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Pugazenthi S, Norris AJ, Lauzier DC, Lele AV, Huguenard A, Dhar R, Zipfel GJ, Athiraman U. Conditioning-based therapeutics for aneurysmal subarachnoid hemorrhage - A critical review. J Cereb Blood Flow Metab 2024; 44:317-332. [PMID: 38017387 PMCID: PMC10870969 DOI: 10.1177/0271678x231218908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/08/2023] [Accepted: 11/19/2023] [Indexed: 11/30/2023]
Abstract
Aneurysmal subarachnoid hemorrhage (SAH) carries significant mortality and morbidity, with nearly half of SAH survivors having major cognitive dysfunction that impairs their functional status, emotional health, and quality of life. Apart from the initial hemorrhage severity, secondary brain injury due to early brain injury and delayed cerebral ischemia plays a leading role in patient outcome after SAH. While many strategies to combat secondary brain injury have been developed in preclinical studies and tested in late phase clinical trials, only one (nimodipine) has proven efficacious for improving long-term functional outcome. The causes of these failures are likely multitude, but include use of therapies targeting only one element of what has proven to be multifactorial brain injury process. Conditioning is a therapeutic strategy that leverages endogenous protective mechanisms to exert powerful and remarkably pleiotropic protective effects against injury to all major cell types of the CNS. The aim of this article is to review the current body of evidence for the use of conditioning agents in SAH, summarize the underlying neuroprotective mechanisms, and identify gaps in the current literature to guide future investigation with the long-term goal of identifying a conditioning-based therapeutic that significantly improves functional and cognitive outcomes for SAH patients.
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Affiliation(s)
- Sangami Pugazenthi
- Department of Neurological Surgery, Washington University, St. Louis MO, USA
| | - Aaron J Norris
- Department of Anesthesiology, Washington University, St. Louis MO, USA
| | - David C Lauzier
- Department of Neurological Surgery, University of California, Los Angeles, CA, USA
| | - Abhijit V Lele
- Department of Anesthesiology, University of Washington, Seattle, WA, USA
| | - Anna Huguenard
- Department of Neurological Surgery, Washington University, St. Louis MO, USA
| | - Rajat Dhar
- Department of Neurology, Washington University, St. Louis, MO, USA
| | - Gregory J Zipfel
- Departments of Neurological Surgery and Neurology, Washington University, St. Louis, MO, USA
| | - Umeshkumar Athiraman
- Department of Anesthesiology and Neurological Surgery, Washington University, St. Louis, MO, USA
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2
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Deniwar MA. Management of multiple and unruptured cerebral aneurysms. EGYPTIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1186/s41984-022-00170-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractThe incidence of multiple aneurysms was 10.7–34% of CA. Multiple associated factors were found; hypertension was the most significant one and others like advancing age and female sex were also documented. The estimated prevalence of UA is 5–10%. They include those aneurysms that did not rupture and discovered incidentally and those presented with symptoms rather than SAH, e.g., cranial nerve palsy or mass effect. Unruptured intracranial aneurysms are diagnosed with higher frequency nowadays as a result of imaging techniques improvement. The reported annual rate of rupture of UA is approximately 0.7–1%. The natural history of unruptured cerebral aneurysms cannot be extrapolated from the evaluation of individuals with ruptured aneurysms. Multiple cerebral aneurysms pose an even greater risk than a single aneurysm; the risk of rebleeding from the original aneurysm is larger and occurs sooner. The natural course of the disease has led to a consensus that all multiple unruptured aneurysms should be treated when technically viable. However, the prophylactic treatment of multiple unruptured is still controversial. Weighing the risk of intervention to the risk of observation is a mandatory pathway. Factors like age of patients, size and location of the aneurysms influence the decision-making and the type of therapy to be elected.
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3
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Aitkulova A, Mukhtarova K, Zholdybayeva E, Medetov Y, Dzhamantayeva B, Kassymbek K, Utupov T, Akhmetollayev I, Akshulakov S, Kulmambetova G, Ramankulov Y. Activated leukocyte cell adhesion molecule/cluster of differentiation 166 rs10933819 (G>A) variant is associated with familial intracranial aneurysms. Biomed Rep 2022; 17:65. [PMID: 35815187 PMCID: PMC9260160 DOI: 10.3892/br.2022.1548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/01/2022] [Indexed: 11/06/2022] Open
Abstract
Rupture of intracranial aneurysms (IAs) is the most common cause of subarachnoid hemorrhage (SAH). Currently, there is sufficient evidence to indicate that inflammatory responses contribute to aneurysm rupture. Moreover, the familial occurrence of SAH suggests that genetic factors may be involved in disease susceptibility. In the present study, a clinically proven case of IA in a patient who is a heterozygous mutation carrier of the activated leukocyte cell adhesion molecule (ALCAM)/cluster of differentiation 166 (CD166) gene, is reported. Genomic DNA was extracted from two siblings diagnosed with SAH and other available family members. A variant prioritization strategy that focused on functional prediction, frequency, predicted pathogenicity, and segregation within the family was employed. Sanger sequencing was also performed on the unaffected relatives to assess the segregation of variants within the phenotype. The verified mutations were sequenced in 145 ethnicity-matched healthy individuals. Based on whole exome sequencing data obtained from three individuals, two of whom were diagnosed with IAs, the single-nucleotide variant rs10933819 was prioritized in the family. Only one variant, rs10933819 (G>A), in ALCAM co-segregated with the phenotype, and this mutation was absent in ethnicity-matched healthy individuals. Collectively, ALCAM c1382 G>A p.Gly229Val was identified, for the first time, as a pathogenic mutation in this IA pedigree.
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Affiliation(s)
- Akbota Aitkulova
- National Center for Biotechnology, Nur Sultan 010000, Republic of Kazakhstan
| | - Kymbat Mukhtarova
- National Center for Biotechnology, Nur Sultan 010000, Republic of Kazakhstan
| | - Elena Zholdybayeva
- National Center for Biotechnology, Nur Sultan 010000, Republic of Kazakhstan
| | - Yerkin Medetov
- National Center of Neurosurgery, Nazarbayev University, Nur Sultan 010000, Republic of Kazakhstan
| | - Botagoz Dzhamantayeva
- National Center of Neurosurgery, Nazarbayev University, Nur Sultan 010000, Republic of Kazakhstan
| | - Kuat Kassymbek
- National Center for Biotechnology, Nur Sultan 010000, Republic of Kazakhstan
| | - Talgat Utupov
- National Center for Biotechnology, Nur Sultan 010000, Republic of Kazakhstan
| | - Ilyas Akhmetollayev
- National Center for Biotechnology, Nur Sultan 010000, Republic of Kazakhstan
| | - Serik Akshulakov
- National Center of Neurosurgery, Nazarbayev University, Nur Sultan 010000, Republic of Kazakhstan
| | | | - Yerlan Ramankulov
- National Center for Biotechnology, Nur Sultan 010000, Republic of Kazakhstan
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Abstract
Intracranial vascular abnormalities rarely are encountered in primary care. Many of the pathologies are occult and prognosis varies widely between inconsequential variants of anatomy to acutely life-threatening conditions. Consequently, there often is a great deal of anxiety associated with any potential diagnosis. This article reviews anatomic intracranial vascular lesions, including vascular malformations (arteriovenous malformations/arteriovenous fistulae and cavernous malformations), structural arteriopathies (aneurysms and moyamoya), and common developmental anomalies of the vasculature. The focus includes a general overview of anatomy, pathology, epidemiology, and key aspects of evaluation for the primary care provider and a review of common questions encountered in practice.
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5
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Giotta Lucifero A, Baldoncini M, Bruno N, Galzio R, Hernesniemi J, Luzzi S. Shedding the Light on the Natural History of Intracranial Aneurysms: An Updated Overview. ACTA ACUST UNITED AC 2021; 57:medicina57080742. [PMID: 34440948 PMCID: PMC8400479 DOI: 10.3390/medicina57080742] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
The exact molecular pathways underlying the multifactorial natural history of intracranial aneurysms (IAs) are still largely unknown, to the point that their understanding represents an imperative challenge in neurovascular research. Wall shear stress (WSS) promotes the genesis of IAs through an endothelial dysfunction causing an inflammatory cascade, vessel remodeling, phenotypic switching of the smooth muscle cells, and myointimal hyperplasia. Aneurysm growth is supported by endothelial oxidative stress and inflammatory mediators, whereas low and high WSS determine the rupture in sidewall and endwall IAs, respectively. Angioarchitecture, age older than 60 years, female gender, hypertension, cigarette smoking, alcohol abuse, and hypercholesterolemia also contribute to growth and rupture. The improvements of aneurysm wall imaging techniques and the implementation of target therapies targeted against inflammatory cascade may contribute to significantly modify the natural history of IAs. This narrative review strives to summarize the recent advances in the comprehension of the mechanisms underlying the genesis, growth, and rupture of IAs.
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Affiliation(s)
- Alice Giotta Lucifero
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
| | - Matías Baldoncini
- Department of Neurological Surgery, Hospital San Fernando, Buenos Aires 1646, Argentina;
| | - Nunzio Bruno
- Division of Neurosurgery, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy;
| | - Renato Galzio
- Neurosurgery Unit, Maria Cecilia Hospital, 48032 Cotignola, Italy;
| | - Juha Hernesniemi
- Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People’s Hospital, Zhengzhou 450000, China;
| | - Sabino Luzzi
- Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;
- Neurosurgery Unit, Department of Surgical Sciences, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Correspondence:
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6
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Zimelewicz Oberman D, Perez Akly MS, Rabelo NN, Elizondo C, Amorim Correa JL, Ajler P, Baccanelli MM. Morphologic Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries. World Neurosurg 2021; 154:e155-e162. [PMID: 34273549 DOI: 10.1016/j.wneu.2021.06.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intracranial aneurysms are acquired abnormal vascular dilations. The most dangerous complication of a cerebral aneurysm is its rupture, with a high rate of mortality. This study aimed to determine whether there is an association between anatomic variations in the circle of Willis and ruptured aneurysms in the anterior and posterior communicating arteries. METHODS A cross-sectional study of adult patients with a diagnosis of intracranial aneurysm was carried out between March 2015 and March 2019. The patients were divided into groups of ruptured or unruptured aneurysm in the anterior and posterior communicating arteries. RESULTS A total of 132 patients with anterior and posterior communicating artery aneurysms were included. The presence of anatomic variation in the circle of Willis presented a statistically significant association with ruptured aneurysms (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11-4.65; P = 0.024). There was a statistically significant difference between the presence of nonspherical aneurysm and rupture (OR, 6.9; 95% CI, 3.12-15.48; P < 0.0001). Multivariate logistic regression observed smoking (OR, 2.4; 95% CI, 1.01-5.9; P = 0.4), anterior complex variations (OR, 2.68; 95% CI, 1.01-7.18; P < 0.04), and nonspherical morphology (OR, 4.7; 95% CI, 1.93-11.45; P = 0.001) presented a statistically significant association with the rupture. CONCLUSIONS Our results suggest that the studied variations of the circle of Willis and nonspherical morphology, in addition to playing a role in the development of cerebral aneurysms, may contribute to their rupture.
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Affiliation(s)
| | | | | | - Cristina Elizondo
- Department of Internal Medicine Research Area, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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7
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Millward CP, Van Tonder L, Williams D, Thornton O, Foster M, Griffiths M, Puthuran M, Chandran A, Israni A, Sinha A, Kneen R, Mallucci C. Screening for cerebrovascular disorder on the basis of family history in asymptomatic children. Br J Neurosurg 2021; 35:584-590. [PMID: 34169790 DOI: 10.1080/02688697.2021.1922607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Cerebrovascular disorders represent a group of uncommon, heterogeneous, and complex conditions in children. We reviewed the screening practice for the detection of cerebrovascular disorder in asymptomatic children referred to our neurovascular service on the basis of a positive family history and parental and/or treating physician concern.Methods: Retrospective case-note review of referrals to our neurovascular service (July 2008-April 2018). Patients were included if the referral was made for screening, on the basis of a positive family history of cerebrovascular disorder. Symptomatic children, those with previous cranial imaging, or children under the care of a clinical geneticist (i.e. due to the child or their relative having HHT or mutations in KRIT1) were not eligible for inclusion.Results: Forty-one children were reviewed, 22 males (Median age 10.7 years, range 0.6-15.6 years). This represented 22% of the total number of referrals over a 10-year period. Twenty-nine children had an MRI/MRA brain. Twenty-eight children were referred due to a family history of intracranial aneurysm and/or subarachnoid haemorrhage, but only two had two first-degree relatives affected. Ten children were referred due to a family history of arteriovenous malformation. Three children were referred due to a family history of stroke. No cerebrovascular disease was detected during the study period (n = 29).Conclusions: Parental and/or physician concern generated a substantial number of referrals but no pathology was detected after screening. Whilst general screening guidance exists for the detection of intracranial aneurysms, consensus guidelines for the screening of children with a positive family history do not, but are required both to guide clinical practice and to assuage parental and/or physician concerns.
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Affiliation(s)
- Christopher Paul Millward
- Neurosurgery Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Libby Van Tonder
- Neurosurgery Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Dawn Williams
- Neurosurgery Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Owen Thornton
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mitchell Foster
- Neurosurgery Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael Griffiths
- Neurosurgery Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Mani Puthuran
- Neurosurgery Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Arun Chandran
- Neurosurgery Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Anil Israni
- Neurosurgery Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Ajay Sinha
- Neurosurgery Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Rachel Kneen
- Neurosurgery Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Conor Mallucci
- Neurosurgery Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
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8
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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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9
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Management of Stroke in Neonates and Children: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2019; 50:e51-e96. [DOI: 10.1161/str.0000000000000183] [Citation(s) in RCA: 240] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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10
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Sánchez van Kammen M, Moomaw CJ, van der Schaaf IC, Brown RD, Woo D, Broderick JP, Mackey JS, Rinkel GJE, Huston J, Ruigrok YM. Heritability of circle of Willis variations in families with intracranial aneurysms. PLoS One 2018; 13:e0191974. [PMID: 29377946 PMCID: PMC5788367 DOI: 10.1371/journal.pone.0191974] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/15/2018] [Indexed: 11/24/2022] Open
Abstract
Background Intracranial aneurysms more often occur in the same arterial territory within families. Several aneurysm locations are associated with specific circle of Willis variations. We investigated whether the same circle of Willis variations are more likely to occur in first-degree relatives than in unrelated individuals. Methods We assessed four circle of Willis variations (classical, A1-asymmetry, incomplete posterior communicating artery and fetal circulation) in two independent groups of families with familial aneurysms and ≥2 first-degree relatives with circle of Willis imaging on MRA/CTA. In each (index) family we determined the proportion of first-degree relatives with the same circle of Willis variation as the proband and compared it to the proportion of first-degree relatives of a randomly selected unrelated (comparison) family who had the same circle of Willis variation as the index family’s proband. Concordance in index families and comparison families was compared with a conditional logistic events/trials model. The analysis was simulated 1001 times; we report the median concordances, odds ratios (ORs), and 95% confidence intervals (95%CI). The groups were analysed separately and together by meta-analysis. Results We found a higher overall concordance in circle of Willis configuration in index families than in comparison families (meta-analysis, 244 families: OR 2.2, 95%CI 1.6–3.0) mostly attributable to a higher concordance in incomplete posterior communicating artery (meta-analysis: OR 2.8, 95%CI 1.8–4.3). No association was found for the other three circle of Willis variations. Conclusions In two independent groups of families with familial aneurysms, the incomplete PcomA variation occurred more often within than between families suggesting heritability of this circle of Willis variation. Further studies should investigate genetic variants associated with circle of Willis formation.
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Affiliation(s)
- Mayte Sánchez van Kammen
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Charles J. Moomaw
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | | | - Robert D. Brown
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Daniel Woo
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Joseph P. Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Jason S. Mackey
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Gabriël J. E. Rinkel
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - John Huston
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Ynte M. Ruigrok
- Department of Neurology and Neurosurgery, University Medical Centre Utrecht, Utrecht, the Netherlands
- * E-mail:
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Hirota K, Akagawa H, Onda H, Yoneyama T, Kawamata T, Kasuya H. Association of Rare Nonsynonymous Variants in PKD1 and PKD2 with Familial Intracranial Aneurysms in a Japanese Population. J Stroke Cerebrovasc Dis 2016; 25:2900-2906. [DOI: 10.1016/j.jstrokecerebrovasdis.2016.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/18/2016] [Accepted: 08/03/2016] [Indexed: 01/01/2023] Open
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Bekelis K, Kerley-Hamilton JS, Teegarden A, Tomlinson CR, Kuintzle R, Simmons N, Singer RJ, Roberts DW, Kellis M, Hendrix DA. MicroRNA and gene expression changes in unruptured human cerebral aneurysms. J Neurosurg 2016; 125:1390-1399. [PMID: 26918470 DOI: 10.3171/2015.11.jns151841] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The molecular mechanisms behind cerebral aneurysm formation and rupture remain poorly understood. In the past decade, microRNAs (miRNAs) have been shown to be key regulators in a host of biological processes. They are noncoding RNA molecules, approximately 21 nucleotides long, that posttranscriptionally inhibit mRNAs by attenuating protein translation and promoting mRNA degradation. The miRNA and mRNA interactions and expression levels in cerebral aneurysm tissue from human subjects were profiled. METHODS A prospective case-control study was performed on human subjects to characterize the differential expression of mRNA and miRNA in unruptured cerebral aneurysms in comparison with control tissue (healthy superficial temporal arteries [STA]). Ion Torrent was used for deep RNA sequencing. Affymetrix miRNA microarrays were used to analyze miRNA expression, whereas NanoString nCounter technology was used for validation of the identified targets. RESULTS Overall, 7 unruptured cerebral aneurysm and 10 STA specimens were collected. Several differentially expressed genes were identified in aneurysm tissue, with MMP-13 (fold change 7.21) and various collagen genes (COL1A1, COL5A1, COL5A2) being among the most upregulated. In addition, multiple miRNAs were significantly differentially expressed, with miR-21 (fold change 16.97) being the most upregulated, and miR-143-5p (fold change -11.14) being the most downregulated. From these, miR-21, miR-143, and miR-145 had several significantly anticorrelated target genes in the cohort that are associated with smooth muscle cell function, extracellular matrix remodeling, inflammation signaling, and lipid accumulation. All these processes are crucial to the pathophysiology of cerebral aneurysms. CONCLUSIONS This analysis identified differentially expressed genes and miRNAs in unruptured human cerebral aneurysms, suggesting the possibility of a role for miRNAs in aneurysm formation. Further investigation for their importance as therapeutic targets is needed.
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Affiliation(s)
| | - Joanna S Kerley-Hamilton
- Dartmouth Genomics and Microarray Laboratory, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Craig R Tomlinson
- Dartmouth Genomics and Microarray Laboratory, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Nathan Simmons
- Section of Neurosurgery and.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Robert J Singer
- Section of Neurosurgery and.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - David W Roberts
- Section of Neurosurgery and.,Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Manolis Kellis
- MIT Computational Biology Group and.,Computer Science and Artificial Intelligence Lab, MIT, Cambridge; and.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts
| | - David A Hendrix
- Department of Biochemistry and Biophysics and.,School of Electrical Engineering and Computer Science, Oregon State University, Corvallis, Oregon.,Broad Institute of MIT and Harvard, Cambridge, Massachusetts
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13
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Etminan N, Brown RD, Beseoglu K, Juvela S, Raymond J, Morita A, Torner JC, Derdeyn CP, Raabe A, Mocco J, Korja M, Abdulazim A, Amin-Hanjani S, Al-Shahi Salman R, Barrow DL, Bederson J, Bonafe A, Dumont AS, Fiorella DJ, Gruber A, Hankey GJ, Hasan DM, Hoh BL, Jabbour P, Kasuya H, Kelly ME, Kirkpatrick PJ, Knuckey N, Koivisto T, Krings T, Lawton MT, Marotta TR, Mayer SA, Mee E, Pereira VM, Molyneux A, Morgan MK, Mori K, Murayama Y, Nagahiro S, Nakayama N, Niemelä M, Ogilvy CS, Pierot L, Rabinstein AA, Roos YBWEM, Rinne J, Rosenwasser RH, Ronkainen A, Schaller K, Seifert V, Solomon RA, Spears J, Steiger HJ, Vergouwen MDI, Wanke I, Wermer MJH, Wong GKC, Wong JH, Zipfel GJ, Connolly ES, Steinmetz H, Lanzino G, Pasqualin A, Rüfenacht D, Vajkoczy P, McDougall C, Hänggi D, LeRoux P, Rinkel GJE, Macdonald RL. The unruptured intracranial aneurysm treatment score: a multidisciplinary consensus. Neurology 2015; 85:881-9. [PMID: 26276380 PMCID: PMC4560059 DOI: 10.1212/wnl.0000000000001891] [Citation(s) in RCA: 256] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 04/18/2015] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE We endeavored to develop an unruptured intracranial aneurysm (UIA) treatment score (UIATS) model that includes and quantifies key factors involved in clinical decision-making in the management of UIAs and to assess agreement for this model among specialists in UIA management and research. METHODS An international multidisciplinary (neurosurgery, neuroradiology, neurology, clinical epidemiology) group of 69 specialists was convened to develop and validate the UIATS model using a Delphi consensus. For internal (39 panel members involved in identification of relevant features) and external validation (30 independent external reviewers), 30 selected UIA cases were used to analyze agreement with UIATS management recommendations based on a 5-point Likert scale (5 indicating strong agreement). Interrater agreement (IRA) was assessed with standardized coefficients of dispersion (vr*) (vr* = 0 indicating excellent agreement and vr* = 1 indicating poor agreement). RESULTS The UIATS accounts for 29 key factors in UIA management. Agreement with UIATS (mean Likert scores) was 4.2 (95% confidence interval [CI] 4.1-4.3) per reviewer for both reviewer cohorts; agreement per case was 4.3 (95% CI 4.1-4.4) for panel members and 4.5 (95% CI 4.3-4.6) for external reviewers (p = 0.017). Mean Likert scores were 4.2 (95% CI 4.1-4.3) for interventional reviewers (n = 56) and 4.1 (95% CI 3.9-4.4) for noninterventional reviewers (n = 12) (p = 0.290). Overall IRA (vr*) for both cohorts was 0.026 (95% CI 0.019-0.033). CONCLUSIONS This novel UIA decision guidance study captures an excellent consensus among highly informed individuals on UIA management, irrespective of their underlying specialty. Clinicians can use the UIATS as a comprehensive mechanism for indicating how a large group of specialists might manage an individual patient with a UIA.
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Affiliation(s)
- Nima Etminan
- Author affiliations are provided at the end of the article.
| | - Robert D Brown
- Author affiliations are provided at the end of the article
| | - Kerim Beseoglu
- Author affiliations are provided at the end of the article
| | - Seppo Juvela
- Author affiliations are provided at the end of the article
| | - Jean Raymond
- Author affiliations are provided at the end of the article
| | - Akio Morita
- Author affiliations are provided at the end of the article
| | - James C Torner
- Author affiliations are provided at the end of the article
| | | | - Andreas Raabe
- Author affiliations are provided at the end of the article
| | - J Mocco
- Author affiliations are provided at the end of the article
| | - Miikka Korja
- Author affiliations are provided at the end of the article
| | - Amr Abdulazim
- Author affiliations are provided at the end of the article
| | | | | | | | | | - Alain Bonafe
- Author affiliations are provided at the end of the article
| | - Aaron S Dumont
- Author affiliations are provided at the end of the article
| | | | - Andreas Gruber
- Author affiliations are provided at the end of the article
| | | | - David M Hasan
- Author affiliations are provided at the end of the article
| | - Brian L Hoh
- Author affiliations are provided at the end of the article
| | - Pascal Jabbour
- Author affiliations are provided at the end of the article
| | | | | | | | | | - Timo Koivisto
- Author affiliations are provided at the end of the article
| | - Timo Krings
- Author affiliations are provided at the end of the article
| | | | | | | | - Edward Mee
- Author affiliations are provided at the end of the article
| | | | | | | | - Kentaro Mori
- Author affiliations are provided at the end of the article
| | | | | | - Naoki Nakayama
- Author affiliations are provided at the end of the article
| | - Mika Niemelä
- Author affiliations are provided at the end of the article
| | | | - Laurent Pierot
- Author affiliations are provided at the end of the article
| | | | | | - Jaakko Rinne
- Author affiliations are provided at the end of the article
| | | | | | - Karl Schaller
- Author affiliations are provided at the end of the article
| | - Volker Seifert
- Author affiliations are provided at the end of the article
| | | | - Julian Spears
- Author affiliations are provided at the end of the article
| | | | | | - Isabel Wanke
- Author affiliations are provided at the end of the article
| | | | | | - John H Wong
- Author affiliations are provided at the end of the article
| | | | | | | | | | | | | | - Peter Vajkoczy
- Author affiliations are provided at the end of the article
| | | | - Daniel Hänggi
- Author affiliations are provided at the end of the article
| | - Peter LeRoux
- Author affiliations are provided at the end of the article
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14
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Thompson BG, Brown RD, Amin-Hanjani S, Broderick JP, Cockroft KM, Connolly ES, Duckwiler GR, Harris CC, Howard VJ, Johnston SCC, Meyers PM, Molyneux A, Ogilvy CS, Ringer AJ, Torner J. Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2015; 46:2368-400. [PMID: 26089327 DOI: 10.1161/str.0000000000000070] [Citation(s) in RCA: 590] [Impact Index Per Article: 65.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. METHODS Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. RESULTS Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.
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15
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Wang Y, Emeto TI, Lee J, Marshman L, Moran C, Seto S, Golledge J. Mouse models of intracranial aneurysm. Brain Pathol 2015; 25:237-47. [PMID: 25041057 PMCID: PMC8029187 DOI: 10.1111/bpa.12175] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/09/2014] [Indexed: 01/04/2023] Open
Abstract
Subarachnoid hemorrhage secondary to rupture of an intracranial aneurysm is a highly lethal medical condition. Current management strategies for unruptured intracranial aneurysms involve radiological surveillance and neurosurgical or endovascular interventions. There is no pharmacological treatment available to decrease the risk of aneurysm rupture and subsequent subarachnoid hemorrhage. There is growing interest in the pathogenesis of intracranial aneurysm focused on the development of drug therapies to decrease the incidence of aneurysm rupture. The study of rodent models of intracranial aneurysms has the potential to improve our understanding of intracranial aneurysm development and progression. This review summarizes current mouse models of intact and ruptured intracranial aneurysms and discusses the relevance of these models to human intracranial aneurysms. The article also reviews the importance of these models in investigating the molecular mechanisms involved in the disease. Finally, potential pharmaceutical targets for intracranial aneurysm suggested by previous studies are discussed. Examples of potential drug targets include matrix metalloproteinases, stromal cell-derived factor-1, tumor necrosis factor-α, the renin-angiotensin system and the β-estrogen receptor. An agreed clear, precise and reproducible definition of what constitutes an aneurysm in the models would assist in their use to better understand the pathology of intracranial aneurysm and applying findings to patients.
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Affiliation(s)
- Yutang Wang
- The Vascular Biology UnitQueensland Research Centre for Peripheral Vascular DiseaseSchool of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Theophilus I. Emeto
- The Vascular Biology UnitQueensland Research Centre for Peripheral Vascular DiseaseSchool of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Discipline of Public Health and Tropical MedicineSchool of Public HealthTropical Medicine and Rehabilitation SciencesJames Cook UniversityTownsvilleQueenslandAustralia
| | - James Lee
- The Vascular Biology UnitQueensland Research Centre for Peripheral Vascular DiseaseSchool of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Department of NeurosurgeryThe Townsville HospitalTownsvilleQueenslandAustralia
| | - Laurence Marshman
- The Vascular Biology UnitQueensland Research Centre for Peripheral Vascular DiseaseSchool of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Department of NeurosurgeryThe Townsville HospitalTownsvilleQueenslandAustralia
| | - Corey Moran
- The Vascular Biology UnitQueensland Research Centre for Peripheral Vascular DiseaseSchool of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Sai‐wang Seto
- The Vascular Biology UnitQueensland Research Centre for Peripheral Vascular DiseaseSchool of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
| | - Jonathan Golledge
- The Vascular Biology UnitQueensland Research Centre for Peripheral Vascular DiseaseSchool of Medicine and DentistryJames Cook UniversityTownsvilleQueenslandAustralia
- Department of Vascular and Endovascular SurgeryThe Townsville HospitalTownsvilleQueenslandAustralia
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16
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Farlow JL, Lin H, Sauerbeck L, Lai D, Koller DL, Pugh E, Hetrick K, Ling H, Kleinloog R, van der Vlies P, Deelen P, Swertz MA, Verweij BH, Regli L, Rinkel GJE, Ruigrok YM, Doheny K, Liu Y, Broderick J, Foroud T. Lessons learned from whole exome sequencing in multiplex families affected by a complex genetic disorder, intracranial aneurysm. PLoS One 2015; 10:e0121104. [PMID: 25803036 PMCID: PMC4372548 DOI: 10.1371/journal.pone.0121104] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 02/10/2015] [Indexed: 12/30/2022] Open
Abstract
Genetic risk factors for intracranial aneurysm (IA) are not yet fully understood. Genomewide association studies have been successful at identifying common variants; however, the role of rare variation in IA susceptibility has not been fully explored. In this study, we report the use of whole exome sequencing (WES) in seven densely-affected families (45 individuals) recruited as part of the Familial Intracranial Aneurysm study. WES variants were prioritized by functional prediction, frequency, predicted pathogenicity, and segregation within families. Using these criteria, 68 variants in 68 genes were prioritized across the seven families. Of the genes that were expressed in IA tissue, one gene (TMEM132B) was differentially expressed in aneurysmal samples (n=44) as compared to control samples (n=16) (false discovery rate adjusted p-value=0.023). We demonstrate that sequencing of densely affected families permits exploration of the role of rare variants in a relatively common disease such as IA, although there are important study design considerations for applying sequencing to complex disorders. In this study, we explore methods of WES variant prioritization, including the incorporation of unaffected individuals, multipoint linkage analysis, biological pathway information, and transcriptome profiling. Further studies are needed to validate and characterize the set of variants and genes identified in this study.
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Affiliation(s)
- Janice L. Farlow
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Hai Lin
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Laura Sauerbeck
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States of America
| | - Dongbing Lai
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Daniel L. Koller
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Elizabeth Pugh
- Center for Inherited Disease Research, Johns Hopkins University; Baltimore, Maryland, United States of America
| | - Kurt Hetrick
- Center for Inherited Disease Research, Johns Hopkins University; Baltimore, Maryland, United States of America
| | - Hua Ling
- Center for Inherited Disease Research, Johns Hopkins University; Baltimore, Maryland, United States of America
| | - Rachel Kleinloog
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Pieter van der Vlies
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Patrick Deelen
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Genomics Coordination Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Morris A. Swertz
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Genomics Coordination Center, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Bon H. Verweij
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Luca Regli
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | - Gabriel J. E. Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ynte M. Ruigrok
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kimberly Doheny
- Center for Inherited Disease Research, Johns Hopkins University; Baltimore, Maryland, United States of America
| | - Yunlong Liu
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Joseph Broderick
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio, United States of America
| | - Tatiana Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail:
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17
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Mackey J, Brown RD, Sauerbeck L, Hornung R, Moomaw CJ, Koller DL, Foroud T, Deka R, Woo D, Kleindorfer D, Flaherty ML, Meissner I, Anderson C, Rouleau G, Connolly ES, Huston J, Broderick JP. Affected twins in the familial intracranial aneurysm study. Cerebrovasc Dis 2015; 39:82-6. [PMID: 25571891 DOI: 10.1159/000369961] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/17/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Very few cases of intracranial aneurysms (IAs) in twins have been reported. Previous work has suggested that vulnerability to IA formation is heritable. Twin studies provide an opportunity to evaluate the impact of genetics on IA characteristics, including IA location. We therefore sought to examine IA location concordance, multiplicity, and rupture status within affected twin-pairs. METHODS The Familial Intracranial Aneurysm study was a multicenter study whose goal was to identify genetic and other risk factors for formation and rupture of IAs. The study required at least three affected family members or an affected sibling pair for inclusion. Subjects with fusiform aneurysms, an IA associated with an AVM, or a family history of conditions known to predispose to IA formation, such as polycystic kidney disease, Ehlers-Danlos syndrome, Marfan syndrome, fibromuscular dysplasia, or moyamoya syndrome were excluded. Twin-pairs were identified by birth date and were classified as monozygotic (MZ) or dizygotic (DZ) through DNA marker genotypes. In addition to zygosity, we evaluated twin-pairs by smoking status, major arterial territory of IAs, and rupture status. Location concordance was defined as the presence of an IA in the same arterial distribution (ICA, MCA, ACA, and vertebrobasilar), irrespective of laterality, in both members of a twin-pair. The Fisher exact test was used for comparisons between MZ and DZ twin-pairs. RESULTS A total of 16 affected twin-pairs were identified. Location concordance was observed in 8 of 11 MZ twin-pairs but in only 1 of 5 DZ twin-pairs (p = 0.08). Three MZ subjects had unknown IA locations and comprised the three instances of MZ discordance. Six of the 11 MZ twin-pairs and none of the 5 DZ twin-pairs had IAs in the ICA distribution (p = 0.03). Multiple IAs were observed in 11 of 22 MZ and 5 of 10 DZ twin-pairs. Thirteen (13) of the 32 subjects had an IA rupture, including 10 of 22 MZ twins. CONCLUSIONS We found that arterial location concordance was greater in MZ than DZ twins, which suggests a genetic influence upon aneurysm location. The 16 twin-pairs in the present study are nearly the total of affected twin-pairs that have been reported in the literature to date. Further studies are needed to determine the impact of genetics in the formation and rupture of IAs.
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Affiliation(s)
- Jason Mackey
- Department of Neurology, Indiana University, Indianapolis, Ind., USA
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18
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Etminan N, Beseoglu K, Barrow DL, Bederson J, Brown RD, Connolly ES, Derdeyn CP, Hänggi D, Hasan D, Juvela S, Kasuya H, Kirkpatrick PJ, Knuckey N, Koivisto T, Lanzino G, Lawton MT, LeRoux P, McDougall CG, Mee E, Mocco J, Molyneux A, Morgan MK, Mori K, Morita A, Murayama Y, Nagahiro S, Pasqualin A, Raabe A, Raymond J, Rinkel GJ, Rüfenacht D, Seifert V, Spears J, Steiger HJ, Steinmetz H, Torner JC, Vajkoczy P, Wanke I, Wong GK, Wong JH, Macdonald RL. Multidisciplinary Consensus on Assessment of Unruptured Intracranial Aneurysms. Stroke 2014; 45:1523-30. [DOI: 10.1161/strokeaha.114.004519] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nima Etminan
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Kerim Beseoglu
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Daniel L. Barrow
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Joshua Bederson
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Robert D. Brown
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - E. Sander Connolly
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Colin P. Derdeyn
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Daniel Hänggi
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - David Hasan
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Seppo Juvela
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Hidetoshi Kasuya
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Peter J. Kirkpatrick
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Neville Knuckey
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Timo Koivisto
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Giuseppe Lanzino
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Michael T. Lawton
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Peter LeRoux
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Cameron G. McDougall
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Edward Mee
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - J Mocco
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Andrew Molyneux
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Michael K. Morgan
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Kentaro Mori
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Akio Morita
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Yuichi Murayama
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Shinji Nagahiro
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Alberto Pasqualin
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Andreas Raabe
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Jean Raymond
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Gabriel J.E. Rinkel
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Daniel Rüfenacht
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Volker Seifert
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Julian Spears
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Hans-Jakob Steiger
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Helmuth Steinmetz
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - James C. Torner
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Peter Vajkoczy
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - Isabel Wanke
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - George K.C. Wong
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - John H. Wong
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
| | - R. Loch Macdonald
- From the Department of Neurosurgery (N.E., K.B., D. Hänggi, H.-J.S.), Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Emory Stroke Center, Emory University School of Medicine, Atlanta, GA (D.L.B.); Department of Neurosurgery, The Mount Sinai Health System, New York, NY (J.B.); Departments of Neurology (R.D.B.) and Neurologic Surgery (G.L.), Mayo Clinic, Rochester, MN; Department of Neurological Surgery, Columbia University, New York, NY (E.S.C.)
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Kataoka H, Aoki T. Molecular basis for the development of intracranial aneurysm. Expert Rev Neurother 2014. [DOI: 10.1586/ern.09.155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Shared associations of nonatherosclerotic, large-vessel, cerebrovascular arteriopathies. Curr Opin Neurol 2013; 26:13-28. [DOI: 10.1097/wco.0b013e32835c607f] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Mackey J, Brown RD, Moomaw CJ, Hornung R, Sauerbeck L, Woo D, Foroud T, Gandhi D, Kleindorfer D, Flaherty ML, Meissner I, Anderson C, Rouleau G, Connolly ES, Deka R, Koller DL, Abruzzo T, Huston J, Broderick JP. Familial intracranial aneurysms: is anatomic vulnerability heritable? Stroke 2012. [PMID: 23204049 DOI: 10.1161/strokeaha.112.667261] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have suggested that family members with intracranial aneurysms (IAs) often harbor IAs in similar anatomic locations. IA location is important because of its association with rupture. We tested the hypothesis that anatomic susceptibility to IA location exists using a family-based IA study. METHODS We identified all affected probands and first-degree relatives (FDRs) with a definite or probable phenotype in each family. We stratified each IA of the probands by major arterial territory and calculated each family's proband-FDR territory concordance and overall contribution to the concordance analysis. We then matched each family unit to an unrelated family unit selected randomly with replacement and performed 1001 simulations. The median concordance proportions, odds ratios (ORs), and P values from the 1001 logistic regression analyses were used to represent the final results of the analysis. RESULTS There were 323 family units available for analysis, including 323 probands and 448 FDRs, with a total of 1176 IAs. IA territorial concordance was higher in the internal carotid artery (55.4% versus 45.6%; OR, 1.54 [1.04-2.27]; P=0.032), middle cerebral artery (45.8% versus 30.5%; OR, 1.99 [1.22-3.22]; P=0.006), and vertebrobasilar system (26.6% versus 11.3%; OR, 2.90 [1.05-8.24], P=0.04) distributions in the true family compared with the comparison family. Concordance was also higher when any location was considered (53.0% versus 40.7%; OR, 1.82 [1.34-2.46]; P<0.001). CONCLUSIONS In a highly enriched sample with familial predisposition to IA development, we found that IA territorial concordance was higher when probands were compared with their own affected FDRs than with comparison FDRs, which suggests that anatomic vulnerability to IA formation exists. Future studies of IA genetics should consider stratifying cases by IA location.
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Affiliation(s)
- Jason Mackey
- IU Health Neuroscience Center, 355 W 16th St, Suite 3200, Indianapolis, IN 46202, USA.
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23
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Foroud T, Koller DL, Lai D, Sauerbeck L, Anderson C, Ko N, Deka R, Mosley TH, Fornage M, Woo D, Moomaw CJ, Hornung R, Huston J, Meissner I, Bailey-Wilson JE, Langefeld C, Rouleau G, Connolly ES, Worrall BB, Kleindorfer D, Flaherty ML, Martini S, Mackey J, De Los Rios La Rosa F, Brown RD, Broderick JP. Genome-wide association study of intracranial aneurysms confirms role of Anril and SOX17 in disease risk. Stroke 2012; 43:2846-52. [PMID: 22961961 DOI: 10.1161/strokeaha.112.656397] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Genomewide association studies have identified novel genetic factors that contribute to intracranial aneurysm (IA) susceptibility. We sought to confirm previously reported loci, to identify novel risk factors, and to evaluate the contribution of these factors to familial and sporadic IA. METHOD We utilized 2 complementary samples, one recruited on the basis of a dense family history of IA (discovery sample 1: 388 IA cases and 397 controls) and the other without regard to family history (discovery sample 2: 1095 IA cases and 1286 controls). Imputation was used to generate a common set of single nucleotide polymorphisms (SNP) across samples, and a logistic regression model was used to test for association in each sample. Results from each sample were then combined in a metaanalysis. RESULTS There was only modest overlap in the association results obtained in the 2 samples. In neither sample did results reach genomewide significance. However, the metaanalysis yielded genomewide significance for SNP on chromosome 9p (CDKN2BAS; rs6475606; P=3.6×10(-8)) and provided further evidence to support the previously reported association of IA with SNP in SOX17 on chromosome 8q (rs1072737; P=8.7×10(-5)). Analyses suggest that the effect of smoking acts multiplicatively with the SNP genotype, and smoking has a greater effect on risk than SNP genotype. CONCLUSIONS In addition to replicating several previously reported loci, we provide further evidence that the association on chromosome 9p is attributable to variants in CDKN2BAS (also known as ANRIL, an antisense noncoding RNA).
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Affiliation(s)
- Tatiana Foroud
- Indiana University School of Medicine, 410 W. 10 Street, Indianapolis, IN 46202, USA.
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Sauerbeck L, Hornung R, Woo D, Moomaw CJ, Anderson C, Connolly ES, Rouleau GA, Brown RD, Broderick JP. Mortality and causes of death in the Familial Intracranial Aneurysm study. Int J Stroke 2012; 8:696-700. [PMID: 22928607 DOI: 10.1111/j.1747-4949.2012.00857.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Higher mortality for patients with aneurysmal subarachnoid haemorrhage has been reported. AIMS In families with intracranial aneurysms, we sought to determine whether mortality among subjects with intracranial aneurysm (affected) was higher and related to rupture, compared with unaffected family members. METHODS Subjects enrolled in the Familial Intracranial Aneurysm protocol were contacted yearly and their status was obtained. If reported to be deceased, the cause of death was verified by available records. A Cox proportional hazards model was utilized to compare mortality rates. RESULTS Of the 2794 subjects, 1073 were affected and 1721 were unaffected. There were 8525 person-years of follow-up (mean 3·05 ± 1·73 years) and 85 deaths. Age at study entry for the affected (58·4 ± 11·9 years) was significantly older (P < 0·0001) than for the unaffected (52·2 ± 16·1). After adjusting for age, the overall mortality rate for the affected subjects was not significantly different from that for the unaffected (Rate Ratio [RR] 1·26, 95% confidence interval 0·82-1·93, P = 0·292). There was a strong effect modification due to age. The mortality rate ratio of the affected to the unaffected who were ≤60 years of age was RR = 3·48 (95% confidence interval: 1·59-7·63, P = 0·002), the rate for the affected subjects who were ≥60 was less than the rate for the unaffected (RR = 0·69, 95% confidence interval: 0·404-1·19, P = 0·178). The affected who had ruptures had 2·62 times the mortality rate as those without ruptures (95% confidence interval 1·43-4·80, P = 0·002). CONCLUSION The overall mortality was similar for the affected and unaffected subjects in this cohort. Among the affected only, those with ruptured intracranial aneurysm had a higher mortality rate than those without ruptured.
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Affiliation(s)
- Laura Sauerbeck
- Department of Medicine, The University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Aeron G, Abruzzo TA, Jones BV. Clinical and Imaging Features of Intracranial Arterial Aneurysms in the Pediatric Population. Radiographics 2012; 32:667-81. [DOI: 10.1148/rg.323105224] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Mackey J, Brown RD, Moomaw CJ, Sauerbeck L, Hornung R, Gandhi D, Woo D, Kleindorfer D, Flaherty ML, Meissner I, Anderson C, Connolly ES, Rouleau G, Kallmes DF, Torner J, Huston J, Broderick JP. Unruptured intracranial aneurysms in the Familial Intracranial Aneurysm and International Study of Unruptured Intracranial Aneurysms cohorts: differences in multiplicity and location. J Neurosurg 2012; 117:60-4. [PMID: 22540404 DOI: 10.3171/2012.4.jns111822] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Familial predisposition is a recognized nonmodifiable risk factor for the formation and rupture of intracranial aneurysms (IAs). However, data regarding the characteristics of familial IAs are limited. The authors sought to describe familial IAs more fully, and to compare their characteristics with a large cohort of nonfamilial IAs. METHODS The Familial Intracranial Aneurysm (FIA) study is a multicenter international study with the goal of identifying genetic and other risk factors for formation and rupture of IAs in a highly enriched population. The authors compared the FIA study cohort with the International Study of Unruptured Intracranial Aneurysms (ISUIA) cohort with regard to patient demographic data, IA location, and IA multiplicity. To improve comparability, all patients in the ISUIA who had a family history of IAs or subarachnoid hemorrhage were excluded, as well as all patients in both cohorts who had a ruptured IA prior to study entry. RESULTS Of 983 patients enrolled in the FIA study with definite or probable IAs, 511 met the inclusion criteria for this analysis. Of the 4059 patients in the ISUIA study, 983 had a previous IA rupture and 657 of the remainder had a positive family history, leaving 2419 individuals in the analysis. Multiplicity was more common in the FIA patients (35.6% vs 27.9%, p<0.001). The FIA patients had a higher proportion of IAs located in the middle cerebral artery (28.6% vs 24.9%), whereas ISUIA patients had a higher proportion of posterior communicating artery IAs (13.7% vs 8.2%, p=0.016). CONCLUSIONS Heritable structural vulnerability may account for differences in IA multiplicity and location. Important investigations into the underlying genetic mechanisms of IA formation are ongoing.
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Affiliation(s)
- Jason Mackey
- Department of Neurology, Indiana University, Indianapolis, Indiana 46202, USA.
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Chalouhi N, Chitale R, Jabbour P, Tjoumakaris S, Dumont AS, Rosenwasser R, Gonzalez LF. The case for family screening for intracranial aneurysms. Neurosurg Focus 2011; 31:E8. [DOI: 10.3171/2011.9.focus11210] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Given that relatives of patients with intracranial aneurysms (IAs) or subarachnoid hemorrhage have a greater risk of harboring an aneurysm, family screening has become a common practice in neurosurgery. Unclear data exist regarding who should be screened and at what age and interval screening should occur. Multiple factors including the natural history of IAs, the risk of treatment, the cost of screening, and the psychosocial impact of finding an aneurysm should be taken into account when family screening is considered. In this paper, the authors review the current literature regarding risk factors and natural history of sporadic and familial aneurysms. Based on these data the authors assess current recommendations for screening and propose their own recommendations.
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Impact of LIMK1, MMP2 and TNF-α variations for intracranial aneurysm in Japanese population. J Hum Genet 2011; 56:211-6. [PMID: 21228795 DOI: 10.1038/jhg.2010.169] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Genetic factors are known to have an important role in intracranial aneurysm (IA) pathogenesis. The purpose of this study is to identify single-nucleotide polymorphisms (SNPs) that are associated with IA in Japanese population. A total of 2050 IA patients and 1835 controls recruited in Biobank Japan, The University of Tokyo were used in this study. In all, 45 SNPs in 24 genes encoding proteins, which have been considered to be possible risk factors to IA pathogenesis, were genotyped using multiplex PCR-invader assay. Association analysis was evaluated by logistic regression analysis before and after adjustment of age, smoking and hypertension status. This case-control association study revealed a SNP, rs6460071 located on LIMK1 gene (P = 0.00069) to be significantly associated with increased risk of IA. In addition, two SNPs, rs243847 (P = 0.00086) and rs243865 (P = 0.00090), on matrix metallopeptidase 2 (MMP2) gene and one SNP rs1799724 (P = 0.0026) on tumor necrosis factor-α (TNF-α) gene, are marginally associated with IA in male- and female-specific manner, respectively. In conclusion, a large-scale case-control association study was conducted to verify genetic variations associated with IA in Japanese population. This study gave insights on the importance of stratified analysis between genders, and suggested that the underlying mechanism of IA pathogenesis might differ between females and males.
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Deka R, Koller DL, Lai D, Indugula SR, Sun G, Woo D, Sauerbeck L, Moomaw CJ, Hornung R, Connolly ES, Anderson C, Rouleau G, Meissner I, Bailey-Wilson JE, Huston J, Brown RD, Kleindorfer DO, Flaherty ML, Langefeld CD, Foroud T, Broderick JP. The relationship between smoking and replicated sequence variants on chromosomes 8 and 9 with familial intracranial aneurysm. Stroke 2010; 41:1132-7. [PMID: 20190001 DOI: 10.1161/strokeaha.109.574640] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this study was to replicate the previous association of single nucleotide polymorphisms (SNPs) with risk of intracranial aneurysm (IA) and to examine the relationship of smoking with these variants and the risk of IA. METHODS White probands with an IA from families with multiple affected members were identified by 26 clinical centers located throughout North America, New Zealand, and Australia. White control subjects free of stroke and IA were selected by random digit dialing from the Greater Cincinnati population. SNPs previously associated with IA on chromosomes 2, 8, and 9 were genotyped using a TaqMan assay or were included in the Affymetrix 6.0 array that was part of a genomewide association study of 406 IA cases and 392 control subjects. Logistic regression modeling tested whether the association of replicated SNPs with IA was modulated by smoking. RESULTS The strongest evidence of association with IA was found with the 8q SNP rs10958409 (genotypic P=9.2x10(-5); allelic P=1.3x10(-5); OR=1.86, 95% CI: 1.40 to 2.47). We also replicated the association with both SNPs on chromosome 9p, rs1333040 and rs10757278, but were not able to replicate the previously reported association of the 2 SNPs on chromosome 2q. Statistical testing showed a multiplicative relationship between the risk alleles and smoking with regard to the risk of IA. CONCLUSIONS Our data provide complementary evidence that the variants on chromosomes 8q and 9p are associated with IA and that the risk of IA in patients with these variants is greatly increased with cigarette smoking.
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Affiliation(s)
- Ranjan Deka
- Department of Neurology, UC Neuroscience Institute, University of Cincinnati Academic Health Center, 260 Stetson Street, Suite 2300, PO Box 670525, Cincinnati, OH 45267-0525, USA
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Woo D, Hornung R, Sauerbeck L, Brown R, Meissner I, Huston J, Foroud T, Broderick J. Age at intracranial aneurysm rupture among generations: Familial Intracranial Aneurysm Study. Neurology 2009; 72:695-8. [PMID: 19237697 DOI: 10.1212/01.wnl.0000342999.99907.fd] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Previous studies have reported intracranial aneurysm (IA) occurring at young ages in subsequent generations. These studies did not correct for duration of follow-up. Second-generation members who would have their ruptured IA late in life may not be detected due to shorter follow-up time than the first generation. We examined families in which ruptured IA occurred in two consecutive generations for the hypothesis that the second generation (F1) was more likely to have a rupture at a younger age than the older generation (F0). METHODS The Familial Intracranial Aneurysm (FIA) Study is a multicenter, international study recruiting families of ruptured and unruptured IA. All available family members are interviewed. Cox proportional hazards regression models and Kaplan-Meier curves were used to examine differences by generation. RESULTS Although we found that the F1 generation was more likely to have an aneurysm rupture at a younger age than the F0 generation, we found that this was largely because of a lack of follow-up time in the F1 generation. The F1 generation had 50% the rupture rate of the prior generation. When analyzed by Kaplan-Meier curves, we found a tendency to have a slightly later rupture rate in the F1 generation once time to follow-up was included in the analysis model. CONCLUSIONS Families of ruptured intracranial aneurysm (IA) do not appear to demonstrate "anticipation." Our finding suggests that genetic epidemiology of ruptured IA should examine all types of variations such as single base-pair changes, deletions, insertions, and other variations that do not demonstrate anticipation.
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Affiliation(s)
- D Woo
- Departments of Neurology, Environmental Health, and Center for Environmental Genetics, University of Cincinnati, Cincinnati, OH 45267-0525, USA.
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Broderick JP, Brown RD, Sauerbeck L, Hornung R, Huston J, Woo D, Anderson C, Rouleau G, Kleindorfer D, Flaherty ML, Meissner I, Foroud T, Moomaw ECJ, Connolly ES. Greater rupture risk for familial as compared to sporadic unruptured intracranial aneurysms. Stroke 2009; 40:1952-7. [PMID: 19228834 DOI: 10.1161/strokeaha.108.542571] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The risk of intracranial aneurysm (IA) rupture in asymptomatic members of families who have multiple affected individuals is not known. METHODS First-degree unaffected relatives of those with a familial history of IA who had a history of smoking or hypertension but no known IA were offered cerebral MR angiography (MRA) and followed yearly as part of a National Institute of Neurological Diseases and Stroke-funded study of familial IA (Familial Intracranial Aneurysm [FIA] Study). RESULTS A total of 2874 subjects from 542 FIA Study families were enrolled. After study enrollment, MRAs were performed in 548 FIA Study family members with no known history of IA. Of these 548 subjects, 113 subjects (20.6%) had 148 IAs by MRA of whom 5 subjects had IA >or=7 mm. Two subjects with an unruptured IA by MRA/CT angiography (3-mm and 4-mm anterior communicating artery) subsequently had rupture of their IA. This represents an annual rate of 1.2 ruptures per 100 subjects (1.2% per year; 95% CI, 0.14% to 4.3% per year). None of the 435 subjects with a negative MRA have had a ruptured IA. Survival curves between the MRA-positive and -negative cohorts were significantly different (P=0.004). This rupture rate of unruptured IA in the FIA Study cohort of 1.2% per year is approximately 17 times higher than the rupture rate for subjects with an unruptured IA in the International Study of Unruptured Aneurysm Study with a matched distribution of IA size and location 0.069% per year. CONCLUSIONS Small unruptured IAs in patients from FIA Study families may have a higher risk of rupture than sporadic unruptured IAs of similar size, which should be considered in the management of these patients.
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Affiliation(s)
- Joseph P Broderick
- Department of Neurology, Center for Stroke and Cerebrovascular Disease, University of Cincinnati Neuroscience Institute, UC College of Medicine, 260 Stetson Street, Cincinnati, OH 45267-0525, USA.
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The effects of study participation in the Familial Intracranial Aneurysm Study on cigarette smoking. J Stroke Cerebrovasc Dis 2009; 17:370-2. [PMID: 18984429 DOI: 10.1016/j.jstrokecerebrovasdis.2008.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Accepted: 04/21/2008] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Cigarette smoking is the most modifiable risk factor for the formation and rupture of intracranial aneurysm (IA). This study examined the impact of participation in the Familial IA study on smoking behavior. METHODS On entry into the study, a baseline smoking history was obtained. At follow-up visits, subjects were surveyed concerning their current smoking status. Risk reduction education was site specific and the study did not include a standard approach. RESULTS Of participants, 66% had a history of cigarette smoking, with 33.1% being current smokers. There was a significant reduction in the proportion of current smokers by the third yearly follow-up visit (26.7%, P < .001). There was a significant reduction in the daily amount of cigarettes smoked (17.7-11.5, P < .001), with the most significant reduction at the first follow-up visit. Current smokers given the diagnosis of an IA before entry or during the course of the study were more likely to decrease their smoking (19.4-9.8 cigarettes/day, P < .001) than those not given a diagnosis of an IA (16.0-13.3, P = .002). Individuals older then 51 years had a greater reduction in the amount of cigarettes smoked per day compared with those younger than 51 years (2.3 cigarettes/day reduction v 1.5, P = .002). CONCLUSION Subjects who entered into the Familial IA study had a significant decrease in their smoking by the end of 3 years. Factors associated with decreased smoking were diagnosis of IA and older age.
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Foroud T, Sauerbeck L, Brown R, Anderson C, Woo D, Kleindorfer D, Flaherty ML, Deka R, Hornung R, Meissner I, Bailey-Wilson JE, Langefeld C, Rouleau G, Connolly ES, Lai D, Koller DL, Huston J, Broderick JP. Genome screen in familial intracranial aneurysm. BMC MEDICAL GENETICS 2009; 10:3. [PMID: 19144135 PMCID: PMC2636777 DOI: 10.1186/1471-2350-10-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 01/13/2009] [Indexed: 11/10/2022]
Abstract
Background Individuals with 1st degree relatives harboring an intracranial aneurysm (IA) are at an increased risk of IA, suggesting genetic variation is an important risk factor. Methods Families with multiple members having ruptured or unruptured IA were recruited and all available medical records and imaging data were reviewed to classify possible IA subjects as definite, probable or possible IA or not a case. A 6 K SNP genome screen was performed in 333 families, representing the largest linkage study of IA reported to date. A 'narrow' (n = 705 definite IA cases) and 'broad' (n = 866 definite or probable IA) disease definition were used in multipoint model-free linkage analysis and parametric linkage analysis, maximizing disease parameters. Ordered subset analysis (OSA) was used to detect gene × smoking interaction. Results Model-free linkage analyses detected modest evidence of possible linkage (all LOD < 1.5). Parametric analyses yielded an unadjusted LOD score of 2.6 on chromosome 4q (162 cM) and 3.1 on chromosome 12p (50 cM). Significant evidence for a gene × smoking interaction was detected using both disease models on chromosome 7p (60 cM; p ≤ 0.01). Our study provides modest evidence of possible linkage to several chromosomes. Conclusion These data suggest it is unlikely that there is a single common variant with a strong effect in the majority of the IA families. Rather, it is likely that multiple genetic and environmental risk factors contribute to the susceptibility for intracranial aneurysms.
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Affiliation(s)
- Tatiana Foroud
- Indiana University School of Medicine, Indianapolis, IN, USA.
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Abstract
Intracranial aneurysms (IAs) are the dilatations of blood vessels in the brain and pose potential risk of rupture leading to subarachnoid hemorrhage. Although the genetic basis of IAs is poorly understood, it is well-known that genetic factors play an important part in the pathogenesis of IAs. Therefore, the identifying susceptible genetic variants might lead to the understanding of the mechanism of formation and rupture of IAs and might also lead to the development of a pharmacological therapy. To elucidate the molecular pathogenesis of diseases has become a crucial step in the development of new treatment strategies. Although extensive genetic research and its potential implications for future prevention of this often fatal condition are urgently needed, efforts to elucidate the susceptibility loci of IAs are hindered by the issues bewildering the most common and complex genetic disorders, such as low penetrance, late onset, and uncertain modes of inheritance. These efforts are further complicated by the fact that many IA lesions remain asymptomatic or go undiagnosed. In this review, we present and discuss the current status of genetic studies of IAs and we recommend comprehensive genome-wide association studies to identify genetic loci that underlie this complex disease.
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Affiliation(s)
- Jun Zhang
- Department of Neurosurgery, The University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Richard E. Claterbuck
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Worrall BB, Foroud T, Brown RD, Connolly ES, Hornung RW, Huston J, Kleindorfer D, Koller DL, Lai D, Moomaw CJ, Sauerbeck L, Woo D, Broderick JP. Genome screen to detect linkage to common susceptibility genes for intracranial and aortic aneurysms. Stroke 2008; 40:71-6. [PMID: 18948608 DOI: 10.1161/strokeaha.108.522631] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Risk for both intracranial aneurysms (IAs) and aortic aneurysms (AAs) is thought to be heritable with mounting evidence for genetic predisposition. The concept of shared risk for these conditions is challenged by differences in age of diagnosis and demographic characteristics. We performed a genomewide linkage analysis in multiplex families with both IA and AA from the Familial Intracranial Aneurysm study. METHODS Available medical records of subjects who reported IA or abdominal/thoracic AA were reviewed with adjudication as definite/probable, possible, or not a case. To identify genes contributing to the susceptibility for IA and AA, genomewide linkage analysis was performed in the 26 multiplex IA families who had members who also had thoracic or abdominal AA. Individuals (n=91) were defined as affected if they had an IA (definite/probable) or an aortic or thoracic AA (definite/probable). RESULTS Maximum logarithm of odds (LOD) scores were found on chromosomes 11 (144 cM; LOD=3.0) and 6 (33 cM; LOD=2.3). In both chromosomal regions, analyses of these same 26 families considering only IA as the disease phenotype produced LOD scores of 1.8 and 1.6, respectively. CONCLUSIONS Our linkage analysis in these 26 families using the broadest disease phenotype, including IA, abdominal AA, and thoracic AA, supports the concept of shared genetic risk. The chromosome 11 locus appears to confirm earlier independent associations in IA and AA. The chromosome 6 finding is novel. Both warrant further investigation.
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Affiliation(s)
- Bradford B Worrall
- University of Virginia Health System, Department of Neurology, Box 800394, Charlottesville, VA 22908, USA.
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Lee JS, Park IS, Park KB, Kang DH, Lee CH, Hwang SH. Familial intracranial aneurysms. J Korean Neurosurg Soc 2008; 44:136-40. [PMID: 19096663 DOI: 10.3340/jkns.2008.44.3.136] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Accepted: 08/10/2008] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Numerous studies have compared the characteristics of familial intracranial aneurysms with those of non-familial aneurysms. To better understand familial subarachnoid hemorrhage (SAH), we studied a series of patients with SAH who had at least one first-degree relative with SAH, and compared our results with those of previous studies. METHODS We identified patients treated for SAH at our hospital between January 1993 and October 2006 and analyzed those patients with one or more first-degree relatives with SAH. We retrospectively collected data from patients with a family history and searched for patients who had relatives with aneurysms or who had been treated at other hospitals for SAH. RESULTS We identified 12 patients from six families with at least two first-degree relatives with SAH. All patients had affected first-degree relatives; in five families, they were siblings. The mean age at the time of rupture was 49.75 years; in four families, the age difference was within 5 years. In five patients (42%), the aneurysm was located in the middle cerebral artery. Only one patient had an aneurysm in the anterior communicating artery. CONCLUSION In agreement with previous studies, our results showed that familial aneurysms, in comparison with non-familiar aneurysms, ruptured at a younger age and smaller size, had a high incidence in the middle cerebral artery, and were underrepresented in the anterior communicating artery. Interestingly, the age at the time of rupture was similar between relatives. Screening should be considered in the fifth or sixth decade for those who have a sibling with SAH.
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Affiliation(s)
- Jin Soo Lee
- Department of Neurosurgery, Gyeongsang National University, School of Medicine, Jinju, Korea
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Brown RD, Huston J, Hornung R, Foroud T, Kallmes DF, Kleindorfer D, Meissner I, Woo D, Sauerbeck L, Broderick J. Screening for brain aneurysm in the Familial Intracranial Aneurysm study: frequency and predictors of lesion detection. J Neurosurg 2008; 108:1132-8. [PMID: 18518716 DOI: 10.3171/jns/2008/108/6/1132] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Approximately 20% of patients with an intracranial saccular aneurysm report a family history of intracranial aneurysm (IA) or subarachnoid hemorrhage. A better understanding of predictors of aneurysm detection in familial IA may allow more targeted aneurysm screening strategies. METHODS The Familial Intracranial Aneurysm (FIA) study is a multicenter study, in which the primary objective is to define the susceptibility genes related to the formation of IA. First-degree relatives (FDRs) of those affected with IA are offered screening with magnetic resonance (MR) angiography if they were previously unaffected, are > or = 30 years of age, and have a history of smoking and/or hypertension. Independent predictors of aneurysm detection on MR angiography were determined using the generalized estimating equation version of logistic regression. RESULTS Among the first 303 patients screened with MR angiography, 58 (19.1%) had at least 1 IA, including 24% of women and 11.7% of men. Ten (17.2%) of 58 affected patients had multiple aneurysms. Independent predictors of aneurysm detection included female sex (odds ratio [OR] 2.46, p = 0.001), pack-years of cigarette smoking (OR 3.24 for 20 pack-years of cigarette smoking compared with never having smoked, p < 0.001), and duration of hypertension (OR 1.26 comparing those with 10 years of hypertension to those with no hypertension, p = 0.006). CONCLUSIONS In the FIA study, among the affected patients' FDRs who are > 30 years of age, those who are women or who have a history of smoking or hypertension are at increased risk of suffering an IA and should be strongly considered for screening.
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Affiliation(s)
- Robert D Brown
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
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Zahuranec DB, Morgenstern LB. Fear factor. Neurology 2008; 70:2022-3. [DOI: 10.1212/01.wnl.0000313381.42329.88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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40
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Foroud T, Sauerbeck L, Brown R, Anderson C, Woo D, Kleindorfer D, Flaherty ML, Deka R, Hornung R, Meissner I, Bailey-Wilson JE, Rouleau G, Connolly ES, Lai D, Koller DL, Huston J, Broderick JP. Genome screen to detect linkage to intracranial aneurysm susceptibility genes: the Familial Intracranial Aneurysm (FIA) study. Stroke 2008; 39:1434-40. [PMID: 18323491 DOI: 10.1161/strokeaha.107.502930] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Evidence supports a substantial genetic contribution to the risk of intracranial aneurysm (IA). The purpose of this study was to identify chromosomal regions likely to harbor genes that contribute to the risk of IA. METHODS Multiplex families having at least 2 individuals with "definite" or "probable" IA were ascertained through an international consortium. First-degree relatives of individuals with IA who were at increased risk of an IA because of a history of hypertension or present smoking were offered cerebral magnetic resonance angiography. A genome screen was completed using the Illumina 6K SNP system, and the resulting data from 192 families, containing 1155 genotyped individuals, were analyzed. Narrow and broad disease definitions were used when testing for linkage using multipoint model-independent methods. Ordered subset analysis was performed to test for a gene x smoking (pack-years) interaction. RESULTS The greatest evidence of linkage was found on chromosomes 4 (LOD=2.5; 156 cM), 7 (LOD=1.7; 183 cM), 8 (LOD=1.9; 70 cM), and 12 (LOD=1.6; 102 cM) using the broad disease definition. Using the average pack-years for the affected individuals in each family, the genes on chromosomes 4 (LOD=3.5; P=0.03), 7 (LOD=4.1; P=0.01) and 12 (LOD=3.6; P=0.02) all appear to be modulated by the degree of smoking in the affected members of the family. On chromosome 8, inclusion of smoking as a covariate did not significantly strengthen the linkage evidence, suggesting no interaction between the loci in this region and smoking. CONCLUSIONS We have detected possible evidence of linkage to 4 chromosomal regions. There is potential evidence for a gene x smoking interaction with 3 of the loci.
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Affiliation(s)
- Tatiana Foroud
- Indiana University School of Medicine, Health Information and Translational Sciences Building - HS 4000, 410 West 10th Street, Indianapolis, IN 46202-3002, USA.
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Komotar RJ, Mocco J, Solomon RA. GUIDELINES FOR THE SURGICAL TREATMENT OF UNRUPTURED INTRACRANIAL ANEURYSMS. Neurosurgery 2008; 62:183-93; discussion 193-4. [PMID: 18300906 DOI: 10.1227/01.neu.0000311076.64109.2e] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
THE MANAGEMENT OF unruptured cerebral aneurysms remains one of the most controversial topics in neurosurgery. To this end, we discuss the diagnosis and estimated prevalence of these lesions as well as review the literature regarding the rate of rupture for cerebral aneurysms and risks of operative intervention. Our interpretation of the literature concludes that aneurysms are present in approximately 1% of the adult population, varying between less than 1% in young adults to 4% in the elderly. The yearly risk of subarachnoid hemorrhage for an unruptured intracranial aneurysm is approximately 1% for lesions 7 to 10 mm in diameter. Based on these assumptions, we recommend that 1) with rare exceptions, all symptomatic unruptured aneurysms should be treated; 2) small, incidental aneurysms less than 5 mm in diameter should be managed conservatively in virtually all cases; 3) aneurysms larger than 5 mm in patients younger than 60 years of age should be seriously considered for treatment; 4) large, incidental aneurysms larger than 10 mm should be treated in nearly all patients younger than 70 years of age; and 5) microsurgical clipping rather than endovascular coiling should be the first treatment choice in low-risk cases. Critical to our guidelines is collaboration by a highly experienced cerebrovascular team of microneurosurgeons and endovascular neurosurgeons working at a tertiary medical center with a high case volume and using a decision-making paradigm designed to offer only low-risk treatments. In certain patients for whom both treatment and natural history carry high risks, such as those with giant aneurysms, nonoperative management is typically elected.
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Affiliation(s)
- Ricardo J. Komotar
- Department of Neurological Surgery, Columbia University, New York, New York
| | - J Mocco
- Department of Neurological Surgery, Columbia University, New York, New York
| | - Robert A. Solomon
- Department of Neurological Surgery, Columbia University, New York, New York
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Affiliation(s)
- Michael E Kelly
- Department of Neurosurgery, Stanford University, Stanford, CA 94305-5327, USA
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Fontanella M, Rainero I, Gallone S, Rubino E, Rivoiro C, Valfrè W, Garbossa D, Nurisso C, Ducati A, Pinessi L. Lack of association between the apolipoprotein E gene and aneurysmal subarachnoid hemorrhage in an Italian population. J Neurosurg 2007; 106:245-9. [PMID: 17410707 DOI: 10.3171/jns.2007.106.2.245] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECT The results of genome-wide scan studies have suggested the presence of a genetic risk factor for aneurysmal subarachnoid hemorrhage (SAH) on chromosome 19 (at 19p13). The apolipoprotein E (APOE) gene is located in this chromosomal region and encodes a protein that exerts several neuroprotective and neurotrophic functions in the brain. The purpose of this study was to evaluate whether a particular allele or genotype of the APOE gene would modify the occurrence or the clinical features of SAH. METHODS Genomic DNA was extracted from 146 patients with aneurysmal SAH and 222 age- and sex-matched healthy controls and genotyped for the triallelic polymorphism of the APOE gene (epsilon2, epsilon3, and epsilon4). Allele and genotype frequencies were compared between patients and controls. The clinical characteristics of the disease were compared according to the different APOE genotypes. Allele and genotype frequencies of the APOE gene polymorphism were nearly identical in cases and controls. Patients carrying the APOE epsilon4 allele had a significantly higher Hunt and Hess grade on admission (p = 0.0014). There was no significant relationship between any of the other clinical characteristics and the APOE genotype. CONCLUSIONS The authors' data do not support the hypothesis that genetic variations within the APOE gene are associated with aneurysmal SAH. However, the APOE gene influences the disease phenotype and may be regarded as a disease modifier gene.
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Affiliation(s)
- Marco Fontanella
- Division of Neurosurgery, Department of Neuroscience, University of Turin, Italy.
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Cosetti M, Amrhein T, Linstrom C. Perioperative management of intracranial aneurysms and otologic disease. Laryngoscope 2007; 117:35-9. [PMID: 17202927 DOI: 10.1097/01.mlg.0000246695.16366.c5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Diagnosis and treatment of asymptomatic, unruptured intracranial aneurysms (UIA) are areas of longstanding controversy in the neurologic and neurosurgical literature. Treatment decisions require careful consideration of both the potential for aneurysm rupture as well as the risks associated with repair. Studies examining the natural history of UIA, the morbidity and mortality associated with subarachnoid hemorrhage (SAH), and the various treatment options have led to general guidelines for UIA management. In the literature, the simultaneous presence of otologic disease and UIA has not been introduced or addressed. It is unknown whether surgical treatment of middle ear disease has an effect on the natural history of UIA. STUDY DESIGN Two illustrative patients with UIA discovered incidentally on radiographic evaluation of middle ear disease are presented. METHODS Patients were managed according to diagnostic and treatment strategies developed and validated in the neurosurgical literature. RESULTS Both patients underwent uneventful endovascular embolization of their intracranial aneurysms before middle ear surgery. The intra- and postoperative courses were uncomplicated without symptoms related to either their history of intracranial aneurysms or the prior embolization. CONCLUSIONS Application of neurosurgical diagnostic and treatment algorithms to otology patients in the perioperative setting is appropriate. Established risk factors such as the size and location of the intracranial aneurysm, prior SAH, and patient age should guide treatment planning in all cases of UIA. Additional research is needed to evaluate the influence of otologic procedures on the natural history of UIA. In addition, studies are needed to evaluate the role of preoperative screening for UIA in otologic surgery candidates.
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Affiliation(s)
- Maura Cosetti
- Department of Otolaryngology, The New York Eye and Ear Infirmary, New York, NY 10003, USA
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Abstract
Muslin-induced optochiasmatic arachnoiditis is a rare complication following surgical repair of an intracranial aneurysm but should be suspected in any delayed visual loss after aneurysm repair in which muslin was used. A 52-year-old male underwent clipping and muslin wrapping of a ruptured aneurysm of an anterior communicating artery. Eight months following surgery, the patient developed progressive visual loss, resulting in a bitemporal hemianopsia. Neuroimaging confirmed a suprasellar mass but no recurrent aneurysm. The patient was treated with prednisone and had significant improvement of his vision. Muslin wrapping of aneurysms should probably be avoided in aneurysms near the optic apparatus.
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Affiliation(s)
- Parisa Taravati
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics (PT), Iowa City, USA
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Krischek B, Inoue I. The genetics of intracranial aneurysms. J Hum Genet 2006; 51:587-94. [PMID: 16736093 DOI: 10.1007/s10038-006-0407-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2006] [Accepted: 03/24/2006] [Indexed: 01/18/2023]
Abstract
The rupture of an intracranial aneurysm (IA) leads to a subarachnoid hemorrhage, a sudden onset disease that can lead to severe disability and death. Several risk factors such as smoking, hypertension and excessive alcohol intake are associated with subarachnoid hemorrhage. IAs, ruptured or unruptured, can be treated either surgically via a craniotomy (through an opening in the skull) or endovascularly by placing coils through a catheter in the femoral artery. Even though the etiology of IA formation is mostly unknown, several studies support a certain role of genetic factors. In reports so far, genome-wide linkage studies suggest several susceptibility loci that may contain one or more predisposing genes. Studies of several candidate genes report association with IAs. To date, no single gene has been identified as responsible for IA formation or rupture. The identification of susceptible genes may lead to the understanding of the mechanism of formation and rupture and possibly lead to the development of a pharmacological therapy.
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MESH Headings
- Aneurysm, Ruptured/pathology
- Cerebral Angiography
- Chromosome Mapping
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 19
- Chromosomes, Human, Pair 5
- Chromosomes, Human, Pair 7
- Chromosomes, Human, X
- Genetic Linkage
- Humans
- Intracranial Aneurysm/diagnostic imaging
- Intracranial Aneurysm/epidemiology
- Intracranial Aneurysm/etiology
- Intracranial Aneurysm/genetics
- Intracranial Aneurysm/pathology
- Intracranial Aneurysm/surgery
- Magnetic Resonance Angiography
- Risk Factors
- Subarachnoid Hemorrhage/genetics
- Subarachnoid Hemorrhage/pathology
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Affiliation(s)
- Boris Krischek
- Division of Genetic Diagnosis, Institute of Medical Science, The University of Tokyo, 4-6-1 Shirokanedai, Tokyo 108-8639, Japan
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