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Kanning JP, van Os HJA, Rakers M, Wermer MJH, Geerlings MI, Ruigrok YM. Prediction of aneurysmal subarachnoid hemorrhage in comparison with other stroke types using routine care data. PLoS One 2024; 19:e0303868. [PMID: 38820263 PMCID: PMC11142441 DOI: 10.1371/journal.pone.0303868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 05/01/2024] [Indexed: 06/02/2024] Open
Abstract
Aneurysmal subarachnoid hemorrhage (aSAH) can be prevented by early detection and treatment of intracranial aneurysms in high-risk individuals. We investigated whether individuals at high risk of aSAH in the general population can be identified by developing an aSAH prediction model with electronic health records (EHR) data. To assess the aSAH model's relative performance, we additionally developed prediction models for acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) and compared the discriminative performance of the models. We included individuals aged ≥35 years without history of stroke from a Dutch routine care database (years 2007-2020) and defined outcomes aSAH, AIS and ICH using International Classification of Diseases (ICD) codes. Potential predictors included sociodemographic data, diagnoses, medications, and blood measurements. We cross-validated a Cox proportional hazards model with an elastic net penalty on derivation cohorts and reported the c-statistic and 10-year calibration on validation cohorts. We examined 1,040,855 individuals (mean age 54.6 years, 50.9% women) for a total of 10,173,170 person-years (median 11 years). 17,465 stroke events occurred during follow-up: 723 aSAH, 14,659 AIS, and 2,083 ICH. The aSAH model's c-statistic was 0.61 (95%CI 0.57-0.65), which was lower than the c-statistic of the AIS (0.77, 95%CI 0.77-0.78) and ICH models (0.77, 95%CI 0.75-0.78). All models were well-calibrated. The aSAH model identified 19 predictors, of which the 10 strongest included age, female sex, population density, socioeconomic status, oral contraceptive use, gastroenterological complaints, obstructive airway medication, epilepsy, childbirth complications, and smoking. Discriminative performance of the aSAH prediction model was moderate, while it was good for the AIS and ICH models. We conclude that it is currently not feasible to accurately identify individuals at increased risk for aSAH using EHR data.
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Affiliation(s)
- Jos P. Kanning
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hendrikus J. A. van Os
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Public Health & Primary Care and National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Margot Rakers
- Department of Public Health & Primary Care and National eHealth Living Lab, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke J. H. Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Mirjam I. Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of General Practice, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later life, and Personalized Medicine, Amsterdam, The Netherlands
- Amsterdam Neuroscience, Neurodegeneration, and Mood, Anxiety, Psychosis, Stress, and Sleep, Amsterdam, The Netherlands
| | - Ynte M. Ruigrok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Dravid A, Sung WS, Song J, Dubey A, Eftekhar B. Subarachnoid Haemorrhage Incidence Pattern Analysis with Circular Statistics. Emerg Med Int 2024; 2024:6631990. [PMID: 38655008 PMCID: PMC11039014 DOI: 10.1155/2024/6631990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/27/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
Knowledge about biological rhythms of diseases may not only help in understanding the pathophysiology of diseases but can also help health service policy makers and emergency department directors to allocate resources efficiently. Aneurysmal subarachnoid haemorrhage (SAH) has high rates of morbidity and mortality. The incidence of SAH has been attributed to patient-related factors such as characteristics of aneurysms, smoking, and hypertension. There are studies showing that the incidence of aneurysmal SAH appears to behave in periodic fashions over long time periods. However, there are inconsistencies in the literature regarding the impact of chronobiological factors such as circadian, seasonal, and lunar cycle factors on the occurrence of SAH. In this study, we focused on the analysis of a temporal pattern of SAH (infradian rhythms) with a novel approach using circular statistical methods. We aimed to see whether there is a circular pattern for the occurrence of SAH at all and if so, whether it can be related to known temporal patterns based on available literature. Our study did not support the notion that aneurysmal subarachnoid haemorrhages occur on any specific day in a cycle with specific lengths up to 365 days including specific weekdays, full moon, equinoxes, and solstices. Hence, we found no relationship between SAH incidence and timing. Study in larger populations using similar circular statistical methods is suggested.
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Affiliation(s)
- Ashish Dravid
- Department of Neurosurgery, Nepean Hospital, The University of Sydney, Sydney, Australia
| | - Wen-Shan Sung
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Australia
| | - Jeeuk Song
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Australia
| | - Arvind Dubey
- Department of Neurosurgery, Royal Hobart Hospital, Hobart, Australia
| | - Behzad Eftekhar
- Department of Neurosurgery, Nepean Hospital, The University of Sydney, Sydney, Australia
- Department of Neurosurgery, Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
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3
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Rahbari-Oskoui FF. Management of Hypertension and Associated Cardiovascular Disease in Autosomal Dominant Polycystic Kidney Disease. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:417-428. [PMID: 38097332 DOI: 10.1053/j.akdh.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/02/2023] [Accepted: 03/15/2023] [Indexed: 12/18/2023]
Abstract
Autosomal dominant polycystic kidney disease is the most commonly inherited disease of the kidneys affecting an estimated 12,000,000 people in the world. Autosomal dominant polycystic kidney disease is a systemic disease, with a wide range of associated features that includes hypertension, valvular heart diseases, cerebral aneurysms, aortic aneurysms, liver cysts, abdominal hernias, diverticulosis, gross hematuria, urinary tract infections, nephrolithiasis, pancreatic cysts, and seminal vesicle cysts. The cardiovascular anomalies are somewhat different than in the general population and also chronic kidney disease population, with higher morbidity and mortality rates. This review will focus on cardiovascular diseases associated with autosomal dominant polycystic kidney disease and their management.
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Affiliation(s)
- Frederic F Rahbari-Oskoui
- Director of the PKD Center of Excellence, Department of Medicine-Renal Division, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA.
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4
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Hankeova S, Van Hul N, Laznovsky J, Verboven E, Mangold K, Hensens N, Adori C, Verhoef E, Zikmund T, Dawit F, Kavkova M, Salplachta J, Sjöqvist M, Johansson BR, Hassan MG, Fredriksson L, Baumgärtel K, Bryja V, Lendahl U, Jheon A, Alten F, Fahnehjelm KT, Fischler B, Kaiser J, Andersson ER. Sex differences and risk factors for bleeding in Alagille syndrome. EMBO Mol Med 2022; 14:e15809. [PMID: 36345711 PMCID: PMC9728057 DOI: 10.15252/emmm.202215809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 09/27/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022] Open
Abstract
Spontaneous bleeds are a leading cause of death in the pediatric JAG1-related liver disease Alagille syndrome (ALGS). We asked whether there are sex differences in bleeding events in patients, whether Jag1Ndr/Ndr mice display bleeds or vascular defects, and whether discovered vascular pathology can be confirmed in patients non-invasively. We performed a systematic review of patients with ALGS and vascular events following PRISMA guidelines, in the context of patient sex, and found significantly more girls than boys reported with spontaneous intracranial hemorrhage. We investigated vascular development, homeostasis, and bleeding in Jag1Ndr/Ndr mice, using retina as a model. Jag1Ndr/Ndr mice displayed sporadic brain bleeds, a thin skull, tortuous blood vessels, sparse arterial smooth muscle cell coverage in multiple organs, which could be aggravated by hypertension, and sex-specific venous defects. Importantly, we demonstrated that retinographs from patients display similar characteristics with significantly increased vascular tortuosity. In conclusion, there are clinically important sex differences in vascular disease in ALGS, and retinography allows non-invasive vascular analysis in patients. Finally, Jag1Ndr/Ndr mice represent a new model for vascular compromise in ALGS.
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Affiliation(s)
- Simona Hankeova
- Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden,Department of Experimental BiologyMasaryk UniversityBrnoCzech Republic
| | - Noemi Van Hul
- Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
| | - Jakub Laznovsky
- CEITEC – Central European Institute of TechnologyBrno University of TechnologyBrnoCzech Republic
| | - Elisabeth Verboven
- Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
| | - Katrin Mangold
- Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
| | - Naomi Hensens
- Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden,University of Applied Sciences UtrechtUtrechtThe Netherlands
| | - Csaba Adori
- Department of NeuroscienceKarolinska InstitutetStockholmSweden
| | - Elvira Verhoef
- Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden,University of Applied Sciences UtrechtUtrechtThe Netherlands
| | - Tomas Zikmund
- CEITEC – Central European Institute of TechnologyBrno University of TechnologyBrnoCzech Republic
| | - Feven Dawit
- Department of Pediatrics, Clinical Science, Intervention and Technology (CLINTEC)Karolinska Institutet and Karolinska University HospitalHuddingeSweden
| | - Michaela Kavkova
- CEITEC – Central European Institute of TechnologyBrno University of TechnologyBrnoCzech Republic
| | - Jakub Salplachta
- CEITEC – Central European Institute of TechnologyBrno University of TechnologyBrnoCzech Republic
| | - Marika Sjöqvist
- Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
| | - Bengt R Johansson
- EM Unit, Institute of BiomedicineUniversity of GothenburgGothenburgSweden
| | - Mohamed G Hassan
- University of San FranciscoSan FranciscoCAUSA,Department of OrthodonticsFaculty of DentistryAssiut UniversityAssiutEgypt
| | - Linda Fredriksson
- Department of Medical Biochemistry and BiophysicsKarolinska InstitutetStockholmSweden
| | | | - Vitezslav Bryja
- Department of Experimental BiologyMasaryk UniversityBrnoCzech Republic
| | - Urban Lendahl
- Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
| | | | - Florian Alten
- Department of OphthalmologyUniversity of Muenster Medical CenterMünsterGermany
| | - Kristina Teär Fahnehjelm
- Department of Pediatric Ophthalmology, Strabismus, Electrophysiology and Ocular Oncology, St. Erik Eye HospitalKarolinska InstitutetStockholmSweden,Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden
| | - Björn Fischler
- Department of Pediatrics, Clinical Science, Intervention and Technology (CLINTEC)Karolinska Institutet and Karolinska University HospitalHuddingeSweden
| | - Jozef Kaiser
- CEITEC – Central European Institute of TechnologyBrno University of TechnologyBrnoCzech Republic
| | - Emma R Andersson
- Department of Cell and Molecular BiologyKarolinska InstitutetStockholmSweden
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Abstract
Subarachnoid haemorrhage (SAH) is the third most common subtype of stroke. Incidence has decreased over past decades, possibly in part related to lifestyle changes such as smoking cessation and management of hypertension. Approximately a quarter of patients with SAH die before hospital admission; overall outcomes are improved in those admitted to hospital, but with elevated risk of long-term neuropsychiatric sequelae such as depression. The disease continues to have a major public health impact as the mean age of onset is in the mid-fifties, leading to many years of reduced quality of life. The clinical presentation varies, but severe, sudden onset of headache is the most common symptom, variably associated with meningismus, transient or prolonged unconsciousness, and focal neurological deficits including cranial nerve palsies and paresis. Diagnosis is made by CT scan of the head possibly followed by lumbar puncture. Aneurysms are commonly the underlying vascular cause of spontaneous SAH and are diagnosed by angiography. Emergent therapeutic interventions are focused on decreasing the risk of rebleeding (ie, preventing hypertension and correcting coagulopathies) and, most crucially, early aneurysm treatment using coil embolisation or clipping. Management of the disease is best delivered in specialised intensive care units and high-volume centres by a multidisciplinary team. Increasingly, early brain injury presenting as global cerebral oedema is recognised as a potential treatment target but, currently, disease management is largely focused on addressing secondary complications such as hydrocephalus, delayed cerebral ischaemia related to microvascular dysfunction and large vessel vasospasm, and medical complications such as stunned myocardium and hospital acquired infections.
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Affiliation(s)
- Jan Claassen
- Department of Neurology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA.
| | - Soojin Park
- Department of Neurology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
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Uhl C, Huscher D, Sommerfeld J, Schönberg B, Vajkoczy P, Dengler NF. Aneurysmal subarachnoid hemorrhage in Germany between 2005 and 2018: a nationwide observational study. Eur J Neurol 2022; 29:3009-3016. [PMID: 35726716 DOI: 10.1111/ene.15457] [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: 04/10/2022] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In recent decades, the global incidence of aneurysmal subarachnoid hemorrhage (aSAH) has declined. However, significant regional differences exist. We present the first comprehensive analysis of time trends in the incidence of aSAH and case fatality in Germany. METHODS All patients hospitalized with aSAH in Germany between 2005 and 2018 were identified using International classification of disease (ICD10) codes I60.0 to I60.7. RESULTS A total of 101,105 cases were included. The incidence of aSAH in Germany decreased at a mean annual rate of 0.5 % (p=0.003) from 8.9 per 100,000 population in 2005 to 8.2 in 2018. Over time, incidences of aSAH declined among patients younger than 55 years and patients aged 70-79 years, increased among ages 60-64 years and remained stable in age groups 65-69 and 85-89 years. This corresponded to an increase in the mean age of aSAH onset from 55.6 (±14.3) to 59.0 (±14.0) years. Throughout the study period, the mean age of aSAH onset was higher in women compared to men (58.3 ±14.4 years vs. 56.1 ±14.1 years). There were no changes in in-hospital case fatality (16.2 vs. 16.6%, p=0.18), but the duration of hospital stay increased significantly from 19.7 to 24.8 days (p<0.001). The most frequent aSAH associated aneurysm location was the anterior circulation throughout the entire study period. CONCLUSIONS In Germany, the incidence of aSAH decreased between 2005 and 2018, especially in younger parts of the population. This may reflect effects of lifestyle adjustments most pronounced in younger age groups.
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Affiliation(s)
- Christian Uhl
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Doerthe Huscher
- Department of Biometry and Clinical Epidemiology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Jenny Sommerfeld
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Benn Schönberg
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Vertebral Spine Center Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Nora F Dengler
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
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7
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Abstract
PURPOSE OF REVIEW Subarachnoid hemorrhage (SAH) remains an important cause of mortality and long-term morbidity. This article uses a case-based approach to guide readers through the fundamental epidemiology and pathogenesis of SAH, the approach to diagnosis and management, the results of clinical trials and evidence to date, prognostic considerations, controversies, recent developments, and future directions in SAH. RECENT FINDINGS Historically, management of SAH focused on prevention and treatment of subsequent cerebral vasospasm, which was thought to be the primary cause of delayed cerebral ischemia. Clinical and translational studies over the past decade, including several therapeutic phase 3 randomized clinical trials, suggest that the pathophysiology of SAH-associated brain injury is multiphasic and multifactorial beyond large vessel cerebral vasospasm. The quest to reduce SAH-associated brain injury and improve outcomes is shifting away from large vessel cerebral vasospasm to a new paradigm targeting multiple brain injury mechanisms, including early brain injury, delayed cerebral ischemia, microcirculatory dysfunction, spreading cortical depolarization, inflammation, and the brain-body interaction in vascular brain injury with critical illness.Despite multiple negative randomized clinical trials in search of potential therapeutic agents ameliorating the downstream effects after SAH, the overall outcome of SAH has improved over recent decades, likely related to improvements in interventional options for ruptured cerebral aneurysms and in critical care management. Emerging clinical evidence also suggests potential harmful impact of historic empiric treatments for SAH-associated vasospasm, such as prophylactic induction of hypertension, hypervolemia, and hemodilution (triple H therapy).With decreasing mortality, long-term SAH survivorship and efforts to reduce chronic morbidity and to improve quality of life and patient-centered outcome are growing areas of unmet need. Despite existing guidelines, significant variabilities in local and regional practices and in scientific terminologies have historically limited advancement in SAH care and therapeutic development. Large global collaborative efforts developed harmonized SAH common data elements in 2019, and studies are under way to examine how existing variabilities in SAH care impact long-term SAH outcomes. SUMMARY Although the overall incidence and mortality of SAH is decreasing with advances in preventive and acute care, SAH remains a major cause of long-term morbidity in survivors. Significant variabilities in care settings and empiric treatment protocols and inconsistent scientific terminologies have limited advancement in patient care and therapeutic clinical studies. Large consensus efforts are under way to introduce clinical guidelines and common data elements to advance therapeutic approaches and improve patient outcome.
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Løvik K, Laupsa-Borge J, Logallo N, Helland CA. Dyslipidemia and rupture risk of intracranial aneurysms-a systematic review. Neurosurg Rev 2021; 44:3143-3150. [PMID: 33704595 PMCID: PMC8593048 DOI: 10.1007/s10143-021-01515-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 01/09/2023]
Abstract
Dyslipidemia is a well-established risk factor for coronary artery disease. However, the effect on cerebral artery disease, and more specifically the rupture risk of intracranial aneurysms, is unclear and has not yet been reviewed. We therefore performed a systematic review to investigate associations between different types of dyslipidemia and incidence of aneurysmal subarachnoid hemorrhage (aSAH). We used the MEDLINE, Embase, and Web of Science databases to identify clinical trials that compared the rupture risk among SAH patients with or without dyslipidemia. The risk of bias in each included study was evaluated using the Critical Appraisal Skills Program (CASP). Of 149 unique citations from the initial literature search, five clinical trials with a case-control design met our eligibility criteria. These studies compared aSAH patients to patients with unruptured aneurysms and found an overall inverse relationship between hypercholesterolemia and rupture risk of intracranial aneurysms. The quality assessment classified all included studies as high risk of bias. The evidence indicates that hypercholesterolemia is associated with a reduced rupture risk of intracranial aneurysms. However, it is not clear whether this relation is due to the dyslipidemic condition itself or the use of antihyperlipidemic medication.
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Affiliation(s)
- Katja Løvik
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | | | - Nicola Logallo
- Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Christian A Helland
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurosurgery, Haukeland University Hospital, Bergen, Norway
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Golnari P, Nazari P, Garcia RM, Weiss H, Shaibani A, Hurley MC, Ansari SA, Potts MB, Jahromi BS. Volumes, outcomes, and complications after surgical versus endovascular treatment of aneurysms in the United States (1993–2015): continued evolution versus steady-state after more than 2 decades of practice. J Neurosurg 2021; 134:848-861. [DOI: 10.3171/2019.12.jns192755] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 12/02/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEAdoption of endovascular treatment (EVT) and other advances in aneurysm care have shifted practice patterns of cerebral aneurysm treatment over the past 2 decades in the US. The objective of this study was to determine whether resulting trends in volumes, outcomes, and complications have matured in general practice or continue to evolve.METHODSData were obtained from the National Inpatient Sample from 1993 to 2015. ICD-9 codes were used to estimate annual volumes, outcomes, and complications following treatment of ruptured and unruptured aneurysms. Univariate and multivariate analyses were used to estimate risk ratios for complications and outcomes. Trends in time were assessed utilizing annual percentage change (APC).RESULTSThe authors found a nearly 5-fold increase in annual admissions with diagnoses of unruptured aneurysms, whereas SAH volume increased less than 50%. Clipping ruptured aneurysms steadily declined (APC −0.86%, p = 0.69 until 1999, then −6.22%, p < 0.001 thereafter), whereas clipping unruptured aneurysms slightly increased (APC 2.02%, p < 0.001). EVT tripled in 2002–2004 and steadily increased thereafter (APC 7.22%, p < 0.001 and 5.85%, p = 0.01 for unruptured and ruptured aneurysms, respectively). Despite a 3-fold increase in both diagnosis and treatment of unruptured aneurysms, the incidence of SAH remained steady at 12 per 100,000 persons per year (APC 0.04%, p = 0.83). In contrast, SAH severity increased over time, as did patient age and comorbidities (all p < 0.001). SAH led to nonroutine discharge more frequently over time after both EVT and clipping (APC 1.24% and 1.10%, respectively), although mortality decreased during the same time (APC −2.48% and −1.44%, respectively). Complications were more frequent after clipping than EVT, but this differential risk diminished during the study period and was less perceptible in ruptured aneurysms. The proportion of patients discharged home after treatment of unruptured aneurysms was significantly lower (p < 0.001) after clipping (69.3%–79.5%) than EVT (88.3%–93.3%); both proportions changed minimally since 1998 (APC −0.39%, p = 0.02, and APC −0.11%, p = 0.14, respectively).CONCLUSIONSEVT volume markedly increased for ruptured and unruptured aneurysms from 1993 to 2015, whereas clipping decreased for ruptured and slightly increased for unruptured aneurysms. The incidence of SAH remained unchanged despite increased diagnosis and treatment of unruptured aneurysms. In ruptured aneurysms, SAH severity has increased over time, as have age, comorbidities, and nonroutine discharges. In contrast, routine discharge after treatment of unruptured aneurysms remains largely unchanged since 1998 and remains lower with clipping.
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Affiliation(s)
- Pedram Golnari
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Pouya Nazari
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Ali Shaibani
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael C. Hurley
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sameer A. Ansari
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew B. Potts
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Babak S. Jahromi
- Departments of 1Neurological Surgery and
- 2Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Heritability of territory of ruptured and unruptured intracranial aneurysms in families. PLoS One 2020; 15:e0236714. [PMID: 32745108 PMCID: PMC7398535 DOI: 10.1371/journal.pone.0236714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/11/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND A previous study suggested that intracranial aneurysms are more likely to occur in the same arterial territory within families. We aimed to replicate this analysis in independent families and in a sample limited to intracranial aneurysms that ruptured. METHODS Among families with ≥2 first-degree relatives with intracranial aneurysms, we randomly matched index families to comparison families, and compared concordance in intracranial aneurysm territory between index and comparison families using a conditional logistic events/trials model. We analyzed three European cohorts separately, and pooled the results with those of the Familial Intracranial Aneurysm study by performing an inverse variance fixed effects meta-analysis. The main analysis included both unruptured and ruptured intracranial aneurysms, and a secondary analysis only ruptured intracranial aneurysms. RESULTS Among 70 Dutch, 142 Finnish, and 34 French families, concordance regarding intracranial aneurysm territory was higher within families than between families, although not statistically significant. Meta-analysis revealed higher concordance in territory within families overall (odds ratio [OR] 1.7, 95%CI 1.3-2.2) and for each separate territory except the anterior cerebral artery. In the analysis of ruptured intracranial aneurysms, overall territory concordance was higher within families than between families (OR 1.8; 95%CI 1.1-2.7) but the territory-specific analysis showed statistical significance only for the internal carotid artery territory. CONCLUSIONS We confirmed that familial intracranial aneurysms are more likely to occur in the same arterial territory within families. Moreover, we found that ruptured aneurysms were also more likely to occur in the same arterial territory within families.
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Al-Khafaji AO, Al-Sharshahi ZF, Lee RP, Alsubaihawi ZA, Dolachee AA, Hoz SS. Unilateral absence of the internal carotid artery associated with anterior communicating artery aneurysms: Systematic review and a proposed management algorithm. Surg Neurol Int 2020; 11:221. [PMID: 32874724 PMCID: PMC7451189 DOI: 10.25259/sni_238_2020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/13/2020] [Indexed: 11/29/2022] Open
Abstract
Background: Absence or hypoplasia of the internal carotid artery (ICA) is a rare congenital anomaly that is mostly unilateral and highly associated with other intracranial vascular anomalies, of which saccular aneurysm is the most common. Blood flow to the circulation of the affected side is maintained by collateral pathways, some of which include the anterior communicating artery (Acom) as part of their anatomy. Therefore, temporary clipping during microsurgery on Acom aneurysms in patients with unilateral ICA anomalies could jeopardize these collaterals and place the patient at risk of ischemic damage. In this paper, we review the literature on cases with a unilaterally absent ICA associated with Acom aneurysms and provide an illustrative case. Methods: We combined our experience of one case of a unilaterally absent ICA associated with an Acom aneurysm with the 33 existing publications on the same subject in the literature, for a total of 40 cases. We provide a detailed systematic literature review of this association of vascular anomalies, exploring different aspects regarding the collateral pathways and how they impact management strategies and propose a management algorithm to deal with such association. Results: The mean age was 48.2 ± 16.5 years. The aneurysmal rupture was the most common presentation (75%). Agenesis was observed in 70% of patients, followed by hypoplasia (20%) and, finally, aplasia (10%). Lie Type A was the most common pattern of collaterals (50%), with Types B and D being of almost equal proportions. Most aneurysms were located at the A1-Acom junction contralateral to the anomalous side (Fisher’s Exact test; P = 0.03). One case of temporary clipping was reported in the literature. Conclusion: Acom aneurysms in patients with unilateral ICA anomalies, given they are more commonly present contralaterally, could be of acquired etiology, warranting periodic screening in asymptomatic patients. Temporary clipping might be safe in patients with Type D collateral pattern, while those with Types A or B may require intraoperative rupture risk assessment and a tailored management plan to avoid disrupting collateral flow and causing ischemia.
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Affiliation(s)
| | | | - Ryan P Lee
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA
| | - Zahraa A Alsubaihawi
- College of Medicine, University of Baghdad, Baghdad, Iraq.,Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq.,Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, USA.,Department of Surgery, College of Medicine, University of Al-Qadisiyah, Diwaniyah, Iraq
| | - Ali A Dolachee
- Department of Surgery, College of Medicine, University of Al-Qadisiyah, Diwaniyah, Iraq
| | - Samer S Hoz
- Department of Neurosurgery, Neurosurgery Teaching Hospital, Baghdad, Iraq
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12
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Gong L, Gu Y, Dong Q, Zhang X, Wang H, Zhao Y, Liu X. A Direct Correlation between Red Blood Cell Indices and Cognitive Impairment After Aneurysmal Subarachnoid Hemorrhage (aSAH). Curr Neurovasc Res 2020; 16:142-147. [PMID: 30977449 DOI: 10.2174/1567202616666190412142718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cognitive impairment can occur after aneurysmal subarachnoid hemorrhage (aSAH) though it commonly tends to be neglected. Red blood cell (RBC) indices are associated with long-term functional outcomes, while it is unclear whether RBC indices could be a potential predictor of cognitive decline after aSAH. We aimed to investigate the association between RBC indices and post-aSAH cognitive impairment at 1 year. METHODS Patients with aSAH received neuropsychological test by the Montreal Cognitive Assessment (MoCA) and underwent serum and cerebrospinal fluid (CSF) samples test. To determine the association between RBC indices and cognitive impairment after acute aSAH, we adjusted for demographic and vascular risk factors using multivariate logistic regression analysis. RESULTS Of the 126 patients included in this study, 33% (42/126) of them were diagnosed with cognitive impairment (MoCA<26). After adjustment for potential confounders, increased mean corpuscular volume (MCV) (OR: 1.36, 95%CI: 1.19-1.55) and mean corpuscular hemoglobin (MCH) (OR: 1.61, 95%CI: 1.25-2.08), reflecting systemic iron status, are more likely to be associated with cognitive impairment after aSAH. CONCLUSION In this aSAH population, our data shows the positive association between MCH and MCV and cognitive impairment at 1 year.
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Affiliation(s)
- Li Gong
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Yongzhe Gu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Qiong Dong
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Xiang Zhang
- Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Haichao Wang
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Yanxin Zhao
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
| | - Xueyuan Liu
- Department of Neurology, Shanghai Tenth People's Hospital, Tongji University, 301# Middle Yanchang Road, Shanghai 200072, China
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13
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Gattellari M, Goumas C, Jalaludin B, Worthington JM. Population-based stroke surveillance using big data: state-wide epidemiological trends in admissions and mortality in New South Wales, Australia. Neurol Res 2020; 42:587-596. [PMID: 32449879 DOI: 10.1080/01616412.2020.1766860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Epidemiological trends for major causes of death and disability, such as stroke, may be monitored using administrative data to guide public health initiatives and service delivery. METHODS We calculated admissions rates for ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage between 1 January 2005 and December 31st, 2013 and rates of 30-day mortality and 365-day mortality in 30-day survivors to 31 December 2014 for patients aged 15 years or older from New South Wales, Australia. Annual Average Percentage Change in rates was estimated using negative binomial regression. RESULTS Of 81,703 eligible admissions, 64,047 (78.4%) were ischaemic strokes and 13,302 (16.3%) and 4,778 (5.8%) were intracerebral and subarachnoid haemorrhages, respectively. Intracerebral haemorrhage admissions significantly declined by an average of 2.2% annually (95% Confidence Interval = -3.5% to -0.9%) (p < 0.001). Thirty-day mortality rates significantly declined for ischaemic stroke (Average Percentage Change -2.9%, 95% Confidence Interval = -5.2% to -1.0%) (p = 0.004) and subarachnoid haemorrhage (Average Percentage Change = -2.6%, 95% Confidence Interval = -4.8% to -0.2%) (p = 0.04). Mortality at 365-days amongst 30-day survivors of ischaemic stroke and intracerebral haemorrhage was stable over time and increased in subarachnoid haemorrhage (Annual Percentage Change 6.2%, 95% Confidence Interval = -0.1% to 12.8%), although not significantly (p = 0.05). DISCUSSION Improved prevention may have underpinned declining intracerebral haemorrhage rates while survival gains suggest that innovations in care are being successfully translated. Mortality in patients surviving the acute period is unchanged and may be increasing for subarachnoid haemorrhage warranting investment in post-discharge care and secondary prevention.
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Affiliation(s)
- Melina Gattellari
- Ingham Institute for Applied Medical Research , Liverpool (Sydney), Australia.,Department of Neurology, Royal Prince Alfred Hospital , Camperdown (Sydney), Australia
| | - Chris Goumas
- Ingham Institute for Applied Medical Research , Liverpool (Sydney), Australia.,School of Public Health, the University of Sydney , Sydney, Australia
| | - Bin Jalaludin
- Ingham Institute for Applied Medical Research , Liverpool (Sydney), Australia.,Population Health Intelligence, Healthy People and Places Unit, South Western Sydney Local Health District , Liverpool, Sydney, Australia.,School of Public Health and Community Medicine, The University of New South Wales , Sydney, Australia
| | - John M Worthington
- Ingham Institute for Applied Medical Research , Liverpool (Sydney), Australia.,Department of Neurology, Royal Prince Alfred Hospital , Camperdown (Sydney), Australia.,School of Public Health and Community Medicine, The University of New South Wales , Sydney, Australia.,South Western Sydney Clinical School, The University of New South Wales , Liverpool, Sydney, Australia
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14
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Ding X, Zhao S, Zhang Q, Yan Z, Wang Y, Wu Y, Li X, Liu J, Niu Y, Zhang Y, Zhang M, Wang H, Zhang Y, Chen W, Yang XZ, Liu P, Posey JE, Lupski JR, Wu Z, Yang X, Wu N, Wang K. Exome sequencing reveals a novel variant in NFX1 causing intracranial aneurysm in a Chinese family. J Neurointerv Surg 2020; 12:221-226. [PMID: 31401562 PMCID: PMC7014815 DOI: 10.1136/neurintsurg-2019-014900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Genetic risk factors play an important role in the pathogenesis of familial intracranial aneurysms (FIAs); however, the molecular mechanisms remain largely unknown. OBJECTIVE To investigate potential FIA-causing genetic variants by rare variant interrogation and a family-based genomics approach in a large family with an extensive multigenerational pedigree with FIAs. METHOD Exome sequencing (ES) was performed in a dominant likely family with intracranial aneurysms (IAs). Variants were analyzed by an in-house developed pipeline and prioritized using various filtering strategies, including population frequency, variant type, and predicted variant pathogenicity. Sanger sequencing was also performed to evaluate the segregation of the variants with the phenotype. RESULTS Based on the ES data obtained from five individuals from a family with 7/21 living members affected with IAs, a total of 14 variants were prioritized as candidate variants. Familial segregation analysis revealed that NFX1 c.2519T>C (p.Leu840Pro) segregated in accordance with Mendelian expectations with the phenotype within the family-that is, present in all IA-affected cases and absent from all unaffected members of the second generation. This missense variant is absent from public databases (1000genome, ExAC, gnomAD, ESP5400), and has damaging predictions by bioinformatics tools (Gerp ++ score = 5.88, CADD score = 16.43, MutationTaster score = 1, LRT score = 0). In addition, 840Leu in NFX1 is robustly conserved in mammals and maps in a region before the RING-type zinc finger domain. CONCLUSION NFX1 c.2519T>C (p.Leu840Pro) may contribute to the pathogenetics of a subset of FIAs.
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Affiliation(s)
- Xinghuan Ding
- Department of Interventional Neuroradiology, Beijing
Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University,
Beijing 100070, China
| | - Sen Zhao
- Beijing Key Laboratory for Genetic Research of Skeletal
Deformity, Beijing 100730, China
- Medical Research Center of Orthopedics, Chinese Academy of
Medical Sciences, Beijing 100730, China
- Department of Orthopedic Surgery, Peking Union Medical
College Hospital, Peking Union Medical College and Chinese Academy of Medical
Sciences, Beijing 100730, China
| | - Qianqian Zhang
- Department of Interventional Neuroradiology, Beijing
Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University,
Beijing 100070, China
| | - Zihui Yan
- Beijing Key Laboratory for Genetic Research of Skeletal
Deformity, Beijing 100730, China
- Medical Research Center of Orthopedics, Chinese Academy of
Medical Sciences, Beijing 100730, China
- Department of Orthopedic Surgery, Peking Union Medical
College Hospital, Peking Union Medical College and Chinese Academy of Medical
Sciences, Beijing 100730, China
| | - Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital
of Nanchang University, Nanchang University, Nanchang 330000, China
| | - Yong Wu
- Beijing Key Laboratory for Genetic Research of Skeletal
Deformity, Beijing 100730, China
| | - Xiaoxin Li
- Beijing Key Laboratory for Genetic Research of Skeletal
Deformity, Beijing 100730, China
- Department of Central Laboratory, Peking Union Medical
College Hospital, Peking Union Medical College and Chinese Academy of Medical
Sciences, Beijing 100730, China
| | - Jian Liu
- Department of Interventional Neuroradiology, Beijing
Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University,
Beijing 100070, China
| | - Yuchen Niu
- Beijing Key Laboratory for Genetic Research of Skeletal
Deformity, Beijing 100730, China
- Department of Central Laboratory, Peking Union Medical
College Hospital, Peking Union Medical College and Chinese Academy of Medical
Sciences, Beijing 100730, China
| | - Yisen Zhang
- Department of Interventional Neuroradiology, Beijing
Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University,
Beijing 100070, China
| | - Mingqi Zhang
- Department of Interventional Neuroradiology, Beijing
Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University,
Beijing 100070, China
| | - Huizi Wang
- Beijing Key Laboratory for Genetic Research of Skeletal
Deformity, Beijing 100730, China
- Department of Central Laboratory, Peking Union Medical
College Hospital, Peking Union Medical College and Chinese Academy of Medical
Sciences, Beijing 100730, China
| | - Ying Zhang
- Department of Interventional Neuroradiology, Beijing
Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University,
Beijing 100070, China
| | - Weisheng Chen
- Beijing Key Laboratory for Genetic Research of Skeletal
Deformity, Beijing 100730, China
- Department of Orthopedic Surgery, Peking Union Medical
College Hospital, Peking Union Medical College and Chinese Academy of Medical
Sciences, Beijing 100730, China
| | - Xin-Zhuang Yang
- Department of Central Laboratory, Peking Union Medical
College Hospital, Peking Union Medical College and Chinese Academy of Medical
Sciences, Beijing 100730, China
| | - Pengfei Liu
- Department of Molecular and Human Genetics, Baylor College
of Medicine, Houston, Texas 77030, USA
| | - Jennifer E. Posey
- Department of Molecular and Human Genetics, Baylor College
of Medicine, Houston, Texas 77030, USA
| | - James R. Lupski
- Department of Molecular and Human Genetics, Baylor College
of Medicine, Houston, Texas 77030, USA
- Department of Pediatrics, Baylor College of Medicine,
Houston, Texas 77030, USA
- Human Genome Sequencing Center, Baylor College of Medicine,
Houston Texas 77030 USA
- Texas Children’s Hospital, Houston, Texas 77030,
USA
| | - Zhihong Wu
- Beijing Key Laboratory for Genetic Research of Skeletal
Deformity, Beijing 100730, China
- Medical Research Center of Orthopedics, Chinese Academy of
Medical Sciences, Beijing 100730, China
- Department of Central Laboratory, Peking Union Medical
College Hospital, Peking Union Medical College and Chinese Academy of Medical
Sciences, Beijing 100730, China
| | - Xinjian Yang
- Department of Interventional Neuroradiology, Beijing
Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University,
Beijing 100070, China
| | - Nan Wu
- Beijing Key Laboratory for Genetic Research of Skeletal
Deformity, Beijing 100730, China
- Medical Research Center of Orthopedics, Chinese Academy of
Medical Sciences, Beijing 100730, China
- Department of Orthopedic Surgery, Peking Union Medical
College Hospital, Peking Union Medical College and Chinese Academy of Medical
Sciences, Beijing 100730, China
| | - Kun Wang
- Department of Interventional Neuroradiology, Beijing
Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University,
Beijing 100070, China
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15
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Common Data Elements for Subarachnoid Hemorrhage and Unruptured Intracranial Aneurysms: Recommendations from the Working Group on Subject Characteristics. Neurocrit Care 2020; 30:20-27. [PMID: 31077079 DOI: 10.1007/s12028-019-00724-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The National Institute of Neurological Disorders and Stroke (NINDS) Common Data Elements (CDEs) have been generated to standardize and define terms used by the scientific community. The widespread use of these CDEs promotes harmonized data collection in clinical research. The aim of the NINDS Unruptured Intracranial Aneurysms (UIA) and Subarachnoid Hemorrhage (SAH), and Subject Characteristics working group (WG) was to identify, define, and classify CDEs describing the characteristics of patients diagnosed with an UIA and SAH. Thus, "Participant/Subject characteristics" is a set of factors defining a population of selected individuals and allowing comparisons with a reference population and overtime. METHODS Based on standard terms defined by the United States' Census Bureau, CDEs previously defined by several (Stroke, Epilepsy and Traumatic Brain Injury) NINDS CDE working groups literature and expert opinion of the WG, the "Participant/Subject characteristics" domain has been defined. RESULTS A set of 192 CDEs divided in 7 subsections: demographics (8 CDEs), social status (8 CDEs), behavioral status (22 CDEs), family and medical history (144 CDEs), pregnancy and perinatal history (8 CDEs), history data source reliability (3 CDEs), and prior functional status (3 CDEs) was defined. SAH is characterized by 6 core elements, all classified in the "Participant/Subject characteristics" domain. Four exploratory elements out of the 39 for SAH overall are in the "Participant/Subject characteristics" domain, and all remaining 182 CDEs in the "Participant/Subject characteristics" domain are classified as Supplemental-Highly Recommended elements. CONCLUSIONS These CDEs would allow the development of best practice guidelines to standardize the assessment and reporting of observations concerning UIA and SAH.
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16
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Britz GW, Desai VR. Commentary: Microsurgical Clipping of Anterior Choroidal Artery Aneurysms: A Systematic Approach to Reducing Ischemic Complications in an Experience with 146 Patients. Oper Neurosurg (Hagerstown) 2019; 17:E143-E144. [PMID: 31058979 DOI: 10.1093/ons/opz079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/13/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gavin W Britz
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas.,Department of Neurological Surgery, Weill Cornell, New York, New York
| | - Virendra R Desai
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas
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17
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Nichols LJ, Gall S, Stirling C. Determining rural risk for aneurysmal subarachnoid hemorrhages: A structural equation modeling approach. J Neurosci Rural Pract 2019; 7:559-565. [PMID: 27695237 PMCID: PMC5006469 DOI: 10.4103/0976-3147.188627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
An aneurysmal subarachnoid hemorrhage (aSAH) carries a high disability burden. The true impact of rurality as a predictor of outcome severity is unknown. Our aim is to clarify the relationship between the proposed explanations of regional and rural health disparities linked to severity of outcome following an aSAH. An initial literature search identified limited data directly linking geographical location, rurality, rural vulnerability, and aSAH. A further search noting parallels with ischemic stroke and acute myocardial infarct literature presented a number of diverse and interrelated predictors. This a priori knowledge informed the development of a conceptual framework that proposes the relationship between rurality and severity of outcome following an aSAH utilizing structural equation modeling. The presented conceptual framework explores a number of system, environmental, and modifiable risk factors. Socioeconomic characteristics, modifiable risk factors, and timely treatment that were identified as predictors of severity of outcome following an aSAH and within each of these defined predictors a number of contributing specific individual predictors are proposed. There are considerable gaps in the current knowledge pertaining to the impact of rurality on the severity of outcome following an aSAH. Absent from the literature is any investigation of the cumulative impact and multiplicity of risk factors associated with rurality. The proposed conceptual framework hypothesizes a number of relationships between both individual level and system level predictors, acknowledging that intervening predictors may mediate the effect of one variable on another.
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Affiliation(s)
- Linda Jayne Nichols
- School of Health Sciences, Faculty of Health Science, University of Tasmania, Hobart Tasmania, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart Tasmania, Australia
| | - Christine Stirling
- Menzies Institute for Medical Research, University of Tasmania, Hobart Tasmania, Australia
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18
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19
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Ma X, Yang Y, Liu D, Zhou Y, Jia W. Demographic and morphological characteristics associated with rupture status of anterior communicating artery aneurysms. Neurosurg Rev 2019; 43:589-595. [DOI: 10.1007/s10143-019-01080-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/30/2018] [Accepted: 01/21/2019] [Indexed: 10/27/2022]
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20
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Tulamo R, Frösen J, Hernesniemi J, Niemelä M. Inflammatory changes in the aneurysm wall: a review. J Neurointerv Surg 2018; 10:i58-i67. [DOI: 10.1136/jnis.2009.002055.rep] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/17/2009] [Accepted: 12/18/2009] [Indexed: 02/06/2023]
Abstract
Rupture of a saccular intracranial artery aneurysm (IA) causes subarachnoid hemorrhage, a significant cause of stroke and death. The current treatment options, endovascular coiling and clipping, are invasive and somewhat risky. Since only some IAs rupture, those IAs at risk for rupture should be identified. However, to improve the imaging of rupture-prone IAs and improve IA treatment, IA wall pathobiology requires more thorough knowledge. Chronic inflammation has become understood as an important phenomenon in IA wall pathobiology, featuring inflammatory cell infiltration as well as proliferative and fibrotic remodulatory responses. We review the literature on what is known about inflammation in the IA wall and also review the probable mechanisms of how inflammation would result in the degenerative changes that ultimately lead to IA wall rupture. We also discuss current options in imaging inflammation and how knowledge of inflammation in IA walls may improve IA treatment.
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21
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Akkermans A, Peelen LM, van Waes JA, Rinkel GJ, van Klei WA. Cardiac events within one year after a subarachnoid haemorrhage: The predictive value of troponin elevation after aneurysm occlusion. Eur J Prev Cardiol 2018; 26:420-428. [PMID: 29771155 PMCID: PMC6388411 DOI: 10.1177/2047487318776098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients who survive after an aneurysmal subarachnoid haemorrhage (ASAH) have an increased incidence of cardiovascular events compared with the general population. We assessed whether troponin elevation after aneurysm occlusion, as marker of myocardial injury, can predict long-term cardiac events. METHODS We analysed a prospectively collected cohort of 159 patients with ASAH and early aneurysm occlusion, in whom routine post-intervention troponin I (TnI) measurements were performed. With competing risk regression modelling we estimated the association between TnI elevation after aneurysm occlusion and major adverse cardiac events within one year. Secondary outcome measures were all-cause mortality and neurological condition within one year. The predictive value of post-intervention TnI was compared with the predictive value of pre-intervention characteristics using c-statistics and the integrated discrimination improvement index. RESULTS Subdistribution hazard ratios for TnI elevation and major adverse cardiac events at one year were 1.05 (95% confidence interval (CI) 1.03-1.07) per 10 ng/l increase in TnI and 7.91 (95% CI 1.46-43.0) for any TnI elevation. After adjustment for pre-intervention variables, the subdistribution hazard ratios were 1.47 (95% CI 0.81-2.67) per 10 ng/l and 9.00 (95% CI 1.62-50.1) for any elevation. The c-statistic was 0.71 for TnI elevation as a continuous measure and 0.69 for any TnI elevation. The integrated discrimination improvement index showed a minimum improvement in prediction of 0.08 (interquartile range 0.06 to 0.09) for TnI as a continuous measure and 0.003 (interquartile range -0.004 to 0.01) for any TnI elevation, when compared with pre-intervention characteristics. CONCLUSION TnI elevation after occlusion of a ruptured intracranial aneurysm predicts the occurrence of a major adverse cardiac event within one year after ASAH.
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Affiliation(s)
- Annemarie Akkermans
- 1 Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Linda M Peelen
- 1 Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, The Netherlands.,2 Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Judith A van Waes
- 1 Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Gabriël J Rinkel
- 3 Department of Neurology and Neurosurgery, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht University, The Netherlands
| | - Wilton A van Klei
- 1 Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht University, The Netherlands
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22
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Foreman PM, Hendrix P, Harrigan MR, Fisher WS, Vyas NA, Lipsky RH, Walters BC, Tubbs RS, Shoja MM, Griessenauer CJ. PHASES score applied to a prospective cohort of aneurysmal subarachnoid hemorrhage patients. J Clin Neurosci 2018; 53:69-73. [PMID: 29685416 DOI: 10.1016/j.jocn.2018.04.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/14/2018] [Accepted: 04/08/2018] [Indexed: 11/16/2022]
Abstract
The treatment of unruptured intracranial aneurysms remains controversial. The PHASES score was developed to predict the 5-year risk of aneurysm rupture. We have assigned PHASES scores to a cohort of aneurysmal subarachnoid hemorrhage (aSAH) patients to assess the distribution of scores and its ability to predict outcome. In this study, the PHASES score was applied to a prospective cohort of aSAH patients that were enrolled in the Cerebral Aneurysm Renin Angiotensin System (CARAS) study. The CARAS study enrolled patients from two academic institutions in the United States from 2012 to 2015. Univariable and multivariable analyses were performed to identify factors predictive of outcome at last follow up. One hundred and forty-nine aSAH patients were included with a mean age of 54.9 ± 12.5 years. Most ruptured aneurysms were <7 mm (62.4%) and located in the anterior circulation (80.5%). Favorable functional outcome (mRS 0-2) at last follow up was achieved in 61.7% of patients. PHASES scores ranged from 0 to 16 with a median of 5; the majority of patients had a score of 4 (20.1%) or 5 (32.2%). Multivariable modeling identified higher PHASES scores (OR 1.235, CI 1.016-1.501, p = 0.034) and higher Hunt and Hess grades (OR 2.224, CI 1.353-3.655, p = 0.002) as independent predictors of poor functional outcome (mRS 3-6) at last follow up. The majority of aSAH patients present with low (≤5) PHASES scores. Elevated PHASES scores are independently associated with poor functional outcome in patients with aSAH.
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Affiliation(s)
- Paul M Foreman
- Department of Neurosurgery, University of Alabama at Birmingham, AL, United States.
| | - Philipp Hendrix
- Department of Neurosurgery, Saarland University Medical Center and Saarland University, Faculty of Medicine, Homburg/Saar, Germany
| | - Mark R Harrigan
- Department of Neurosurgery, University of Alabama at Birmingham, AL, United States
| | - Winfield S Fisher
- Department of Neurosurgery, University of Alabama at Birmingham, AL, United States
| | - Nilesh A Vyas
- Department of Neurosciences, Inova Health System, Falls Church, VA, United States
| | - Robert H Lipsky
- Department of Neurosciences, Inova Health System, Falls Church, VA, United States; Department of Molecular Neuroscience, George Mason University, Fairfax, VA, United States
| | - Beverly C Walters
- Department of Neurosurgery, University of Alabama at Birmingham, AL, United States; Department of Neurosciences, Inova Health System, Falls Church, VA, United States; Department of Molecular Neuroscience, George Mason University, Fairfax, VA, United States
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, WA, United States; Department of Anatomical Sciences, St. George's University, Grenada
| | - Mohammadali M Shoja
- Neuroscience Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Christoph J Griessenauer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States; Department of Neurosurgery, Geisinger Health System, Danville, PA, United States; Department of Neurosurgery, Paracelsus Medical University, Salzburg, Austria; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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23
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Cho WS, Kim JE, Park SQ, Ko JK, Kim DW, Park JC, Yeon JY, Chung SY, Chung J, Joo SP, Hwang G, Kim DY, Chang WH, Choi KS, Lee SH, Sheen SH, Kang HS, Kim BM, Bae HJ, Oh CW, Park HS. Korean Clinical Practice Guidelines for Aneurysmal Subarachnoid Hemorrhage. J Korean Neurosurg Soc 2018. [PMID: 29526058 PMCID: PMC5853198 DOI: 10.3340/jkns.2017.0404.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Despite advancements in treating ruptured cerebral aneurysms, an aneurysmal subarachnoid hemorrhage (aSAH) is still a grave cerebrovascular disease associated with a high rate of morbidity and mortality. Based on the literature published to date, worldwide academic and governmental committees have developed clinical practice guidelines (CPGs) to propose standards for disease management in order to achieve the best treatment outcomes for aSAHs. In 2013, the Korean Society of Cerebrovascular Surgeons issued a Korean version of the CPGs for aSAHs. The group researched all articles and major foreign CPGs published in English until December 2015 using several search engines. Based on these articles, levels of evidence and grades of recommendations were determined by our society as well as by other related Quality Control Committees from neurointervention, neurology and rehabilitation medicine. The Korean version of the CPGs for aSAHs includes risk factors, diagnosis, initial management, medical and surgical management to prevent rebleeding, management of delayed cerebral ischemia and vasospasm, treatment of hydrocephalus, treatment of medical complications and early rehabilitation. The CPGs are not the absolute standard but are the present reference as the evidence is still incomplete, each environment of clinical practice is different, and there is a high probability of variation in the current recommendations. The CPGs will be useful in the fields of clinical practice and research.
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Affiliation(s)
- Won-Sang Cho
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sukh Que Park
- Department of Neurosurgery, Soonchunhyang University School of Medicine, Seoul, Korea
| | - Jun Kyeung Ko
- Departments of Neurosurgery, Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dae-Won Kim
- Department of Neurosurgery, Institute of Wonkwang Medical Science, Wonkwang University School of Medicine, Iksan, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Je Young Yeon
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Young Chung
- Department of Neurosurgery, Eulji University Hospital, Daejeon, Korea
| | - Joonho Chung
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung-Pil Joo
- Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Gyojun Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Deog Young Kim
- Department of Rehabilitation Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Sung Ho Lee
- Department of Neurosurgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seung Hun Sheen
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Moon Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Hyeon Seon Park
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
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24
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Hauer AJ, Ruigrok YM, Algra A, van Dijk EJ, Koudstaal PJ, Luijckx GJ, Nederkoorn PJ, van Oostenbrugge RJ, Visser MC, Wermer MJ, Kappelle LJ, Klijn CJM. Age-Specific Vascular Risk Factor Profiles According to Stroke Subtype. J Am Heart Assoc 2017; 6:JAHA.116.005090. [PMID: 28483775 PMCID: PMC5524074 DOI: 10.1161/jaha.116.005090] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Ischemic and hemorrhagic stroke are increasingly recognized as heterogeneous diseases with distinct subtypes and etiologies. Information on variation in distribution of vascular risk factors according to age in stroke subtypes is limited. We investigated the prevalence of vascular risk factors in stroke subtypes in relation to age. METHODS AND RESULTS We studied a prospective multicenter university hospital-based cohort of 4033 patients. For patients with ischemic stroke caused by large artery atherosclerosis, small vessel disease, or cardioembolism and for patients with spontaneous intracerebral hemorrhage or aneurysmal subarachnoid hemorrhage, we calculated prevalences of vascular risk factors in 4 age groups: <55, 55 to 65, 65 to 75, and ≥75 years, and mean differences with 95% CIs in relation to the reference age group. Patients aged <55 years were significantly more often of non-white origin (in particular in spontaneous intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage patients) and most often smoked (most prominent for aneurysmal subarachnoid hemorrhage patients). Patients aged <55 years with ischemic stroke caused by large artery atherosclerosis or small vessel disease more often had hypertension, hyperlipidemia, and diabetes mellitus than patients with ischemic stroke of cardiac origin. Overall, the frequency of hypertension, hyperlipidemia, and diabetes mellitus increased with age among all stroke subtypes, whereas smoking decreased with age. Regardless of age, accumulation of potentially modifiable risk factors was most pronounced in patients with ischemic stroke caused by large artery atherosclerosis or small vessel disease. CONCLUSIONS The prevalence of common cardiovascular risk factors shows different age-specific patterns among various stroke subtypes. Recognition of these patterns may guide tailored stroke prevention efforts aimed at specific risk groups.
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Affiliation(s)
- Allard J Hauer
- 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
| | - Ale Algra
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ewoud J van Dijk
- Department of Neurology, Donders Institute of Brain Behaviour & Cognition, Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter J Koudstaal
- Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Gert-Jan Luijckx
- Department of Neurology, University Medical Center Groningen, Groningen, The Netherlands
| | - Paul J Nederkoorn
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Marieke C Visser
- Department of Neurology, VU Medical Center, Amsterdam, The Netherlands
| | - Marieke J Wermer
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Catharina J M Klijn
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands .,Department of Neurology, Donders Institute of Brain Behaviour & Cognition, Center for Neuroscience, Radboud University Medical Center, Nijmegen, The Netherlands
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25
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Abstract
Subarachnoid haemorrhage is an uncommon and severe subtype of stroke affecting patients at a mean age of 55 years, leading to loss of many years of productive life. The rupture of an intracranial aneurysm is the underlining cause in 85% of cases. Survival from aneurysmal subarachnoid haemorrhage has increased by 17% in the past few decades, probably because of better diagnosis, early aneurysm repair, prescription of nimodipine, and advanced intensive care support. Nevertheless, survivors commonly have cognitive impairments, which in turn affect patients' daily functionality, working capacity, and quality of life. Additionally, those deficits are frequently accompanied by mood disorders, fatigue, and sleep disturbances. Management requires specialised neurological intensive care units and multidisciplinary clinical expertise, which is better provided in high-volume centres. Many clinical trials have been done, but only two interventions are shown to improve outcome. Challenges that remain relate to prevention of subarachnoid haemorrhage by improved screening and development of lower-risk methods to repair or stabilise aneurysms that have not yet ruptured. Multicentre cooperative efforts might increase the knowledge that can be gained from clinical trials, which is often limited by small studies with differing criteria and endpoints that are done in single centres. Outcome assessments that incorporate finer assessment of neurocognitive function and validated surrogate imaging or biomarkers for outcome could also help to advance the specialty.
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Affiliation(s)
- R Loch Macdonald
- Division of Neurosurgery, St Michael's Hospital, Toronto, ON, Canada; Labatt Family Centre of Excellence in Brain Injury and Trauma Research, St Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada.
| | - Tom A Schweizer
- Division of Neurosurgery, St Michael's Hospital, Toronto, ON, Canada; Labatt Family Centre of Excellence in Brain Injury and Trauma Research, St Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
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26
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The Genetics of Intracranial Aneurysms. CURRENT GENETIC MEDICINE REPORTS 2017. [DOI: 10.1007/s40142-017-0111-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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27
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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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28
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Incidence and Mortality of Spontaneous Subarachnoid Hemorrhage in Martinique. PLoS One 2016; 11:e0155945. [PMID: 27213614 PMCID: PMC4877008 DOI: 10.1371/journal.pone.0155945] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 05/07/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Incidence of spontaneous subarachnoid hemorrhages (SAH) varies wildly across the world and seems to be low in Central and South America (4.2 per 100 000 person-years; CI 95%; 3.1-5.7). The objective of our study was to describe the characteristics of SAH and to estimate its incidence and severity in Martinique, a small French island located in the Caribbean Sea. METHODS Due to its insular nature and small captive population, Martinique is ideal for the setting up of population-based epidemiological studies with good exhaustiveness. Our study, spanning a 7 year period (2007-2013), consisted of retrospective case ascertainment with multiple overlapping methods. Crude incidence and 30 day case-fatality rates for SAH among the Martinican population were computed for the study period. Incidence and disease severity was also analyzed according to age, gender and aneurysm presence. World age-standardized incidence rates were also calculated. RESULTS A total of 121 patients had a SAH during the study period, with a higher frequency of female cases (71.1% versus 28.9%, p<0.001). Patient mean age was 57.1 years (median = 55 [46-66]). An aneurysmal origin was found in 96 SAH cases (79.3%). Crude annual incidence was 4.36 per 100 000 person-years (CI 95% 2.30-6.42). World age-standardized incidence was 3.29 per 100 000 person-years (CI 95% 1.74-4.84). During the 30 days following SAH diagnosis, 29 patients died (case fatality rate: 24% (CI 95% 16.4-31.6)). CONCLUSIONS The incidence of spontaneous subarachnoid hemorrhage in Martinique is much lower than in other parts of the world and similar to countries in Central and South America. These results are possibly related to environmental factors and most particularly to a low rate of smoking in the Martinican population. Thirty-day case-fatality rate is similar to what is observed in developed countries.
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29
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Comprehensive Overview of Contemporary Management Strategies for Cerebral Aneurysms. World Neurosurg 2015; 84:1147-60. [DOI: 10.1016/j.wneu.2015.05.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 05/19/2015] [Accepted: 05/20/2015] [Indexed: 01/06/2023]
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30
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Abstract
Cerebral aneurysms are an important health issue in the United States, and the mortality rate following aneurysm rupture, or SAH, remains high. The treatment of these aneurysms uses endovascular options which include coil placement, stent assistant coiling and, recently, flow diversion. However, microsurgical clipping remains an option in those aneurysms not suited for endovascular therapy. These are often the more complicated aneurysms such as in large, giant aneurysms or deep-seated aneurysms. Circumferential visualization of the aneurysm, parent vessels, branches, perforators, and other neurovascular structures is important to prevent residual aneurysms or strokes from vessel or perforator occlusion. Decompression of the aneurysm sac is often required and we believe that adenosine-induced transient asystole should be an important option for clipping of complex cerebral aneurysms.
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31
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Wesali S, Persson HC, Cederin B, Sunnerhagen KS. Improved survival after non-traumatic subarachnoid haemorrhage with structured care pathways and modern intensive care. Clin Neurol Neurosurg 2015; 138:52-8. [PMID: 26276728 DOI: 10.1016/j.clineuro.2015.07.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 07/27/2015] [Accepted: 07/28/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Patients with subarachnoid haemorrhage (SAH) often require multidisciplinary management and their treatment is difficult to standardize. The aim was to describe baseline characteristics, care pathways and discharge status in an unselected group of patients with first ever non-traumatic SAH, and to examine whether their care pathways and outcomes vary. METHODS Patients admitted with first ever non-traumatic SAH to a neurosurgical unit (NSU) in Sweden during a period of 18 months in 2009-2010 were included. The data was retrospectively collected from patient charts. RESULTS A total of 131 patients were admitted with first ever non-traumatic SAH. Forty-nine (37%) patients initially sought medical care nearby the NSU and 82 (63%) in other parts of the catchment area. The average age was 55.5 years and 79 (60%) were female. In 98 (75%) cases, a ruptured aneurysm was found to be the cause of SAH. There was a significant correlation between poor clinical grade at admission and poor patient outcome (p<0.0005). No significant correlation between early aneurysm treatment and improved clinical outcome were seen. No significant differences in outcome were seen between patients who initially sought medical care nearby the NSU and those in other parts of the catchment area. There was no difference seen in the number of patients who had follow-up at the NSU depending on where they initially sought help. CONCLUSION This study shows an improvement in survival after SAH compared to earlier studies in Sweden. The results are indicative of effective management of all patients with SAH in the catchment area that are treated at the NSU. A nationwide registry to assess the overall management of patients treated for SAH would be useful to further investigate patients with SAH.
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Affiliation(s)
- Sahar Wesali
- Department of Internal Medicine, Sahlgrenska University Hospital, Sweden.
| | - Hanna C Persson
- Institute of Neuroscience and Physiology, Section of clinical neuroscience and rehabilitation, University of Gothenburg, Sweden
| | - Björn Cederin
- Department of Internal Medicine, Skaraborg Hospital Skövde, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Section of clinical neuroscience and rehabilitation, University of Gothenburg, Sweden
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32
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Dalyai R, Starke RM, Chalouhi N, Theofanis T, Busack C, Jabbour P, Gonzalez LF, Rosenwasser R, Tjoumakaris S. Smoking is a negative predictor of arteriovenous malformation posttreatment obliteration: analysis of vascular risk factors in 774 patients. Neurosurg Focus 2014; 37:E3. [PMID: 25175441 DOI: 10.3171/20145.focus14121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Cigarette smoking has been well established as a risk factor in vascular pathology, such as cerebral aneurysms. However, tobacco's implications for patients with cerebral arteriovenous malformations (AVMs) are controversial. The object of this study was to identify predictors of AVM obliteration and risk factors for complications. METHODS The authors conducted a retrospective analysis of a prospectively maintained database for all patients with AVMs treated using surgical excision, staged endovascular embolization (with N-butyl-cyanoacrylate or Onyx), stereotactic radiosurgery (Gamma Knife or Linear Accelerator), or a combination thereof between 1994 and 2010. Medical risk factors, such as smoking, abuse of alcohol or intravenous recreational drugs, hypercholesterolemia, diabetes mellitus, hypertension, and coronary artery disease, were documented. A multivariate logistic regression analysis was conducted to detect predictors of periprocedural complications, obliteration, and posttreatment hemorrhage. RESULTS Of 774 patients treated at a single tertiary care cerebrovascular center, 35% initially presented with symptomatic hemorrhage and 57.6% achieved complete obliteration according to digital subtraction angiography (DSA) or MRI. In a multivariate analysis a negative smoking history (OR 1.9, p = 0.006) was a strong independent predictor of AVM obliteration. Of the patients with obliterated AVMs, 31.9% were smokers, whereas 45% were not (p = 0.05). Multivariate analysis of obliteration, after controlling for AVM size and location (eloquent vs noneloquent tissue), revealed that nonsmokers were more likely (0.082) to have obliterated AVMs through radiosurgery. Smoking was not predictive of treatment complications or posttreatment hemorrhage. Abuse of alcohol or intravenous recreational drugs, hypercholesterolemia, diabetes mellitus, and coronary artery disease had no discernible effect on AVM obliteration, periprocedural complications, or posttreatment hemorrhage. CONCLUSIONS Cerebral AVM patients with a history of smoking are significantly less likely than those without a smoking history to have complete AVM obliteration on follow-up DSA or MRI. Therefore, patients with AVMs should be strongly advised to quit smoking.
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Affiliation(s)
- Richard Dalyai
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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33
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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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Long-term outcome after aneurysmal subarachnoid hemorrhage—risks of vascular events, death from cancer and all-cause death. J Neurol 2013; 261:309-15. [DOI: 10.1007/s00415-013-7192-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/08/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022]
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Shiue I, Hankey GJ, Arima H, Anderson CS. Suboptimal awareness and control of hypertension increases the risk of subarachnoid hemorrhage in the community: results from the ACROSS. Neurol Res 2013; 33:1068-71. [DOI: 10.1179/1743132811y.0000000020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Steiner T, Juvela S, Unterberg A, Jung C, Forsting M, Rinkel G. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage. Cerebrovasc Dis 2013; 35:93-112. [PMID: 23406828 DOI: 10.1159/000346087] [Citation(s) in RCA: 707] [Impact Index Per Article: 64.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 11/22/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Intracranial aneurysm with and without subarachnoid haemorrhage (SAH) is a relevant health problem: The overall incidence is about 9 per 100,000 with a wide range, in some countries up to 20 per 100,000. Mortality rate with conservative treatment within the first months is 50-60%. About one third of patients left with an untreated aneurysm will die from recurrent bleeding within 6 months after recovering from the first bleeding. The prognosis is further influenced by vasospasm, hydrocephalus, delayed ischaemic deficit and other complications. The aim of these guidelines is to provide comprehensive recommendations on the management of SAH with and without aneurysm as well as on unruptured intracranial aneurysm. METHODS We performed an extensive literature search from 1960 to 2011 using Medline and Embase. Members of the writing group met in person and by teleconferences to discuss recommendations. Search results were graded according to the criteria of the European Federation of Neurological Societies. Members of the Guidelines Committee of the European Stroke Organization reviewed the guidelines. RESULTS These guidelines provide evidence-based information on epidemiology, risk factors and prognosis of SAH and recommendations on diagnostic and therapeutic methods of both ruptured and unruptured intracranial aneurysms. Several risk factors of aneurysm growth and rupture have been identified. We provide recommendations on diagnostic work up, monitoring and general management (blood pressure, blood glucose, temperature, thromboprophylaxis, antiepileptic treatment, use of steroids). Specific therapeutic interventions consider timing of procedures, clipping and coiling. Complications such as hydrocephalus, vasospasm and delayed ischaemic deficit were covered. We also thought to add recommendations on SAH without aneurysm and on unruptured aneurysms. CONCLUSION Ruptured intracranial aneurysm with a high rate of subsequent complications is a serious disease needing prompt treatment in centres having high quality of experience of treatment for these patients. These guidelines provide practical, evidence-based advice for the management of patients with intracranial aneurysm with or without rupture. Applying these measures can improve the prognosis of SAH.
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Affiliation(s)
- Thorsten Steiner
- Department of Neurology, Heidelberg University, Heidelberg, Germany.
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Yang S, Wang T, You C, Liu W, Zhao K, Sun H, Mao B, Li X, Xiao A, Mao X, Zhang H. Association of polymorphisms in the elastin gene with sporadic ruptured intracranial aneurysms and unruptured intracranial aneurysms in Chinese patients. Int J Neurosci 2013; 123:454-8. [DOI: 10.3109/00207454.2013.763803] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bhat AR, Afzalwani M, Kirmani AR. Subarachnoid hemorrhage in Kashmir: Causes, risk factors, and outcome. Asian J Neurosurg 2012; 6:57-71. [PMID: 22347326 PMCID: PMC3277072 DOI: 10.4103/1793-5482.92159] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Context: Kashmir, a snow bound and mountain locked valley, is populated by about 7 million ethnic and non-migratory Kashmiris who have specific dietary and social habits than rest of the world. The neurological disorders are common in Kashmiri population. Aims: To study the prevalence and outcome of spontaneous intracranial subarachnoid hemorrhage (SAH) in Kashmir compared withother parts of the world. Settings and Design: A retrospective and hospital based study from 1982 to 2010 in the single and only Neurosurgical Centre of the State of Jammu and Kashmir. Materials and Methods: A hospital based study, in which, information concerning all Kashmiri patients was collected from the case sheets, patient files, discharge certificates, death certificates, and telephonic conversations with the help of Medical Records Department and Central Admission Register of Sher–i-Kashmir Institute of Medical Sciences, Kashmir India. Statistical Analysis: Analysis of variance and students T-test were used at occasions. Results: Incidence of SAH in Kashmiris is about 13/100,000 persons per year. SAH comprises 31.02% of total strokes and aneurysmal ruptures are cause of 54.35% SAHs. The female suffers 1.78 times more than the male. Total mortality of 36.60% was recorded against a good recovery of 14.99%. The familial SAHs and multiple aneurysms were also common. Intra-operative finding of larger aneurysmal size than recorded on pre-operative computed tomography (CT) angiogram of same patients was noteworthy. In 493 patients of SAH, the angiography revealed 705 aneurysms. Conclusion: Spontaneous intracranial subarachnoid hemorrhage, due to aneurysmal rupture, is common in Kashmir, with worst outcome. Food habits like “salt-tea twice a day”, group-smoking of wet tobacco like “Jejeer”, winter season, female gender, hypertension, and inhalation of “Kangri” smoke are special risk factorsof SAH, in Kashmiris. The plain CT brain and CT angiography are best diagnostic tools. The preventive measures for aneurysmal formation and rupture seems most promising management of future. The detachable endovascular aneurysmal occupying video assisted micro-camera capsules or plugs may be future treatment.
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Affiliation(s)
- Abdul Rashid Bhat
- Department of Neurosurgery, Sher i Kashmir Institute of Medical sciences (SKIMS), Srinagar, Kashmir, India
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Nieuwkamp DJ, Vaartjes I, Algra A, Rinkel GJE, Bots ML. Risk of cardiovascular events and death in the life after aneurysmal subarachnoid haemorrhage: a nationwide study. Int J Stroke 2012; 9:1090-6. [PMID: 22973950 DOI: 10.1111/j.1747-4949.2012.00875.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM The increased mortality rates of survivors of aneurysmal subarachnoid haemorrhage have been attributed to an increased risk of cardiovascular events in a registry study in Sweden. Swedish registries have however not been validated for subarachnoid haemorrhage and Scandinavian incidences of cardiovascular disease differ from that in Western European countries. We assessed risks of vascular disease and death in subarachnoid haemorrhage survivors in the Netherlands. METHODS From the Dutch hospital discharge register, we identified all patients with subarachnoid haemorrhage admission between 1997 and 2008. We determined the accuracy of coding of the diagnosis subarachnoid haemorrhage for patients admitted to our centre. Conditional on survival of three-months after the subarachnoid haemorrhage, we calculated standardized incidence and mortality ratios for fatal or nonfatal vascular diseases, vascular death, and all-cause death. Cumulative risks were estimated with survival analysis. RESULTS The diagnosis of nontraumatic subarachnoid haemorrhage was correct in 95·4% of 1472 patients. Of 11,263 admitted subarachnoid haemorrhage patients, 6999 survived more than three-months. During follow-up (mean 5·1 years), 874 (12·5%) died. The risks of death were 3·3% within one-year, 11·3% within five-years, and 21·5% within 10 years. The standardized mortality ratio was 3·4 (95% confidence interval: 3·1 to 3·7) for vascular death and 2·2 (95% confidence interval: 2·1 to 2·3) for all-cause death. The standardized incidence ratio for fatal or nonfatal vascular diseases was 2·7 (95% confidence interval: 2·6 to 2·8). CONCLUSIONS Dutch hospital discharge and cause of death registries are a valid source of data for subarachnoid haemorrhage, and show that the increased mortality rate in subarachnoid haemorrhage survivors is explained by increased risks for vascular diseases and death.
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Affiliation(s)
- Dennis J Nieuwkamp
- Departments of Neurology and Neurosurgery, the Rudolf Magnus Institute of Neuroscience, Utrecht Stroke Center, University Medical Center Utrecht, Utrecht, The Netherlands
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Shiue I. Urine phthalate concentrations are higher in people with stroke: United States National Health and Nutrition Examination Surveys (NHANES), 2001-2004. Eur J Neurol 2012; 20:728-31. [DOI: 10.1111/j.1468-1331.2012.03862.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 07/26/2012] [Indexed: 12/01/2022]
Affiliation(s)
- I. Shiue
- European Centre for Environment and Human Health; University of Exeter; Exeter UK
- The William A. & Barbara R. Owens Institute for Behavioral Research; University of Georgia; Athens GA USA
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Sandvei MS, Lindekleiv H, Romundstad PR, Müller TB, Vatten LJ, Ingebrigtsen T, Njølstad I, Mathiesen EB, Vik A. Risk factors for aneurysmal subarachnoid hemorrhage - BMI and serum lipids: 11-year follow-up of the HUNT and the Tromsø Study in Norway. Acta Neurol Scand 2012; 125:382-8. [PMID: 21793808 DOI: 10.1111/j.1600-0404.2011.01578.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Life-style factors have been associated with the risk for aneurysmal subarachnoid hemorrhage (aSAH), but it is not clear whether body mass index (BMI) and serum lipids are associated with risk. We prospectively assessed these associations in two large population studies. METHODS A total of 65,526 participants in the Nord-Trøndelag Health Study (1995-1997) and 26,882 participants in the Tromsø Study (1994-1995) were included. Studies included measurements of body weight and height, serum lipids, and self-administered questionnaires. Participants who experienced aSAH were identified, and hazard ratios (HRs) were estimated using Cox regression analysis. RESULTS During 11 years of follow-up, aSAH was diagnosed in 122 participants. Overweight (BMI 25-29.9) was negatively associated with the risk of aSAH (HR 0.7, 95% CI 0.4-1.0). There was no over all association of total serum cholesterol, HDL cholesterol, or triglycerides with the risk of aSAH, but in participants younger than 50 years, HDL cholesterol was inversely associated with the risk (HR per standard deviation increase 0.6, 95% CI 0.4-0.9). CONCLUSIONS Overweight may be associated with reduced risk of aSAH, but there was no over all association of total serum cholesterol, HDL cholesterol, or triglycerides with the risk of aSAH in this prospective study.
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Affiliation(s)
- M S Sandvei
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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Béjot Y, Giroud M, Touzé E. Pressione arteriosa e cervello. Neurologia 2012. [DOI: 10.1016/s1634-7072(12)60701-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Modifiable lifestyle behaviours account for most cases of subarachnoid haemorrhage: A population-based case–control study in Australasia. J Neurol Sci 2012; 313:92-4. [DOI: 10.1016/j.jns.2011.09.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 09/12/2011] [Accepted: 09/14/2011] [Indexed: 11/19/2022]
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Matouk CC, Hanbidge A, Mandell DM, Terbrugge KG, Agid R. Osteogenesis imperfecta, multiple intra-abdominal arterial dissections and a ruptured dissecting-type intracranial aneurysm. Interv Neuroradiol 2011; 17:371-5. [PMID: 22005702 DOI: 10.1177/159101991101700315] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 06/08/2011] [Indexed: 11/17/2022] Open
Abstract
We describe an adult patient with a ruptured dissecting-type superior cerebellar artery aneurysm and known osteogenesis imperfecta. He was successfully treated with coil embolization and intentional parent vessel sacrifice. During his hospital admission, he also suffered from abdominal distension. An incidental note was made of multiple intra-abdominal arterial dissections. These were managed conservatively. We review the rare association of osteogenesis imperfecta and intracranial aneurysms, as well as discuss management implications.
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Affiliation(s)
- C C Matouk
- Department of Medical Imaging, The Toronto Hospital, Toronto, Canada.
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Abstract
The incidental discovery of an asymptomatic intracranial arterial aneurysm is no longer uncommon. It can change a person's life. Decision-making should be guided by a thorough comparison of the risks associated with the natural course and with microsurgical or endovascular intervention. At present this comparison will favor a conservative approach in the majority of patients, especially in those with small aneurysms or who are over 50 years old.
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Affiliation(s)
- H Steinmetz
- Klinik für Neurologie, Zentrum der Neurologie und Neurochirurgie, Klinikum der Johann-Wolfgang-Goethe-Universität, Schleusenweg 2-16, 60528 Frankfurt am Main, Deutschland.
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Rinkel GJE, Algra A. Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage. Lancet Neurol 2011; 10:349-56. [DOI: 10.1016/s1474-4422(11)70017-5] [Citation(s) in RCA: 237] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Trends in incidence and in short term survival following a subarachnoid haemorrhage in Scotland, 1986-2005: a retrospective cohort study. BMC Neurol 2011; 11:38. [PMID: 21447158 PMCID: PMC3074551 DOI: 10.1186/1471-2377-11-38] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 03/29/2011] [Indexed: 11/24/2022] Open
Abstract
Background To examine age and sex specific incidence and 30 day case fatality for subarachnoid haemorrhage (SAH) in Scotland over a 20 year period. Methods A retrospective cohort study using routine hospital discharge data linked to death records. Results Between 1986 and 2005, 12,056 individuals experienced an incident SAH. Of these 10,113 (84%) survived to reach hospital. Overall age-standardised incidence rates were greater in women than men and remained relatively stable over the study period. In 2005, incidence in women was 12.8 (95% CI 11.5 to 14.2) and in men 7.9 (95% CI 6.9 to 9.1). 30 day case fatality in individuals hospitalised with SAH declined substantially, falling from 30.0% in men and 33.9% in women in 1986-1990 to 24.5% in men and 29.1% in women in 2001-2005. For both men and women, the largest reductions were observed in those aged between 40 to 59 years. After adjustment for age, socio-economic status and co-morbidity, the odds of death at 30 days in 2005 compared to odds of death in 1986 was 0.64 (0.54 to 0.76), p < 0.001 for those below 70 years, and 1.14 (0.83 to 1.56), p = 0.4 in those 70 years and above. Conclusions Incidence rates for SAH remained stable between 1986 and 2005 suggesting that a better understanding of SAH risk factors and their reduction is needed. 30 day case fatality rates have declined substantially, particularly in middle-age. However, they remain high and it is important to ensure that this is not due to under-diagnosis or under-treatment.
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Ruigrok Y, Klijn CJ. Genetics of Aneurysms and Arteriovenous Malformations. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Shiue I, Zhang JF, Arima H, Wang JG, Liu GR, Li YC, Wang M, Cheng GJ, Anderson CS. Design of the China Epidemiology Research in Subarachnoid Haemorrhage (CHERISH) Study. Int J Stroke 2010; 5:493-8. [PMID: 21050407 DOI: 10.1111/j.1747-4949.2010.00521.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Rationale Limited epidemiological data exist on subarachnoid haemorrhage (SAH) in China. Effective prevention requires knowledge of the rates and risk factors for SAH the most lethal type of stroke that most often affects younger adults. We report the methods and the initial experience of a new study to address this deficiency. Aims To determine the incidence, risk factors, management and outcomes of SAH. Design The CHina Epidemiology Research In Subarachnoid Haemorrhage (CHERISH) is a prospective, population-based, case–control study in a defined region (study population 1.7 million) of the city of Baotou in Inner Mongolia, China. Methods Cases of spontaneous SAH are identified using standard definitions through prospective surveillance of all major acute care hospitals with neurology/neurosurgery facilities, small hospitals/clinics, and the single city crematorium over a 2-year period. Verbal autopsy procedures are used to ascertain the probable causes of deaths outside of hospital. For each case, two nonrelative controls without SAH are matched by age (5-year strata), gender, and district of residence. Data are collected on socio-demography, lifestyle factors, and medical history, and blood is taken for the extraction and storage of DNA. Details of the clinical features, presentation, and management of SAH are obtained from cases, and survivors provide details on health care utilisation, physical function, health-related quality of life, and complications, at 6-months. Study outcomes The primary outcomes are overall, age- and gender-specific incidence, relative (odds ratios) and population-attributable risks for defined exposures, and 28-day and 6-month case fatality ratios and other outcomes. Conclusions Preliminary experience confirms the completeness of the surveillance methods, with no clear missed out-of-hospital cases of SAH with sudden death, and of high participation and reliable data collection procedures. CHERISH is well placed to provide reliable estimates of the burden of SAH in China.
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Affiliation(s)
- Ivy Shiue
- The George Institute for Global Health, Royal Prince Alfred Hospital and the University of Sydney, Sydney, NSW 2050, Australia
| | - Jing Fen Zhang
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China
| | - Hisatomi Arima
- The George Institute for Global Health, Royal Prince Alfred Hospital and the University of Sydney, Sydney, NSW 2050, Australia
| | - Ji Guang Wang
- Center of Epidemiological Studies and Clinical Trials, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guo Rong Liu
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China
| | - Yue Chun Li
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China
| | - Min Wang
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China
| | - Guo Juan Cheng
- Department of Neurology, Baotou Central Hospital, Baotou, Inner Mongolia, China
| | - Craig S. Anderson
- The George Institute for Global Health, Royal Prince Alfred Hospital and the University of Sydney, Sydney, NSW 2050, Australia
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Bae JS, Cheong HS, Park BL, Kim LH, Park TJ, Kim JY, Pasaje CFA, Lee JS, Cui T, Inoue I, Shin HD. Genome-wide association analysis of copy number variations in subarachnoid aneurysmal hemorrhage. J Hum Genet 2010; 55:726-30. [PMID: 20703242 DOI: 10.1038/jhg.2010.97] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Subarachnoid aneurysmal hemorrhage (SAH) due to cerebral aneurysm rupture is a very serious disease resulting in high mortality rate. It has been known that genetic factors are involved in the risk of SAH. A recent breakthrough in genomic variation called copy number variation (CNV) has been revealed to be involved in risks of human diseases. In this study, we hypothesized that CNVs can predict the risk of SAH. We used the Illumina HumanHap300 BeadChip (317 503 markers) to genotype 497 individuals in a Japanese population. Furthermore, individual CNVs were identified using signal and allelic intensities. The genetic effect of CNV on the risk of SAH was evaluated using multivariate logistic regression controlling for age and gender in 187 common CNV regions (frequency >1%). From a total of 4574 individual CNVs identified in this study (9.7 CNVs per individual), we were able to discover 1644 unique CNV regions containing 1232 genes. The identified variations were validated using visual examination of the genoplot image, overlapping analysis with the Database of Genomic Variants (73.2%), CNVpartition (72.4%) and quantitative PCR. Interestingly, two CNV regions, chr4:153210505-153212191 (deletion, 4q31.3, P=0.0005, P(corr) (corrected P-value)=0.04) and chr10:6265006-6267388 (duplication, 10p15.1, P=0.0006, P(corr)=0.05), were significantly associated with the risk of SAH after multiple testing corrections. Our results suggest that the newly identified CNV regions may contribute to SAH disease susceptibility.
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Affiliation(s)
- Joon Seol Bae
- Laboratory of Genomic Diversity, Department of Life Science, Sogang University, Shinsu-dong, Mapo-gu, Seoul, Republic of Korea
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