Aneurysm_RRT_max) with rupture state (area under curve = 0.75). Conclusion: A high number of established morphological and hemodynamical parameters seem to have no or only low effect on prediction of aneurysm rupture in patients with MIAs. For best possible rupture risk assessment of patients with MIAs, only the morphological parameter AR1 and the hemodynamical parameter Aneurysm_RRT_max need to be included in the prediction model.
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Affiliation(s)
- Belal Neyazi
- Department of Neurosurgery, Otto-von-Guericke University, Leipziger Straße 44, Magdeburg, Saxony Anhalt 39120, Germany
| | - Vanessa M Swiatek
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Martin Skalej
- Department of Neuroradiology, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Oliver Beuing
- Department of Neuroradiology, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Klaus-Peter Stein
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Jörg Hattingen
- Institute of Neuroradiology, KRH Klinikum Nordstadt, Hanover, Niedersachsen, Germany
| | - Bernhard Preim
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Philipp Berg
- Department of Fluid Dynamics and Technical Flows, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - Sylvia Saalfeld
- Department of Simulation and Graphics, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
| | - I Erol Sandalcioglu
- Department of Neurosurgery, Otto-von-Guericke University, Magdeburg, Saxony Anhalt, Germany
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21
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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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López Del Moral Cuesta C, Mazón Ruiz J, Fernández Fresnedo G. Should all patients with polycystic kidney disease be screened for intracraneal aneurysms? Nefrologia 2020; 41:S0211-6995(20)30150-8. [PMID: 33243593 DOI: 10.1016/j.nefro.2020.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/25/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Jaime Mazón Ruiz
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Cantabria, España
| | - Gema Fernández Fresnedo
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla - IDIVAL, Santander, Cantabria, España
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23
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Yin X, Blumenfeld JD, Riyahi S, Luo X, Rennert H, Barash I, Prince MR. Prevalence of Inferior Vena Cava Compression in ADPKD. Kidney Int Rep 2020; 6:168-178. [PMID: 33426396 PMCID: PMC7783582 DOI: 10.1016/j.ekir.2020.10.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/17/2020] [Accepted: 10/20/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Kidney and liver cysts in autosomal dominant polycystic kidney disease (ADPKD) can compress the inferior vena cava (IVC), but IVC compression prevalence and its risk factors are unknown. Methods Patients who have ADPKD (n = 216) with abdominal magnetic resonance imaging (MRI) studies and age-/sex-matched controls (n = 216) were evaluated for IVC compression as well as azygous vein diameter (a marker of collateral blood flow) and IVC aspect ratio (left-to-right dimension divided by anterior-to-posterior dimension with a value of 1 corresponding to a circular (high pressure) IVC caudal to compression. Results Severe IVC compression (≥70%) was observed in 33 (15%) ADPKD subjects and mild compression (≥50% to <70%) was observed in 33 (15%) subjects; whereas controls had no IVC compression (P < 0.001). Severe IVC compression was associated with larger azygous vein (4.0 ± 1.3 mm versus 2.3 ± 0.8 mm without IVC compression; P < 0.001) and a more circular IVC cross-section upstream (mean IVC aspect ratio: 1.16 ± 0.27 vs. 1.69 ± 0.67, P < 0.001), suggesting higher pressure upstream from the compression. IVC compression was associated with older age, lower estimated glomerular filtration rate (eGFR), greater height-adjusted total kidney volumes, greater height-adjusted liver volume (ht-LV), and greater liver and renal cyst fractions (P < 0.001). No subject younger than 30 years had IVC compression, but ADPKD subjects ≥40 years old had 12-fold higher risk of IVC compression (95% confidence interval [CI]: 4.2–42.4), with highest predicted probability for Mayo Clinic classes 1D (59%; 95% CI: 39%–76%) and 1E (74%; 95% CI: 49%–90%) after adjustment (P < 0.001). Women with ht-LV ≥ 2000 ml/m had 83% (95% CI: 59%–95%) prevalence of IVC compression. Complications of IVC compression included deep vein thrombosis (DVT) and symptomatic hypotension. Conclusions IVC compression is common in ADPKD patients >40 years old, with Mayo Clinic class 1D/E, and in females with ht-LV > 2000 ml/m.
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Affiliation(s)
- Xiaorui Yin
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jon D Blumenfeld
- The Rogosin Institute, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Sadjad Riyahi
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Xianfu Luo
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Hanna Rennert
- Department of Pathology, Weill Cornell Medicine, New York, New York, USA
| | - Irina Barash
- The Rogosin Institute, New York, New York, USA.,Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Department of Radiology, Columbia College of Physicians and Surgeons, New York, New York, USA
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24
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Moughal S, Bashir M. Correlation of intracranial and aortic aneurysms: current trends and evidence. Asian Cardiovasc Thorac Ann 2020; 28:250-257. [PMID: 32486829 DOI: 10.1177/0218492320930848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The correlation between intracranial and aortic aneurysms remains elusive. Data in the literature are scattered, and outcome reporting is swamped with heterogeneity and single-center bias. This calamity is adding to confusion on decision-making and delays the instigation of appropriate clinical applications. This literature review delves into the abyss of the lack of clinically driven scientific input, and highlights the trends explored thus far.
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Affiliation(s)
- Saad Moughal
- Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
| | - Mohamad Bashir
- Department of Vascular and Endovascular Surgery, Royal Blackburn Teaching Hospital, Blackburn, UK
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25
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Colbert GB, Elrggal ME, Gaur L, Lerma EV. Update and review of adult polycystic kidney disease. Dis Mon 2020; 66:100887. [DOI: 10.1016/j.disamonth.2019.100887] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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26
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Pierot L. [Place of interventional neuroradiology in the prevention of hemorrhagic stroke]. Presse Med 2019; 48:672-683. [PMID: 31153681 DOI: 10.1016/j.lpm.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The risk of bleeding of unruptured aneurysms is increasing with aneurysm size. Small unruptured aneurysms can be treated conservatively with a regular MRI/MRA follow-up to detect a potential increase in size. If coiling is still the main endovascular technique for the treatment of unruptured aneurysms, several other techniques are now available including stent-assisted coiling, flow diversion, and flow disruption. After ARUBA study, there is no recommendation to treat unruptured brain AVMs. According to their hemorrhagic risk, dural arteriovenous fistulas with cortical venous drainage have to be treated, generally by endovascular approach through an arterial route.
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Affiliation(s)
- Laurent Pierot
- Hôpital Maison-Blanche, service de neuroradiologie, 45, rue Cognacq-Jay, 51092 Reims cedex, France.
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27
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Malhotra A, Wu X, Matouk CC, Forman HP, Gandhi D, Sanelli P. MR Angiography Screening and Surveillance for Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease: A Cost-effectiveness Analysis. Radiology 2019; 291:400-408. [PMID: 30777807 DOI: 10.1148/radiol.2019181399] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Autosomal dominant polycystic kidney disease (ADPKD) affects one in 400 to one in 1000 individuals; 10%-11% of these individuals have intracranial aneurysms. The frequency and patterns of screening for intracranial aneurysms have not been defined. Purpose To evaluate different MR angiography screening and surveillance strategies for unruptured intracranial aneurysms in patients with ADPKD. Materials and Methods A Markov decision-analytic model was constructed accounting for both costs and outcomes from a societal perspective. Five different management strategies were evaluated: (a) no screening for intracranial aneurysm, (b) one-time screening with annual MR angiography follow-up in patients with intracranial aneurysm, (c) MR angiographic screening every 5 years with endovascular treatment in detected intracranial aneurysm, (d) MR angiography screening every 5 years with annual MR angiography follow-up in patients with intracranial aneurysm, and (e) MR angiography screening every 5 years with biennial follow-up in patients with intracranial aneurysm. One-way, two-way, and probabilistic sensitivity analyses were performed. Results Base case calculation shows that MR angiography screening of patients with ADPKD every 5 years and annual follow-up in patients with detected intracranial aneurysm is the optimal strategy (cost, $19 839; utility, 25.86 quality-adjusted life years), which becomes more favorable as the life expectancy increases beyond 6 years. The conclusion remains robust in probabilistic and one-way sensitivity analyses. When the prevalence of intracranial aneurysms is greater than 10%, annual rupture risk is 0.35%-2.5%, and the rate of de novo aneurysm detection is lower than 1.8%, MR angiography screening every 5 years with annual MR angiography follow-up is the favorable strategy. Conclusion Screening for intracranial aneurysms with MR angiography in patients with autosomal dominant polycystic kidney disease is cost-effective. Repeat screening every 5 years should be performed after a negative initial study. Annual surveillance MR angiography is optimal in patients with detected, incidental intracranial aneurysm, and treatment may be considered in patients with growing, high-risk aneurysms. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Anzai in this issue.
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Affiliation(s)
- Ajay Malhotra
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., C.C.M., H.P.F.), Neurosurgery (C.C.M.), Economics (H.P.F.), Management (H.P.F.), and Public Health (H.P.F.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Xiao Wu
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., C.C.M., H.P.F.), Neurosurgery (C.C.M.), Economics (H.P.F.), Management (H.P.F.), and Public Health (H.P.F.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Charles C Matouk
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., C.C.M., H.P.F.), Neurosurgery (C.C.M.), Economics (H.P.F.), Management (H.P.F.), and Public Health (H.P.F.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Howard P Forman
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., C.C.M., H.P.F.), Neurosurgery (C.C.M.), Economics (H.P.F.), Management (H.P.F.), and Public Health (H.P.F.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Dheeraj Gandhi
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., C.C.M., H.P.F.), Neurosurgery (C.C.M.), Economics (H.P.F.), Management (H.P.F.), and Public Health (H.P.F.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
| | - Pina Sanelli
- From the Departments of Radiology and Biomedical Imaging (A.M., X.W., C.C.M., H.P.F.), Neurosurgery (C.C.M.), Economics (H.P.F.), Management (H.P.F.), and Public Health (H.P.F.), Yale School of Medicine, 333 Cedar St, Box 208042, Tompkins East 2, New Haven, CT 06520-8042; Department of Radiology, University of Maryland School of Medicine, Baltimore, Md (D.G.); and Department of Radiology, Northwell Health, Manhasset, NY (P.S.)
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28
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Perez JL, McDowell MM, Zussman B, Jadhav AP, Miyashita Y, McKiernan P, Greene S. Ruptured intracranial aneurysm in a patient with autosomal recessive polycystic kidney disease. J Neurosurg Pediatr 2019; 23:75-79. [PMID: 30497224 DOI: 10.3171/2018.8.peds18286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/01/2018] [Indexed: 12/25/2022]
Abstract
Aneurysmal rupture can result in devastating neurological consequences and can be complicated by comorbid disease processes. Patients with autosomal recessive polycystic kidney disease (ARPKD) have a low rate of reported aneurysms, but this may be due to the relative high rate of end-stage illnesses early in childhood. Authors here report the case of a 10-year-old boy with ARPKD who presented with a Hunt and Hess grade V subarachnoid hemorrhage requiring emergency ventriculostomy, embolization, and decompressive craniectomy. Despite initial improvements in his neurological status, the patient succumbed to hepatic failure. Given the catastrophic outcomes of subarachnoid hemorrhage in young patients, early radiographic screening in those with ARPKD may be warranted.
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Affiliation(s)
- Jennifer L Perez
- Departments of1Neurological Surgery and
- Divisions of2Pediatric Neurological Surgery
| | - Michael M McDowell
- Departments of1Neurological Surgery and
- Divisions of2Pediatric Neurological Surgery
| | | | - Ashutosh P Jadhav
- Departments of1Neurological Surgery and
- 3Neurology, University of Pittsburgh Medical Center; and
| | | | - Patrick McKiernan
- 5Pediatric Hepatology, Children's Hospital of Pittsburgh, Pennsylvania
| | - Stephanie Greene
- Departments of1Neurological Surgery and
- Divisions of2Pediatric Neurological Surgery
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29
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Niemczyk M, Gradzik M, Fliszkiewicz M, Kulesza A, Gołębiowski M, Pączek L. Natural history of intracranial aneurysms in autosomal dominant polycystic kidney disease. Neurol Neurochir Pol 2017; 51:476-480. [PMID: 28843770 DOI: 10.1016/j.pjnns.2017.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 11/16/2022]
Abstract
Autosomal-dominant polycystic kidney disease (ADPKD) is a relatively frequent genetic disorder that is associated with increased prevalence of intracranial aneurysms (IAs). However, evidence on the natural history of IAs in ADPKD is suboptimal. That leads to difficulties in development of recommendations on surveillance on patients with IAs in their medical history, or the need for repeat imaging for IAs in those with a negative result of the initial screening. The aim of the article is to present our experience on the natural history of IAs in ADPKD patients. MATERIAL AND METHODS Thirty-four ADPKD patients, managed at our outpatient department, with imaging for intracranial aneurysms performed at least twice, were included into present retrospective analysis. RESULTS Among 8 patients with an IA in their medical history, no new IA was observed during 93 patient-years of follow-up. In 6 patients with untreated, unruptured IAs, IA growth was observed in 2 cases during 32 patient-years of follow-up. Finally, among 20 patients with a negative result of initial screening, 2 new IAs were noticed during 115 patient-years of follow-up, including 1 patient with a positive family history for an IA, and 1 patient without a family history. CONCLUSIONS Our observations support repeat imaging for IAs in patients with ADPKD, positive family history of IA, and negative result of initial screening. Additionally, efforts should be made to develop clinical and/or laboratory risk factors for IAs development in ADPKD patients without family history of IA, which enable to identify patients who should undergo repeat imaging for IAs.
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Affiliation(s)
- Mariusz Niemczyk
- Department of Immunology, Transplant Medicine, and Internal Diseases, Medical University of Warsaw, Poland.
| | - Monika Gradzik
- Department of Radiology, Medical University of Warsaw, Poland
| | - Magda Fliszkiewicz
- Department of Immunology, Transplant Medicine, and Internal Diseases, Medical University of Warsaw, Poland
| | - Andrzej Kulesza
- Department of Immunology, Transplant Medicine, and Internal Diseases, Medical University of Warsaw, Poland
| | | | - Leszek Pączek
- Department of Immunology, Transplant Medicine, and Internal Diseases, Medical University of Warsaw, Poland
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