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Chen C, Tang F, Zhu M, Wang C, Zhou H, Zhang C, Feng Y. Role of inflammatory mediators in intracranial aneurysms: A review. Clin Neurol Neurosurg 2024; 242:108329. [PMID: 38781806 DOI: 10.1016/j.clineuro.2024.108329] [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: 01/28/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
The formation, growth, and rupture of intracranial aneurysms (IAs) involve hemodynamics, blood pressure, external stimuli, and a series of hormonal changes. In addition, inflammatory response causes the release of a series of inflammatory mediators, such as IL, TNF-α, MCP-1, and MMPs, which directly or indirectly promote the development process of IA. However, the specific role of these inflammatory mediators in the pathophysiological process of IA remains unclear. Recently, several anti-inflammatory, lipid-lowering, hormone-regulating drugs have been found to have a potentially protective effect on reducing IA formation and rupture in the population. These therapeutic mechanisms have not been fully elucidated, but we can look for potential therapeutic targets that may interfere with the formation and breakdown of IA by studying the relevant inflammatory response and the mechanism of IA formation and rupture involved in inflammatory mediators.
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Affiliation(s)
- Cheng Chen
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Fengjiao Tang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Meng Zhu
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Chao Wang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Han Zhou
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Chonghui Zhang
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China
| | - Yugong Feng
- Department of Neurosurgery, The Affiliated Hospital of Qingdao University, Qingdao city, China.
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Chen T, You W, Zhang L, Ye W, Feng J, Lu J, Lv J, Tang Y, Wei D, Gui S, Jiang J, Wang Z, Wang Y, Zhao Q, Zhang Y, Qu J, Li C, Jiang Y, Zhang X, Li Y, Guan S. Automated anatomical labeling of the intracranial arteries via deep learning in computed tomography angiography. Front Physiol 2024; 14:1310357. [PMID: 38239880 PMCID: PMC10794642 DOI: 10.3389/fphys.2023.1310357] [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: 10/09/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024] Open
Abstract
Background and purpose: Anatomical labeling of the cerebral vasculature is a crucial topic in determining the morphological nature and characterizing the vital variations of vessels, yet precise labeling of the intracranial arteries is time-consuming and challenging, given anatomical structural variability and surging imaging data. We present a U-Net-based deep learning (DL) model to automatically label detailed anatomical segments in computed tomography angiography (CTA) for the first time. The trained DL algorithm was further tested on a clinically relevant set for the localization of intracranial aneurysms (IAs). Methods: 457 examinations with varying degrees of arterial stenosis were used to train, validate, and test the model, aiming to automatically label 42 segments of the intracranial arteries [e.g., 7 segments of the internal carotid artery (ICA)]. Evaluation metrics included Dice similarity coefficient (DSC), mean surface distance (MSD), and Hausdorff distance (HD). Additionally, 96 examinations containing at least one IA were enrolled to assess the model's potential in enhancing clinicians' precision in IA localization. A total of 5 clinicians with different experience levels participated as readers in the clinical experiment and identified the precise location of IA without and with algorithm assistance, where there was a washout period of 14 days between two interpretations. The diagnostic accuracy, time, and mean interrater agreement (Fleiss' Kappa) were calculated to assess the differences in clinical performance of clinicians. Results: The proposed model exhibited notable labeling performance on 42 segments that included 7 anatomical segments of ICA, with the mean DSC of 0.88, MSD of 0.82 mm and HD of 6.59 mm. Furthermore, the model demonstrated superior labeling performance in healthy subjects compared to patients with stenosis (DSC: 0.91 vs. 0.89, p < 0.05; HD: 4.75 vs. 6.19, p < 0.05). Concurrently, clinicians with model predictions achieved significant improvements when interpreting the precise location of IA. The clinicians' mean accuracy increased by 0.04 (p = 0.003), mean time to diagnosis reduced by 9.76 s (p < 0.001), and mean interrater agreement (Fleiss' Kappa) increased by 0.07 (p = 0.029). Conclusion: Our model stands proficient for labeling intracranial arteries using the largest CTA dataset. Crucially, it demonstrates clinical utility, helping prioritize the patients with high risks and ease clinical workload.
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Affiliation(s)
- Ting Chen
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Wei You
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurointerventional Engineering and Technology, Beijing Engineering Research Center (NO: BG0287), Beijing, China
| | - Liyuan Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Wanxing Ye
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Junqiang Feng
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Lu
- Department of Radiology, Third Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jian Lv
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yudi Tang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Dachao Wei
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Siming Gui
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jia Jiang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Ziyao Wang
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Yanwen Wang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qi Zhao
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yifan Zhang
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Junda Qu
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Chunlin Li
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Xu Zhang
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Capital Medical University, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital and Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- School of Biomedical Engineering, Capital Medical University, Beijing, China
- Department of Neurointerventional Engineering and Technology, Beijing Engineering Research Center (NO: BG0287), Beijing, China
| | - Sheng Guan
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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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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Galassi W, Yuyangkate W, Paholthep P, Tangsriwong T, Jaikon P, Leiwan T, Jiranukool J, Thiarawat P. Prevalence of unruptured intracranial aneurysms among first-degree relatives of Thai patients who had aneurysmal subarachnoid hemorrhage. Surg Neurol Int 2021; 12:566. [PMID: 34877052 PMCID: PMC8645480 DOI: 10.25259/sni_741_2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/09/2021] [Indexed: 12/16/2022] Open
Abstract
Background: The prevalence of familial unruptured intracranial aneurysm (UIA) in Thai population was unknown. Methods: Our study population comprised first-degree relatives of patients who were diagnosed with aneurysmal subarachnoid hemorrhage (aSAH) in two cerebrovascular neurosurgical centers from January 2018 to December 2018. The volunteers underwent three-dimensional time-of-flight magnetic resonance angiography for screening intracranial aneurysms (IA). Those who were reported positive or suspected of IA then underwent computed tomography angiography for confirmation. Results: We identified 12 patients who had 12 unruptured IAs (UIAs) from among 93 first-degree relatives. The prevalence of UIA among our study population was 12.9%. An estimated prevalence of UIA among Thai population was 9.05% (95% confidence interval [CI] 7.32–10.78). Of the 93 relatives, 84 had only one first-degree relative who suffered aSAH. Siblings posed a higher risk for UIA than offspring (16% vs. 9.5%), but the difference was not statistically significant (odds ratio 1.810, 95% CI 0.50–6.50, P = 0.274). The most common aneurysm location was the anterior cerebral artery territory (50%). Conclusion: The prevalence of familial UIA in a Thai population was relatively high. There was no significant between-group difference in the occurrence of UIA between the siblings and offspring of the aSAH patients.
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Affiliation(s)
| | - Warin Yuyangkate
- Department of Surgery Buddhashinnaraj Hospital, Mueang, Phitsanulok, Thailand
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Han HJ, Lee W, Kim J, Park KY, Park SK, Chung J, Kim YB. Formation, Growth, or Rupture of De Novo Intracranial Aneurysms: Long-Term Follow-up Study of Subarachnoid Hemorrhage Survivors. Neurosurgery 2021; 89:1104-1111. [PMID: 34634821 DOI: 10.1093/neuros/nyab364] [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: 11/22/2020] [Accepted: 08/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The survival rate of aneurysmal subarachnoid hemorrhage (aSAH) has gradually increased, leading to more clinical cases of de novo intracranial aneurysms (DNIAs). OBJECTIVE To identify the characteristics of patients with DNIA growth or rupture. METHODS We included 1601 patients with aSAH treated by clipping from January 1993 to May 2010. According to the inclusion and exclusion criteria, 233 patients had no DNIAs, and 63 patients had 77 DNIAs. We assessed the incidence rate of DNIAs and risk factors for DNIA formation. After dichotomizing the DNIA group into the heed (patients with DNIA rupture or growth) and stable groups (patients without DNIA growth), we assessed the risk factors for DNIA growth or rupture. RESULTS The total follow-up period was 4427.9 patient-years. The incidence rate per patient-year was 1.42%. Age ≤50 yr, family history of aneurysm, and multiplicity at initial aSAH were significant risk factors for DNIA formation. Multivariate regression analysis revealed that female sex (odds ratio [OR], 5.566; 95% confidence interval [CI], 1.241-24.952), duration from initial aSAH to DNIA detection <120 mo (OR, 5.043; 95% CI, 1.362-18.668), multiplicity at initial aSAH (OR, 4.859; 95% CI, 1.207-19.563), and maximum DNIA diameter ≥4 mm (OR, 11.104; 95% CI, 2.337-52.772) were significant risk factors for DNIA growth or rupture. CONCLUSION DNIAs had a higher incidence rate than expected. Taking into account the presented incidence rate and risk factors, long-term surveillance in aSAH survivors for more than a decade may be worth considering, at least on a case-by-case basis.
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Affiliation(s)
- Hyun Jin Han
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woosung Lee
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Junhyung Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Keun Young Park
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Kyu Park
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joonho Chung
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Bae Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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Abstract
Aneurysmal subarachnoid hemorrhage is an acute neurologic emergency. Prompt definitive treatment of the aneurysm by craniotomy and clipping or endovascular intervention with coils and/or stents is needed to prevent rebleeding. Extracranial manifestations of aneurysmal subarachnoid hemorrhage include cardiac dysfunction, neurogenic pulmonary edema, fluid and electrolyte imbalances, and hyperglycemia. Data on the impact of anesthesia on long-term neurologic outcomes of aneurysmal subarachnoid hemorrhage do not exist. Perioperative management should therefore focus on optimizing systemic physiology, facilitating timely definitive treatment, and selecting an anesthetic technique based on patient characteristics, severity of aneurysmal subarachnoid hemorrhage, and the planned intervention and monitoring. Anesthesiologists should be familiar with evoked potential monitoring, electroencephalographic burst suppression, temporary clipping, management of external ventricular drains, adenosine-induced cardiac standstill, and rapid ventricular pacing to effectively care for these patients.
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7
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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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Methylation of the CDKN2A Gene Increases the Risk of Brain Arteriovenous Malformations. J Mol Neurosci 2019; 69:316-323. [DOI: 10.1007/s12031-019-01360-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/18/2019] [Indexed: 12/19/2022]
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9
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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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Masoud H, Nair V, Odulate-Williams A, Sharma S, Gould G, Thatcher J, Nguyen TN. Incidence of Aneurysmal Subarachnoid Hemorrhage with Procedures Requiring General Anesthesia in Patients with Unruptured Intracranial Aneurysms. INTERVENTIONAL NEUROLOGY 2018; 7:452-456. [PMID: 30410524 DOI: 10.1159/000490582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/02/2018] [Indexed: 11/19/2022]
Abstract
Background The role of general anesthesia in precipitating aneurysm rupture is not clearly defined. In this study, we aimed to assess the natural history of unruptured aneurysms in patients undergoing non-aneurysm-related procedures requiring general anesthesia. Methods Retrospective review of consecutive patients with untreated intracranial aneurysms that underwent unrelated surgery with operative note documentation of general anesthesia. Events of intraoperative and postoperative subarachnoid hemorrhage were recorded to determine the incidence of rupture. Results A total of 110 patients harboring 134 unsecured aneurysms were studied. The mean age was 56.5 years (range, 17-92), and 68% were women (n = 75/110). Mean aneurysm size was 3.5 mm (range 1.5-17). A total of 208 procedures were performed under general anesthesia. There were no events of subarachnoid hemorrhage in 5.7 years of follow-up. Conclusion In our study, general anesthesia did not precipitate aneurysm rupture, and there were no instances of subarachnoid hemorrhage during the follow-up period. Our results suggest a benign natural history for aneurysms undergoing unrelated general anesthesia. However, this should be interpreted with caution given limitations related to our small sample size and retrospective study design.
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Affiliation(s)
- Hesham Masoud
- SUNY Upstate Medical University, Upstate University Hospital, Syracuse, New York, USA
| | - Vijaylakshmi Nair
- SUNY Upstate Medical University, Upstate University Hospital, Syracuse, New York, USA
| | | | - Sameer Sharma
- SUNY Upstate Medical University, Upstate University Hospital, Syracuse, New York, USA
| | - Grahame Gould
- SUNY Upstate Medical University, Upstate University Hospital, Syracuse, New York, USA
| | - Joshua Thatcher
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
| | - Thanh N Nguyen
- Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, USA
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Lorenzo-Betancor O, Blackburn PR, Edwards E, Vázquez-do-Campo R, Klee EW, Labbé C, Hodges K, Glover P, Sigafoos AN, Soto AI, Walton RL, Doxsey S, Bober MB, Jennings S, Clark KJ, Asmann Y, Miller D, Freeman WD, Meschia J, Ross OA. PCNT point mutations and familial intracranial aneurysms. Neurology 2018; 91:e2170-e2181. [PMID: 30413633 DOI: 10.1212/wnl.0000000000006614] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To identify novel genes involved in the etiology of intracranial aneurysms (IAs) or subarachnoid hemorrhages (SAHs) using whole-exome sequencing. METHODS We performed whole-exome sequencing in 13 individuals from 3 families with an autosomal dominant IA/SAH inheritance pattern to look for candidate genes for disease. In addition, we sequenced PCNT exon 38 in a further 161 idiopathic patients with IA/SAH to find additional carriers of potential pathogenic variants. RESULTS We identified 2 different variants in exon 38 from the PCNT gene shared between affected members from 2 different families with either IA or SAH (p.R2728C and p.V2811L). One hundred sixty-four samples with either SAH or IA were Sanger sequenced for the PCNT exon 38. Five additional missense mutations were identified. We also found a second p.V2811L carrier in a family with a history of neurovascular diseases. CONCLUSION The PCNT gene encodes a protein that is involved in the process of microtubule nucleation and organization in interphase and mitosis. Biallelic loss-of-function mutations in PCNT cause a form of primordial dwarfism (microcephalic osteodysplastic primordial dwarfism type II), and ≈50% of these patients will develop neurovascular abnormalities, including IAs and SAHs. In addition, a complete Pcnt knockout mouse model (Pcnt -/-) published previously showed general vascular abnormalities, including intracranial hemorrhage. The variants in our families lie in the highly conserved PCNT protein-protein interaction domain, making PCNT a highly plausible candidate gene in cerebrovascular disease.
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Affiliation(s)
- Oswaldo Lorenzo-Betancor
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Patrick R Blackburn
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Emily Edwards
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Rocío Vázquez-do-Campo
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Eric W Klee
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Catherine Labbé
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Kyndall Hodges
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Patrick Glover
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Ashley N Sigafoos
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Alexandra I Soto
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Ronald L Walton
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Stephen Doxsey
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Michael B Bober
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Sarah Jennings
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Karl J Clark
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - Yan Asmann
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - David Miller
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - William D Freeman
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA
| | - James Meschia
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA.
| | - Owen A Ross
- From the Department of Neuroscience (O.L.-B., C.L., K.H., P.G., A.I.S., R.L.W., O.A.R.), Center for Individualized Medicine (P.R.B., J.M.), Department of Health Sciences Research (P.R.B., Y.A.), Department of Neurology (E.E., R.V.-d-C., W.D.F., J.M.), Clinical Research Internship Study Program (P.G.), Department of Neurosurgery (D.M., W.D.F.), and Department of Clinical Genomics (O.A.R.), Mayo Clinic, Jacksonville, FL; Center for Individualized Medicine (E.W.K.), Department of Health Sciences Research (E.W.K.), Department of Laboratory Medicine and Pathology (E.W.K.), Department of Clinical Genomics (E.W.K.), and Department of Biochemistry and Molecular Biology (A.N.S., K.J.C.), Mayo Clinic, Rochester, MN; Department of Biology (K.H., O.A.R.), Basic Research Internship in Neuroscience and Cancer, University of North Florida, Jacksonville; Program in Molecular Medicine (S.D.), University of Massachusetts Medical School, Worcester; Division of Genetics (M.B.B.), Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; and Section of Clinical Genetics & Genetic Counseling (S.J.), St. Christopher's Hospital for Children, Philadelphia, PA.
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Chen J, Liu J, Zhang Y, Tian Z, Wang K, Zhang Y, Mu S, Lv M, Jiang P, Duan C, Zhang H, Qu Y, He M, Yang X. China Intracranial Aneurysm Project (CIAP): protocol for a registry study on a multidimensional prediction model for rupture risk of unruptured intracranial aneurysms. J Transl Med 2018; 16:263. [PMID: 30257699 PMCID: PMC6158879 DOI: 10.1186/s12967-018-1641-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/20/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ruptured aneurysms, the commonest cause of nontraumatic subarachnoid hemorrhage, can be catastrophic; the mortality and morbidity of affected patients being very high. Some risk factors, such as smoking, hypertension and female sex have been identified, whereas others, such as hemodynamics, imaging, and genomics, remain unclear. Currently, no accurate model that includes all factors for predicting such rupture is available. We plan to use data from a large cohort of Chinese individuals to set up a multidimensional model for predicting risk of rupture of unruptured intracranial aneurysms (UIAs). METHODS The China Intracranial Aneurysm Project-2 (CIAP-2) will comprise screening of a cohort of 500 patients with UIA (From CIAP-1) and focus on hemodynamic factors, high resolution magnetic resonance imaging (HRMRI) findings, genetic factors, and biomarkers. Possible risk factors for rupture of UIA, including genetic factors, biomarkers, HRMRI, and hemodynamic factors, will be analyzed. The first project of the China Intracranial Aneurysm Project (CIAP-1; chaired by the Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China) will prospectively collect a cohort of 5000 patients with UIA from 20 centers in China, and collect baseline information for each patient. Multidimensional data will be acquired in follow-up assessments. Statistically significant clinical features in the UIA cohort will also be analyzed and integrated into the model for predicting risk of UIA rupture. After the model has been set up, the resultant evidence-based prediction will provide a preliminary theoretical basis for treating aneurysms at high risk of rupture. DISCUSSION This study will explore the risk of rupture of aneurysms and develop a scientific multidimensional model for predicting rupture of unruptured intracranial aneurysms. Clinical Trials registration A Study on a Multidimensional Prediction Model for Rupture Risk of Unruptured Intracranial Aneurysms (CIAP-2), NCT03133624. Registered: 16 April 2017. https://clinicaltrials.gov/ct2/show/NCT03133624.
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Affiliation(s)
- Junfan Chen
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Zhongbin Tian
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Ming Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Peng Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - ChuanZhi Duan
- Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Qu
- Department of Neurosurgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Min He
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China.
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Risk Factors for and Clinical Consequences of Multiple Intracranial Aneurysms. Stroke 2018; 49:848-855. [DOI: 10.1161/strokeaha.117.020342] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/10/2018] [Accepted: 02/15/2018] [Indexed: 11/16/2022]
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Cooke DL, Bauer D, Sun Z, Stillson C, Nelson J, Barry D, Hetts SW, Higashida RT, Dowd CF, Halbach VV, Su H, Saeed MM. Endovascular biopsy: Technical feasibility of novel endothelial cell harvesting devices assessed in a rabbit aneurysm model. Interv Neuroradiol 2018; 21:120-8. [PMID: 25934786 DOI: 10.15274/inr-2014-10103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The lack of safe and reliable methods to sample vascular tissue in situ limits discovery of the underlying genetic and pathophysiological mechanisms of many vascular disorders, including aneurysms. We investigated the feasibility and comparable efficacy of in vivo vascular endothelial cell sampling using a spectrum of endovascular devices. Using the rabbit elastase carotid aneurysm model we evaluated the performance of existing aneurysmal coils, intracranial stents, and stent-like devices to collect vascular endothelial cells. Additionally, we modified a subset of devices to assess the effects of alterations to coil pitch, coil wire contour, and stent surface finishing. Device performance was evaluated by (1) the number of viable endothelial cells harvested, (2) the degree of vascular wall damage analyzed using digital subtraction angiography and histopathological analysis, and (3) the ease of device navigability and retrieval. Isolated cells underwent immunohistochemical analysis to confirm cell type and viability. Coil and stent specifications, technique, and endothelial cell counts were tabulated and statistical analysis performed. Using conventional detachable-type and modified aneurysm coils 11 of 14 (78.6%) harvested endothelial cells with a mean of 7.93 (±8.33) cells/coil, while 15 of 15 (100%) conventional stents, stent-like devices and modified stents harvested endothelial cells with a mean of 831.33 (±887.73) cells/device. Coil stiffness was significantly associated with endothelial cell count in univariate analysis (p = 0.044). For stents and stent-like devices univariate analysis demonstrated stent-to-aorta diameter ratios (p = 0.001), stent length (p = 0.049), and the use of a pulling retrieval technique (p = 0.019) significantly predictive of endothelial cell counts, though a multivariate model using these variables demonstrated only the stent-to-aorta diameter ratio (p = 0.029) predictive of endothelial cell counts. Modified devices did not significantly impact harvesting. The efficacy and safety of existing aneurysm coils, intracranial stents and stent-like devices in collecting viable endothelial cells was confirmed. The technique is reproducible and the quantity and quality of collected endothelial cells is adequate for targeted genetic analysis.
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Affiliation(s)
- Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Diana Bauer
- Laboratory Animal Resource Center, University of California, San Francisco, CA, USA
| | - Zhengda Sun
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Carol Stillson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jeffrey Nelson
- Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA
| | | | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Randall T Higashida
- Department of Radiology, Neurology, and Neurological Surgery, University of California, San Francisco, CA, USA
| | - Christopher F Dowd
- Department of Radiology, Neurology, and Neurological Surgery, University of California, San Francisco, CA, USA
| | - Van V Halbach
- Department of Radiology, Neurology, and Neurological Surgery, University of California, San Francisco, CA, USA
| | - Hua Su
- Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA
| | - Maythem M Saeed
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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15
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Wang GX, Yu JY, Wen L, Zhang L, Mou KJ, Zhang D. Risk Factors for the Rupture of Middle Cerebral Artery Bifurcation Aneurysms Using CT Angiography. PLoS One 2016; 11:e0166654. [PMID: 27977691 PMCID: PMC5157982 DOI: 10.1371/journal.pone.0166654] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE To investigate the clinical and morphological characteristics associated with risk factors for the rupture of bifurcation-type middle cerebral artery aneurysms (MCAAs). METHODS A total of 169 consecutive patients with 177 bifurcation-type MCAAs were reviewed from August 2011 to January 2016. Based on the clinical and morphologic characteristics findings, the risk factors of aneurysm rupture were assessed using statistical methods. RESULTS Age, cerebral atherosclerosis, no hypertension, hypertension grade 2 and coronary artery disease (CAD) were negatively correlated with aneurysm rupture. The mean diameter (MD) of the parent and two daughter arteries was negatively correlated with rupture. Aneurysms with irregularity, depth, width, maximum size, aspect ratio, depth-to-width ratio, bottleneck factor, and size ratio were positively correlated with rupture. The multivariate logistic regression model revealed that irregular shape (odds ratio (OR) 2.697) and aspect ratio (OR 3.723) were significantly and positively correlated with rupture, while cerebral atherosclerosis (OR 0.033), CAD (OR 0.080), and MD (OR 0.201) were negatively correlated with rupture. Receiver operating characteristic analysis revealed that the threshold value of the aspect ratio and MD were 0.96 and 2.43 mm, respectively. CONCLUSIONS Cerebral atherosclerosis and CAD are protective factors against rupture. Morphological characteristics such as an aneurysm with an irregular shape, a high aspect ratio (>0.96) and a small MD (<2.43 mm) are likely better predictors of rupture.
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Affiliation(s)
- Guang-xian Wang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Jiao-yan Yu
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Li Wen
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Lei Zhang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Ke-jie Mou
- Department of neurosurgery, Xinqiao Hospital, Third Military Medical University, Chongqing, China
| | - Dong Zhang
- Department of Radiology, Xinqiao Hospital, Third Military Medical University, Chongqing, China
- * E-mail:
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16
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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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17
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Kim T, Lee H, Ahn S, Kwon OK, Bang JS, Hwang G, Kim JE, Kang HS, Son YJ, Cho WS, Oh CW. Incidence and risk factors of intracranial aneurysm: A national cohort study in Korea. Int J Stroke 2016; 11:917-927. [PMID: 27422699 DOI: 10.1177/1747493016660096] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Estimations of the intracranial aneurysm incidence require long-term follow-up of a relatively large at-risk population; as a result, the incidence remains largely unknown. Aims To investigate the national incidence of intracranial aneurysm in a Korean population. Methods After excluding 18,604 potential subjects with a previous history of stroke (I6x.x), 998,216 subjects were included in this observational cohort. The primary endpoint was the earliest date of diagnosis of either unruptured intracranial aneurysm (UIA; I67.1) or subarachnoid hemorrhage (SAH; I60.x). We collected anthropometric data, blood pressure measurements, laboratory data, and smoking, drinking, and physical exercise habits of 132,355 subjects for whom healthcare screening data were available. Factors influencing intracranial aneurysm were evaluated via multivariate Cox regression. Results The overall observation size was 8,792,214 person-years. During follow-up, 4346 subjects were diagnosed with intracranial aneurysm (SAH, 1960; UIA, 2386). The crude incidence of intracranial aneurysm was 49.4/100,000 person-years. The hazard ratio for women was 1.56 ( p < 0.01), and older subjects had an increased hazard ratio. Subjects with hypertension had an approximately 1.5-fold higher risk of intracranial aneurysm. A history of heart disease and family history of stroke were associated with respective hazard ratios of 2.08 and 1.77. Conclusions In this Korean population study, the standardized incidence of intracranial aneurysm was 52.2/100,000 person-years. Older age, female sex, hypertension, history of heart disease, and family history of stroke were independent risk factors for intracranial aneurysm.
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Affiliation(s)
- Tackeun Kim
- 1 Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Heeyoung Lee
- 2 Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Soyeon Ahn
- 3 Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - O-Ki Kwon
- 1 Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jae Seung Bang
- 1 Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Gyojun Hwang
- 1 Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jeong Eun Kim
- 4 Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Seung Kang
- 4 Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young-Je Son
- 5 Department of Neurosurgery, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
| | - Won-Sang Cho
- 4 Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang Wan Oh
- 1 Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
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18
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Jiang H, Weng YX, Zhu Y, Shen J, Pan JW, Zhan RY. Patient and aneurysm characteristics associated with rupture risk of multiple intracranial aneurysms in the anterior circulation system. Acta Neurochir (Wien) 2016; 158:1367-75. [PMID: 27165300 DOI: 10.1007/s00701-016-2826-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 04/28/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Multiple intracranial aneurysms (MIAs) are associated with poorer outcomes after rupture than are single intracranial aneurysms (SIAs). Although the risk factors for intracranial aneurysm rupture have been widely investigated, few studies have focused on MIAs. Thus, the present study aimed to determine whether there are differences in the patient and aneurysm characteristics between those with ruptured and unruptured anterior circulation MIAs (AC-MIAs). METHOD The present study included 97 patients with AC-MIAs (58 ruptured, 39 unruptured). Data regarding patient characteristics, aneurysm location, mirror aneurysms (MirAns), and bleb formations were collected from medical records and angiography images. Three-dimensional (3D) geometries generated with a 3D Slicer were evaluated to determine the range of morphological parameters. A univariate analysis was conducted to identify significant differences between the groups and receiver-operating characteristic (ROC) analyses were performed for each morphological parameter. RESULTS There are significantly fewer patients younger than 40 years of age in the ruptured group (P = 0.04); although the groups did not significantly differ with regard to smoking and hypertension, the ruptured group included significantly more current smokers who smoked more than 20 cigarettes per day (P = 0.025) and significantly more patients with a history of hypertension but an irregular use of anti-hypertensive medications (P = 0.043). Ruptured AC-MIAs were more likely to be located in the internal carotid artery (ICA) communicating artery (ICA C7) and anterior communicating artery (AComA; P = 0.000), to have formed a pair of MirAns (P = 0.001), and to have a bleb formation (P = 0.000). In terms of morphological parameters, the two groups differed significantly regarding aneurysm size (P = 0.000), neck width (P = 0.016), bottleneck factor (BNF; P = 0.000), height/width ratio (H/W; P = 0.031), aspect ratio (AR; P = 0.000) and size ratio (SR; P = 0.000). Additionally, the ROC analyses revealed that the optimal threshold size for rupture was 4.00 mm and that the SR had the highest area under the curve (AUC) value (0.826). CONCLUSIONS The present study found that current smokers who smoked more than 20 cigarettes per day and those with hypertension but an irregular use of anti-hypertensive medications were more likely to suffer from rupture. Aneurysm location and bleb formation were closely related to the rupture of AC-MIAs, and SR was a better predictor of AC-MIAs rupture status than size, neck width, BNF, H/W and AR. These findings should be verified by future prospective follow-up studies of AC-MIAs.
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Affiliation(s)
- Hao Jiang
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Yu-Xiang Weng
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Yu Zhu
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Jian Shen
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Jian-Wei Pan
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, Zhejiang, 310003, China
| | - Ren-Ya Zhan
- Department of Neurosurgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou, Zhejiang, 310003, China.
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19
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Verdure P, Gilard V, Guyant-Maréchal L, Belien J, Cebula H, Hannequin D, Dacher JN, Johannides R, Proust F. Familial intracranial aneurysm, the relationship of the aortic diameter. Neurochirurgie 2015; 61:385-91. [PMID: 26597604 DOI: 10.1016/j.neuchi.2015.08.001] [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: 02/17/2015] [Revised: 05/11/2015] [Accepted: 08/10/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Familial predisposition appears as an identified risk factor for cerebrovascular disease. The primary objective of our study was to assess intracranial aneurysm (IA) recurrence rate in a population of familial IA. Secondary objectives were first to analyse the inheritance categorisation/pattern of these families and second to assess the correlation between the aortic diameter on MRI and the aneurysmal characteristics. PATIENTS AND METHODS Over a period of 20 years (1990-2010), 26 patients from 23 families, identified from a regional register, accepted to participate in this prospective trial in order to determine, the inheritance pattern, the screening of de novo aneurysms by CT angioscan, and the aortic mensuration by MRI. The transmission pattern was categorised into autosomal dominant inheritance, autosomal recessive and autosomal dominance with incomplete penetrance. The aortic diameter was measured: anatomic coverage in the caudo-cranial direction from the iliac arteries to the ventriculo-aortic junction. RESULTS All 26 patients [from 55.4 ± 11.2 years, sex ratio female/male: 1.36] were reviewed after a mean follow-up of 7.9 ± 6.6 years after the diagnosis of a cerebral aneurysm. The characteristics of this population were the diagnostic circumstances such as a subarachnoid hemorrhage (SAH) in 14 (53.8%), the multiple locations in 10 (38.5%) and a giant aneurysm in 4 (15.4%). Four de novo aneurysms were diagnosed in 3 patients (11.5%) after a mean follow-up of 22.3 ± 4 years, which corresponds to an annual incidence of 1.9 (95% CI 1.4-2.6%). The transmission pattern was autosomal dominant in 16 (61.5%), recessive in 3 (11.5%) and not defined in 7 (26.9%). As regards the aortic diameter, a significant decrease in the aortic diameter was observed in patients with an aneurysmal diameter superior to 10mm. CONCLUSION The rate of de novo aneurysm justifies prolonged monitoring by imaging of these patients with familial intracranial aneurysm. The narrowing of the terminal part of the aorta could be a hemodynamic factor involved into the IA development.
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Affiliation(s)
- P Verdure
- Department of Neurosurgery, Rouen University Hospital, Rouen, France
| | - V Gilard
- Department of Neurosurgery, Rouen University Hospital, Rouen, France
| | - L Guyant-Maréchal
- Department of Neurophysiology, Rouen University Hospital, Rouen, France
| | - J Belien
- Department of Pharmacology, Rouen University Hospital, Rouen, France
| | - H Cebula
- Department of Neurosurgery, Hôpital Hautepierre, Strasbourg University Hospital, 67000 Strasbourg cedex, France
| | - D Hannequin
- Department of Neurology, Rouen University Hospital, Rouen, France
| | - J-N Dacher
- Department of Radiology, Rouen University Hospital, Rouen, France
| | - R Johannides
- Department of Pharmacology, Rouen University Hospital, Rouen, France
| | - F Proust
- Department of Neurosurgery, Rouen University Hospital, Rouen, France; Inserm U982, Neuronal and Neuroendocrine Communication and Differenciation, Rouen University, Rouen, France; Department of Neurosurgery, Hôpital Hautepierre, Strasbourg University Hospital, 67000 Strasbourg cedex, France.
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20
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Abstract
Cerebrospinal vascular malformations are a group of anomalies affecting the arterial wall, the capillary arteriovenous interface, or the venous and lymphatic structures. Heritability and family studies allow identification of mutations in single genes associated with rare familial conditions causing cerebral or spinal vascular malformations, as is the case in hemorrhagic hereditary telangiectasia diseases. This article reviews the genetic and epigenetic influences increasingly reported in recent years as causal factors or triggers involved in the formation and growth of cerebromedullary vascular malformations.
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Affiliation(s)
- Hortensia Alvarez
- Interventional Neuroradiology, UNC at Chapel Hill, Chapel Hill, NC 27516, USA
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21
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Thompson BG, Brown RD, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES, Duckwiler GR, Harris CC, Howard VJ, Johnston SCC, Meyers PM, Molyneux A, Ogilvy CS, Ringer AJ, Torner J. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46:2368-400. [PMID: 26089327 DOI: 10.1161/str.0000000000000070] [Citation(s) in RCA: 616] [Impact Index Per Article: 68.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. METHODS Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. RESULTS Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.
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22
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Can A, Ho AL, Emmer BJ, Dammers R, Dirven CMF, Du R. Association Between Vascular Anatomy and Posterior Communicating Artery Aneurysms. World Neurosurg 2015; 84:1251-5. [PMID: 26074436 DOI: 10.1016/j.wneu.2015.05.078] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 05/29/2015] [Accepted: 05/30/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Hemodynamic stress, conditioned by the geometry and morphology of the vessel trees, plays an important role in the formation of intracranial aneurysms. The aim of this study was to identify image-based location-specific morphologic parameters that are associated with posterior communicating artery (PCoA) aneurysms. METHODS Morphologic parameters obtained from computed tomography angiography of 56 patients with PCoA aneurysms and 23 control patients were evaluated with 3D Slicer, an open-source image analysis software, to generate 3-dimensional models of the aneurysms and surrounding vasculature. Segment lengths, diameters, and vessel-to-vessel angles were examined. To control for genetic and clinical risk factors, the unaffected contralateral side of patients with unilateral PCoA aneurysms was used as a control group for internal carotid artery (ICA)-related parameters. A separate control group with visible PCoAs and aneurysms elsewhere was used as a control group for PCoA-related parameters. RESULTS Internal carotid artery-related parameters were not statistically different between the PCoA aneurysm and control groups. Univariate and multivariate subgroup analysis for patients with visualized PCoAs demonstrated that a larger PCoA diameter was significantly associated with the presence of a PCoA aneurysm (odds ratio = 12.1, 95% confidence interval = 1.3-17.1, P = 0.04) after adjusting for other morphologic parameters. CONCLUSIONS Larger PCoA diameters are associated with the presence of PCoA aneurysms. These parameters may provide objective metrics to assess aneurysm formation and growth risk stratification in high-risk patients.
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Affiliation(s)
- Anil Can
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Allen L Ho
- Department of Neurosurgery, Stanford University, Palo Alto, California, USA
| | - Bart J Emmer
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA.
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23
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Farlow JL, Lin H, Sauerbeck L, Lai D, Koller DL, Pugh E, Hetrick K, Ling H, Kleinloog R, van der Vlies P, Deelen P, Swertz MA, Verweij BH, Regli L, Rinkel GJE, Ruigrok YM, Doheny K, Liu Y, Broderick J, Foroud T. Lessons learned from whole exome sequencing in multiplex families affected by a complex genetic disorder, intracranial aneurysm. PLoS One 2015; 10:e0121104. [PMID: 25803036 PMCID: PMC4372548 DOI: 10.1371/journal.pone.0121104] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 02/10/2015] [Indexed: 12/30/2022] Open
Abstract
Genetic risk factors for intracranial aneurysm (IA) are not yet fully understood. Genomewide association studies have been successful at identifying common variants; however, the role of rare variation in IA susceptibility has not been fully explored. In this study, we report the use of whole exome sequencing (WES) in seven densely-affected families (45 individuals) recruited as part of the Familial Intracranial Aneurysm study. WES variants were prioritized by functional prediction, frequency, predicted pathogenicity, and segregation within families. Using these criteria, 68 variants in 68 genes were prioritized across the seven families. Of the genes that were expressed in IA tissue, one gene (TMEM132B) was differentially expressed in aneurysmal samples (n=44) as compared to control samples (n=16) (false discovery rate adjusted p-value=0.023). We demonstrate that sequencing of densely affected families permits exploration of the role of rare variants in a relatively common disease such as IA, although there are important study design considerations for applying sequencing to complex disorders. In this study, we explore methods of WES variant prioritization, including the incorporation of unaffected individuals, multipoint linkage analysis, biological pathway information, and transcriptome profiling. Further studies are needed to validate and characterize the set of variants and genes identified in this study.
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Affiliation(s)
- Janice L. Farlow
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Hai Lin
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Laura Sauerbeck
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States of America
| | - Dongbing Lai
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Daniel L. Koller
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Elizabeth Pugh
- Center for Inherited Disease Research, Johns Hopkins University; Baltimore, Maryland, United States of America
| | - Kurt Hetrick
- Center for Inherited Disease Research, Johns Hopkins University; Baltimore, Maryland, United States of America
| | - Hua Ling
- Center for Inherited Disease Research, Johns Hopkins University; Baltimore, Maryland, United States of America
| | - Rachel Kleinloog
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pieter van der Vlies
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Patrick Deelen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Genomics Coordination Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Morris A. Swertz
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Genomics Coordination Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bon H. Verweij
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Luca Regli
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Gabriel J. E. Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ynte M. Ruigrok
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kimberly Doheny
- Center for Inherited Disease Research, Johns Hopkins University; Baltimore, Maryland, United States of America
| | - Yunlong Liu
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Joseph Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States of America
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
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Can A, Ho AL, Dammers R, Dirven CM, Du R. Morphological Parameters Associated With Middle Cerebral Artery Aneurysms. Neurosurgery 2015; 76:721-6; discussion 726-7. [DOI: 10.1227/neu.0000000000000713] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Morphological factors contribute to the hemodynamics of the middle cerebral artery (MCA).
OBJECTIVE:
To identify image-based morphological parameters that correlated with the presence of MCA aneurysms.
METHODS:
Image-based anatomic parameters obtained from 110 patients with and without MCA bifurcation aneurysms were evaluated with Slicer, an open-source image analysis software, to generate 3-dimensional models of the aneurysms and surrounding vascular architecture. We examined segment lengths, diameters, and vessel-to-vessel angles of the parent and daughter vessels at the MCA bifurcation. In order to reduce confounding by genetic and clinical risk factors, 2 control groups were selected: group A (the unaffected contralateral side of patients with unilateral MCA bifurcation aneurysms) and group B (patients without intracranial aneurysms or other vascular malformations). Univariate and multivariate analyses were performed to determine statistical significance.
RESULTS:
One hundred ten patients who were evaluated from 2007 to 2014 were analyzed (73 patients with MCA aneurysms and 37 control patients). Multivariate analysis revealed that a smaller parent artery diameter (group A: odds ratio [OR] 0.20, P < .01, group B: OR 0.23, P < .01) and a larger daughter-to-daughter branch angle (group A: OR 1.01, P = .04, group B: OR 1.02, P = .04) were most strongly associated with MCA aneurysm presence after adjusting for other morphological factors.
CONCLUSION:
Smaller parent artery diameter and larger daughter-to-daughter branch angles are associated with the presence of MCA bifurcation aneurysms. These easily measurable parameters may provide objective metrics to assess aneurysm formation and growth risk stratification in high-risk patients.
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Affiliation(s)
- Anil Can
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Allen L. Ho
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Clemens M.F. Dirven
- Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Bourcier R, Redon R, Desal H. Genetic investigations on intracranial aneurysm: update and perspectives. J Neuroradiol 2015; 42:67-71. [PMID: 25676693 DOI: 10.1016/j.neurad.2015.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 11/26/2014] [Accepted: 01/12/2015] [Indexed: 11/30/2022]
Abstract
Detection of an intracranial aneurysm (IA) is a common finding in MRI practice. Nowadays, the incidence of unruptured IA seems to be increasing with the continuous evolution of imaging techniques. Important modifiable risk factors for SAH are well defined, but familial history of IA is the best risk marker for the presence of IA. Numerous heritable conditions are associated with IA formation but these syndromes account for less than 1% of all IAs in the population. No diagnostic test based on genetic knowledge is currently available to identify theses mutations and patients who are at higher risk for developing IAs. In the longer term, a more comprehensive understanding of independent and interdependent molecular pathways germane to IA formation and rupture may guide the physician in developing targeted therapies and optimizing prognostic risk assessment.
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Affiliation(s)
- Romain Bourcier
- Department of neuroradiology, CHU Nantes, boulevard J.-Monod, 44000 Nantes, France; 1087 Inserm unit, institut du thorax, 44000 Nantes, France.
| | - Richard Redon
- 1087 Inserm unit, institut du thorax, 44000 Nantes, France
| | - Hubert Desal
- Department of neuroradiology, CHU Nantes, boulevard J.-Monod, 44000 Nantes, France; 1087 Inserm unit, institut du thorax, 44000 Nantes, France
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26
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Mackey J, Brown RD, Sauerbeck L, Hornung R, Moomaw CJ, Koller DL, Foroud T, Deka R, Woo D, Kleindorfer D, Flaherty ML, Meissner I, Anderson C, Rouleau G, Connolly ES, Huston J, Broderick JP. Affected twins in the familial intracranial aneurysm study. Cerebrovasc Dis 2015; 39:82-6. [PMID: 25571891 PMCID: PMC4348212 DOI: 10.1159/000369961] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Very few cases of intracranial aneurysms (IAs) in twins have been reported. Previous work has suggested that vulnerability to IA formation is heritable. Twin studies provide an opportunity to evaluate the impact of genetics on IA characteristics, including IA location. We therefore sought to examine IA location concordance, multiplicity, and rupture status within affected twin-pairs. METHODS The Familial Intracranial Aneurysm study was a multicenter study whose goal was to identify genetic and other risk factors for formation and rupture of IAs. The study required at least three affected family members or an affected sibling pair for inclusion. Subjects with fusiform aneurysms, an IA associated with an AVM, or a family history of conditions known to predispose to IA formation, such as polycystic kidney disease, Ehlers-Danlos syndrome, Marfan syndrome, fibromuscular dysplasia, or moyamoya syndrome were excluded. Twin-pairs were identified by birth date and were classified as monozygotic (MZ) or dizygotic (DZ) through DNA marker genotypes. In addition to zygosity, we evaluated twin-pairs by smoking status, major arterial territory of IAs, and rupture status. Location concordance was defined as the presence of an IA in the same arterial distribution (ICA, MCA, ACA, and vertebrobasilar), irrespective of laterality, in both members of a twin-pair. The Fisher exact test was used for comparisons between MZ and DZ twin-pairs. RESULTS A total of 16 affected twin-pairs were identified. Location concordance was observed in 8 of 11 MZ twin-pairs but in only 1 of 5 DZ twin-pairs (p = 0.08). Three MZ subjects had unknown IA locations and comprised the three instances of MZ discordance. Six of the 11 MZ twin-pairs and none of the 5 DZ twin-pairs had IAs in the ICA distribution (p = 0.03). Multiple IAs were observed in 11 of 22 MZ and 5 of 10 DZ twin-pairs. Thirteen (13) of the 32 subjects had an IA rupture, including 10 of 22 MZ twins. CONCLUSIONS We found that arterial location concordance was greater in MZ than DZ twins, which suggests a genetic influence upon aneurysm location. The 16 twin-pairs in the present study are nearly the total of affected twin-pairs that have been reported in the literature to date. Further studies are needed to determine the impact of genetics in the formation and rupture of IAs.
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Affiliation(s)
- Jason Mackey
- Department of Neurology, Indiana University, Indianapolis, IN
| | | | - Laura Sauerbeck
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Richard Hornung
- Department of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Daniel L. Koller
- Department of Medical & Molecular Genetics, Indiana University, Indianapolis, IN
| | - Tatiana Foroud
- Department of Medical & Molecular Genetics, Indiana University, Indianapolis, IN
| | - Ranjan Deka
- Department of Environmental Health, University of Cincinnati, Cincinnati, OH
| | - Daniel Woo
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | - Dawn Kleindorfer
- Department of Neurology, University of Cincinnati, Cincinnati, OH
| | | | | | - Craig Anderson
- The George Institute for International Health, University of Sydney, Sydney, Australia
| | - Guy Rouleau
- Notre Dame Hospital, University of Montreal, Montreal, Canada
| | | | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, MN
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Cooke DL, Bauer D, Sun Z, Stillson C, Nelson J, Barry D, Hetts SW, Higashida RT, Dowd CF, Halbach VV, Su H, Saeed MM. Endovascular Biopsy: Technical Feasibility of Novel Endothelial Cell Harvesting Devices Assessed in a Rabbit Aneurysm Model. Interv Neuroradiol 2015. [DOI: 10.15274/inr-2015-10103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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28
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Mohan D, Munteanu V, Coman T, Ciurea AV. Genetic factors involves in intracranial aneurysms--actualities. J Med Life 2015; 8:336-41. [PMID: 26351537 PMCID: PMC4556916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 05/26/2015] [Indexed: 11/03/2022] Open
Abstract
UNLABELLED Intracranial aneurysm (IA) is a common vascular disorder, which frequently leads to fatal vascular rupture leading to subarachnoid hemorrhage (SAH). Although various acquired risk factors associated with IAs have been identified, heritable conditions are associated with IAs formation but these syndromes account for less than 1% of all IAs in the population. Cerebral aneurysm disease is related to hemodynamic and genetic factors, associated with structural weakness in the arterial wall, which was acquired by a specific, often unknown, event. Possibly, the trigger moment of aneurysm formation may depend on the dynamic arterial growth, which is closely related to aging/ atherosclerosis. Genetic factors are known to have an important role in IA pathogenesis. Literature data provide complementary evidence that the variants on chromosomes 8q and 9p are associated with IA and that the risk of IA in patients with these variants is greatly increased with cigarette smoking. Intracranial aneurysms are acquired lesions (5-10% of the population). In comparison with sporadic aneurysms, familial aneurysms tend to be larger, more often located in the middle cerebral artery, and more likely to be multiple. ABBREVIATIONS DNA = deoxyribonucleic acid, FIA = familial Intracranial Aneurysm, GWAS = genome-wide association studies, IL-6 = interleukin-6, ISUIA = International Study of Unruptured Intracranial Aneurysms, IA = Intracranial aneurysm, mRNA = Messager ribonucleic acid, SNPs = single-nucleotide polymorphisms, SMCs = smooth muscle cells, sIAs = sporadic IAs, SAH = subarachnoid hemorrhage, TNF-α = tumor necrosis factor-alpha, COL4A1 = type IV collagen alpha-1.
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Affiliation(s)
- D Mohan
- Department of Neurosurgery, Clinical Emergency Hospital Oradea, Romania
| | - V Munteanu
- Department of Neurosurgery, “Sanador” Medical Center Hospital, Bucharest, Romania
| | - T Coman
- Department of Neurosurgery, “Bagdasar-Arseni” Clinical Hospital, Bucharest, Romania
| | - AV Ciurea
- Romanian Ministry of Health Neurosurgical Committee; “Sanador” Medical Center Hospital, Bucharest, Romania; “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Can A, Mouminah A, Ho AL, Du R. Effect of Vascular Anatomy on the Formation of Basilar Tip Aneurysms. Neurosurgery 2014; 76:62-6; discussion 66. [DOI: 10.1227/neu.0000000000000564] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Abstract
BACKGROUND:
The pathogenesis of intracranial aneurysms is multifactorial and includes genetic, environmental, and anatomic influences. Hemodynamic stress plays a particular role in the formation of intracranial aneurysms, which is conditioned by the geometry and morphology of the vessel trees.
OBJECTIVE:
To identify image-based morphological parameters that correlated with the formation of basilar artery tip aneurysms (BTAs) in a location-specific manner.
METHODS:
Morphological parameters obtained from computed tomographic angiographies of 33 patients with BTAs and 33 patients with aneurysms at other locations were evaluated with Slicer, an open-source image analysis software, to generate 3-dimensional models of the aneurysms and surrounding vascular architecture. We examined the diameters and vessel-to-vessel angles of the main vessels at the basilar bifurcation in patients with and without BTAs. To control for genetic and other risk factors, only patients with at least 1 aneurysm were included. Univariate and multivariate analyses were performed to determine statistical significance.
RESULTS:
Sixty-six patients (33 with BTAs, 33 with other aneurysms) who were evaluated from 2008 to 2013 were analyzed. Multivariate logistic regression revealed that a larger angle between the posterior cerebral arteries (odds ratio, 1.04; P = 1.42 × 10−3) and a smaller basilar artery diameter (odds ratio, 0.23; P = .02) were most strongly associated with BTA formation after adjustment for other morphological and clinical variables.
CONCLUSION:
Larger posterior cerebral artery angles and smaller basilar artery diameters are associated with the formation of basilar tip aneurysms. These parameters are easily measurable by the clinician and will aid in screening strategies in high-risk patients.
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Affiliation(s)
- Anil Can
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amr Mouminah
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Allen L. Ho
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Rose Du
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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30
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Hirsch JA, Schaefer PW, Romero JM, Rabinov JD, Sanelli PC, Manchikanti L. Comparative effectiveness research. AJNR Am J Neuroradiol 2014; 35:1677-80. [PMID: 24874531 DOI: 10.3174/ajnr.a3985] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The goal of comparative effectiveness research is to improve health care while dealing with the seemingly ever-rising cost. An understanding of comparative effectiveness research as a core topic is important for neuroradiologists. It can be used in a variety of ways. Its goal is to look at alternative methods of interacting with a clinical condition, ideally, while improving delivery of care. While the Patient-Centered Outcome Research initiative is the most mature US-based foray into comparative effectiveness research, it has been used more robustly in decision-making in other countries for quite some time. The National Institute for Health and Clinical Excellence of the United Kingdom is a noteworthy example of comparative effectiveness research in action.
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Affiliation(s)
- J A Hirsch
- From the Department of Radiology (J.A.H., P.W.S., J.M.R., J.D.R.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - P W Schaefer
- From the Department of Radiology (J.A.H., P.W.S., J.M.R., J.D.R.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - J M Romero
- From the Department of Radiology (J.A.H., P.W.S., J.M.R., J.D.R.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - J D Rabinov
- From the Department of Radiology (J.A.H., P.W.S., J.M.R., J.D.R.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - P C Sanelli
- Department of Radiology (P.C.S.), Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - L Manchikanti
- Pain Management Center of Paducah (L.M.), Paducah, Kentucky Department of Anesthesiology and Perioperative Medicine (L.M.), University of Louisville, Louisville, Kentucky
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31
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Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. Lancet Neurol 2014; 13:393-404. [DOI: 10.1016/s1474-4422(14)70015-8] [Citation(s) in RCA: 341] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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32
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Kurki MI, Gaál EI, Kettunen J, Lappalainen T, Menelaou A, Anttila V, van 't Hof FNG, von und zu Fraunberg M, Helisalmi S, Hiltunen M, Lehto H, Laakso A, Kivisaari R, Koivisto T, Ronkainen A, Rinne J, Kiemeney LAL, Vermeulen SH, Kaunisto MA, Eriksson JG, Aromaa A, Perola M, Lehtimäki T, Raitakari OT, Salomaa V, Gunel M, Dermitzakis ET, Ruigrok YM, Rinkel GJE, Niemelä M, Hernesniemi J, Ripatti S, de Bakker PIW, Palotie A, Jääskeläinen JE. High risk population isolate reveals low frequency variants predisposing to intracranial aneurysms. PLoS Genet 2014; 10:e1004134. [PMID: 24497844 PMCID: PMC3907358 DOI: 10.1371/journal.pgen.1004134] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 12/10/2013] [Indexed: 11/18/2022] Open
Abstract
3% of the population develops saccular intracranial aneurysms (sIAs), a complex trait, with a sporadic and a familial form. Subarachnoid hemorrhage from sIA (sIA-SAH) is a devastating form of stroke. Certain rare genetic variants are enriched in the Finns, a population isolate with a small founder population and bottleneck events. As the sIA-SAH incidence in Finland is >2× increased, such variants may associate with sIA in the Finnish population. We tested 9.4 million variants for association in 760 Finnish sIA patients (enriched for familial sIA), and in 2,513 matched controls with case-control status and with the number of sIAs. The most promising loci (p<5E-6) were replicated in 858 Finnish sIA patients and 4,048 controls. The frequencies and effect sizes of the replicated variants were compared to a continental European population using 717 Dutch cases and 3,004 controls. We discovered four new high-risk loci with low frequency lead variants. Three were associated with the case-control status: 2q23.3 (MAF 2.1%, OR 1.89, p 1.42×10-9); 5q31.3 (MAF 2.7%, OR 1.66, p 3.17×10-8); 6q24.2 (MAF 2.6%, OR 1.87, p 1.87×10-11) and one with the number of sIAs: 7p22.1 (MAF 3.3%, RR 1.59, p 6.08×-9). Two of the associations (5q31.3, 6q24.2) replicated in the Dutch sample. The 7p22.1 locus was strongly differentiated; the lead variant was more frequent in Finland (4.6%) than in the Netherlands (0.3%). Additionally, we replicated a previously inconclusive locus on 2q33.1 in all samples tested (OR 1.27, p 1.87×10-12). The five loci explain 2.1% of the sIA heritability in Finland, and may relate to, but not explain, the increased incidence of sIA-SAH in Finland. This study illustrates the utility of population isolates, familial enrichment, dense genotype imputation and alternate phenotyping in search for variants associated with complex diseases.
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Affiliation(s)
- Mitja I. Kurki
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Neurobiology, A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland
- * E-mail:
| | - Emília Ilona Gaál
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Johannes Kettunen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Tuuli Lappalainen
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - Androniki Menelaou
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Verneri Anttila
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Analytical and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
| | - Femke N. G. van 't Hof
- UMC Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands
| | - Mikael von und zu Fraunberg
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Seppo Helisalmi
- Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikko Hiltunen
- Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Hanna Lehto
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Timo Koivisto
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Antti Ronkainen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Jaakko Rinne
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Lambertus A. L. Kiemeney
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Sita H. Vermeulen
- Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Mari A. Kaunisto
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Johan G. Eriksson
- Folkhälsan Research Centre, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
- Department of Internal Medicine, Vasa Central Hospital, Vasa, Finland
- Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland
| | - Arpo Aromaa
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Markus Perola
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
- Estonian Genome Center, University of Tartu, Tartu, Estonia
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Olli T. Raitakari
- Department of Clinical Physiology and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku and Turku University Central Hospital, Turku, Finland
| | - Veikko Salomaa
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
| | - Murat Gunel
- Department of Neurosurgery, Department of Neurobiology and Department of Genetics, Program on Neurogenetics, Howard Hughes Medical Institute, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Emmanouil T. Dermitzakis
- Department of Genetic Medicine and Development, University of Geneva Medical School, Geneva, Switzerland
| | - Ynte M. Ruigrok
- UMC Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands
| | - Gabriel J. E. Rinkel
- UMC Utrecht Stroke Center, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, The Netherlands
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Juha Hernesniemi
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland
- Hjelt Institute, University of Helsinki, Helsinki, Finland
| | - Paul I. W. de Bakker
- Department of Medical Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
- Division of Genetics, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
- Analytical and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, Cambridge, Massachusetts, United States of America
- Department of Human Genetics, The Wellcome Trust Sanger Institute, Cambridge, United Kingdom
| | - Juha E. Jääskeläinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Factors affecting formation and rupture of intracranial saccular aneurysms. Neurosurg Rev 2013; 37:1-14. [PMID: 24306170 DOI: 10.1007/s10143-013-0501-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/31/2013] [Accepted: 08/11/2013] [Indexed: 01/19/2023]
Abstract
Unruptured intracranial aneurysms represent a decisional challenge. Treatment risks have to be balanced against an unknown probability of rupture. A better understanding of the physiopathology is the basis for a better prediction of the natural history of an individual patient. Knowledge about the possible determining factors arises from a careful comparison between ruptured versus unruptured aneurysms and from the prospective observation and analysis of unbiased series with untreated, unruptured aneurysms. The key point is the correct identification of the determining variables for the fate of a specific aneurysm in a given individual. Thus, the increased knowledge of mechanisms of formation and eventual rupture of aneurysms should provide significant clues to the identification of rupture-prone aneurysms. Factors like structural vessel wall defects, local hemodynamic stress determined also by peculiar geometric configurations, and inflammation as trigger of a wall remodeling are crucial. In this sense the study of genetic modifiers of inflammatory responses together with the computational study of the vessel tree might contribute to identify aneurysms prone to rupture. The aim of this article is to underline the value of a unifying hypothesis that merges the role of geometry, with that of hemodynamics and of genetics as concerns vessel wall structure and inflammatory pathways.
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Perioperative variables contributing to the rupture of intracranial aneurysm: an update. ScientificWorldJournal 2013; 2013:396404. [PMID: 24324371 PMCID: PMC3845728 DOI: 10.1155/2013/396404] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 09/11/2013] [Indexed: 11/17/2022] Open
Abstract
Background. Perioperative aneurysm rupture (PAR) is one of the most dreaded complications of intracranial aneurysms, and approximately 80% of nontraumatic SAHs are related to such PAR aneurysms. The literature is currently scant and even controversial regarding the issues of various contributory factors on different phases of perioperative period. Thus this paper highlights the current understanding of various risk factors, variables, and outcomes in relation to PAR and try to summarize the current knowledge. Method. We have performed a PubMed search (1 January 1991–31 December 2012) using search terms including “cerebral aneurysm,” “intracranial aneurysm,” and “intraoperative/perioperative rupture.” Results. Various risk factors are summarized in relation to different phases of perioperative period and their relationship with outcome is also highlighted. There exist many well-known preoperative variables which are responsible for the highest percentage of PAR. The role of other variables in the intraoperative/postoperative period is not well known; however, these factors may have important contributory roles in aneurysm rupture. Preoperative variables mainly include natural course (age, gender, and familial history) as well as the pathophysiological factors (size, type, location, comorbidities, and procedure). Previously ruptured aneurysm is associated with rupture in all the phases of perioperative period. On the other hand intraoperative/postoperative variables usually depend upon anesthesia and surgery related factors. Intraoperative rupture during predissection phase is associated with poor outcome while intraoperative rupture at any step during embolization procedure imposes poor outcome. Conclusion. We have tried to create such an initial categorization but know that we cannot scale according to its clinical importance. Thorough understanding of various risk factors and other variables associated with PAR will assist in better clinical management as well as patient care in this group and will give insight into the development and prevention of such a catastrophic complication in these patients.
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Mangiafico S, Guarnieri G, Consoli A, Ambrosanio G, Muto M. Endovascular strategy for unruptured cerebral aneurysms. Eur J Radiol 2013; 82:1638-45. [DOI: 10.1016/j.ejrad.2012.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 11/02/2012] [Indexed: 11/24/2022]
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Sadasivan C, Fiorella DJ, Woo HH, Lieber BB. Physical factors effecting cerebral aneurysm pathophysiology. Ann Biomed Eng 2013; 41:1347-65. [PMID: 23549899 DOI: 10.1007/s10439-013-0800-z] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 03/21/2013] [Indexed: 12/21/2022]
Abstract
Many factors that are either blood-, wall-, or hemodynamics-borne have been associated with the initiation, growth, and rupture of intracranial aneurysms. The distribution of cerebral aneurysms around the bifurcations of the circle of Willis has provided the impetus for numerous studies trying to link hemodynamic factors (flow impingement, pressure, and/or wall shear stress) to aneurysm pathophysiology. The focus of this review is to provide a broad overview of such hemodynamic associations as well as the subsumed aspects of vascular anatomy and wall structure. Hemodynamic factors seem to be correlated to the distribution of aneurysms on the intracranial arterial tree and complex, slow flow patterns seem to be associated with aneurysm growth and rupture. However, both the prevalence of aneurysms in the general population and the incidence of ruptures in the aneurysm population are extremely low. This suggests that hemodynamic factors and purely mechanical explanations by themselves may serve as necessary, but never as necessary and sufficient conditions of this disease's causation. The ultimate cause is not yet known, but it is likely an additive or multiplicative effect of a handful of biochemical and biomechanical factors.
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Affiliation(s)
- Chander Sadasivan
- Department of Neurological Surgery, Stony Brook University Medical Center, 100 Nicolls Road, HSC T12, Room 080, Stony Brook, NY 11794-8122, USA
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Caranci F, Briganti F, Cirillo L, Leonardi M, Muto M. Epidemiology and genetics of intracranial aneurysms. Eur J Radiol 2013; 82:1598-605. [PMID: 23399038 DOI: 10.1016/j.ejrad.2012.12.026] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 12/16/2012] [Accepted: 12/17/2012] [Indexed: 11/18/2022]
Abstract
Intracranial aneurysms are acquired lesions (5-10% of the population), a fraction of which rupture leading to subarachnoid hemorrhage with devastating consequences. Until now, the exact etiology of intracranial aneurysms formation remains unclear. The low incidence of subarachnoid hemorrhage in comparison with the prevalence of unruptured IAs suggests that the vast majority of intracranial aneurysms do not rupture and that identifying those at highest risk is important in defining the optimal management. The most important factors predicting rupture are aneurysm size and site. In addition to ambiental factors (smoking, excessive alcohol consumption and hypertension), epidemiological studies have demonstrated a familiar influence contributing to the pathogenesis of intracranial aneurysms, with increased frequency in first- and second-degree relatives of people with subarachnoid hemorrhage. In comparison to sporadic aneurysms, familial aneurysms tend to be larger, more often located at the middle cerebral artery, and more likely to be multiple. Other than familiar occurrence, there are several heritable conditions associated with intracranial aneurysm formation, including autosomal dominant polycystic kidney disease, neurofibromatosis type I, Marfan syndrome, multiple endocrine neoplasia type I, pseudoxanthoma elasticum, hereditary hemorrhagic telangiectasia, and Ehlers-Danlos syndrome type II and IV. The familial occurrence and the association with heritable conditions indicate that genetic factors may play a role in the development of intracranial aneurysms. Genome-wide linkage studies in families and sib pairs with intracranial aneurysms have identified several loci on chromosomes showing suggestive evidence of linkage, particularly on chromosomes 1p34.3-p36.13, 7q11, 19q13.3, and Xp22. For the loci on 1p34.3-p36.13 and 7q11, a moderate positive association with positional candidate genes has been demonstrated (perlecan gene, elastin gene, collagen type 1 A2 gene). Moreover, 3 of the polymorphisms analyzed in 2 genes (endothelial nitric oxide synthase T786C, interleukin-6 G572C, and interleukin-6 G174C) were found to be significantly associated with ruptured/unruptured aneurysms: the endothelial nitric oxide synthase gene single-nucleotide polymorphisms increased the risk, while IL-6 G174C seemed protective. More recently, two genomic loci (endothelin receptor A and cyclin-dependent kinase inhibitor 2BAS) have been found to be significantly associated with intracranial aneurysms in the Japanese population; endothelin-1 is a potent vasoconstrictor produced by the endothelial cells. Until now, there are no diagnostic tests for specific genetic risk factors to identify patients who are at a high risk of developing intracranial aneurysms. Knowledge of the genetic determinants may be useful in order to allow clues on stopping aneurysm formation and obtain diagnostic tools for identifying individuals at increased risk. Further multicenter studies have to be carried out.
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Affiliation(s)
- F Caranci
- Unit of Neuroradiology, Department of Diagnostic Radiology and Radiotherapy, Federico II University, Naples, Italy.
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