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Rosi Junior J, Gomes Dos Santos A, Solla DJF, Rabelo NN, da Silva SA, Iglesio RF, Caldas JGMP, Teixeira MJ, Figueiredo EG. Cavernous carotid aneurysms do not influence the occurrence of upstream ipsilateral aneurysm. Br J Neurosurg 2024; 38:205-207. [PMID: 33170054 DOI: 10.1080/02688697.2020.1820950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/29/2020] [Accepted: 09/04/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Cavernous carotid aneurysms (CCA) comprehend around 5% of all intracranial aneurysms. The main risk factors for an intracranial aneurysm seem not to influence the incidence of CCAs. The aim of this study was to investigate the association of CCAs and the presence of upstream aneurysms. METHODS 1403 patients, admitted in Hospital das Clinicas de São Paulo, Brazil, from September 2009 to August 2018, enrolled this study. Diagnosis was performed with Digital Subtraction Angiography (DSA). Upstream aneurysm was defined as an intracranial aneurysm on anterior cerebral circulation, ipsilateral to the CCA (if present) or crossing the midline (e.g. anterior communicating artery). RESULTS 177 individuals were diagnosed with CCA (12.6% of the population), totalizing 225 aneurysms (10% of the total number of aneurysms, 2253). No association was found between CCA and UA (p= .090, OR: 1.323, 95% CI: 0.957-1.828). Studying only patients with CCA, multivariable analysis showed smoking as the only factor associated with UA (p= .010, OR: 0.436, 95% CI: 0.232-0.821). CONCLUSIONS Cavernous carotid aneurysms were present in 12% of our population, mostly in female. They seem to be independent of the modifiable risk factors already associated with intracranial aneurysms. A higher frequency of mirror aneurysms was seen in this location. CCA did not influence the presence of ipsilateral and anterior circulation aneurysms.
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Affiliation(s)
- Jefferson Rosi Junior
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Davi Jorge Fontoura Solla
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Saul Almeida da Silva
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ricardo Ferrareto Iglesio
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Manoel Jacobsen Teixeira
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Eberval Gadelha Figueiredo
- Division of Neurological Surgery, Hospital das Clinicas, University of São Paulo Medical School, Sao Paulo, Brazil
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2
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Larson AS, Bathla G, Brinjikji W, Lanzino G, Cheek-Norgan EH, Aubry MC, Huston J, Benson JC. A review of histopathologic and radiologic features of non-atherosclerotic pathologies of the extracranial carotid arteries. Neuroradiol J 2024:19714009241242592. [PMID: 38557110 DOI: 10.1177/19714009241242592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Diseases of the carotid arteries can be classified into different categories based on their origin. Atherosclerotic carotid disease remains the most encountered arterial wall pathology. However, other less-common non-atherosclerotic diseases can have detrimental clinical consequences if not appropriately recognized. The underlying histological features of each disease process may result in imaging findings that possess features that are obvious of the disease. However, some carotid disease processes may have histological characteristics that manifest as non-specific radiologic findings. The purpose of this manuscript is to review various non-atherosclerotic causes of carotid artery disease as well as their histologic-radiologic characteristics to aid in the appropriate recognition of these less-commonly encountered pathologies.
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Affiliation(s)
| | | | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, USA
- Department of Neurosurgery, Mayo Clinic, USA
| | - Giuseppe Lanzino
- Department of Radiology, Mayo Clinic, USA
- Department of Neurosurgery, Mayo Clinic, USA
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3
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Song J, Lim YC, Kim DJ. Prevalence of aortic aneurysms and dissections in patients with systemic vessel aneurysms and dissections; matched case-control study using a national sample cohort. Front Cardiovasc Med 2023; 10:1266430. [PMID: 37937285 PMCID: PMC10626494 DOI: 10.3389/fcvm.2023.1266430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023] Open
Abstract
Objective Aneurysms in systemic arteries are rare, and little is known about their relationship with aortic aneurysms. In this study, we aimed to evaluate the prevalence of aortic aneurysms and dissections (AAD) in patients with other systemic vessel aneurysms and dissections (OVAD) and identify their potential risk factors. Methods This cross-sectional study used a nationwide representative cohort sample from the Korea National Health Insurance Service-National Sample Cohort database. We defined OVAD as systemic vessel aneurysms and dissections excluding intracranial and aortic dissections and aneurysms. With a total of 690 OVAD patients and 2,760 non-OVAD matched controls, we investigated the prevalence of AAD in patients with OVAD and potential risk factors for their concurrence using the χ2 test and logistic regression. Results The prevalence of AAD in patients with OVAD was 10.6% (73/690) and 0.3% (9/2,760) in patients with non-OVAD. The adjusted odds ratio (OR) for having concurrent AAD with OVAD was 37.56 (95% CI: 18.29-77.12, p < 0.001) after stratification by sex, age, income, region of residence and after adjustment for hypertension, diabetes mellitus, dyslipidemia, and extent of disability. The adjusted ORs of AAD were significantly higher in females [adjusted OR = 47.63 (95% CI: 10.72-211.55)], and individuals aged ≥60 years [adjusted OR = 28.18 (95% CI: 13.42-59.17)], as well as those without hypertension [adjusted OR = 95.44 (95% CI: 18.21-500.23)], diabetes mellitus [adjusted OR = 46.39 (95% CI: 18.85-114.17)], without dyslipidemia [adjusted OR = 60.99 (95% CI: 20.83-178.56), p < 0.001 for all]. The prevalence of AAD significantly differed by according to specific sites of OVAD in carotid artery, upper extremity artery, iliac artery, lower extremity artery, and splanchnic artery (p < 0.001 for all). Conclusions The prevalence of AAD in patients with OVAD was 37.56 times higher than that in the matched population. We may approach aneurysms as systemic diseases and further investigations of pathophysiology would help to clarify the relationships between AAD and OVAD.
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Affiliation(s)
- Jihye Song
- Department of Neurosurgery, Ajou University School of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou University School of Medicine, Ajou University Hospital, Suwon, Republic of Korea
| | - Do Jung Kim
- Department of Thoracic and Cardiovascular Surgery, Ajou University School of Medicine, Ajou University Hospital, Suwon, Republic of Korea
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4
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Jaha L, Ademi B, Rudari H, Vokrri L, Gjikolli B, Koshi A, Kuçi A, Jaha A. Surgical management of extracranial internal carotid artery aneurysm-Case report and literature review. Clin Case Rep 2023; 11:e8015. [PMID: 37799567 PMCID: PMC10547859 DOI: 10.1002/ccr3.8015] [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: 04/26/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/07/2023] Open
Abstract
Key Clinical Message Extracranial internal carotid artery aneurysms (EICAAs) can lead to serious medical conditions, such as stroke or compression over cranial nerves. In very few cases, there may be hemorrhagic complications due to the rupture. Although rare, they should be suspected cause in every patient with transitory ischemic attack or stroke, especially in the presence of pain, palpable mass or bruit in the neck. Abstract Extracranial internal carotid artery aneurysms (EICAAs) are rare arterial aneurysms, with a prevalence of less than 1%. Although they are not common, these aneurysms can lead to serious medical conditions, such as stroke or compression over cranial nerves. In very few cases, there may be hemorrhagic complications due to the rupture of the aneurysm. This report presents a case of a successful surgical intervention for EICAA, and an overview of symptoms, risk factors, causes, diagnostic procedures, treatments, and potential postoperative complications. A 70-year-old Albanian lady had been experiencing pain due to a pulsating mass in her neck for many years. Physical examination did not reveal any signs of infection, injury, or previous surgery. A palpable thrill and a carotid bruit were detected over an evident pulsating mass on the left side of her neck. Her past medical history was consistent with three transitory ischemic attacks in recent months and a stroke 5 years earlier. Comorbidities included hypercholesterolemia, hypertension, and long-standing coronary artery disease. Imaging investigation in terms of ultrasound and CT-scan confirmed the presence of an aneurysm of the proximal tract of the internal carotid artery measuring 42 × 31 mm. Surgery was indicated on symptomatic and anatomical grounds. The procedure was carried out under general anesthesia. After proximal and distal clamping, the aneurysm was excised followed by end-to-end anastomosis of the internal carotid artery. The postoperative course was uneventful, and the patient was discharged home on the fifth postoperative day. Despite the growing number of reported cases of successful endovascular treatment for internal carotid artery aneurysms, open surgery remains a safe and effective treatment option. However, it is crucial to provide customized treatment plans for each patient based on their individual characteristics and the particularities of their aneurysm.
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Affiliation(s)
- Luan Jaha
- Department of Vascular SurgeryUniversity Clinical Center of KosovoPrishtinaKosovo
| | - Bekim Ademi
- Department of Vascular SurgeryUniversity Clinical Center of KosovoPrishtinaKosovo
| | - Hajriz Rudari
- Department of Vascular SurgeryUniversity Clinical Center of KosovoPrishtinaKosovo
| | - Lulzim Vokrri
- Department of Vascular SurgeryUniversity Clinical Center of KosovoPrishtinaKosovo
| | - Bujar Gjikolli
- Department of RadiologyUniversity Clinical Center of KosovoPrishtinaKosovo
| | - Adhurim Koshi
- Department of Vascular SurgeryUniversity Clinical Center of KosovoPrishtinaKosovo
| | - Astrit Kuçi
- Department of DentistryUniversity Dentistry Clinical Center of KosovoPrishtinaKosovo
| | - Art Jaha
- Department of Vascular SurgeryUniversity Clinical Center of KosovoPrishtinaKosovo
- Department of RadiologyUniversity Clinical Center of KosovoPrishtinaKosovo
- Department of DentistryUniversity Dentistry Clinical Center of KosovoPrishtinaKosovo
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5
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Hwang M, Choi DS, Choi KH, Baek HJ, Cho E, Park JM. Prevalence and Clinical Implications of Incidental Aortic Arch Abnormalities on Contrast-Enhanced Neck MR Angiography: A Single-Center Experience. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1172. [PMID: 37374376 DOI: 10.3390/medicina59061172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Vascular abnormalities within the anatomical coverage are frequently encountered in imaging studies. The aortic arch is often overlooked as an anatomical blind spot, especially in neck magnetic resonance (MR) angiography. This study investigated the prevalence of incidental aortic arch abnormalities. We also estimated the potential clinical significance of aortic arch abnormalities as blind spots detected on contrast-enhanced neck MR angiography. Materials and Methods: Between February 2016 and March 2023, 348 patients were identified based on contrast-enhanced neck MR angiography reports. The clinical and radiological characteristics of the patients and the presence of additional imaging studies were assessed. The aortic arch abnormalities and coexisting non-aortic arterial abnormalities were classified into two categories according to their clinical significance. We performed the χ2 test and Fisher's exact test for group comparisons. Results: Of the 348 study patients, only 29 (8.3%) had clinically significant incidental aortic arch abnormalities. Among these 348 patients, 250 (71.8%) and 136 (39%) had intracranial and extracranial abnormalities, respectively; the clinically significant intracranial abnormalities in the two groups were 130 lesions (52.0%) and 38 lesions (27.9%), respectively. In addition, there was a significantly higher tendency of clinically significant aortic arch abnormalities (13/29, 44.8%) in the patients who had clinically significant coexisting non-aortic arterial abnormalities than in the other group (87/319, 27.3%) (p = 0.044). The patient groups with clinically significant intracranial or extracranial arterial abnormalities had higher rates of clinically significant aortic abnormalities (31.0% and 17.2%), but there was no statistical significance (p = 0.136). Conclusions: The incidence of clinically significant aortic arch abnormalities was 8.3% on neck MR angiography, with a significant association between aortic and coexisting non-aortic arterial abnormalities. The findings of this study could improve the understanding of incidental aortic arch lesions on neck MR angiography, which is of crucial clinical importance for radiologists to achieve accurate diagnoses and management.
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Affiliation(s)
- Minhee Hwang
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 49241, Republic of Korea
| | - Dae-Seob Choi
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
- Department of Radiology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju 52727, Republic of Korea
| | - Kwang-Ho Choi
- Department of Thoracic and Cardiovascular Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, 20 Geumo-ro, Mulgeum-eup, Yangsan-si 50612, Republic of Korea
| | - Hye-Jin Baek
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Republic of Korea
| | - Eun Cho
- Department of Medicine, Gyeongsang National University College of Medicine, 816-15 Jinju-daero, Jinju 52727, Republic of Korea
- Department of Radiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, 11 Samjeongja-ro, Seongsan-gu, Changwon 51472, Republic of Korea
| | - Jong-Myung Park
- Department of Thoracic and Cardiovascular Surgery, Busan Medical Center, 359 World cup-daero, Yeonje-gu, Busan 47527, Republic of Korea
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Haldar R, Kadian S, Trivedi N. Common carotid artery pseudoaneurysm: A perilous powderkeg. J Pediatr Neurosci 2023. [DOI: 10.4103/jpn.jpn_161_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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7
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Xu JF, Liu ZB, Wang T, Liu Y. Clinical Analysis of Interventional Therapy for Eight Cases of Extracranial ICA Aneurysm. Pak J Med Sci 2021; 37:1086-1092. [PMID: 34290788 PMCID: PMC8281154 DOI: 10.12669/pjms.37.4.3957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 12/22/2020] [Accepted: 03/05/2021] [Indexed: 12/02/2022] Open
Abstract
Objective: To explore the interventional therapy and clinical efficacy of extracranial ICA aneurysm. Methods: The clinical data of eight patients with extracranial ICA aneurysm treated by interventional stent implantation from December 2014 to February 2018 in the Neurosurgery Department of the Third Hospital of Mianyang were analyzed. And this research was a retrospective analysis. All patients underwent digital subtraction angiography (DSA) and were diagnosed with extracranial carotid artery aneurysm. These patients, therefore, were treated with interventional stent implantation. Results: Interventional treatment was successfully conducted on all eight patients. In eight patients, the aneurysm cavity was not developed immediately after angiography, and in one case, the aneurysm cavity was developed with coil-assisted embolization. All the internal carotid arteries were well developed, with no complications such as intraoperative rupture, bleeding and thrombosis occur. Follow-up for three months to two years showed that the patients recovered well, the GOS score was 4 points for patients with cerebral infarction, and the rest reached five points. Follow-up CTA showed no signs of aneurysm recurrence or ICA restenosis. Conclusion: Interventional stent placement is a preferable and relatively safe method for the treatment of extracranial carotid artery aneurysm with less trauma and short operation time.
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Affiliation(s)
- Jian-Feng Xu
- Jian-Feng Xu, Neurosurgery Department, The Third Hospital of Mianyang/Sichuan Mental Health Center, Mianyang, Sichuan, 621000, P.R. China
| | - Zao-Bin Liu
- Zao-Bin Liu, Neurosurgery Department, The Third Hospital of Mianyang/Sichuan Mental Health Center, Mianyang, Sichuan, 621000, P.R. China
| | - Tong Wang
- Tong Wang, Neurosurgery Department, The Third Hospital of Mianyang/Sichuan Mental Health Center, Mianyang, Sichuan, 621000, P.R. China
| | - Yang Liu
- Yang Liu Neurosurgery Department, The Third Hospital of Mianyang/Sichuan Mental Health Center, Mianyang, Sichuan, 621000, P.R. China
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8
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Mirror aneurysms of extracranial internal carotid arteries in a patient with beta-thalassemia major. Acta Neurol Belg 2020; 120:1261-1263. [PMID: 32440865 DOI: 10.1007/s13760-020-01379-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022]
Abstract
Beta-thalassemia major is a chronic disorder characterised by severe anemia. This patient with beta-thalassemia major is the first magnetic resonance (MR) angiographic case for symmetric mirror aneurysms of the extracranial internal carotid arteries. For diagnosis of vascular complications requires angiographic procedures such as catheter angiography, computed tomography angiography, MR angiography, or Doppler ultrasonography. Time-of-flight MR angiography is a non-invasive useful technique in diagnosis of the aneurysmatic patients.
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9
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Benson JC, Lehman VT, Carr CM, Wald JT, Cloft HJ, Lanzino G, Brinjikji W. Beyond plaque: A pictorial review of non-atherosclerotic abnormalities of extracranial carotid arteries. J Neuroradiol 2020; 48:51-60. [PMID: 32169468 DOI: 10.1016/j.neurad.2020.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 02/12/2020] [Accepted: 02/12/2020] [Indexed: 02/06/2023]
Abstract
The common carotid artery (CCA) and extracranial internal carotid artery are subject to a wide variety of non-atheromatous pathologies. These entities are often overshadowed in both research and clinical realms by atherosclerotic disease. Nevertheless, non-atherosclerotic disease of the carotid arteries may have profound, even devastating, neurologic consequences. Hence, this review will cover both common and uncommon forms of extracranial carotid artery pathologies in a pictorial format, in order to aid the diagnostician in identifying and differentiating such pathologies.
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Affiliation(s)
- John C Benson
- Mayo Clinic, Department of Neuroradiology, Rochester, MN, USA.
| | - Vance T Lehman
- Mayo Clinic, Department of Neuroradiology, Rochester, MN, USA
| | - Carrie M Carr
- Mayo Clinic, Department of Neuroradiology, Rochester, MN, USA
| | - John T Wald
- Mayo Clinic, Department of Neuroradiology, Rochester, MN, USA
| | - Harry J Cloft
- Mayo Clinic, Department of Neuroradiology, Rochester, MN, USA
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10
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van Laarhoven CJHCM, Pourier VEC, Lindgren AE, Vergouwen MDI, Jääskeläinen JE, Rinkel GJE, de Kleijn DPV, de Borst GJ. Co-prevalence of extracranial carotid aneurysms differs between European intracranial aneurysm cohorts. PLoS One 2020; 15:e0228041. [PMID: 31971973 PMCID: PMC6977743 DOI: 10.1371/journal.pone.0228041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/06/2020] [Indexed: 02/05/2023] Open
Abstract
Background and purpose Previously, we showed that co-prevalence of extracranial carotid artery aneurysms (ECAAs) in patients with intracranial aneurysms (IAs) was 2% in a Dutch cohort. In order to obtain more precise estimates and discover potential predictors of ECAA co-prevalence in the European population, we retrospectively compared differences and similarities of our Dutch cohort with a Finnish cohort using protocolled imaging of the cerebrovascular tree. Methods IA patients within the prospective database of the Kuopio University Hospital were eligible for this study (n = 1,118). Image analysis and hospital chart review were conducted. Results In total, 458 patients with complete carotid imaging conform protocol were analyzed. Twenty-four ECAAs in 21 patients were identified (4.6%, 95% CI 2.9–6.9), a higher co-prevalence than in the Dutch cohort (1.9%; 95% CI 1.0–3.3), prevalence odds ratio (POR) 2.45 (95% CI 1.19–5.03). In the Finnish cohort, 25% of all ECAAs were located around the carotid bifurcation, others in the internal carotid artery distally from the bifurcation. Independent predictors for ECAA co-prevalence were origin of country (POR 2.41, 95% CI 1.15–5.06) and male gender (POR 2.25, 95% CI 1.09–4.64). Conclusion The co-prevalence of ECAA in IA patients was twice as high in the Finnish compared to the Dutch IA cohort, with origin of country and male gender as independent predictors. Twenty-five percent of ECAAs would be missed, if the carotid bifurcation was not imaged. Therefore, we propose to always include imaging of the carotid bifurcation as the gold standard technique to identify ECAA in IA patients.
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Affiliation(s)
| | - Vanessa E. C. Pourier
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Antti E. Lindgren
- Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mervyn D. I. Vergouwen
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Juha E. Jääskeläinen
- Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Gabriël J. E. Rinkel
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Dominique P. V. de Kleijn
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gert J. de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- * E-mail:
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11
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Song J, Lim YC, Ko I, Kim JY, Kim DK. Prevalence of Intracranial Aneurysms in Patients With Systemic Vessel Aneurysms: A Nationwide Cohort Study. Stroke 2019; 51:115-120. [PMID: 31735136 DOI: 10.1161/strokeaha.119.027285] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Most aneurysms are a focal manifestation of a systemic condition. Some reports have suggested genetic and environmental factors may play a role in pathogenesis. The aim of the present study was to evaluate the prevalence of intracranial aneurysms (IA) in a large cohort of patients with other systemic vessel aneurysms and dissections (OVAD) and identify potential risk factors for IA in this population. Methods- We defined OVAD as systemic vessel aneurysms, excluding aortic dissections and aneurysms. A cohort of 1.1 million patients was extracted from the population-based cohort from the Korea National Health Insurance Service, which holds almost all medical data including diagnostic codes, procedures, and personal information. Using χ2 or Fisher exact test, the prevalence of the IA concerning OVAD status was analyzed. Results- In OVAD individuals, 25.7% (261/1017) of patients had been concurrently diagnosed with IA. The odds ratios for having concurrent IA in patients with OVAD were 56.31 (95% CI, 48.821-64.949; P=0.000). OVAD patients with dyslipidemia were >7× likely to be affected by IA (adjusted odds ratio, 7.7 [95% CI, 6.59-9.01]; P=0.000). Hypertension, diabetes mellitus, old age (>60 years), and male sex had increased odds for having concurrent IA by 5.89, 3.48, 1.83, and 1.35, respectively. Subgroup analysis with socioeconomic or disability revealed that the prevalence of IA was significantly higher in all groups. Uncertainty regarding the temporal sequence of onset and lack of detail on disease severity and subtype prevented more conclusive results. Conclusions- Patients with OVAD have a higher prevalence of IA than control groups. Therefore, we may approach aneurysms as systemic disease, and further investigations about their pathophysiology must follow.
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Affiliation(s)
- Jihye Song
- From the Department of Neurosurgery, Ajou College of Medicine, Ajou University Hospital, Suwon, Republic of Korea (J.S., Y.C.L.)
| | - Yong Cheol Lim
- From the Department of Neurosurgery, Ajou College of Medicine, Ajou University Hospital, Suwon, Republic of Korea (J.S., Y.C.L.)
| | - Inseok Ko
- Department of Biomedical Informatics (I.K., J.-Y.K.)
| | - Jong-Yeup Kim
- Department of Biomedical Informatics (I.K., J.-Y.K.).,Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Konyang University, Daejeon, Republic of Korea (J.-Y.K.)
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital (D.-K.K.), Hallym University College of Medicine, Chuncheon, Republic of Korea.,Institutes of New Frontier Research (D.-K.K.), Hallym University College of Medicine, Chuncheon, Republic of Korea
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12
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Kim BJ, Lee SH, Kwun BD, Kang HG, Hong KS, Kang DW, Kim JS, Kwon SU. Intracranial Aneurysm Is Associated with High Intracranial Artery Tortuosity. World Neurosurg 2018; 112:e876-e880. [PMID: 29425982 DOI: 10.1016/j.wneu.2018.01.196] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although intracranial aneurysms (IAs) are focal bulges of arterial walls, an uncharacterized predisposing factor that affects cerebral arteries may increase tortuosity of intracranial arteries in patients with IAs. METHODS Subjects who underwent routine health examinations and magnetic resonance angiography at a university hospital health promotion center were enrolled. Age- and sex-matched control subjects were selected from among individuals who did not have IAs. Tortuosity of right and left middle cerebral arteries and basilar artery (BA) was measured. Distant factor [(arc/chord ratio × 100) - 100] was used to estimate tortuosity. Vascular risk factors and intracranial arterial tortuosities were compared between subjects with IAs and control subjects. Independent factors associated with intracranial artery tortuosity were also investigated. RESULTS Of 18,954 (1.9%) subjects, 367 exhibited IAs. The prevalence of hypertension (P = 0.01) and current smoking (P = 0.01) were higher in subjects with IAs than in control subjects. The BA tortuosity was greater in subjects with IAs compared with control subjects (9.0 ± 8.1 vs. 5.5 ± 7.2; P < 0.001). In addition to hypertension, smoking, and absence of coronary artery disease, BA tortuosity (P < 0.001) was independently associated with presence of IAs. The presence of IA (P < 0.001) and absence of coronary artery disease (P = 0.002) were independently associated with high BA tortuosity. CONCLUSIONS Patients with IAs exhibit a more tortuous BA. A predisposing factor weakening the cerebrovasculature in patients with IAs may exist and may manifest as high tortuosity of intracranial arteries.
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Affiliation(s)
- Bum Joon Kim
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea
| | - Sung Ho Lee
- Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
| | - Byung Duk Kwun
- Department of Neurosurgery, Kyung Hee University Hospital, Seoul, Korea
| | - Hyun Goo Kang
- Department of Neurology, Chosun University, Gwang-ju, Korea
| | - Keun-Sik Hong
- Department of Neurology, Ilsan Paik Hospital, Inje University, Ilsan, Korea
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, Korea.
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