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Glavan M, Jelic A, Levard D, Frösen J, Keränen S, Franx BAA, Bras AR, Louet ER, Dénes Á, Merlini M, Vivien D, Rubio M. CNS-associated macrophages contribute to intracerebral aneurysm pathophysiology. Acta Neuropathol Commun 2024; 12:43. [PMID: 38500201 PMCID: PMC10946177 DOI: 10.1186/s40478-024-01756-5] [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: 12/17/2023] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
Intracerebral aneurysms (IAs) are pathological dilatations of cerebral arteries whose rupture leads to subarachnoid hemorrhage, a significant cause of disability and death. Inflammation is recognized as a critical contributor to the formation, growth, and rupture of IAs; however, its precise actors have not yet been fully elucidated. Here, we report CNS-associated macrophages (CAMs), also known as border-associated macrophages, as one of the key players in IA pathogenesis, acting as critical mediators of inflammatory processes related to IA ruptures. Using a new mouse model of middle cerebral artery (MCA) aneurysms we show that CAMs accumulate in the IA walls. This finding was confirmed in a human MCA aneurysm obtained after surgical clipping, together with other pathological characteristics found in the experimental model including morphological changes and inflammatory cell infiltration. In addition, in vivo longitudinal molecular MRI studies revealed vascular inflammation strongly associated with the aneurysm area, i.e., high expression of VCAM-1 and P-selectin adhesion molecules, which precedes and predicts the bleeding extent in the case of IA rupture. Specific CAM depletion by intracerebroventricular injection of clodronate liposomes prior to IA induction reduced IA formation and rupture rate. Moreover, the absence of CAMs ameliorated the outcome severity of IA ruptures resulting in smaller hemorrhages, accompanied by reduced neutrophil infiltration. Our data shed light on the unexplored role of CAMs as main actors orchestrating the progression of IAs towards a rupture-prone state.
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Affiliation(s)
- Martina Glavan
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France
- Department of Neuroscience, Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Ana Jelic
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France
| | - Damien Levard
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital and AIV Institute for Molecular Medicine, University of Eastern Finland, Kuopio, Finland
- Dept of Neurosurgery, Tampere University Hospital and Hemorrhagic Brain Pathology Research Group, Tampere University, Tampere, Finland
| | - Sara Keränen
- Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital and AIV Institute for Molecular Medicine, University of Eastern Finland, Kuopio, Finland
- Dept of Neurosurgery, Tampere University Hospital and Hemorrhagic Brain Pathology Research Group, Tampere University, Tampere, Finland
| | - Bart A A Franx
- Translational Neuroimaging Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Ana-Rita Bras
- "Momentum" Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
- János Szentágothai Doctoral School of Neurosciences, Schools of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Estelle R Louet
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France
| | - Ádám Dénes
- "Momentum" Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - Mario Merlini
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France
| | - Denis Vivien
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France
- Department of Clinical Research, Caen Normandie University Hospital, Caen, France
| | - Marina Rubio
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France.
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Kotikoski S, Paavola J, Nurmonen HJ, Kärkkäinen V, Huuskonen TJ, Huttunen J, Koivisto T, von Und Zu Fraunberg M, Jääskeläinen JE, Lindgren AE. Prevalence of pre-eclampsia in 265 patients with an intracranial aneurysm, 393 female relatives versus a control cohort: A case-control study. Eur J Neurol 2024; 31:e16113. [PMID: 37889887 DOI: 10.1111/ene.16113] [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: 07/11/2023] [Revised: 09/24/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND AND OBJECTIVES There is emerging evidence on the connection between pre-eclampsia and saccular intracranial aneurysms (sIAs). Our aim was to study the prevalence of pre-eclampsia in sIA patients, their female relatives, and matched controls, and to examine familial sIA disease and familial pre-eclampsia in sIA patients' families. METHODS We included all female sIA patients in the Kuopio Intracranial Aneurysm Patient and Family Database from 1995 to 2018. First, we identified the sIA patients, their female relatives, and matched population controls with the first birth in 1987 or later and studied the prevalence of pre-eclampsia. Second, all female sIA patients and all female relatives were analyzed for familial sIA disease and familial pre-eclampsia. Using the Finnish nationwide health registries, we obtained data on drug purchases, hospital diagnoses, and causes of death. RESULTS In total, 265 sIA patients, 57 daughters, 167 sisters, 169 nieces, and 546 matched controls had the first birth in 1987 or later. Among them, 29 (11%) sIA patients, 5 (9%) daughters, 10 (6%) sisters, 10 (6%) nieces, and 32 (6%) controls had pre-eclampsia. Of all the 1895 female sIA patients and 12,141 female relatives, 68 sIA patients and 375 relatives had pre-eclampsia, including 32 families with familial pre-eclampsia. CONCLUSIONS Pre-eclampsia was significantly more common in the sIA patients than in their matched controls. Familial sIA disease and familial pre-eclampsia co-occurred in seven families. Further studies of the mechanisms by which pre-eclampsia could affect the walls of brain arteries and increase the rupture risk in sIA disease are indicated.
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Affiliation(s)
- Satu Kotikoski
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juho Paavola
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Heidi J Nurmonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Virve Kärkkäinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terhi J Huuskonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Department of Neurosurgery, Oulu University Hospital, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Juha E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti E Lindgren
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
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Paavola JT, Jokimäki J, Huttunen TJ, Fraunberg MVUZ, Koivisto T, Kämäräinen OP, Lång M, Jääskeläinen JE, Kälviäinen R, Lindgren AE, Huttunen J. Long-term Risk of Epilepsy in Subarachnoid Hemorrhage Survivors With Positive Family History: A Population-Based Follow-up Study. Neurology 2023; 101:e1623-e1632. [PMID: 37643884 PMCID: PMC10585675 DOI: 10.1212/wnl.0000000000207737] [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: 02/05/2023] [Accepted: 06/20/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating form of stroke affecting the working-age population, where epilepsy is a common complication and major prognostic factor for increased morbidity in aSAH survivors. The objective of this analysis was to assess whether epilepsy in first-degree relatives is a risk of developing epilepsy after aSAH. METHODS We used a region-specific database that includes all cases of unruptured and ruptured saccular intracranial aneurysm admitted to Kuopio University Hospital from its defined Eastern Finnish catchment population. We also retrieved data from Finnish national health registries for prescription drug purchases and reimbursement, hospital discharge, and cause of death and linked them to patients with aSAH, their first-degree relatives, and population controls matched 3:1 by age, sex, and birth municipality. Cox regression modeling and Kaplan-Meier survival curves were used for analysis. RESULTS We examined data for 760 consecutive 12-month survivors of aSAH, born in 1950 or after, with a first aSAH from January 1, 1995, to December 31, 2018. Of the 760 patients (median age, 47 years; 53% female; median follow-up, 11 years), 111 (15%) developed epilepsy at a median of 7 months (interquartile range, 2-14 months) after admission for aSAH. Of the 2,240 population controls and 4,653 first-degree relatives of patients with aSAH, 23 (0.9%) and 80 (1.7%), respectively, developed epilepsy during the follow-up period. Among 79 patients with epilepsy in first-degree relatives, 22 (28%) developed epilepsy after aSAH; by contrast, among 683 patients with no epilepsy in first-degree relatives, 89 (13%) developed epilepsy after aSAH. Having at least 1 relative with epilepsy was an independent risk factor of epilepsy after aSAH (hazard ratio, 2.44; 95% CI 1.51-3.95). Cumulative 1-year rates by first-degree relationship were 40% with 1 or more children with epilepsy, 38% with 1 or more affected parents, 5% with 1 or more affected siblings, and 10% with no relatives with epilepsy. DISCUSSION Patients who developed epilepsy after aSAH were significantly more likely to have first-degree relatives with epilepsy than those who did not develop epilepsy after the aSAH.
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Affiliation(s)
- Juho Tapio Paavola
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland.
| | - Jenna Jokimäki
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Terhi Johanna Huttunen
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Mikael von Und Zu Fraunberg
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Timo Koivisto
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Olli-Pekka Kämäräinen
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Maarit Lång
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Juha Eerik Jääskeläinen
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Reetta Kälviäinen
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Antti Elias Lindgren
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
| | - Jukka Huttunen
- From the Neurosurgery of NeuroCenter (J.T.P., T.J.H., T.K., O.-P.K., J.E.J., R.K., A.E.L., J.H.), Kuopio University Hospital; Institute of Clinical Medicine (J.T.P., J.J., T.J.H., T.K., O.-P.K., M.L., J.E.J., A.E.L., J.H.), Faculty of Health Sciences, University of Eastern Finland, Kuopio; Department of Neurosurgery (M.U.Z.F.), Oulu University Hospital; Research Unit of Clinical Medicine (M.U.Z.F.), University of Oulu; Neurointensive Care Unit (M.L.), Kuopio University Hospital; Epilepsy Center (R.K.), Neuro Center, Kuopio University Hospital, Member of the European Reference Network EpiCARE; and Department of Clinical Radiology (A.E.L.), Kuopio University Hospital, Finland
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Sanicola HW, Stewart CE, Luther P, Yabut K, Guthikonda B, Jordan JD, Alexander JS. Pathophysiology, Management, and Therapeutics in Subarachnoid Hemorrhage and Delayed Cerebral Ischemia: An Overview. PATHOPHYSIOLOGY 2023; 30:420-442. [PMID: 37755398 PMCID: PMC10536590 DOI: 10.3390/pathophysiology30030032] [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: 07/20/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
Subarachnoid hemorrhage (SAH) is a type of hemorrhagic stroke resulting from the rupture of an arterial vessel within the brain. Unlike other stroke types, SAH affects both young adults (mid-40s) and the geriatric population. Patients with SAH often experience significant neurological deficits, leading to a substantial societal burden in terms of lost potential years of life. This review provides a comprehensive overview of SAH, examining its development across different stages (early, intermediate, and late) and highlighting the pathophysiological and pathohistological processes specific to each phase. The clinical management of SAH is also explored, focusing on tailored treatments and interventions to address the unique pathological changes that occur during each stage. Additionally, the paper reviews current treatment modalities and pharmacological interventions based on the evolving guidelines provided by the American Heart Association (AHA). Recent advances in our understanding of SAH will facilitate clinicians' improved management of SAH to reduce the incidence of delayed cerebral ischemia in patients.
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Affiliation(s)
- Henry W. Sanicola
- Department of Neurology, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA 71103, USA;
| | - Caleb E. Stewart
- Department of Neurosurgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA 71103, USA;
| | - Patrick Luther
- School of Medicine, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA 71103, USA; (P.L.); (K.Y.)
| | - Kevin Yabut
- School of Medicine, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA 71103, USA; (P.L.); (K.Y.)
| | - Bharat Guthikonda
- Department of Neurosurgery, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA 71103, USA;
| | - J. Dedrick Jordan
- Department of Neurology, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA 71103, USA;
| | - J. Steven Alexander
- Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center in Shreveport, Shreveport, LA 71103, USA
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Gulati A, Watnick T. Vascular Complications in Autosomal Dominant Polycystic Kidney Disease: Perspectives, Paradigms, and Current State of Play. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:429-439. [PMID: 38097333 DOI: 10.1053/j.akdh.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 12/18/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the leading cause of inherited kidney disease with significant contributions to CKD and end-stage kidney disease. The underlying polycystin proteins (PC1 and PC2) have widespread tissue expression and complex functional roles making ADPKD a systemic disease. Vascular complications, particularly intracranial aneurysms (ICA) are the most feared due to their potential for devastating neurological complications and sudden death. Intracranial aneurysms occur in 8-12% of all patients with ADPKD, but the risk is intensified 4-5-fold in those with a positive family history. The basis for this genetic risk is not well understood and could conceivably be due to features of the germline mutation with a significant contribution of other genetic modifiers and/or environmental factors. Here we review what is known about the natural history and genetics of unruptured ICA in ADPKD including the prevalence and risk factors for aneurysm formation and subarachnoid hemorrhage. We discuss two alternative screening strategies and recommend a practical algorithm that targets those at highest risk for ICA with a positive family history for screening.
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Affiliation(s)
- Ashima Gulati
- Division of Nephrology, Children's National Hospital and Children's National Research Institute, Washington, DC
| | - Terry Watnick
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
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Urvi S, Suman V, Subathra A. Assessment of morphometric parameters of middle cerebral artery using CT angiography in a tertiary care hospital. Surg Radiol Anat 2023:10.1007/s00276-023-03148-1. [PMID: 37269412 DOI: 10.1007/s00276-023-03148-1] [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: 10/01/2022] [Accepted: 04/12/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE Middle cerebral artery (MCA) favors secondaries and emboli deposition. Also, with an increase in incidence of MCA aneurysms, majorly at the M1 division point, actual standardized measurement of MCA is necessary. Thus, main aim of the study is assessment of the MCA morphometry using CT Angiography in Indian population. METHODS CT cerebral Angiography datasets of 289 patients (180 males and 109 females) were assessed for the MCA morphometry (Average age - 49.29 ± 16.16 years, Range- 11 to 85 years). The cases involving aneurysms and infarcts were excluded. The total length of MCA, length of M1 segment and diameter were measured and the results were statistically analysed. RESULTS The mean total length of MCA, length of M1 segment and diameter were 24.02 ± 1.22 mm, 14.32 ± 1.27 mm, 3.33 ± 0.62 mm, respectively. The mean length of M1 segment on the right and left sides was 14.19 ± 1.39 mm and 14.44 ± 1.12 mm, respectively and the difference was statistically significant (p ≤ 0.05). The mean diameter on the right and left sides was 3.32 ± 0.62 mm and 3.33 ± 0.62 mm, respectively and the difference was not statistically significant (p = 0.832). The M1 segment length was maximum in patients over 60 years and diameter was maximum in young patients (20-40 years). The mean length of M1 segment in early bifurcation (4.4 ± 0.65 mm), bifurcation (14.32 ± 1.27 mm) and trifurcation (14.15 ± 1.43 mm) was also noted. CONCLUSION The MCA measurements will be useful for surgeons to minimize errors in handling cases of intracranial aneurysms or infarcts and provide the best possible outcome to the patients.
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Affiliation(s)
- Sharma Urvi
- Department of Anatomy, AIIMS Raipur, Raipur, Chhattisgarh, India.
| | - Verma Suman
- Department of Anatomy, JIPMER, Puducherry, India
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Risk factors for aneurysm rupture among Kazakhs: findings from a national tertiary. BMC Neurol 2022; 22:357. [PMID: 36127629 PMCID: PMC9487045 DOI: 10.1186/s12883-022-02892-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 09/14/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Rupture of intracranial aneurysms (RIA) leads to subarachnoid hemorrhage (SAH) with severe consequences. Although risks for RIA are established, the results vary between ethnic groups and were never studied in Kazakhstan. This study aimed to establish the risk factors of RIA in the Kazakh population. METHODS: Retrospective analysis of 762 patients with single IAs, who attended the neurosurgical center from 2008 until 2018, was conducted. Demographic characteristics, such as age, sex, smoking status, and hypertension were considered. Descriptive and bivariate analyses were performed. A multivariable logistic regression model was built to identify factors correlated with RIA. RESULTS The mean age of participants was 48.49 ± 0.44 years old. The majority (68.37%) of IAs have ruptured. Of the ruptured aneurysms, 43.76% were < 6 mm, and 38.39% were located on the anterior cerebral and anterior communicating arteries (ACA). Logistic regression model indicates younger age group (16-40 years), smoking, having stage 3 hypertension, smaller IA size and its location on ACA increase the odds of rupture. CONCLUSIONS This study has revealed that younger, smoking patients with stage 3 arterial hypertension are at higher risk for RIA. Small aneurysms (< 6 mm) and location on ACA had increased odds of rupture, while larger aneurysms on internal carotid arteries had lower odds.
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Studying the Role of Cerebrovascular Changes in Different Compartments in Human Brains in Hypertension Prediction. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12094291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Hypertension is a major cause of mortality of millions of people worldwide. Cerebral vascular changes are clinically observed to precede the onset of hypertension. The early detection and quantification of these cerebral changes would help greatly in the early prediction of the disease. Hence, preparing appropriate medical plans to avoid the disease and mitigate any adverse events. This study aims to investigate whether studying the cerebral changes in specific regions of human brains (specifically, the anterior, and the posterior compartments) separately, would increase the accuracy of hypertension prediction compared to studying the vascular changes occurring over the entire brain’s vasculature. This was achieved by proposing a computer-aided diagnosis system (CAD) to predict hypertension based on cerebral vascular changes that occur at the anterior compartment, the posterior compartment, and the whole brain separately, and comparing corresponding prediction accuracy. The proposed CAD system works in the following sequence: (1) an MRA dataset of 72 subjects was preprocessed to enhance MRA image quality, increase homogeneity, and remove noise artifacts. (2) each MRA scan was then segmented using an automatic adaptive local segmentation algorithm. (3) the segmented vascular tree was then processed to extract and quantify hypertension descriptive vascular features (blood vessels’ diameters and tortuosity indices) the change of which has been recorded over the time span of the 2-year study. (4) a classification module used these descriptive features along with corresponding differences in blood pressure readings for each subject, to analyze the accuracy of predicting hypertension by examining vascular changes in the anterior, the posterior, and the whole brain separately. Experimental results presented evidence that studying the vascular changes that take place in specific regions of the brain, specifically the anterior compartment reported promising accuracy percentages of up to 90%. However, studying the vascular changes occurring over the entire brain still achieve the best accuracy (of up to 100%) in hypertension prediction compared to studying specific compartments.
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Tervonen J, Adams H, Lindgren A, Elomaa AP, Kämäräinen OP, Kärkkäinen V, von Und Zu Fraunberg M, Huttunen J, Koivisto T, Jääskeläinen JE, Leinonen V, Huuskonen TJ. Shunt performance in 349 patients with hydrocephalus after aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2021; 163:2703-2714. [PMID: 34169389 PMCID: PMC8437876 DOI: 10.1007/s00701-021-04877-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/09/2021] [Indexed: 11/25/2022]
Abstract
Background Shunt-dependent hydrocephalus after aneurysmal subarachnoid hemorrhage (aSAH) is a common sequelae leading to poorer neurological outcomes and predisposing to various complications. Methods A total of 2191 consecutive patients with aSAH were acutely admitted to the Neurointensive Care at the Kuopio University Hospital between 1990 and 2018 from a defined population. A total of 349 (16%) aSAH patients received a ventriculoperitoneal shunt, 101 with an adjustable valve (2012–2018), 232 with a fixed pressure valve (1990–2011), and 16 a valveless shunt (2010–2013). Clinical timelines were reconstructed from the hospital records and nationwide registries until death (n = 120) or June 2019. Results Comparing the adjustable valves vs. the fixed pressure valves vs. the valveless shunts, intraventricular hemorrhage was present in 61%, 44% and 100%, respectively. The median times to the shunt were 7 days vs. 38 days vs. 10 days. The rates of the first revision were 25% vs. 32% vs. 69%. The causes included infection in 11% vs. 7% vs. 25% and overdrainage in 1% vs. 4% vs. 31%. The valveless shunt was the only independent risk factor (HR 2.9) for revision. After the first revision, more revisions were required in 48% vs. 52% vs. 45%. Conclusions The protocol to shunt evolved over time to favor earlier shunt. In post-aSAH hydrocephalus, adjustable valve shunts, without anti-siphon device, can be installed at an early phase after aSAH, in spite of intraventricular blood, with a modest risk (25%) of revision. Valveless shunts are not recommendable due to high risk of revisions.
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Affiliation(s)
- Joona Tervonen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Hadie Adams
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Antti Lindgren
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti-Pekka Elomaa
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Olli-Pekka Kämäräinen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Virve Kärkkäinen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Ville Leinonen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terhi J Huuskonen
- Department of Neurosurgery, Neurosurgery of KUH NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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10
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Kotikoski S, Kurtelius A, Nurmonen HJ, Paavola J, Kärkkäinen V, Huuskonen TJ, Huttunen J, Koivisto T, von Und Zu Fraunberg M, Jääskeläinen JE, Lindgren AE. Pre-eclampsia, gestational diabetes and hypertensive disorders in patients with intracranial aneurysms: A case-control study. Eur J Neurol 2021; 29:199-207. [PMID: 34570429 DOI: 10.1111/ene.15125] [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: 05/03/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this study was to define the prevalence of pre-eclampsia, gestational hypertension (HT), chronic HT, and gestational diabetes during pregnancy in a defined population of patients with saccular intracranial aneurysms (sIAs). METHODS We included all patients with sIA, first admitted to the Neurosurgery Department of Kuopio University Hospital from its defined catchment population between 1990 and 2015, who had given birth for the first time in 1990 or later. The patients' medical records were reviewed, and clinical data were linked with prescription drug usage, hospital diagnoses and causes of death, obtained from nationwide registries. The prevalences of pre-eclampsia, other hypertensive disorders and gestational diabetes in patients were compared with a matched control population (n = 324). In addition, the characteristics of sIA disease in patients with pre-eclampsia were compared to those of sIA patients without pre-eclampsia. RESULTS A total of 169 patients with sIA fulfilled the inclusion criteria. Of these, 22 (13%) had pre-eclampsia and 32 (19%) had other hypertensive disorders during pregnancy. In 324 matched controls who had given birth, the prevalence of pre-eclampsia was 5% (n = 15) and other hypertensive disorders were diagnosed in 10% (n = 34). There was no significant difference in prevalence of gestational diabetes (12% vs. 11%). Patients with sIA with pre-eclampsia more frequently had irregularly shaped aneurysms (p = 0·003). CONCLUSIONS Pre-eclampsia was significantly more frequent in patients with sIA than in their population controls. Irregularly shaped aneurysms were more frequent in sIA patients with pre-eclampsia. Further studies are required to determine whether history of pre-eclampsia may indicate an elevated risk for sIA formation or rupture.
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Affiliation(s)
- Satu Kotikoski
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Arttu Kurtelius
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Heidi J Nurmonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juho Paavola
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Virve Kärkkäinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terhi J Huuskonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti E Lindgren
- Neurosurgery of NeuroCenter, Kuopio University Hospital and Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
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Zhu D, Chen Y, Zheng K, Chen C, Li Q, Zhou J, Jia X, Xia N, Wang H, Lin B, Ni Y, Pang P, Yang Y. Classifying Ruptured Middle Cerebral Artery Aneurysms With a Machine Learning Based, Radiomics-Morphological Model: A Multicentral Study. Front Neurosci 2021; 15:721268. [PMID: 34456680 PMCID: PMC8385786 DOI: 10.3389/fnins.2021.721268] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 07/26/2021] [Indexed: 01/08/2023] Open
Abstract
Objective Radiomics and morphological features were associated with aneurysms rupture. However, the multicentral study of their predictive power for specific-located aneurysms rupture is rare. We aimed to determine robust radiomics features related to middle cerebral artery (MCA) aneurysms rupture and evaluate the additional value of combining morphological and radiomics features in the classification of ruptured MCA aneurysms. Methods A total of 632 patients with 668 MCA aneurysms (423 ruptured aneurysms) from five hospitals were included. Radiomics and morphological features of aneurysms were extracted on computed tomography angiography images. The model was developed using a training dataset (407 patients) and validated with the internal (152 patients) and external validation (73 patients) datasets. The support vector machine method was applied for model construction. Optimal radiomics, morphological, and clinical features were used to develop the radiomics model (R-model), morphological model (M-model), radiomics-morphological model (RM-model), clinical-morphological model (CM-model), and clinical-radiomics-morphological model (CRM-model), respectively. A comprehensive nomogram integrating clinical, morphological, and radiomics predictors was generated. Results We found seven radiomics features and four morphological predictors of MCA aneurysms rupture. The R-model obtained an area under the receiver operating curve (AUC) of 0.822 (95% CI, 0.776, 0.867), 0.817 (95% CI, 0.744, 0.890), and 0.691 (95% CI, 0.567, 0.816) in the training, temporal validation, and external validation datasets, respectively. The RM-model showed an AUC of 0.848 (95% CI, 0.810, 0.885), 0.865 (95% CI, 0.807, 0.924), and 0.721 (95% CI, 0.601, 0.841) in the three datasets. The CRM-model obtained an AUC of 0.856 (95% CI, 0.820, 0.892), 0.882 (95% CI, 0.828, 0.936), and 0.738 (95% CI, 0.618, 0.857) in the three datasets. The CRM-model and RM-model outperformed the CM-model and M-model in the internal datasets (p < 0.05), respectively. But these differences were not statistically significant in the external dataset. Decision curve analysis indicated that the CRM-model obtained the highest net benefit for most of the threshold probabilities. Conclusion Robust radiomics features were determined related to MCA aneurysm rupture. The RM-model exhibited good ability in classifying ruptured MCA aneurysms. Integrating radiomics features into conventional models might provide additional value in ruptured MCA aneurysms classification.
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Affiliation(s)
- Dongqin Zhu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Kuikui Zheng
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chao Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qiong Li
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Radiology, Wenzhou Central Hospital, Wenzhou, China
| | - Jiafeng Zhou
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiufen Jia
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nengzhi Xia
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hao Wang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Boli Lin
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yifei Ni
- The First School of Medicine, Wenzhou Medical University, Wenzhou, China
| | - Peipei Pang
- GE Healthcare China Co., Ltd., Shanghai, China
| | - Yunjun Yang
- Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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12
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Kawaguchi R, Miyachi S, Ohshima T, Matsuo N. Unruptured Paraclinoid Carotid Aneurysms Occur More Frequently in Younger Ages. Neurointervention 2021; 16:111-116. [PMID: 34030220 PMCID: PMC8261117 DOI: 10.5469/neuroint.2021.00059] [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: 01/25/2021] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose We investigated the age distribution of cerebral saccular aneurysms in various locations to clarify the differences by location and discuss the mechanism of formation. Materials and Methods We retrospectively assessed clinical material obtained from 1,252 unruptured aneurysms treated with endovascular embolization between 2004 and 2019. Age, sex, laterality, and size were investigated by the location of aneurysms, classified as cavernous internal carotid artery (ICA), paraclinoid ICA, supraclinoid ICA, anterior communicating artery, anterior cerebral artery, middle cerebral artery, basilar artery complex, and posterior inferior cerebellar artery. Paraclinoid aneurysms were subclassified into 3 patterns according to their projecting direction: S-type, with superior protrusion; M-type, with medial protrusion; and P-type, with posteroinferior protrusion. Results There was no significant difference by location for sex, laterality, and size. The mean age of patients with paraclinoid aneurysms (56.5 years old) was significantly lower than that of other aneurysm patients (64.3 years old). Notably, 40% of the patients with M-type aneurysms were <50 years old. This percentage was significantly higher than that of aneurysms at other locations (P<0.05). Conclusion We found a young female predominance for patients with paraclinoid carotid aneurysms. This study may suggest that congenital factors contribute to paraclinoid aneurysm formation as well acquired factors, such as hemodynamic stress, atherosclerotic wall damage, and local inflammation.
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Affiliation(s)
- Reo Kawaguchi
- Department of Neurological Surgery and Neuroendovascular Therapy Center, Aichi Medical University, Aichi, Japan
| | - Shigeru Miyachi
- Department of Neurological Surgery and Neuroendovascular Therapy Center, Aichi Medical University, Aichi, Japan
| | - Tomotaka Ohshima
- Department of Neurological Surgery and Neuroendovascular Therapy Center, Aichi Medical University, Aichi, Japan
| | - Naoki Matsuo
- Department of Neurological Surgery and Neuroendovascular Therapy Center, Aichi Medical University, Aichi, Japan
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Screening for Intracranial Aneurysms in Individuals with a Positive First-Degree Family History: A Systematic Review. World Neurosurg 2021; 151:235-248.e5. [PMID: 33684573 DOI: 10.1016/j.wneu.2021.02.112] [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: 11/30/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Subarachnoid hemorrhage secondary to rupture of an intracranial aneurysm (IA) is a devastating condition with high morbidity and mortality. Individuals with a positive family history of aneurysmal subarachnoid hemorrhage (aSAH) or IA can have an increased risk for aSAH or IA themselves. Screening is currently recommended in families with ≥2 affected first-degree relatives. We sought to assess the usefulness and cost-effectiveness of IA screening in individuals with a positive first-degree family history, relative to the number of family members affected. METHODS We performed a systematic literature search using PubMed and Google Scholar and identified additional studies by reviewing reference lists. Only original studies and review papers were considered. We excluded genetic diseases associated with IA and studies with unclear data concerning the number of first-versus second-degree relatives affected. RESULTS This review included 37 articles. Individuals with ≥2 affected first-degree relatives had a greater prevalence of IA (average 13.1% vs. 3% in the general population). Similarly, we found a greater prevalence of IA in individuals with ≥1 affected first-degree relative (average 4.8%, up to 19% in individuals with additional risk factors). The risk of aSAH also was increased in both categories. Recent studies stressed the importance of serial screening over time and suggested that such screening can be cost-effective in persons with only one first-degree relative with IA or aSAH. CONCLUSIONS While current guidelines do not recommend screening individuals with ≥1 first-degree relative affected, we found strong arguments in favor of this approach.
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14
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Nisson PL, Meybodi AT, Berger GK, Thompson A, Morshed RA, Lawton MT. A Location-Based Outcome Analysis of the Most Common Microsurgically Clipped Cerebral Aneurysms: A Single-Center Experience. NEUROSURGERY OPEN 2021. [DOI: 10.1093/neuopn/okaa028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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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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16
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Xin WQ, Sun PJ, Li F, Cheng MX, Yang SX, Cui BL, Wang ZG, Yang XY. Risk factors involved in the formation of multiple intracranial aneurysms. Clin Neurol Neurosurg 2020; 198:106172. [PMID: 32942133 DOI: 10.1016/j.clineuro.2020.106172] [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: 06/11/2020] [Revised: 08/05/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although several risk factors of the multiple intracranial aneurysms (MIAs) formation has been reported, the results are controversial. We aimed to find out the risk factors of MIAs formation by analyzing our clinic data combined with a meta-analysis. MATERIAL AND METHODS A retrospective review work of medical records for the patients with aneurysms was undertaken. Univariate analysis was used to examine all mentioned variables. Binary logistic regression analysis was used to identify the risk factors of MIAs formation. RESULTS In the retrospective review work, a total of 565 patients with aneurysm were included in this study. Of these 565 participants, 449 patients suffered SIAs and 116 patients suffered MIAs. Univariate analysis showed a significant difference in terms of female, cigarette smoking, family history of hypertension, and primary hypertension between the SIAs and MIAs group. The binary logistic regression analysis showed that the female (OR = 1.624), primary hypertension (OR = 1.563), and family history of hypertension (OR = 2.496) were independent risk factors of the formation of MIAs (for each P < 0.05). With regard to the meta-analysis results, it revealed that there was significant difference in the rates of female (P < 0.001), cigarette smoking (P < 0.001), primary hypertension (P = 0.001), and higher age (P = 0.011) among the MIAs patients. CONCLUSIONS A higher rate of the formation of MIAs is closely associated with the elder and female. Patients with hypertension history, cigarette smoking, and family primary hypertension history also affected the formation of MIAs, these risk factors should be a guard against.
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Affiliation(s)
- Wen-Qiang Xin
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, PR China; Department of Neurology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Peng-Ju Sun
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, PR China.
| | - Fan Li
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, PR China.
| | - Ming-Xun Cheng
- Department of Vascular Surgery, The First Affiliated Hospital of Jiamusi University Jiamusi, Heilongjiang Province, 154002, PR China.
| | - Shi-Xue Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, PR China.
| | - Bao-Long Cui
- Department of Neurology, University Medical Center Goettingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Zeng-Guang Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, PR China.
| | - Xin-Yu Yang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, 300052, PR China.
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17
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Presence of vasa vasorum in human intracranial aneurysms. Acta Neurochir (Wien) 2020; 162:2283-2293. [PMID: 32696328 DOI: 10.1007/s00701-020-04502-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/15/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Vasa vasorum is associated with the pathogenesis of various cerebrovascular diseases, but its presence in intracranial aneurysms (IA) and its ability to act as a predicting factor of IA rupture remain unrevealed. METHODS Histological investigation was performed for 3 middle meningeal arteries and 25 human IAs that were sequentially collected from 2017 to 2019. Relevant medical information was collected from the hospital information and imaging system. Fisher's exact tests and Student's t tests were performed to identify the histological and clinical differences between aneurysms with and without vasa vasorum. RESULTS Vasa vasorum were present in 14/25 (56%) aneurysm samples. They were detected at a similar frequency in male patients (4/9, 44.4%) and (10/16, 62.5%) female patients. Patients with vasa vasorum present aneurysms (47.07 ± 3.668 years, n = 14) or vasa vasorum absent aneurysms (50.27 ± 2.289 years, n = 11) did not differ in age (p = 0.49). True aneurysms and pseudoaneurysms also shared a similar rate of vasa vasorum presence (10/16, 62.5% in true aneurysms vs 4/9, 44.4% in pseudoaneurysms). The average size of aneurysms with vasa vasorum varied from 21.70 to 3.00 mm, and no statistical difference in size was detected when comparing aneurysms with and without vasa vasorum (p = 0.71). The vasa vasorum in almost all IAs had uniform vascular trajectory with occasional exceptions. The presence of vasa vasorum appears to be tightly associated with important histopathological changes of myointimal hyperplasia and increased immune cell infiltration in IAs (both p value < 0.05), though it does not appear to be indicative of IA rupture or other rupture-related histological degenerations (all p values > 0.05). CONCLUSIONS The presence of vasa vasorum is common in IAs. While it is associated with aneurysm wall remodeling and robust inflammatory cell infiltration, our results indicate that it is not a single specific marker of rupture-prone aneurysms.
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18
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Jiang Z, Huang J, You L, Zhang J, Li B. STAT3 Contributes to Intracranial Aneurysm Formation and Rupture by Modulating Inflammatory Response. Cell Mol Neurobiol 2020; 41:1715-1725. [PMID: 32804311 DOI: 10.1007/s10571-020-00941-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/08/2020] [Indexed: 02/04/2023]
Abstract
Intracranial aneurysm (IA) is a common type of refractory cerebrovascular diseases. Inflammatory responses have been reported to be associated with the pathogenesis of IA. We aimed to study the role of STAT3 on IA formation and inflammatory response. STAT3 expression and clinicopathological factors were analyzed in IA and normal cerebral arteries. mRNA level of STAT3 was detected in normal, unruptured, and ruptured IA tissues by RT-PCR and Western blot. Inflammatory cytokines were examined by ELISA in unruptured, ruptured IA tissues, as well as cells with STAT3 overexpression or knockdown. mRNA of phenotypic modulation-related factors was tested by RT-PCR in STAT3 overexpressing or knockdown VSMCs. STAT3 expression was upregulated in ruptured IA tissues and highly associated with IA diameter and IA type. Inflammatory cytokine secretion was increased in ruptured IA samples and positively correlated with STAT3 expression. STAT3 overexpression led to enhanced expression of SM-α actin, SM-MHC, MMP2, and MMP9, and increased secretion of inflammatory cytokines. Our findings have demonstrated that STAT3 is a key regulator in IA formation by modulating inflammatory cytokine expression.
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Affiliation(s)
- Zhixian Jiang
- Inpatient Department District N13, Chendong Branch of Quanzhou First Hospital, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Jiaxin Huang
- Inpatient Department District N13, Chendong Branch of Quanzhou First Hospital, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Lingtong You
- Inpatient Department District N13, Chendong Branch of Quanzhou First Hospital, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Jinning Zhang
- Inpatient Department District N13, Chendong Branch of Quanzhou First Hospital, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Bingyu Li
- Geriatrics Dept District 7, Dongjie Branch of Quanzhou First Hospital, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000, Fujian, China.
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19
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Heritability of territory of ruptured and unruptured intracranial aneurysms in families. PLoS One 2020; 15:e0236714. [PMID: 32745108 PMCID: PMC7398535 DOI: 10.1371/journal.pone.0236714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/11/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND A previous study suggested that intracranial aneurysms are more likely to occur in the same arterial territory within families. We aimed to replicate this analysis in independent families and in a sample limited to intracranial aneurysms that ruptured. METHODS Among families with ≥2 first-degree relatives with intracranial aneurysms, we randomly matched index families to comparison families, and compared concordance in intracranial aneurysm territory between index and comparison families using a conditional logistic events/trials model. We analyzed three European cohorts separately, and pooled the results with those of the Familial Intracranial Aneurysm study by performing an inverse variance fixed effects meta-analysis. The main analysis included both unruptured and ruptured intracranial aneurysms, and a secondary analysis only ruptured intracranial aneurysms. RESULTS Among 70 Dutch, 142 Finnish, and 34 French families, concordance regarding intracranial aneurysm territory was higher within families than between families, although not statistically significant. Meta-analysis revealed higher concordance in territory within families overall (odds ratio [OR] 1.7, 95%CI 1.3-2.2) and for each separate territory except the anterior cerebral artery. In the analysis of ruptured intracranial aneurysms, overall territory concordance was higher within families than between families (OR 1.8; 95%CI 1.1-2.7) but the territory-specific analysis showed statistical significance only for the internal carotid artery territory. CONCLUSIONS We confirmed that familial intracranial aneurysms are more likely to occur in the same arterial territory within families. Moreover, we found that ruptured aneurysms were also more likely to occur in the same arterial territory within families.
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20
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Thiarawat P, Jahromi BR, Kozyrev DA, Intarakhao P, Teo MK, Choque-Velasquez J, Niemelä M, Hernesniemi J. Are Fetal-Type Posterior Cerebral Arteries Associated With an Increased Risk of Posterior Communicating Artery Aneurysms? Neurosurgery 2020; 84:1306-1312. [PMID: 29788502 DOI: 10.1093/neuros/nyy186] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 04/11/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Fetal-type posterior cerebral arteries (F-PCAs) might result in alterations in hemodynamic flow patterns and may predispose an individual to an increased risk of posterior communicating artery aneurysms (PCoAAs). OBJECTIVE To determine the association between PCoAAs and the presence of ipsilateral F-PCAs. METHODS We retrospectively reviewed the radiographic findings from 185 patients harboring 199 PCoAAs that were treated at our institution between 2005 and 2015. Our study population consisted of 4 cohorts: (A) patients with 171 internal carotid arteries (ICAs) harboring unilateral PCoAAs; (B) 171 unaffected ICAs in the same patients from the first group; (C) 28 ICAs of 14 patients with bilateral PCoAAs; and (D) 180 ICAs of 90 patients with aneurysms in other locations. We then determined the presence of ipsilateral F-PCAs and recorded all aneurysm characteristics. RESULTS Group A had the highest prevalence of F-PCAs (42%) compared to 19% in group B, 3% in group C, and 14% in group D (odds ratio A : B = 3.041; A : C = 19.626; and A : D = 4.308; P < .001). PCoAAs were associated with larger diameters of the posterior communicating arteries (median value 1.05 vs 0.86 mm; P = .001). The presence of F-PCAs was associated with larger sizes of the aneurysm necks (median value 3.3 vs 3.0 mm; P = .02). CONCLUSION PCoAAs were associated with a higher prevalence of ipsilateral F-PCAs. This variant was associated with larger sizes of the aneurysm necks but was not associated with the sizes of the aneurysm domes or with their rupture statuses.
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Affiliation(s)
- Peeraphong Thiarawat
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.,De-partment of Surgery, Naresuan University, Phitsanulok, Thailand
| | | | - Danil A Kozyrev
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.,Department of Paediatric Neurology and Neurosurgery, North-western State Medical University, St. Petersburg, Russia
| | - Patcharin Intarakhao
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland.,Department of Anesthesiology, Naresuan University, Phitsanulok, Thailand
| | - Mario K Teo
- Bristol Institute of Clinical Neurosciences, North Bristol University Hospital, Bristol, United Kingdom
| | | | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
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21
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Size of ruptured intracranial aneurysms: a systematic review and meta-analysis. Acta Neurochir (Wien) 2020; 162:1353-1362. [PMID: 32215742 DOI: 10.1007/s00701-020-04291-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is wide variation in the reported size of ruptured intracranial aneurysms and methods of size estimation. There is widespread belief that small aneurysms < 7 mm do not rupture. Therefore, we performed a systematic review and meta-analysis of the literature to determine the size of ruptured aneurysms according to aneurysm locations and methods of size estimation. METHODS We searched PubMed, Cochrane, CINAHL, and EMBASE databases using a combination of Medical Subject Headings (MeSH) terms. We included articles that reported mean aneurysm size in consecutive series of ruptured intracranial. We excluded studies limited to a specific aneurysm location or type. The random-effects model was used to calculate overall mean size and location-specific mean size. We performed meta-regression to explain observed heterogeneity and variation in reported size. RESULTS The systematic review included 36 studies and 12,609 ruptured intracranial aneurysms. Overall mean aneurysm size was 7.0 mm (95% confidence interval [CI 6.2-7.4]). Pooled mean size varied with location. Overall mean size of 2145 ruptured anterior circulation aneurysms was 6.0 mm (95% CI 5.6-6.4, residual I2 = 86%). Overall mean size of 743 ruptured posterior circulation aneurysms was 6.2 mm (95% CI 5.3-7.0, residual I2 = 93%). Meta-regression identified aneurysm location and definition of size (i.e., maximum dimension vs. aneurysm height) as significant determinants of aneurysm size reported in the studies. CONCLUSIONS The mean size of ruptured aneurysms in most studies was approximately 7 mm. The general wisdom that aneurysms of this size do not rupture is incorrect. Location and size definition were significant determinants of aneurysm size.
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22
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Role of oral pathogens in the pathogenesis of intracranial aneurysm: review of existing evidence and potential mechanisms. Neurosurg Rev 2020; 44:239-247. [PMID: 32034564 PMCID: PMC7850994 DOI: 10.1007/s10143-020-01253-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/12/2020] [Accepted: 01/27/2020] [Indexed: 12/13/2022]
Abstract
Degeneration of intracranial aneurysm wall is under active research and recent studies indicate an increased risk of rupture of intracranial aneurysm among patients with periodontal diseases. In addition, oral bacterial DNA has been identified from wall samples of ruptured and unruptured aneurysms. These novel findings led us to evaluate if oral diseases could predispose to pathological changes seen on intracranial aneurysm walls eventually leading to subarachnoid hemorrhage. The aim of this review is to consider mechanisms on the relationship between periodontitis and aneurysm rupture, focusing on recent evidence.
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23
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Räisänen S, Frösen J, Kurki MI, Huttunen T, Huttunen J, Koivisto T, Helin K, von Und Zu Fraunberg M, Jääskeläinen JE, Lindgren AE. Impact of Young Age on the Presentation of Saccular Intracranial Aneurysms: Population-Based Analysis of 4082 Patients. Neurosurgery 2019; 82:815-823. [PMID: 28605505 DOI: 10.1093/neuros/nyx305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/04/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Formation and rupture of saccular intracranial aneurysms (sIAs) may have different pathobiologies in patients with younger age at first diagnosis of sIA disease. OBJECTIVE To study the phenotype of sIA disease and formation of new (de novo) sIAs in patients below 40 yr. METHODS A population-based cohort study was conducted in 613 young (<40 yr) sIA patients with first diagnosis between 1980 and 2014 and total angiographic follow-up of 3768 yr. RESULTS Of the 613 sIA patients <40 yr, 508 had aneurysmal subarachnoid hemorrhage (sIA-SAH) and 105 unruptured sIA(s) at first sIA diagnosis. Hypertension was 2 times less common among <40 than >40-yr-old patients (unruptured and ruptured). Smoking was very prevalent in <40-yr-old patients (33% in SAH, 68% unruptured). SAH patients <40 yr more often had family history of sIA, and lower PHASES scores (age omitted, P < .001). Ruptured sIAs were small (<7 mm) in 33% of 39 to 30 yr patients, in 44% of 29 to 20 yr patients, and 57% of <19 yr patients. Their shape was irregular in 90%, 94%, and 95%, respectively. Smoking history (hazard ratio [HR] 2.8, 95% confidence interval [CI] 1.2-7.0), family history for sIAs (HR 3.1, 95% CI 1.3-7.7), and age at presentation (HR .91 per year, 95% CI .85-.98) were risk factors for de novo sIA formation, diagnosed in 4% even after 20 yr (median 11.8 yr). CONCLUSION Smoking and family history are risk factors for sIA formation and aneurysmal SAH at young age. Young aneurysmal SAH patients had lower PHASES scores and often rupture from a small sIA, suggesting need for more aggressive management.
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Affiliation(s)
- Sari Räisänen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland
| | - Juhana Frösen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mitja I Kurki
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Terhi Huttunen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Jukka Huttunen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koivisto
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Katariina Helin
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti E Lindgren
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland
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24
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Kurtelius A, Väntti N, Rezai Jahromi B, Tähtinen O, Manninen H, Koskenvuo J, Tulamo R, Kotikoski S, Nurmonen H, Kämäräinen OP, Huttunen T, Huttunen J, von Und Zu Fraunberg M, Koivisto T, Jääskeläinen JE, Lindgren AE. Association of Intracranial Aneurysms With Aortic Aneurysms in 125 Patients With Fusiform and 4253 Patients With Saccular Intracranial Aneurysms and Their Family Members and Population Controls. J Am Heart Assoc 2019; 8:e013277. [PMID: 31538843 PMCID: PMC6818001 DOI: 10.1161/jaha.119.013277] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Varying degrees of co‐occurrence of intracranial aneurysms (IA) and aortic aneurysms (AA) have been reported. We sought to compare the risk for AA in fusiform intracranial aneurysms (fIA) and saccular intracranial aneurysms (sIA) disease and evaluate possible genetic connection between the fIA disease and AAs. Additionally, the characteristics and aneurysms of the fIA and sIA patients were compared. Methods and Results The Kuopio Intracranial Aneurysm Database includes all 4253 sIA and 125 fIA patients from its Eastern Finnish catchment population, and 13 009 matched population controls and 18 455 first‐degree relatives to the IA patients were identified, and the Finnish national registers were used to identify the individuals with AA. A total of 33 fIA patients were studied using an exomic gene panel of 37 genes associated with AAs. Seventeen (14.4%) fIA patients and 48 (1.2%) sIA patients had a diagnosis of AA. Both fIA and sIA patients had AAs significantly more often than their controls (1.2% and 0.5%) or relatives (0.9% and 0.3%). In a competing risks Cox regression model, the presence of fIA was the strongest risk factor for AA (subdistribution hazard ratio 7.6, 95% CI 3.9–14.9, P<0.0005). One likely pathogenic variant in COL5A2 and 3 variants of unknown significance were identified in MYH11,COL11A1, and FBN1 in 4 fIA patients. Conclusions The prevalence of AAs is increased slightly in sIA patients and significantly in fIA patients. fIA patients are older and have more comorbid diseases than sIA patients but this alone does not explain their clinically significant AA risk.
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Affiliation(s)
- Arttu Kurtelius
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Nelli Väntti
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery Helsinki University Hospital University of Helsinki Finland
| | - Olli Tähtinen
- Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland.,Department of Clinical Radiology Kuopio University Hospital Kuopio Finland
| | - Hannu Manninen
- Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland.,Department of Clinical Radiology Kuopio University Hospital Kuopio Finland
| | - Juha Koskenvuo
- Blueprint Genetics Helsinki Finland.,Department of Clinical Physiology and Nuclear Medicine Turku University Hospital Turku Finland
| | - Riikka Tulamo
- Department of Vascular Surgery Helsinki University Hospital University of Helsinki Finland
| | - Satu Kotikoski
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Heidi Nurmonen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Olli-Pekka Kämäräinen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Terhi Huttunen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Jukka Huttunen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Mikael von Und Zu Fraunberg
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Timo Koivisto
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Juha E Jääskeläinen
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
| | - Antti E Lindgren
- Neurosurgery NeuroCenter Kuopio University Hospital Kuopio Finland.,Institute of Clinical Medicine Faculty of Health Sciences University of Eastern Finland Kuopio Finland
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25
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Paavola JT, Väntti N, Junkkari A, Huttunen TJ, von und zu Fraunberg M, Koivisto T, Kämäräinen OP, Lång M, Meretoja A, Räikkönen K, Viinamäki H, Jääskeläinen JE, Huttunen J, Lindgren AE. Antipsychotic Use Among 1144 Patients After Aneurysmal Subarachnoid Hemorrhage. Stroke 2019; 50:1711-1718. [DOI: 10.1161/strokeaha.119.024914] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background and Purpose—
At acute phase and neurointensive care, patients with aneurysmal subarachnoid hemorrhage (aSAH) may become agitated or delirious. We found no previous studies on psychotic disorders or antipsychotic drug (APD) use by long-term aSAH survivors. We defined the APD use and its risk factors among 12-month survivors of aSAH in an Eastern Finnish population–based cohort with long-term follow-up.
Methods—
We analyzed APD use in 1144 consecutive patients with aSAH alive at 12 months of the Kuopio intracranial aneurysm patient and family database and their age, sex, and birth municipality matched controls (3:1; n=3432) from 1995 to 2013 and median follow-up of 9 years. Using the Finish nationwide health registries, we obtained drug purchase and hospital discharge data.
Results—
In total, 140 (12%) of the 1144 patients started APD use first time after aSAH (index date), in contrast to 145 (4%) of the 3432 matched population controls. The cumulative rate of starting APD was 6% at 1 year and 9% at 5 years, in contrast to 1% and 2% in the controls, respectively. The rates at 1 and 5 years were only 1% and 2% in the 489 patients with a good condition (modified Rankin Scale score, 0 or 1 at 12 months; no shunt, intracerebral hemorrhage, or intraventricular hemorrhage). Instead, the highest rate of APD use, 23% at 5 years was among the 192 patients shunted for hydrocephalus after aSAH. Eighty-eight (63%) of the 140 aSAH patients with APD use had also concomitant antidepressant or antiepileptic drug use.
Conclusions—
The 12-month survivors of aSAH were significantly more likely to be started on APD after aSAH than their matched population controls. These patients often used antidepressant and antiepileptic drugs concomitantly. The use of APDs strongly correlated with signs of brain injury after aSAH, with low use if no signs of significant brain injury were present.
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Affiliation(s)
- Juho T. Paavola
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
- School of Medicine (J.T.P., N.V., O.-P.K., H.V., J.E.J., J.H.), University of Eastern Finland, Kuopio
| | - Nelli Väntti
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
- School of Medicine (J.T.P., N.V., O.-P.K., H.V., J.E.J., J.H.), University of Eastern Finland, Kuopio
| | - Antti Junkkari
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
| | - Terhi J. Huttunen
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
| | - Mikael von und zu Fraunberg
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
| | - Timo Koivisto
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
| | - Olli-Pekka Kämäräinen
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
- School of Medicine (J.T.P., N.V., O.-P.K., H.V., J.E.J., J.H.), University of Eastern Finland, Kuopio
| | - Maarit Lång
- Neurointensive Care, Institute of Clinical Medicine (M.L.), University of Eastern Finland, Kuopio
| | - Atte Meretoja
- Department of Neurology, Helsinki University Hospital, Finland (A.M.)
- Department of Medicine at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (A.M.)
| | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Finland (K.R.)
| | - Heimo Viinamäki
- Psychiatry (H.V.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
- School of Medicine (J.T.P., N.V., O.-P.K., H.V., J.E.J., J.H.), University of Eastern Finland, Kuopio
| | - Juha E. Jääskeläinen
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
- School of Medicine (J.T.P., N.V., O.-P.K., H.V., J.E.J., J.H.), University of Eastern Finland, Kuopio
| | - Jukka Huttunen
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
- School of Medicine (J.T.P., N.V., O.-P.K., H.V., J.E.J., J.H.), University of Eastern Finland, Kuopio
| | - Antti E. Lindgren
- From the Neurosurgery of NeuroCenter (J.T.P., N.V., A.J., T.J.H., M.v.u.z.F., T.K., O.-P.K., J.E.J., J.H., A.E.L.), Kuopio University Hospital and Institute of Clinical Medicine, Finland
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26
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Slot EMH, Rinkel GJE, Algra A, Ruigrok YM. Patient and aneurysm characteristics in familial intracranial aneurysms. A systematic review and meta-analysis. PLoS One 2019; 14:e0213372. [PMID: 30958821 PMCID: PMC6453525 DOI: 10.1371/journal.pone.0213372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/19/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Patient and aneurysm characteristics have been reported to differ between patients with familial and non-familial intracranial aneurysms (IAs), although results are inconsistent. We systematically reviewed and meta-analyzed the literature to identify and quantify patient- and aneurysm characteristics associated with familial IAs. METHODS We searched PubMed and EMBASE for case-control and cohort studies comparing patient- and aneurysm characteristics between familial and non-familial IAs. Two observers independently assessed study eligibility and appraised quality with the Newcastle Ottawa Scale. With univariable weighted linear regression analysis we calculated β-coefficients with corresponding 95% confidence intervals (CIs) for ruptured and unruptured IAs combined and for ruptured IAs only. Heterogeneity was assessed with Higgins I2. RESULTS A total of 15 articles were included in the meta-analysis in which 16,346 patients were analyzed with a total of 14,225 IAs. For ruptured and unruptured IAs combined, multiple IAs were more prevalent in familial (28.5%) than in non-familial IAs (20.4%; β = 0.10, 95% CI, 0.04 to 0.16; I2 0%). For ruptured IAs only, in familial patients IAs were more prevalent on the middle cerebral artery (41.1% versus 29.5%; β = 0.12, 95% CI, 0.01 to 0.24; I2 12%) and ruptured at a younger age (46.5 years versus 50.8 years; β = -5.00, 95% CI, -9.31 to -0.69; I2 98%) than in non-familial patients. No significant differences were found for the proportion of women, size of the aneurysm at time of rupture, smoking or hypertension. CONCLUSION These results suggest that characteristics of familial and non-familial IAs show considerable overlap, yet differ on specific aspects. However, results for age at rupture showed considerable heterogeneity. These findings should be taken into consideration for future etiological research into IAs.
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Affiliation(s)
- Emma M. H. Slot
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, the Netherlands
| | - Gabriel J. E. Rinkel
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, the Netherlands
| | - Ale Algra
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Ynte M. Ruigrok
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, the Netherlands
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Secondary hypertension in patients with saccular intracranial aneurysm disease: A population based study. PLoS One 2018; 13:e0206432. [PMID: 30379949 PMCID: PMC6209332 DOI: 10.1371/journal.pone.0206432] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/12/2018] [Indexed: 11/24/2022] Open
Abstract
Background Secondary hypertension is a serious form of hypertension, involving 5% to 10% of all hypertension patients. Hypertension is a risk factor of the saccular intracranial aneurysm (sIA) disease and subarachnoid hemorrhage from ruptured sIA (aSAH), but the impact of secondary hypertension on sIA disease is poorly known. In a defined Eastern Finnish sIA population we studied the prevalence of secondary hypertension and its impact on sIA disease phenotype. Methods We included 2704 consecutive sIA patients first admitted to Kuopio University Hospital from 1995 to 2014. Their clinical data from Kuopio Intracranial Aneurysm patient and Family Database was fused with prescription drug usage data, hospital diagnoses and causes of death, retrieved from nationwide registries. Medical records of hypertensive sIA patients were reviewed to confirm or exclude secondary hypertension. Prevalence of secondary hypertension and associated diagnoses were calculated. Logistic regression was used to identify clinical characteristics of sIA disease that associated with secondary hypertension. Results We identified 2029 (75%) sIA patients with hypertension and 208 (10%) of them had secondary hypertension. Most frequent conditions associated with secondary hypertension were kidney and renovascular diseases (45%), sleep apnea (27%) and hypothyroidism (19%); 46 (22%) of the 208 patients had more than one such condition. In multivariate logistic regression analyses of 1561 aSAH patients, secondary hypertension significantly associated with the number of sIAs (p = 0.003; OR 1.32; 95% CI 1.10–1.58) and male gender (p = 0.034; OR 1.59; 95% CI 1.04–2.43). Conclusions Secodary hypertension was relatively common (10%) among hypertensive sIA patients. Secondary causes for hypertension should be taken into account in hypertensive sIA patients, especially in aSAH patients with multiple intracranial aneurysms. Further research is indicated to evaluate the impact of secondary hypertension on the long-term rupture risk of unruptured sIA carriers and long-term outcome after aSAH.
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28
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Treatment and outcome of thrombosed aneurysms of the middle cerebral artery: institutional experience and a systematic review. Neurosurg Rev 2018; 42:649-661. [DOI: 10.1007/s10143-018-0984-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/04/2018] [Accepted: 05/10/2018] [Indexed: 12/12/2022]
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29
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Björkman J, Frösen J, Tähtinen O, Huttunen T, Huttunen J, Kurki MI, von und zu Fraunberg M, Koivisto T, Manninen H, Jääskeläinen JE, Lindgren AE. Aneurysm Size is the Strongest Risk Factor for Intracranial Aneurysm Growth in the Eastern Finnish Population. Neurosurgery 2018; 84:1098-1103. [DOI: 10.1093/neuros/nyy161] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 04/04/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Saccular intracranial aneurysm (sIA) growth during follow-up is associated with high risk for subsequent rupture. Finnish patients have been suggested to have higher risk for subarachnoid hemorrhage, but follow-up studies of sIA growth in the Finnish population are scarce.
OBJECTIVE
To identify the strongest risk factors for sIA growth in Eastern Finnish population by studying 205 patients with 350 unruptured sIAs with angiographic follow-up imaging.
METHODS
In this population-based cohort study, we included unruptured sIA patients from the Kuopio University Hospital Intracranial Aneurysm Patient and Family database with at least 6 mo of angiographic follow-up after the diagnosis of sIAs. Angiograms were re-evaluated to detect aneurysms with growth of at least 1.0 mm. Cox regression analysis with patient- and aneurysm-related risk factors was used to calculate hazard ratios with 95% confidence intervals for growth. In addition, we tested the diagnostic value of previously introduced PHASES score for the prediction of sIA growth in Eastern Finnish population.
RESULTS
Of the 350 unruptured aneurysms, 36 (10.3%) showed growth during median follow-up of 1.7 yr and total follow-up of 790 yr. In the multivariate Cox regression analysis, sIA size and location in the middle cerebral artery were significant risk factors for sIA growth. In receiver operator characteristic curves, both PHASES score and sIA size had relatively low areas under the curve.
CONCLUSION
Our study indicates that aneurysm size is the strongest risk factor for aneurysm growth in Eastern Finnish population. Further studies are required to identify new risk factors for aneurysm growth.
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Affiliation(s)
- Joel Björkman
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Juhana Frösen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Olli Tähtinen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Terhi Huttunen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Jukka Huttunen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mitja I Kurki
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mikael von und zu Fraunberg
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Hannu Manninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti E Lindgren
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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30
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Roethlisberger M, Achermann R, Bawarjan S, Stienen MN, Fung C, D'Alonzo D, Maldaner N, Ferrari A, Corniola MV, Schöni D, Valsecchi D, Maduri R, Seule MA, Burkhardt JK, Marbacher S, Bijlenga P, Blackham KA, Bucher HC, Mariani L, Guzman R, Zumofen DW, Fandino J, Colluccia D, Arrighi M, Venier A, Kuhlen DE, Robert T, Reinert M, Weyerbrock A, Hlavica M, Fournier JY, Raabe A, Beck J, Bervini D, Schaller K, Daniel RT, Starnoni D, Messerer M, Levivier M, Keller E, Regli L, Bozinov O, Finkenstaedt S, Remonda L, Stippich C, Gralla J, Kulcsar Z, Mendes-Pereira V, Ahlborn P, Smoll NR, Rohde V, Tok S, Baumann F, Kothbauer K, Kerkeni H, Dan-Ura H, Landolt H, Mostaguir K, Gasche Y, Sarrafzadeh A, Hildebrandt G, Winkler K, Woernle C, Bernays R. Predictors of Occurrence and Anatomic Distribution of Multiple Aneurysms in Patients with Aneurysmal Subarachnoid Hemorrhage. World Neurosurg 2018; 111:e199-e205. [DOI: 10.1016/j.wneu.2017.12.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 12/05/2017] [Accepted: 12/08/2017] [Indexed: 11/29/2022]
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31
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Bourcier R, Le Scouarnec S, Bonnaud S, Karakachoff M, Bourcereau E, Heurtebise-Chrétien S, Menguy C, Dina C, Simonet F, Moles A, Lenoble C, Lindenbaum P, Chatel S, Isidor B, Génin E, Deleuze JF, Schott JJ, Le Marec H, Loirand G, Desal H, Redon R, Desal H, Bourcier R, Daumas-Duport B, Isidor B, Connault J, Lebranchu P, Le Tourneau T, Viarouge MP, Papagiannaki C, Piotin M, Redjem H, Mazighi M, Desilles JP, Naggara O, Trystram D, Edjlali-Goujon M, Rodriguez C, Ben Hassen W, Saleme S, Mounayer C, Levrier O, Aguettaz P, Combaz X, Pasco A, Berthier E, Bintner M, Molho M, Gauthier P, Chivot C, Costalat V, Darganzil C, Bonafé A, Januel AC, Michelozzi C, Cognard C, Bonneville F, Tall P, Darcourt J, Biondi A, Iosif C, Pomero E, Ferre JC, Gauvrit JY, Eugene F, Raoult H, Gentric JC, Ognard J, Anxionnat R, Bracard S, Derelle AL, Tonnelet R, Spelle L, Ikka L, Fahed R, Rouchaud A, Ozanne A, Caroff J, Ben Achour N, Moret J, Chabert E, Berge J, Marnat G, Barreau X, Gariel F, Clarencon F, Aggour M, Ricolfi F, Chavent A, Thouant P, Lebidinsky P, Lemogne B, Herbreteau D, Bibi R, Pierot L, Soize S, Labeyrie MA, Vandendries C, Houdart E, Kazemi A, Leclerc X, Pruvo JP, Gallas S, Velasco S. Rare Coding Variants in ANGPTL6 Are Associated with Familial Forms of Intracranial Aneurysm. Am J Hum Genet 2018; 102:133-141. [PMID: 29304371 DOI: 10.1016/j.ajhg.2017.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022] Open
Abstract
Intracranial aneurysms (IAs) are acquired cerebrovascular abnormalities characterized by localized dilation and wall thinning in intracranial arteries, possibly leading to subarachnoid hemorrhage and severe outcome in case of rupture. Here, we identified one rare nonsense variant (c.1378A>T) in the last exon of ANGPTL6 (Angiopoietin-Like 6)-which encodes a circulating pro-angiogenic factor mainly secreted from the liver-shared by the four tested affected members of a large pedigree with multiple IA-affected case subjects. We showed a 50% reduction of ANGPTL6 serum concentration in individuals heterozygous for the c.1378A>T allele (p.Lys460Ter) compared to relatives homozygous for the normal allele, probably due to the non-secretion of the truncated protein produced by the c.1378A>T transcripts. Sequencing ANGPTL6 in a series of 94 additional index case subjects with familial IA identified three other rare coding variants in five case subjects. Overall, we detected a significant enrichment (p = 0.023) in rare coding variants within this gene among the 95 index case subjects with familial IA, compared to a reference population of 404 individuals with French ancestry. Among the 6 recruited families, 12 out of 13 (92%) individuals carrying IA also carry such variants in ANGPTL6, versus 15 out of 41 (37%) unaffected ones. We observed a higher rate of individuals with a history of high blood pressure among affected versus healthy individuals carrying ANGPTL6 variants, suggesting that ANGPTL6 could trigger cerebrovascular lesions when combined with other risk factors such as hypertension. Altogether, our results indicate that rare coding variants in ANGPTL6 are causally related to familial forms of IA.
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32
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Huang ZQ, Zhou XW, Hou ZJ, Huang SQ, Meng ZH, Wang XL, Yu H, Feng LJ, Wang QJ, Li PA, Wen ZB. Risk factors analysis of mirror aneurysms: A multi-center retrospective study based on clinical and demographic profile of patients. Eur J Radiol 2017; 96:80-84. [PMID: 29103480 DOI: 10.1016/j.ejrad.2017.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 02/05/2023]
Abstract
As a special subgroup of multiple intracranial aneurysms, mirror aneurysms are located bilaterally on the corresponding intracranial arteries. The current study sought to compare the clinical and demographic features of patients harboring mirror aneurysm, and to elucidate the corresponding risk factors. We performed a retrospective cohort study of 2641 intracranial aneurysms patients, who were admitted to our hospitals between January 2005 and June 2014. Patients were subdivided into three groups based on the inclusion criteria: (i) single (n=2250); (ii) non-mirror multiple (n=285); and (iii) mirror aneurysms (n=106). Clinical and demographic files of the three groups were collected and compared, and medical histories including stroke, hyperlipemia, hypertension, hyperglycemia, valvular heart disease were considered as potential risk factors. Potential morphological reasons for mirror cerebral aneurysms rupture, including aneurysms size, irregular walls and cerebral hemispheric dominance, were also compared. Our data showed that the male to female ratio of mirror aneurysms patients was 1:3.61, which was significantly different from that of single aneurysm (1:1.27) and multiple aneurysms (1:2.00). The prevalence of mirror aneurysms in women is higher than that in men (P<0.001). Older patients (especially 60-69 years old) also appear to be more vulnerable to mirror aneurysm than single aneurysm (P<0.001). In 84 mirror aneurysm patients the aneurysms were located on the internal carotid arteries (79.2%), most typically at the PComA or in the Cavernous ICA. Patients with medical history of hyperlipemia appear to have an increased risk of harboring mirror aneurysms. Larger aneurysm size and presence of an irregular aneurysm wall appear to be the morphological factors that predispose for mirror aneurysms rupture.
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Affiliation(s)
- Zhong-Qing Huang
- Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China; Department of Medical Image Center, Yuebei People's Hospital, Shantou University Medical College, Shantou, Guangdong Province, China
| | - Xin-Wei Zhou
- Department of Medical Image Center, Yuebei People's Hospital, Shantou University Medical College, Shantou, Guangdong Province, China
| | - Zhong-Jun Hou
- Department of Radiology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Sui-Qiao Huang
- Department of Radiology, Sun Yat-Sen Memorial hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Zhi-Hua Meng
- Department of Medical Image Center, Yuebei People's Hospital, Shantou University Medical College, Shantou, Guangdong Province, China
| | - Xian-Long Wang
- Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Hao Yu
- Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Lv-Jin Feng
- Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Qiu-Jing Wang
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Ping-An Li
- Department of Neurosurgery, Yuebei people's Hospital, Shantou University Medical College, Shantou, Guangdong Province, China
| | - Zhi-Bo Wen
- Department of Medical Image Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China.
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33
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Nurmonen HJ, Huttunen T, Huttunen J, Kurki MI, Helin K, Koivisto T, von Und Zu Fraunberg M, Jääskeläinen JE, Lindgren AE. Polycystic kidney disease among 4,436 intracranial aneurysm patients from a defined population. Neurology 2017; 89:1852-1859. [PMID: 28978659 DOI: 10.1212/wnl.0000000000004597] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/18/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To define the association of autosomal dominant polycystic kidney disease (ADPKD) with the characteristics of aneurysmal subarachnoid hemorrhage (aSAH) and unruptured intracranial aneurysm (IA) disease. METHODS We fused data from the Kuopio Intracranial Aneurysm database (n = 4,436 IA patients) and Finnish nationwide registries into a population-based series of 53 IA patients with ADPKD to compare the aneurysm- and patient-specific characteristics of IA disease in ADPKD and in the general IA population, and to identify risks for de novo IA formation. RESULTS In total, there were 33 patients with ADPKD with aSAH and 20 patients with ADPKD with unruptured IAs. The median size of ruptured IAs in ADPKD was significantly smaller than in the general population (6.00 vs 8.00 mm) and the proportion of small ruptured IAs was significantly higher (31% vs 18%). Median age at aSAH was 42.8 years, 10 years younger than in the general IA population. Multiple IAs were present in 45% of patients with ADPKD compared to 28% in the general IA population. Cumulative risk of de novo IA formation was 1.3% per patient-year (vs 0.2% in the general IA population). Hazard for de novo aneurysm formation was significantly elevated in patients with ADPKD (Cox regression hazard ratio 7.7, 95% confidence interval 2.8-20; p < 0.0005). CONCLUSIONS Subarachnoid hemorrhage occurs at younger age and from smaller IAs in patients with ADPKD and risk for de novo IAs is higher than in the general Eastern Finnish population. ADPKD should be considered as an indicator for long-term angiographic follow-up in patients with diagnosed IAs.
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Affiliation(s)
- Heidi J Nurmonen
- From Neurosurgery (H.J.N.), School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio; Neurosurgery of NeuroCenter (T.H., J.H., K.H., T.K., M.v.u.z.F., J.E.J. A.E.L.), Kuopio University Hospital, Finland; and Broad Institute (M.I.K.), Boston, MA
| | - Terhi Huttunen
- From Neurosurgery (H.J.N.), School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio; Neurosurgery of NeuroCenter (T.H., J.H., K.H., T.K., M.v.u.z.F., J.E.J. A.E.L.), Kuopio University Hospital, Finland; and Broad Institute (M.I.K.), Boston, MA
| | - Jukka Huttunen
- From Neurosurgery (H.J.N.), School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio; Neurosurgery of NeuroCenter (T.H., J.H., K.H., T.K., M.v.u.z.F., J.E.J. A.E.L.), Kuopio University Hospital, Finland; and Broad Institute (M.I.K.), Boston, MA
| | - Mitja I Kurki
- From Neurosurgery (H.J.N.), School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio; Neurosurgery of NeuroCenter (T.H., J.H., K.H., T.K., M.v.u.z.F., J.E.J. A.E.L.), Kuopio University Hospital, Finland; and Broad Institute (M.I.K.), Boston, MA
| | - Katariina Helin
- From Neurosurgery (H.J.N.), School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio; Neurosurgery of NeuroCenter (T.H., J.H., K.H., T.K., M.v.u.z.F., J.E.J. A.E.L.), Kuopio University Hospital, Finland; and Broad Institute (M.I.K.), Boston, MA
| | - Timo Koivisto
- From Neurosurgery (H.J.N.), School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio; Neurosurgery of NeuroCenter (T.H., J.H., K.H., T.K., M.v.u.z.F., J.E.J. A.E.L.), Kuopio University Hospital, Finland; and Broad Institute (M.I.K.), Boston, MA
| | - Mikael von Und Zu Fraunberg
- From Neurosurgery (H.J.N.), School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio; Neurosurgery of NeuroCenter (T.H., J.H., K.H., T.K., M.v.u.z.F., J.E.J. A.E.L.), Kuopio University Hospital, Finland; and Broad Institute (M.I.K.), Boston, MA
| | - Juha E Jääskeläinen
- From Neurosurgery (H.J.N.), School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio; Neurosurgery of NeuroCenter (T.H., J.H., K.H., T.K., M.v.u.z.F., J.E.J. A.E.L.), Kuopio University Hospital, Finland; and Broad Institute (M.I.K.), Boston, MA
| | - Antti E Lindgren
- From Neurosurgery (H.J.N.), School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio; Neurosurgery of NeuroCenter (T.H., J.H., K.H., T.K., M.v.u.z.F., J.E.J. A.E.L.), Kuopio University Hospital, Finland; and Broad Institute (M.I.K.), Boston, MA.
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Jalava I, Pyysalo L, Alanen M, Snicker O, Öhman J, Ronkainen A. Regional differences in the incidence of aneurysmal subarachnoid haemorrhage in Finland. Acta Neurochir (Wien) 2017; 159:1657-1662. [PMID: 28695447 DOI: 10.1007/s00701-017-3248-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 06/07/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the years, the consensus has generally been that Finland is a country with a significantly high incidence of aneurysmal subarachnoid haemorrhage (SAH) when compared to the rest of the world, excluding Japan. Most of the traditionally cited Finnish incidence studies are several decades old and have clear differences in their methodology and study design. The objective of this study was to determine the hospital-admitted incidence of aneurysmal SAH at Tampere University Hospital between 1990 and 2014. We also compared the incidence to other geographical regions in Finland. METHODS The material for this study consists of patients admitted to Tampere University Hospital between 1990 and 2014 with the presentation of aneurysmal SAH. There was a total of 1965 patients with aneurysmal SAH in our data. RESULTS The mean hospital-admitted aneurysmal SAH incidence over the period was 7.41 per 100,000 person-years. The hospital-admitted aneurysmal SAH incidence in the Eastern Finland region was two-thirds greater than in the Tampere University Hospital region. CONCLUSIONS We observed a relatively steady hospital-admitted incidence of aneurysmal SAH (7.41 per 100,000 person-years) in the Tampere University Hospital region. This result is parallel to a recent study looking into the incidence of aneurysmal SAH for the whole of Finland. Compared to the Tampere University Hospital region, the incidence was 64% greater in the Eastern Finland region.
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Affiliation(s)
- Iiro Jalava
- University of Tampere, Pellervonkatu 23 A 33, 33540, Tampere, Finland.
| | - Liisa Pyysalo
- University of Tampere, Pellervonkatu 23 A 33, 33540, Tampere, Finland
| | - Mikko Alanen
- University of Tampere, Pellervonkatu 23 A 33, 33540, Tampere, Finland
| | - Oona Snicker
- University of Tampere, Pellervonkatu 23 A 33, 33540, Tampere, Finland
| | - Juha Öhman
- University of Tampere, Pellervonkatu 23 A 33, 33540, Tampere, Finland
| | - Antti Ronkainen
- University of Tampere, Pellervonkatu 23 A 33, 33540, Tampere, Finland
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Huttunen J, Lindgren A, Kurki MI, Huttunen T, Frösen J, Koivisto T, von Und Zu Fraunberg M, Immonen A, Jääskeläinen JE, Kälviäinen R. Epilepsy-associated long-term mortality after aneurysmal subarachnoid hemorrhage. Neurology 2017; 89:263-268. [PMID: 28615425 PMCID: PMC5513818 DOI: 10.1212/wnl.0000000000004113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/24/2017] [Indexed: 11/25/2022] Open
Abstract
Objective: To elucidate the epilepsy-associated causes of death and subsequent excess long-term mortality among 12-month survivors of subarachnoid hemorrhage from saccular intracranial aneurysm (SIA-SAH). Methods: The Kuopio SIA Database (kuopioneurosurgery.fi) includes all SIA-SAH patients admitted to the Kuopio University Hospital from its defined catchment population in Eastern Finland. The study cohort consists of 779 patients, admitted from 1995 to 2007, who were alive at 12 months after SIA-SAH. Their use of reimbursable antiepileptic drugs and the causes of death (ICD-10) were fused from the Finnish national registries from 1994 to 2014. Results: The 779 12-month survivors were followed up until death (n = 197) or December 31, 2014, a median of 12.0 years after SIA-SAH. Epilepsy had been diagnosed in 121 (15%) patients after SIA-SAH, and 34/121 (28%) had died at the end of follow-up, with epilepsy as the immediate cause of death in 7/34 (21%). In the 779 patients alive at 12 months after SIA-SAH, epilepsy was an independent risk factor for mortality (hazard ratio 1.8, 95% confidence interval 1.1–3.0). Conclusions: Comorbid epilepsy in 12-month survivors of SIA-SAH is associated with increased risk of death in long-term follow-up. Survivors of SIA-SAH require long-term dedicated follow-up, including identification and effective treatment of comorbid epilepsy to prevent avoidable deaths.
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Affiliation(s)
- Jukka Huttunen
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio.
| | - Antti Lindgren
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Mitja I Kurki
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Terhi Huttunen
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Juhana Frösen
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Timo Koivisto
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Mikael von Und Zu Fraunberg
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Arto Immonen
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Juha E Jääskeläinen
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Reetta Kälviäinen
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
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Kurtelius A, Kallionpää RA, Huttunen J, Huttunen TJ, Helin K, Koivisto T, Frösen J, von und zu Fraunberg M, Peltonen S, Peltonen J, Jääskeläinen JE, Lindgren AE. Neurofibromatosis type 1 is not associated with subarachnoid haemorrhage. PLoS One 2017; 12:e0178711. [PMID: 28575128 PMCID: PMC5456355 DOI: 10.1371/journal.pone.0178711] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The prevalence of intracranial aneurysms (IAs) has been proposed to be elevated in the patients with neurofibromatosis type 1 (NF1). Our aims were to determine the prevalence of NF1 in a large Finnish population based cohort of IA patients and, on the other hand, the occurrences of subarachnoid haemorrhage and unruptured intracranial aneurysms in a nationwide population-based cohort of NF1 patients and its matched ten-fold control cohort. METHODS The Kuopio IA Database (www.kuopioneurosurgery.fi) includes all ruptured and unruptured IA cases admitted to the Kuopio University Hospital (KUH) from its defined Eastern Finnish catchment population since 1980. In this registry-based study, we cross-linked the Kuopio IA database with the Finnish national registry covering all hospital diagnoses. The NF1 diagnoses of the 4543 patients with either saccular of fusiform IA were identified from 1969 to 2015 and verified from patient records. Our second approach was to analyze the occurrence of aneurysmal subarachnoid haemorrhage (aSAH) and unruptured IAs in a nationwide population-based database of 1410 NF1 patients and its ten-fold matched control cohort (n = 14030) using national registry of hospital diagnoses between 1987 and 2014. RESULTS One NF1 patient was identified among the 4543 IA patients. Three verified IA cases (one unruptured IA and two aSAH cases) were identified in the cohort of 1410 NF1 patients, with similar occurrences in the control cohort. CONCLUSIONS We found no evidence in our population-based cohorts to support the conception that NF1 is associated with IAs. Our results indicate that the incidence of aSAH is not elevated in patients with NF1. Further studies are required to confirm that there is no association between NF1 and unruptured IAs.
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Affiliation(s)
- Arttu Kurtelius
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Roope A. Kallionpää
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Jukka Huttunen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terhi J. Huttunen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Katariina Helin
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koivisto
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juhana Frösen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikael von und zu Fraunberg
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sirkku Peltonen
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland
| | - Juha Peltonen
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Juha E. Jääskeläinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti E. Lindgren
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- * E-mail:
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Bourcier R, Chatel S, Bourcereau E, Jouan S, Marec HL, Daumas-Duport B, Sevin-Allouet M, Guillon B, Roualdes V, Riem T, Isidor B, Lebranchu P, Connault J, Tourneau TL, Gaignard A, Loirand G, Redon R, Desal H. Understanding the Pathophysiology of Intracranial Aneurysm: The ICAN Project. Neurosurgery 2017; 80:621-626. [DOI: 10.1093/neuros/nyw135] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 02/22/2017] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND: Understanding the pathophysiologic mechanism of intracranial aneurysm (IA) formation is a prerequisite to assess the potential risk of rupture. Nowadays, there are neither reliable biomarkers nor diagnostic tools to predict the formation or the evolution of IA. Increasing evidence suggests a genetic component of IA but genetics studies have failed to identify genetic variation causally related to IA.
OBJECTIVE: To develop diagnostic and predictive tools for the risk of IA formation and rupture.
METHODS: The French ICAN project is a noninterventional nationwide and multicentric research program. Each typical IA of bifurcation will be included. For familial forms, further IA screening will be applied among first-degree relatives. By accurate phenotype description with high-throughput genetic screening, we aim to identify new genes involved in IA. These potential genetic markers will be tested in large groups of patients. Any relevant pathway identified will be further explored in a large cohort of sporadic carriers of IA, which will be well documented with clinical, biological, and imaging data.
EXPECTED OUTCOMES: Discovering genetic risk factors, better understanding the pathophysiology, and identifying molecular mechanisms responsible for IA formation will be essential bases for the development of biomarkers and identification of therapeutic targets.
DISCUSSION: Our protocol has many assets. A nationwide recruitment allows for the inclusion of large pedigrees with familial forms of IA. It will combine accurate phenotyping and comprehensive imaging with high-throughput genetic screening. Last, it will enable exploiting metadata to explore new pathophysiological pathways of interest by crossing clinical, genetic, biological, and imaging information.
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Affiliation(s)
- Romain Bourcier
- Neuroradiological Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Stéphanie Chatel
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Emmanuelle Bourcereau
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Solène Jouan
- Neuroradiological Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Hervé Le Marec
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
- Cardiology Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Benjamin Daumas-Duport
- Neuroradiological Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | | | - Benoit Guillon
- Neurology Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Vincent Roualdes
- Neurosurgery Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Tanguy Riem
- Neurosurgery Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Bertrand Isidor
- Clinical genetics Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Pierre Lebranchu
- Ophtalmologic Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Jérôme Connault
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Nantes, France
| | - Thierry Le Tourneau
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
- Cardiology Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
| | - Alban Gaignard
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Gervaise Loirand
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Richard Redon
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Hubert Desal
- Neuroradiological Department, Centre Hospitalier Universitaire of Nantes, Nantes, France
- L'institut du thorax Nantes, INSERM, CNRS, UNIV Nantes, Centre Hospitalier Universitaire Nantes, Nantes, France
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The Genetics of Intracranial Aneurysms. CURRENT GENETIC MEDICINE REPORTS 2017. [DOI: 10.1007/s40142-017-0111-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Leinonen V, Jääskeläinen JE. Selling vs. non-selling neuro-oncology research cohorts and manuscripts in the eyes of a grumpy reviewer after 2,000 reviews. Acta Neurochir (Wien) 2017; 159:3-6. [PMID: 27055528 DOI: 10.1007/s00701-016-2787-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/21/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Ville Leinonen
- UEF Neurosurgery, UEF Clinical Research School, Kuopio NPH and Early AD Research Group, Kuopio, Finland
| | - Juha E Jääskeläinen
- UEF Neurosurgery, Neurosurgery of KUH NeuroCenter, KUH Neuro-Oncology Group and CyberKnife, Kuopio Intracranial Aneurysm Patient and Family Database, Clinical Research Grant Board of Finnish Cancer Society, Acta Neurochirurgica Editorial Board, Kuopio, Finland.
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Safety and efficacy of treatment strategies for posterior inferior cerebellar artery aneurysms: a systematic review and meta-analysis. Acta Neurochir (Wien) 2016; 158:2415-2428. [PMID: 27718027 DOI: 10.1007/s00701-016-2965-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 09/12/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION We conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies for PICA aneurysms. METHODS A systematic search of Medline, EMBASE, Scopus, and Web of Science was done for studies published through November 2015. We included studies that described treatment of PICA aneurysms with ≥10 patients. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality, stroke rates, aneurysm recurrence/rebleed, CN palsies rates, and long-term neurological morbidity/mortality. RESULTS We included 29 studies with 796 PICA aneurysms. When considering all ruptured PICA aneurysms, complete occlusion rates were 97.1 % (95 % CI = 94.5-99.0 %) in the surgical group and 84.3 % (95 % CI = 73.8-92.6 %) in the endovascular group. Aneurysm recurrence occurred in 1.4 % (95 % CI = 0.3-3.3 %) after surgery and in 6.9 % (95 % CI = 3.6-10.9 %) after endovascular treatment. Overall neurological morbidity and mortality were 14.4 % (95 % CI = 8.7-21.2 %) and 9.8 % (95 % CI = 5.8-14.8 %) after surgery and 15.1 % (95 % CI = 10.5-20.2 %) and 17.1 % (95 % CI = 11.5-23.7 %) after endovascular treatment, respectively. When considering all unruptured PICA aneurysms, complete occlusion rates were 92.9 % (95 % CI = 79.5-100 %) in the surgical group and 75.7 % (95 % CI = 45.4-97.1 %) in the endovascular group. Overall long-term good neurological outcome rates were 91.5 % (95 % CI = 74.4-100 %) in the surgical series and 93.3 % (95 % CI = 82.7-99.5 %) in the endovascular group. CONCLUSIONS Our meta-analysis demonstrated that both treatment modalities are technically feasible with high rates of technical success and effective with sufficient long-term aneurysm occlusion rates. Our data suggest that surgery is associated with superior angiographic outcomes. While endovascular therapy could be a reasonable first-line treatment option for proximal PICA aneurysms, surgery remains a highly effective first-line choice for distal PICA aneurysms. These findings should be considered when deciding the best therapeutic strategy.
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Luo J, Jin H, Jiang Y, Ge H, Wang J, Li Y. Aberrant Expression of microRNA-9 Contributes to Development of Intracranial Aneurysm by Suppressing Proliferation and Reducing Contractility of Smooth Muscle Cells. Med Sci Monit 2016; 22:4247-4253. [PMID: 27824808 PMCID: PMC5108371 DOI: 10.12659/msm.897511] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND MiR-9 is reportedly involved with many diseases, such as acute myeloid leukemia and liver oncogenesis. In the present study we investigated the molecular mechanism, including the potential regulator and signaling pathways, of MYOCD, which is the gene that in humans encodes the protein myocardin. MATERIAL AND METHODS We searched the online miRNA database (www.mirdb.org) with the "seed sequence" located within the 3'-UTR of the target gene, and then validated MYOCD to be the direct gene via luciferase reporter assay system, and further confirmed it in cultured cells by using Western blot analysis and realtime PCR. RESULTS We established the negative regulatory relationship between miR-9 and MYOCD via studying the relative luciferase activity. We also conducted realtime PCR and Western blot analysis to study the mRNA and protein expression level of MYOCD between different groups (intracranial aneurysm vs. normal control) or cells treated with scramble control, miR-9 mimics, MYOCD siRNA, and miR-9 inhibitors, indicating the negative regulatory relationship between miR-9 and MYOCD. We also investigated the relative viability of smooth muscle cells when transfected with scramble control, miR-9 mimics, MYOCD siRNA, and miR-9 inhibitors to validate that miR-9 t negatively interferes with the viability of smooth muscle cells. We then investigated the relative contractility of smooth muscle cells when transfected with scramble control, miR-9 mimics, MYOCD siRNA, and miR-9 inhibitors, and the results showed that miR-9 weakened contractility. CONCLUSIONS Our findings show that dysregulation of miR-9 is responsible for the development of IA via targeting MYOCD. miR-9 and its direct target, MYOCD, might novel therapeutic targets in the treatment of IA.
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Affiliation(s)
- Jing Luo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Hengwei Jin
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Huijian Ge
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Jiwei Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (mainland)
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Cebral J, Ollikainen E, Chung BJ, Mut F, Sippola V, Jahromi BR, Tulamo R, Hernesniemi J, Niemelä M, Robertson A, Frösen J. Flow Conditions in the Intracranial Aneurysm Lumen Are Associated with Inflammation and Degenerative Changes of the Aneurysm Wall. AJNR Am J Neuroradiol 2016; 38:119-126. [PMID: 27686488 DOI: 10.3174/ajnr.a4951] [Citation(s) in RCA: 119] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/22/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Saccular intracranial aneurysm is a common disease that may cause devastating intracranial hemorrhage. Hemodynamics, wall remodeling, and wall inflammation have been associated with saccular intracranial aneurysm rupture. We investigated how saccular intracranial aneurysm hemodynamics is associated with wall remodeling and inflammation of the saccular intracranial aneurysm wall. MATERIALS AND METHODS Tissue samples resected during a saccular intracranial aneurysm operation (11 unruptured, 9 ruptured) were studied with histology and immunohistochemistry. Patient-specific computational models of hemodynamics were created from preoperative CT angiographies. RESULTS More stable and less complex flows were associated with thick, hyperplastic saccular intracranial aneurysm walls, while slower flows with more diffuse inflow were associated with degenerated and decellularized saccular intracranial aneurysm walls. Wall degeneration (P = .041) and rupture were associated with increased inflammation (CD45+, P = .031). High wall shear stress (P = .018), higher vorticity (P = .046), higher viscous dissipation (P = .046), and high shear rate (P = .046) were associated with increased inflammation. Inflammation was also associated with lack of an intact endothelium (P = .034) and the presence of organized luminal thrombosis (P = .018), though overall organized thrombosis was associated with low minimum wall shear stress (P = .034) and not with the flow conditions associated with inflammation. CONCLUSIONS Flow conditions in the saccular intracranial aneurysm are associated with wall remodeling. Inflammation, which is associated with degenerative wall remodeling and rupture, is related to high flow activity, including elevated wall shear stress. Endothelial injury may be a mechanism by which flow induces inflammation in the saccular intracranial aneurysm wall. Hemodynamic simulations might prove useful in identifying saccular intracranial aneurysms at risk of developing inflammation, a potential biomarker for rupture.
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Affiliation(s)
- J Cebral
- From the Bioengineering Department (J.C., B.J.C., F.M.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - E Ollikainen
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - B J Chung
- From the Bioengineering Department (J.C., B.J.C., F.M.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - F Mut
- From the Bioengineering Department (J.C., B.J.C., F.M.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - V Sippola
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - B R Jahromi
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - R Tulamo
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Department of Vascular Surgery (R.T.), Helsinki University Central Hospital, Helsinki, Finland
| | - J Hernesniemi
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - M Niemelä
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - A Robertson
- Mechanical Engineering and Materials Science and Department of Bioengineering (A.R.), Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - J Frösen
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland .,Department of Neurosurgery and Hemorrhagic Brain Pathology Research Group (J.F.), Neurocenter, Kuopio University Hospital, Kuopio, Finland
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43
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Huttunen J, Lindgren A, Kurki MI, Huttunen T, Frösen J, von und zu Fraunberg M, Koivisto T, Kälviäinen R, Räikkönen K, Viinamäki H, Jääskeläinen JE, Immonen A. Antidepressant Use After Aneurysmal Subarachnoid Hemorrhage. Stroke 2016; 47:2242-8. [DOI: 10.1161/strokeaha.116.014327] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/13/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
To elucidate the predictors of antidepressant use after subarachnoid hemorrhage from saccular intracranial aneurysm (sIA-SAH) in a population-based cohort with matched controls.
Methods—
The Kuopio sIA database includes all unruptured and ruptured sIA cases admitted to the Kuopio University Hospital from its defined catchment population in Eastern Finland, with 3 matched controls for each patient. The use of all prescribed medicines has been fused from the Finnish national registry of prescribed medicines. In the present study, 2 or more purchases of antidepressant medication indicated antidepressant use. The risk factors of the antidepressant use were analyzed in 940 patients alive 12 months after sIA-SAH, and the classification tree analysis was used to create a predicting model for antidepressant use after sIA-SAH.
Results—
The 940 12-month survivors of sIA-SAH had significantly more antidepressant use (odds ratio, 2.6; 95% confidence interval, 2.2–3.1) than their 2676 matched controls (29% versus 14%). Classification tree analysis, based on independent risk factors, was used for the best prediction model of antidepressant use after sIA-SAH. Modified Rankin Scale until 12 months was the most potent predictor, followed by condition (Hunt and Hess Scale) and age on admission for sIA-SAH.
Conclusions—
The sIA-SAH survivors use significantly more often antidepressants, indicative of depression, than their matched population controls. Even with a seemingly good recovery (modified Rankin Scale score, 0) at 12 months after sIA-SAH, there is a significant risk of depression requiring antidepressant medication.
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Affiliation(s)
- Jukka Huttunen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Antti Lindgren
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Mitja I. Kurki
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Terhi Huttunen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Juhana Frösen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Mikael von und zu Fraunberg
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Timo Koivisto
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Reetta Kälviäinen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Katri Räikkönen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Heimo Viinamäki
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Juha E. Jääskeläinen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Arto Immonen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
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A 54-year-old man with 12 intracranial aneurysms and familial subarachnoid hemorrhage: case report. Neurosurg Rev 2016; 39:711-6. [PMID: 27452953 DOI: 10.1007/s10143-016-0769-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/01/2016] [Accepted: 07/13/2016] [Indexed: 10/21/2022]
Abstract
Unruptured intracranial aneurysms occur in 1-3 % of the general population, and the risk of rupture is generally considered to be low. However, patients with multiple aneurysms and familial predisposition carry a particular risk of subarachnoid hemorrhage (SAH). A 54-year-old hypertensive man underwent screening with a head CT angiography (CTA) because of his comorbidities. CTA revealed multiple bilateral aneurysms around the circle of Willis. At first surgery, seven aneurysms were clipped (BA, ACOM, ICA ×2, and MCA ×3), two of which were detected intraoperatively only. During the second surgery, another three aneurysms were surgically clipped (PCOM and MCA ×2), one of which was detected intraoperatively. Follow-up angiography revealed another two aneurysms. A PCOM aneurysm was treated by coil embolization and a VA aneurysm clipped surgically during a third admission. The patient made an uneventful recovery. However, 4 months after his second surgery, his daughter underwent surgical clipping of a right-sided ICA aneurysm. This case report highlights both the importance of screening of high risk patients with family history of SAH, as well as its limitations, as our patient developed two de novo aneurysms during 6-month follow-up and CTA preoperatively missed three small aneurysms.
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45
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Ambekar S, Khandelwal P, Bhattacharya P, Watanabe M, Yavagal DR. Treatment of unruptured intracranial aneurysms: a review. Expert Rev Neurother 2016; 16:1205-16. [PMID: 27292542 DOI: 10.1080/14737175.2016.1199958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Unruptured brain aneurysms (UIAs) present a challenge due to the lack of definitive understanding of their natural history and treatment outcomes. As the treatment of UIAs is aimed at preventing the possibility of rupture, the immediate risk of treatment must be weighed against the risk of rupture in the future. As such, treatment for a large proportion of UIAs is currently individualized. AREAS COVERED In this article, we discuss the important natural history studies of UIAs and discuss the existing scientific evidence and recent advances that help identify the rupture risk guide management of UIAs. We also address the recent advances in pharmacological therapy of UIAs. Expert commentary: In the recent years, there have been great advances in understanding the pathophysiology of UIAs and determining the rupture risk going beyond the traditional parameter of aneurysm size. Aneurysm morphology and hemodynamics play a pivotal role in growth and rupture. A true randomized trial for the management of UIAs is the need of the hour.
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Affiliation(s)
- Sudheer Ambekar
- a Department of Neurological Surgery , University of Miami, Miller School of Medicine , Miami , FL , USA
| | - Priyank Khandelwal
- b Department of Neurology , University of Miami, Miller School of Medicine , Miami , FL , USA
| | - Pallab Bhattacharya
- b Department of Neurology , University of Miami, Miller School of Medicine , Miami , FL , USA
| | - Mitsuyoshi Watanabe
- b Department of Neurology , University of Miami, Miller School of Medicine , Miami , FL , USA
| | - Dileep R Yavagal
- b Department of Neurology , University of Miami, Miller School of Medicine , Miami , FL , USA
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46
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Mensing LA, Rinkel GJE, Vlak MHM, van der Schaaf IC, Ruigrok YM. Difference in Aneurysm Characteristics between Patients with Familial and Sporadic Aneurysmal Subarachnoid Haemorrhage. PLoS One 2016; 11:e0154281. [PMID: 27112915 PMCID: PMC4841589 DOI: 10.1371/journal.pone.0154281] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/11/2016] [Indexed: 11/18/2022] Open
Abstract
Object Patients with familial intracranial aneurysms (IA) have a higher risk of rupture than patients with sporadic IA. We compared geometric and morphological risk factors for aneurysmal rupture between patients with familial and sporadic aneurysmal subarachnoid hemorrhage (aSAH) to analyse if these risk factors contribute to the increased rupture rate of familial IA. Methods Geometric and morphological aneurysm characteristics were studied on CT-angiography in a prospectively collected series of patients with familial and sporadic aSAH, admitted between September 2006 and September 2009, and additional patients with familial aSAH retrieved from the prospectively collected database of familial IA patients of our center. Odds ratios (OR) with corresponding 95% confidence intervals (95% CI) were calculated to compare the aneurysm characteristics between patients with familial and sporadic aSAH. Results We studied 67 patients with familial and 184 with sporadic aSAH. OR’s for familial compared with sporadic aSAH were for oval shape 1.16(95%CI:0.65–2.09), oblong shape 0.26(95%CI:0.03–2.13), irregular shape 0.83(95%CI:0.47–1.49), aspect ratio ≥ 1.6 0.94(95%CI:0.54–1.66), contact with the perianeurysmal environment (PAE) 1.15(95%CI:0.56–2.40), deformation by the PAE 1.05(95%CI:0.47–2.35) and for dominance of the posterior communicating artery (PCoA) in case of PCoA aneurysms 1.97(95% CI:0.50–7.83). Conclusions The geometric and morphological risk factors for aneurysm rupture do not have a higher prevalence in familial than in sporadic aSAH and thus do not explain the increased risk of IA rupture in patients with familial IA. We recommend further search for other potential risk factors for rupture of familial IA, such as genetic factors.
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Affiliation(s)
- Liselore A. Mensing
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- * E-mail: ;
| | - Gabriel J. E. Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Monique H. M. Vlak
- Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands
| | | | - Ynte M. Ruigrok
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
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47
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Lindgren AE, Räisänen S, Björkman J, Tattari H, Huttunen J, Huttunen T, Kurki MI, Frösen J, Koivisto T, Jääskeläinen JE, von Und Zu Fraunberg M. De Novo Aneurysm Formation in Carriers of Saccular Intracranial Aneurysm Disease in Eastern Finland. Stroke 2016; 47:1213-8. [PMID: 27026632 DOI: 10.1161/strokeaha.115.012573] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/03/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Formation of new (de novo) aneurysms in patients carrying saccular intracranial aneurysm (sIA) disease has been published, but data from population-based cohorts are scarce. METHODS Kuopio sIA database (http://www.uef.fi/ns) contains all unruptured and ruptured sIA patients admitted to Kuopio University Hospital from its Eastern Finnish catchment population. We studied the incidence and risk factors for de novo sIA formation in 1419 sIA patients with ≥5 years of angiographic follow-up, a total follow-up of 18 526 patient-years. RESULTS There were 42 patients with a total of 56 de novo sIAs, diagnosed in a median of 11.7 years after the first sIA diagnosis. The cumulative incidence of de novo sIAs was 0.23% per patient-year and that of subarachnoid hemorrhage from a ruptured de novo sIA 0.05% per patient-year. The risk of de novo sIA discovery per patient-year increased with younger age at the first sIA diagnosis: 2.2% in the patients aged <20 years and 0.46% in the patients aged between 20 and 39 years. In Cox regression analysis, smoking history and younger age at the first sIA diagnosis significantly associated with de novo sIA formation, but female sex, multiple sIAs, and sIA family did not. CONCLUSIONS Patients aged < 40 years at the first sIA diagnosis are in a significant risk of developing de novo sIAs, and they should be scheduled for long-term angiographic follow-up. Smoking increases the risk of de novo sIA formation, suggesting long-term follow-up for smokers. Antismoking efforts are highly recommended for sIA patients.
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Affiliation(s)
- Antti E Lindgren
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
| | - Sari Räisänen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Joel Björkman
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Hanna Tattari
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jukka Huttunen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terhi Huttunen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mitja I Kurki
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juhana Frösen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- From the Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland; and Department of Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Topcuoglu OM, Akgul E, Daglioglu E, Topcuoglu ED, Peker A, Akmangit I, Belen D, Arat A. Flow Diversion in Middle Cerebral Artery Aneurysms: Is It Really an All-Purpose Treatment? World Neurosurg 2016; 87:317-27. [DOI: 10.1016/j.wneu.2015.11.073] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 11/24/2015] [Indexed: 11/16/2022]
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Avdagic SS, Brkic H, Avdagic H, Smajic J, Hodzic S. Impact of Comorbidity on Early Outcome of Patients with Subarachnoid Hemorrhage Caused by Cerebral Aneurysm Rupture. Med Arch 2015; 69:280-3. [PMID: 26622076 PMCID: PMC4639362 DOI: 10.5455/medarh.2015.69.280-283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 10/05/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND One of the complications aneurysms subarachnoid hemorrhage is the development of vasospasm, which is the leading cause of disability and death from ruptured cerebral aneurysm. AIM To evaluate the significance of previous comorbidities on early outcome of patients with subarachnoid hemorrhage caused by rupture of a cerebral aneurysm in the prevention of vasospasm. PATIENTS AND METHODS The study had prospective character in which included 50 patients, whose diagnosed with SAH caused by the rupture of a brain aneurysm in the period from 2011to 2013. Two groups of patients were formed. Group I: patients in addition to the standard initial treatment and "3H therapy" administered nimodipine at a dose of 15-30 mg / kg bw / h (3-10 ml) for the duration of the initial treatment. Group II: patients in addition to the standard initial treatment and "3H therapy" administered with MgSO4 at a dose of 12 grams in 500 ml of 0.9% NaCl / 24 h during the initial treatment. RESULTS Two-thirds of the patients (68%) from both groups had a good outcome measured with values according to GOS scales, GOS IV and V. The poorer outcome, GOS III had 20% patients, the GOS II was at 2% and GOS I within 10% of patients. If we analyze the impact of comorbidity on the outcome, it shows that there is a significant relationship between the presence of comorbidity and outcomes. The patients without comorbidity (83.30%) had a good outcome (GOS IV and V), the same outcome was observed (59.4%) with comorbidities, which has a statistically significant difference (p = 0.04). Patients without diabetes (32%) had a good outcome (GOS IV and V), while the percentage of patients with diabetes less frequent (2%) with a good outcome, a statistically significant difference (p = 0.009). CONCLUSION The outcome of treatment 30 days after the subarachnoid hemorrhage analyzed values WFNS and GOS, is not dependent on the method of prevention and treatment of vasospasm. Most concomitant diseases in patients with SAH which, requiring additional treatment measures are arterial hypertension and diabetes mellitus. The best predictors in the initial treatment of patients with subarachnoid hemorrhage caused by rupture of a cerebral aneurysm has the presence of comorbidity, which has statistical significance.
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Affiliation(s)
- Selma Sijercic Avdagic
- Clinic for Anesthesiology and Reanimatology, University Clinical Center Tuzla, Tuzla, Bosna i Hercegovina
| | - Harun Brkic
- Clinic for Anesthesiology and Reanimatology, University Clinical Center Tuzla, Tuzla, Bosna i Hercegovina
| | - Harun Avdagic
- Clinic for Neurosurgery, University Clinical Center Tuzla, Tuzla, Bosna i Hercegovina
| | - Jasmina Smajic
- Clinic for Neurosurgery, University Clinical Center Tuzla, Tuzla, Bosna i Hercegovina
| | - Samir Hodzic
- Clinic for Cardiovascular Desease, University Clinical Center Tuzla, Tuzla, Bosna i Hercegovina
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Epidemiology, genetic, natural history and clinical presentation of giant cerebral aneurysms. Neurochirurgie 2015; 61:361-5. [DOI: 10.1016/j.neuchi.2015.08.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 05/30/2015] [Accepted: 08/10/2015] [Indexed: 11/21/2022]
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