Risk factors for the formation of multiple intracranial aneurysms

2001 ◽  
Vol 94 (5) ◽  
pp. 728-732 ◽  
Author(s):  
Habib E. Ellamushi ◽  
Joan P. Grieve ◽  
H. Rolf Jäger ◽  
Neil D. Kitchen
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Cigarette Smoking ◽  
Cerebrovascular Disease ◽  
Intracranial Aneurysms ◽  
Content Type ◽  
Multiple Aneurysms ◽  
Female Patients ◽  
History Of ◽  
Fine Print

Object. Several factors are known to increase the risk of subarachnoid hemorrhage (SAH) and spontaneous intracerebral hematoma. However, information on the roles of these same factors in the formation of multiple aneurysms is less well defined. The purpose of this study was to examine factors associated with an increased risk of multiple aneurysm formation. Methods. A retrospective review of the medical records of all patients with a diagnosis of SAH and intracranial aneurysms who were admitted to a single institution between 1985 and 1997 was undertaken. The authors examined associations between risk factors (patient age and sex, menopausal state of female patients, hypertension, cigarette smoking, alcohol consumption, history of cardiovascular disease or diabetes mellitus, and family history of cerebrovascular disease) and the presence of multiple aneurysms by using the Fisher exact test and logistic regression analysis. Of 400 patients admitted with a diagnosis of cerebral aneurysms, 392 were included in the study (287 women and 105 men). Two hundred eighty-four patients harbored a single aneurysm and 108 harbored multiple aneurysms (2 aneurysms in 68 patients, three aneurysms in 22 patients, four aneurysms in 13 patients, and five aneurysms in five patients). Conclusions. Statistical analysis revealed that, as opposed to the occurrence of a single aneurysm, there was a significant association between the presence of multiple aneurysms and hypertension (p < 0.001), cigarette smoking (p < 0.001), family history of cerebrovascular disease (p < 0.001), female sex (p < 0.001), and postmenopausal state in female patients (p < 0.001).

Dutch Normal-Pressure Hydrocephalus Study: the role of cerebrovascular disease

1999 ◽  
Vol 90 (2) ◽  
pp. 221-226 ◽  
Author(s):  
Agnita J. W. Boon ◽  
Joseph T. J. Tans ◽  
Ernst J. Delwel ◽  
Saskia M. Egeler-Peerdeman ◽  
Patrick W. Hanlo ◽  
...  
Keyword(s):  
Risk Factors ◽  
White Matter ◽  
Cerebrovascular Disease ◽  
Normal Pressure Hydrocephalus ◽  
Normal Pressure ◽  
Content Type ◽  
Shunt Placement ◽  
History Of ◽  
Intent To Treat ◽  
Fine Print

Object. This study was conducted to determine the prevalence of cerebrovascular disease and its risk factors among patients with normal-pressure hydrocephalus (NPH) and to assess the influence of these factors on the outcome of shunt placement.Methods. A cohort of 101 patients with NPH underwent shunt placement and was followed for 1 year. Gait disturbance and dementia were quantified using an NPH scale and handicap was determined using a modified Rankin scale (mRS). Primary outcome measures consisted of the differences between preoperative and last NPH scale and mRS scores. The presence of risk factors such as hypertension, diabetes mellitus, cardiac disease, peripheral vascular disease, male gender, and advancing age was recorded. Cerebrovascular disease was defined as a history of stroke or a computerized tomography (CT) scan revealing infarcts or moderate-to-severe white matter hypodense lesions.The prevalence of risk factors for cerebrovascular disease was higher in the 45 patients with cerebrovascular disease than the 56 without it. Risk factors did not influence outcome after shunt placement. Intent-to-treat analysis revealed that the mean improvement in the various scales was significantly less for patients with a history of stroke (14 patients), CT scans revealing infarctions (13), or white matter hypodense lesions (32 patients) than for those without cerebrovascular disease. The proportion of patients who responded to shunt placement was also significantly lower among patients with than those without cerebrovascular disease (p = 0.02).Conclusions. The authors identified a subgroup of patients with NPH and cerebrovascular disease who showed disappointing results after shunt placement. Cerebrovascular disease was an important predictor of poor outcome.

Rupture of intracranial aneurysms during treatment with Guglielmi detachable coils: incidence, outcome, and risk factors

2001 ◽  
Vol 94 (2) ◽  
pp. 238-240 ◽  
Author(s):  
Menno Sluzewski ◽  
Job A. Bosch ◽  
Willem Jan van Rooij ◽  
Peter C. G. Nijssen ◽  
Douwe Wijnalda
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysms ◽  
Guglielmi Detachable Coils ◽  
Content Type ◽  
Occlusion Balloon ◽  
Aneurysm Size ◽  
Detachable Coils ◽  
History Of ◽  
Temporary Occlusion ◽  
Fine Print

Object. The aim of this study was to assess the incidence and outcome of procedure-related rupture of intracranial aneurysms in patients treated with Guglielmi detachable coils (GDCs) and to identify risk factors for this complication. Methods. Procedure-related rupture occurred in seven of 264 treated aneurysms in 239 consecutive patients. Aneurysm size, history of previous subarachnoid hemorrhage (SAH) caused by the treated aneurysm, timing of treatment after SAH, and the use of a temporary occlusion balloon in the seven procedures in which rupture occurred were compared with the remaining 257 procedures, and these findings were correlated with data from 13 studies in the literature, in which results of 2030 aneurysm treatments were reported. Conclusions. Procedure-related rupture of intracranial aneurysms during GDC treatment occurs in 2.5% of cases and is responsible for 1% of treatment-related deaths. Risk factors are as follows: small aneurysm size, previous SAH, and probably the use of a temporary occlusion balloon.

Current implications for the efficacy of noninvasive screening for occult intracranial aneurysms in patients with a family history of aneurysms

1995 ◽  
Vol 83 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Nancy A. Obuchowski ◽  
Michael T. Modic ◽  
Michele Magdinec
Keyword(s):  
Family History ◽  
Natural History ◽  
Life Expectancy ◽  
Intracranial Aneurysms ◽  
Positive Family History ◽  
Aneurysm Rupture ◽  
Average Life Expectancy ◽  
Content Type ◽  
Rupture Rate ◽  
History Of

✓ Although the technology exists for accurate noninvasive screening for intracranial aneurysms, the efficacy of screening depends on several key parameters of the natural history of aneurysms. Recent studies suggest that the prevalence of intracranial aneurysms may reach 20% in the subpopulation of patients with a family history of these lesions; other key parameters are less certain. The authors investigated factors that impact the efficacy of screening to establish interim guidelines. Three plausible models for the natural history of aneurysms were constructed. For each model the monetary cost of screening and the average gain in life expectancy were computed for a range of screening ages and prevalence rates. It is shown that the efficacy of screening depends on the pattern of aneurysm rupture. If aneurysms develop and rupture rapidly, then screening has no benefit. On the other hand, if aneurysms remain at risk for some time after formation, then screening may improve average life expectancy depending on when it occurs. The authors recommend that patients with a positive family history of aneurysms who are 30 years of age or younger be screened. This recommendation is based on the belief that the gains attributable to screening, assuming a constant rupture rate, outweigh the losses attributable to screening using a decreasing rupture rate model.

Natural history of unruptured intracranial aneurysms: probability of and risk factors for aneurysm rupture

2000 ◽  
Vol 93 (3) ◽  
pp. 379-387 ◽  
Author(s):  
Seppo Juvela ◽  
Matti Porras ◽  
Kristiina Poussa
Keyword(s):  
Risk Factors ◽  
Smoking Status ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Aneurysm Rupture ◽  
Content Type ◽  
Unruptured Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Fine Print

Object. The authors conducted a study to investigate the long-term natural history of unruptured intracranial aneurysms and the predictive risk factors determining subsequent rupture in a patient population in which surgical selection of cases was not performed.Methods. One hundred forty-two patients with 181 unruptured aneurysms were followed from the 1950s until death or the occurrence of subarachnoid hemorrhage or until the years 1997 to 1998. The annual and cumulative incidence of aneurysm rupture as well as several potential risk factors predictive of rupture were studied using life-table analyses and Cox's proportional hazards regression models including time-dependent covariates.The median follow-up time was 19.7 years (range 0.8–38.9 years). During 2575 person-years of follow up, there were 33 first-time episodes of hemorrhage from previously unruptured aneurysms, for an average annual incidence of 1.3%. In 17 patients, hemorrhage led to death. The cumulative rate of bleeding was 10.5% at 10 years, 23% at 20 years, and 30.3% at 30 years after diagnosis. The diameter of the unruptured aneurysm (relative risk [RR] 1.11 per mm in diameter, 95% confidence interval [CI] 1–1.23, p = 0.05) and patient age at diagnosis inversely (RR 0.97 per year, 95% CI 0.93–1, p = 0.05) were significant independent predictors for a subsequent aneurysm rupture after adjustment for sex, hypertension, and aneurysm group. Active smoking status at the time of diagnosis was a significant risk factor for aneurysm rupture (RR 1.46, 95% CI 1.04–2.06, p = 0.033) after adjustment for size of the aneurysm, patient age, sex, presence of hypertension, and aneurysm group. Active smoking status as a time-dependent covariate was an even more significant risk factor for aneurysm rupture (adjusted RR 3.04, 95% CI 1.21–7.66, p = 0.02).Conclusions. Cigarette smoking, size of the unruptured intracranial aneurysm, and age, inversely, are important factors determining risk for subsequent aneurysm rupture. The authors conclude that such unruptured aneurysms should be surgically treated regardless of their size and of a patient's smoking status, especially in young and middle-aged adults, if this is technically possible and if the patient's concurrent diseases are not contraindications. Cessation of smoking may also be a good alternative to surgery in older patients with small-sized aneurysms.

Long-term natural history of hemorrhagic type moyamoya disease in 42 patients

2000 ◽  
Vol 93 (6) ◽  
pp. 976-980 ◽  
Author(s):  
Eiichi Kobayashi ◽  
Naokatsu Saeki ◽  
Hiromichi Oishi ◽  
Shinji Hirai ◽  
Akira Yamaura
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Moyamoya Disease ◽  
Bypass Surgery ◽  
Bleeding Episode ◽  
Content Type ◽  
History Of ◽  
Fine Print

Object. The purpose of this study was to delineate the long-term natural history of hemorrhagic moyamoya disease (MMD).Methods. A retrospective review was conducted among 42 patients suffering from hemorrhagic MMD who had been treated conservatively without bypass surgery. The group included four patients who had undergone indirect bypass surgery after an episode of rebleeding. The follow-up period averaged 80.6 months. The clinical features of the first bleeding episode and repeated bleeding episodes were analyzed to determine the risk factors of rebleeding and poor outcome.Intraventricular hemorrhage with or without intracerebral hemorrhage was a dominant finding on computerized tomography scans during the first bleeding episode in 29 cases (69%). During the follow-up period, 14 patients experienced a second episode of bleeding, which occurred 10 years or longer after the original hemorrhage in five cases (35.7%). The annual rebleeding rate was 7.09%/person/year. The second bleeding episode was characterized by a change in which hemisphere bleeding occurred in three cases (21.4%) and by the type of bleeding in seven cases (50%). After rebleeding the rate of good recovery fell from 45.5% to 21.4% and the mortality rate rose from 6.8% to 28.6%. Rebleeding and patient age were statistically significant risk factors of poor outcome. All four patients in whom there was indirect revascularization after the second bleeding episode experienced a repeated bleeding episode within 8 years.Conclusions. The occurrence of rebleeding a long time after the first hemorrhagic episode was not uncommon. Furthermore, the change in which hemisphere and the type of bleeding that occurred after the first episode suggested the difficulty encountered in the prevention of repeated hemorrhage.

Spinal arterial malformation in a child with hereditary hemorrhagic telangiectasia

1976 ◽  
Vol 44 (5) ◽  
pp. 613-616 ◽  
Author(s):  
Glen S. Merry ◽  
D. Barry Appleton
Keyword(s):  
Spinal Cord ◽  
Family History ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Cauda Equina ◽  
Content Type ◽  
Cauda Equina Compression ◽  
History Of ◽  
Spinal Aneurysm ◽  
Arterial Malformation ◽  
Fine Print

✓ A case is reported of spinal aneurysm in a child with a family history of hereditary hemorrhagic telangiectasia causing spinal cord and cauda equina compression. The operative approach is discussed.

Familial aneurysmal subarachnoid hemorrhage: a community-based study

1995 ◽  
Vol 83 (3) ◽  
pp. 426-429 ◽  
Author(s):  
Wouter I. Schievink ◽  
Daniel J. Schaid ◽  
Virginia V. Michels ◽  
David G. Piepgras
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Family History ◽  
Intracranial Aneurysms ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Familial Aggregation ◽  
Familial Occurrence ◽  
Content Type ◽  
First Degree Relatives ◽  
Increased Risk ◽  
Fine Print

✓ The familial occurrence of intracranial aneurysms has been well described. However, intracranial aneurysms are not rare and the great majority of reported families consist of only two affected members. Therefore, the familial aggregation of intracranial aneurysms could be fortuitous. The authors investigated the familial occurrence of aneurysmal subarachnoid hemorrhage (SAH) in their community to determine whether family members of patients with a ruptured aneurysm are at an increased risk of developing an SAH. All 81 patients from Rochester, Minnesota, who suffered an SAH between 1970 and 1989 from a proven aneurysmal rupture were identified, and they or their families were contacted and a family history was obtained. The number of expected SAHs among first-degree relatives was calculated using previously established age- and sex-specific incidence rates in the community of Rochester. Of the 81 index patients, 76 had complete follow up for family history. Fifteen (20%) of these 76 patients had a first- or second-degree relative with aneurysmal SAH. The number of observed first-degree relatives with aneurysmal SAH was 11, compared to an expected number of 2.66, giving a relative risk of 4.14 (95% confidence interval 2.06–7.40; p < 0.001). In the authors' community, aneurysmal SAH was familial in one of five patients, and this familial aggregation was not fortuitous. The increase in familial risk of aneurysmal SAH is approximately fourfold among first-degree relatives.

Intracranial aneurysms

1979 ◽  
Vol 51 (1) ◽  
pp. 27-32 ◽  
Author(s):  
Russell J. Andrews ◽  
Peter K. Spiegel
Keyword(s):  
Intracranial Aneurysms ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Male And Female ◽  
Content Type ◽  
Multiple Aneurysms ◽  
The Individual ◽  
Undetermined Etiology ◽  
Fine Print

✓ All cases of intracranial aneurysm, arteriovenous malformation, and subarachnoid hemorrhage of undetermined etiology seen at one hospital over a 13-year period were reviewed to assess relationships between age, sex, systolic and diastolic blood pressure, and number of aneurysms. There were 350 patients, of whom 212 had aneurysms. The major findings were as follows: 1) Hypertension was not significantly more prevalent in the aneurysm population than in the age-matched general population, except for females aged 18 to 54 years (systolic pressure elevation of 10 to 15 mm Hg). 2) Under 55 years of age, both male and female hypertensive patients were twice as likely to have multiple aneurysms as normotensive patients. 3) Females were more likely than males to have multiple aneurysms. 4) For females but not males, increasing age, higher systolic pressure, and higher diastolic pressure all correlated with an increasing number of aneurysms. Hypertension appears to be more prevalent in certain subgroups of the total aneurysm population, although the individual relationships between hypertension, atherosclerosis, and aneurysms cannot be determined from either the present or previous studies. The possible role of familial factors, as well as implications for both diagnosis and further research, are briefly noted.

Extracranial—intracranial bypass in the treatment of occlusive cerebrovascular disease and intracranial aneurysms in the United States between 1992 and 2001: a population-based study

2005 ◽  
Vol 103 (5) ◽  
pp. 794-804 ◽  
Author(s):  
Sepideh Amin-Hanjani ◽  
William E. Butler ◽  
Christopher S. Ogilvy ◽  
Bob S. Carter ◽  
Fred G. Barker
Keyword(s):  
Mortality Rate ◽  
Cerebrovascular Disease ◽  
Intracranial Aneurysms ◽  
Mortality Rates ◽  
Population Based ◽  
Annual Number ◽  
Content Type ◽  
Bypass Procedure ◽  
The Us ◽  
Fine Print

Object. The authors assessed the results of extracranial—intracranial (EC—IC) bypass surgery in the treatment of occlusive cerebrovascular disease and intracranial aneurysms in the US between 1992 and 2001 by using population-based methods. Methods. This is a retrospective cohort study based on data from the Nationwide Inpatient Sample (Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality, Rockville, MD). Five hundred fifty-eight operations were performed at 158 hospitals by 115 identified surgeons. The indications for surgery were cerebral ischemia in 74% of the operations (2.4% mortality rate), unruptured aneurysms in 19% of the operations (7.7% mortality rate), and ruptured aneurysms in 7% of the operations (21% mortality rate). Overall, 4.6% of the patients died and 4.7% of the patients were discharged to long-term facilities, 16.4% to short-term facilities, and 74.2% to their homes. The annual number of admissions in the US increased from 190 per year (1992–1996) to 360 per year (1997–2001), whereas the mortality rates increased from 2.8% (1992–1996) to 5.7% (1997–2001). The median annual number of procedures was three per hospital (range one–27 operations) or two per surgeon (range one–21 operations). For 29% of patients, their bypass procedure was the only one recorded at their particular hospital during that year; for these institutions the mean annual caseload was 0.4 admissions per year. For 42% of patients, their particular surgeon performed no other bypass procedure during that year. Older patient age (p < 0.001) and African-American race (p = 0.005) were risk factors for adverse outcome. In a multivariate analysis in which adjustments were made for age, sex, race, diagnosis, admission type, geographic region, medical comorbidity, and year of surgery, high-volume hospitals less frequently had an adverse discharge disposition (odds ratio 0.54, p = 0.03). Conclusions. Most EC—IC bypasses performed in the US during the last decade were performed for occlusive cerebrovascular disease. Community mortality rates for aneurysm treatment including bypass procedures currently exceed published values from specialized centers and, during the period under study, the mortality rates increased with time for all diagnostic subgroups. This technically demanding procedure has become a very low-volume operation at most US centers.

Enlargement of small, asymptomatic, unruptured intracranial aneurysms in patients with no history of subarachnoid hemorrhage: the different factors related to the growth of single and multiple aneurysms

2013 ◽  
Vol 119 (1) ◽  
pp. 190-197 ◽  
Author(s):  
Aichi Chien ◽  
Feng Liang ◽  
James Sayre ◽  
Noriko Salamon ◽  
Pablo Villablanca ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracranial Aneurysms ◽  
Posterior Circulation ◽  
Unruptured Aneurysms ◽  
Multiple Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
History Of ◽  
Aneurysm Growth ◽  
Small Aneurysms

Object This study was performed to investigate the risk factors related to the growth of small, asymptomatic, unruptured aneurysms in patients with no history of subarachnoid hemorrhage (SAH). Methods Between January 2005 and December 2010, a total of 508 patients in whom unruptured intracranial aneurysms were diagnosed at the University of California, Los Angeles medical center did not receive treatment to prevent rupture. Of these, 235 patients with no history of SAH who had asymptomatic, small, unruptured aneurysms (< 7 mm) were monitored with 3D CT angiography images. Follow-up images of the lesions were used to measure aneurysm size changes. Patient medical history, family history of SAH, aneurysm size, and location were studied to find the risk factors associated with small aneurysm growth. Results A total of 319 small aneurysms were included, with follow-up durations of 29.2 ± 20.6 months. Forty-two aneurysms increased in size during the follow-up; 5 aneurysms grew to become ≥ 7 mm within 38.2 ± 18.3 months. A trend of higher growth rates was found in single aneurysms than in multiple aneurysms (p = 0.07). A history of stroke was the only factor associated with single aneurysm growth (p = 0.03). The number of aneurysms (p = 0.011), number of aneurysms located within the posterior circulation (p = 0.030), and patient history of transient ischemic attack (p = 0.044) were related to multiple aneurysm growth. Conclusions Multiple small aneurysms are more likely to grow, and multiple aneurysms located in the posterior circulation may require additional attention. Although single aneurysms have a lower risk of growth, a trend of higher growth rates in single aneurysms was found.

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