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Frerich S, Cole JW. Novel Polygenic Risk Score for Intracranial Aneurysms. Stroke 2023; 54:819-820. [PMID: 36655556 PMCID: PMC10090445 DOI: 10.1161/strokeaha.122.041807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Simon Frerich
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
- Graduate School of Systemic Neurosciences (GSN), LMU Munich, Munich, Germany
| | - John W. Cole
- Maryland Stroke Center, Department of Neurology
- Baltimore VA Medical Center and University of Maryland School of Medicine, Bressler Research Building, Room 12-006, 655 West Baltimore Street, Baltimore, MD 21201-1559
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Oberman DZ, Perez Akly MS, Rabelo NN, Elizondo C, Amorim Correa JL, Ajler P, Baccanelli MM. In Reply to Letter to the Editor Regarding ''Morphological Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries''. World Neurosurg 2022; 161:215. [PMID: 35505532 DOI: 10.1016/j.wneu.2022.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/23/2022]
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Abstract
Rupture of an intracranial aneurysm leads to aneurysmal subarachnoid hemorrhage, a severe type of stroke which is, in part, driven by genetic variation. In the past 10 years, genetic studies of IA have boosted the number of known genetic risk factors and improved our understanding of the disease. In this review, we provide an overview of the current status of the field and highlight the latest findings of family based, sequencing, and genome-wide association studies. We further describe opportunities of genetic analyses for understanding, prevention, and treatment of the disease.
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Affiliation(s)
- Mark K Bakker
- University Medical Center Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands
| | - Ynte M Ruigrok
- University Medical Center Utrecht Brain Center, Department of Neurology and Neurosurgery, University Medical Center Utrecht, the Netherlands
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van Kammen MS, Bourcier R, Moomaw CJ, Broderick JP, Woo D, Papagiannaki C, Levrier O, Lindgren AE, Koivisto T, Jääskeläinen JE, Rinkel GJE, Ruigrok YM. Heritability of territory of ruptured and unruptured intracranial aneurysms in families. PLoS One 2020; 15:e0236714. [PMID: 32745108 DOI: 10.1371/journal.pone.0236714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Yu X, Xia L, Jiang Q, Wei Y, Wei X, Cao S. Prevalence of Intracranial Aneurysm in Patients with Aortopathy: A Systematic Review with Meta-Analyses. J Stroke 2020; 22:76-86. [PMID: 32027793 PMCID: PMC7005354 DOI: 10.5853/jos.2019.01312] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/21/2019] [Accepted: 10/15/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND PURPOSE Patients with aortic disease might have an increased risk of intracranial aneurysm (IA). We conducted this research to assess the prevalence of IA in patients with aortopathy, considering the impact of gender, age, and cardiovascular risk factors. METHODS We searched PubMed and Scopus from inception to August 2019 for epidemiological studies reporting the prevalence of IA in patients with aortopathy. Random-effect meta-analyses were performed to calculate the overall prevalence, and the effect of risk factors on the prevalence was also evaluated. Anatomical location of IAs in patients suffered from distinct aortic disease was extracted and further analyzed. RESULTS Thirteen cross-sectional studies involving 4,041 participants were included in this systematic review. We reported an estimated prevalence of 12% (95% confidence interval [CI], 9% to 14%) of IA in patients with aortopathy. The pooled prevalence of IA in patients with bicuspid aortic valve, coarctation of the aorta, aortic aneurysm, and aortic dissection was 8% (95% CI, 6% to 10%), 10% (95% CI, 7% to 14%), 12% (95% CI, 9% to 15%), and 23% (95% CI, 12% to 34%), respectively. Gender (female) and smoking are risk factors related to an increased risk of IA. The anatomical distribution of IAs was heterogeneously between participants with different aortic disease. CONCLUSIONS According to current epidemiological evidence, the prevalence of IA in patients with aortic disease is quadrupled compared to that in the general population, which suggests that an early IA screening should be considered among patients with aortic disease for timely diagnosis and treatment of IA.
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Affiliation(s)
- Xinyu Yu
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liangtao Xia
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qingqing Jiang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yupeng Wei
- Biological Science Department, University of Pittsburgh, Pittsburgh, PA, USA
| | - Xiang Wei
- Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Organ Transplantation, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- NHC Key Laboratory of Organ Transplantation, Wuhan, China
- Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Wuhan, China
| | - Shiyi Cao
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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van Laarhoven CJHCM, van Setten J, van Herwaarden JA, Pasterkamp G, de Kleijn DPV, de Borst GJ, van der Laan SW. Polygenic Susceptibility of Aortic Aneurysms Associates to the Diameter of the Aneurysm Sac: the Aneurysm-Express Biobank Cohort. Sci Rep 2019; 9:19844. [PMID: 31882626 PMCID: PMC6934821 DOI: 10.1038/s41598-019-56230-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/08/2019] [Indexed: 11/23/2022] Open
Abstract
Recent genome-wide association studies (GWAS) have discovered ten genetic risk variants for abdominal aortic aneurysms (AAA). To what extent these genetic variants contribute to the pathology of aneurysms is yet unknown. The present study aims to investigate whether genetic risk variants are associated with three clinical features: diameter of aneurysm sac, type of artery and aneurysm related-symptoms in aortic and peripheral aneurysm patients. Aneurysm tissue of 415 patients included in the Aneurysm-Express biobank was used. A best-fit polygenic risk score (PRS) based on previous GWAS effect estimates was modeled for each clinical phenotype. The best-fit PRS (including 272 variants at PT = 0.01015) showed a significant correlation with aneurysm diameter (R2 = 0.019, p = 0.001). No polygenic association was found with clinical symptoms or artery type. In addition, the ten genome-wide significant risk variants for AAA were tested individually, but no associations were observed with any of the clinical phenotypes. All models were corrected for confounders and data was normalized. In conclusion, a weighted PRS of AAA susceptibility explained 1.9% of the phenotypic variation (p = 0.001) in diameter in aneurysm patients. Given our limited sample size, future biobank collaborations need to confirm a potential causal role of susceptibility variants on aneurysmal disease initiation and progression.
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Affiliation(s)
- Constance J H C M van Laarhoven
- Department of Vascular Surgery, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jessica van Setten
- Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joost A van Herwaarden
- Department of Vascular Surgery, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gerard Pasterkamp
- Laboratory of Clinical Chemistry and Hematology, Division Laboratories, Pharmacy, and Biomedical genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Dominique P V de Kleijn
- Department of Vascular Surgery, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, Division of Surgical Specialties, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sander W van der Laan
- Laboratory of Clinical Chemistry and Hematology, Division Laboratories, Pharmacy, and Biomedical genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
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Frösen J, Joutel A. Smooth muscle cells of intracranial vessels: from development to disease. Cardiovasc Res 2019; 114:501-512. [PMID: 29351598 DOI: 10.1093/cvr/cvy002] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/12/2018] [Indexed: 02/02/2023] Open
Abstract
Cerebrovascular diseases that cause ischaemic or haemorrhagic stroke with subsequent loss of life or functional capacity due to damage of the brain tissue are among the leading causes of human suffering and economic burden inflicted by diseases in the developed world. Diseases affecting intracranial vessels are significant contributors to ischaemic and haemorrhagic strokes. Brain arteriovenous malformations, which are a collection of abnormal blood vessels connecting arteries to veins, are the most common cause of intracranial haemorrhage in children and young adults. Saccular intracranial aneurysms, which are pathological saccular dilations mainly occurring at bifurcations of the large intracranial arteries near the circle of Willis, are highly prevalent in the middle-aged population, causing significant anxiety and concern; their rupture, although rare, is a significant cause of intracranial haemorrhage in those past middle age that is associated with a very sinister prognosis. Cerebral small-vessel disease, which comprise all pathological processes affecting vessels <500 microns in diameter, account for the majority of intracerebral haemorrhages and ∼25% of ischaemic strokes and 45% of dementias in the elderly. In this review, we summarize the developmental, structural, and functional features of intracranial vessels. We then describe the role of smooth muscle cells in brain arteriovenous malformations, intracranial aneurysms, and small-vessel diseases, and discuss how the peculiar ontogeny, structure, and function of intracranial vessels are related to the development of these diseases.
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Affiliation(s)
- Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio 70029, Finland.,Department of Neurosurgery, Kuopio University Hospital, Kuopio 70029, Finland
| | - Anne Joutel
- Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, Université Paris Diderot-Paris 7, 10 av de Verdun, Paris 75010, France.,DHU NeuroVasc, Sorbonne Paris Cité, Paris 75010, France
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8
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Slot EMH, Rinkel GJE, Algra A, Ruigrok YM. Patient and aneurysm characteristics in familial intracranial aneurysms. A systematic review and meta-analysis. PLoS One 2019; 14:e0213372. [PMID: 30958821 PMCID: PMC6453525 DOI: 10.1371/journal.pone.0213372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/19/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Patient and aneurysm characteristics have been reported to differ between patients with familial and non-familial intracranial aneurysms (IAs), although results are inconsistent. We systematically reviewed and meta-analyzed the literature to identify and quantify patient- and aneurysm characteristics associated with familial IAs. METHODS We searched PubMed and EMBASE for case-control and cohort studies comparing patient- and aneurysm characteristics between familial and non-familial IAs. Two observers independently assessed study eligibility and appraised quality with the Newcastle Ottawa Scale. With univariable weighted linear regression analysis we calculated β-coefficients with corresponding 95% confidence intervals (CIs) for ruptured and unruptured IAs combined and for ruptured IAs only. Heterogeneity was assessed with Higgins I2. RESULTS A total of 15 articles were included in the meta-analysis in which 16,346 patients were analyzed with a total of 14,225 IAs. For ruptured and unruptured IAs combined, multiple IAs were more prevalent in familial (28.5%) than in non-familial IAs (20.4%; β = 0.10, 95% CI, 0.04 to 0.16; I2 0%). For ruptured IAs only, in familial patients IAs were more prevalent on the middle cerebral artery (41.1% versus 29.5%; β = 0.12, 95% CI, 0.01 to 0.24; I2 12%) and ruptured at a younger age (46.5 years versus 50.8 years; β = -5.00, 95% CI, -9.31 to -0.69; I2 98%) than in non-familial patients. No significant differences were found for the proportion of women, size of the aneurysm at time of rupture, smoking or hypertension. CONCLUSION These results suggest that characteristics of familial and non-familial IAs show considerable overlap, yet differ on specific aspects. However, results for age at rupture showed considerable heterogeneity. These findings should be taken into consideration for future etiological research into IAs.
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Affiliation(s)
- Emma M. H. Slot
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, the Netherlands
| | - Gabriel J. E. Rinkel
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, the Netherlands
| | - Ale Algra
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Ynte M. Ruigrok
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery, University Medical Center, Utrecht, the Netherlands
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Affiliation(s)
- Sirui Zhou
- From the Montréal Neurological Institute and Hospital (S.Z., P.A.D., G.A.R.) and Department of Neurology and Neurosurgery (P.A.D., G.A.R.), McGill University, Québec, Canada; and Department of Medicine, Université de Montréal, Québec, Canada (S.Z.)
| | - Patrick A. Dion
- From the Montréal Neurological Institute and Hospital (S.Z., P.A.D., G.A.R.) and Department of Neurology and Neurosurgery (P.A.D., G.A.R.), McGill University, Québec, Canada; and Department of Medicine, Université de Montréal, Québec, Canada (S.Z.)
| | - Guy A. Rouleau
- From the Montréal Neurological Institute and Hospital (S.Z., P.A.D., G.A.R.) and Department of Neurology and Neurosurgery (P.A.D., G.A.R.), McGill University, Québec, Canada; and Department of Medicine, Université de Montréal, Québec, Canada (S.Z.)
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10
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Abstract
BACKGROUND Intracranial saccular aneurysms are acquired lesions that often present with neuro-ophthalmologic symptoms and signs. Recent advances in neurosurgical techniques, endovascular treatments, and neurocritical care have improved the optimal management of symptomatic unruptured aneurysms, but whether the chosen treatment has an impact on neuro-ophthalmologic outcomes remains debated. EVIDENCE ACQUISITION A review of the literature focused on neuro-ophthalmic manifestations and treatment of intracranial aneurysms with specific relevance to neuro-ophthalmologic outcomes was conducted using Ovid MEDLINE and EMBASE databases. Cavernous sinus aneurysms were not included in this review. RESULTS Surgical clipping vs endovascular coiling for aneurysms causing third nerve palsies was compared in 13 retrospective studies representing 447 patients. Complete recovery was achieved in 78% of surgical patients compared with 44% of patients treated with endovascular coiling. However, the complication rate, hospital costs, and days spent in intensive care were reported as higher in surgically treated patients. Retrospective reviews of surgical clipping and endovascular coiling for all ocular motor nerve palsies (third, fourth, or sixth cranial nerves) revealed similar results of complete resolution in 76% and 49%, respectively. Improvement in visual deficits related to aneurysmal compression of the anterior visual pathways was also better among patients treated with clipping than with coiling. The time to treatment from onset of visual symptoms was a predictive factor of visual recovery in several studies. Few reports have specifically assessed the improvement of visual deficits after treatment with flow diverters. CONCLUSIONS Decisions regarding the choice of therapy for intracranial aneurysms causing neuro-ophthalmologic signs ideally should be made at high-volume centers with access to both surgical and endovascular treatments. The status of the patient, location of the aneurysm, and experience of the treating physicians are important factors to consider. Although a higher rate of visual recovery was reported with neurosurgical clipping, this must be weighed against the potentially longer intensive care stays and increased early morbidity.
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Zhou S, Ambalavanan A, Rochefort D, Xie P, Bourassa CV, Hince P, Dionne-Laporte A, Spiegelman D, Gan-Or Z, Mirarchi C, Zaharieva V, Dupré N, Kobayashi H, Hitomi T, Harada K, Koizumi A, Xiong L, Dion PA, Rouleau GA. RNF213 Is Associated with Intracranial Aneurysms in the French-Canadian Population. Am J Hum Genet 2016; 99:1072-1085. [PMID: 27745834 DOI: 10.1016/j.ajhg.2016.09.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 09/06/2016] [Indexed: 12/14/2022] Open
Abstract
Intracranial aneurysms (IAs) are the result of focal weakness in the artery wall and have a complex genetic makeup. To date, genome-wide association and sequencing studies have had limited success in identifying IA risk factors. Distinct populations, such as the French-Canadian (FC) population, have increased IA prevalence. In our study, we used exome sequencing to prioritize risk variants in a discovery cohort of six FC families affected by IA, and the analysis revealed an increased variation burden for ring finger protein 213 (RNF213). We resequenced RNF213 in a larger FC validation cohort, and association tests on further identified variants supported our findings (SKAT-O, p = 0.006). RNF213 belongs to the AAA+ protein family, and two variants (p.Arg2438Cys and p.Ala2826Thr) unique to affected FC individuals were found to have increased ATPase activity, which could lead to increased risk of IA by elevating angiogenic activities. Common SNPs in RNF213 were also extracted from the NeuroX SNP-chip genotype data, comprising 257 FC IA-affected and 1,988 control individuals. We discovered that the non-ancestral allele of rs6565666 was significantly associated with the affected individuals (p = 0.03), and it appeared as though the frequency of the risk allele had changed through genetic drift. Although RNF213 is a risk factor for moyamoya disease in East Asians, we demonstrated that it might also be a risk factor for IA in the FC population. It therefore appears that the function of RNF213 can be differently altered to predispose distinct populations to dissimilar neurovascular conditions, highlighting the importance of a population's background in genetic studies of heterogeneous disease.
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Affiliation(s)
- Sirui Zhou
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada; Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Amirthagowri Ambalavanan
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada; Department of Human Genetics, McGill University, Montréal, QC H3A 0G4, Canada
| | - Daniel Rochefort
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada
| | - Pingxing Xie
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada; Faculty of Medicine, McGill University, Montréal, QC H3A 0G4, Canada
| | - Cynthia V Bourassa
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada
| | - Pascale Hince
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada
| | | | - Dan Spiegelman
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada
| | - Ziv Gan-Or
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada; Department of Human Genetics, McGill University, Montréal, QC H3A 0G4, Canada; Department of Neurology and Neurosurgery, McGill University, Montréal, QC H3A 0G4, Canada
| | - Cathy Mirarchi
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada
| | - Vessela Zaharieva
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada
| | - Nicolas Dupré
- Department of Neurological Sciences, Centre Hospitalier Universitaire de Québec, Québec, QC G1V 0A6, Canada; Department of Medicine, Faculty of Medicine, Laval University, Québec, QC G1V 0A6, Canada
| | - Hatasu Kobayashi
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoecho, Kyoto 606-8501, Japan
| | - Toshiaki Hitomi
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoecho, Kyoto 606-8501, Japan
| | - Kouji Harada
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoecho, Kyoto 606-8501, Japan
| | - Akio Koizumi
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoecho, Kyoto 606-8501, Japan
| | - Lan Xiong
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada; Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montréal QC H1N 3M5, Canada
| | - Patrick A Dion
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada; Department of Neurology and Neurosurgery, McGill University, Montréal, QC H3A 0G4, Canada
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada; Department of Neurology and Neurosurgery, McGill University, Montréal, QC H3A 0G4, Canada.
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Abstract
Rupture of an intracranial aneurysm is the most common cause of subarachnoid haemorrhage (SAH), which is a life-threatening acute cerebrovascular event that typically affects working-age people. The exact prevalence of unruptured intracranial aneurysms (UIAs) is unknown, but at least one in 20 to 30 adults is likely to carry an asymptomatic UIA. Approximately one quarter of these UIAs rupture in a lifetime. Complex methodological challenges in conducting studies of epidemiology and risk factors for UIAs and SAH might have led to conclusions being drawn on the basis of epidemiological data of variable quality. We believe that, as a result, misconceptions about UIAs and SAH may have arisen. In this Perspectives article, we discuss three possible misconceptions about the epidemiology of UIAs and SAH, and suggest how the quality of future research could be improved.
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Affiliation(s)
- Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, P.O. BOX 266, FI-00029 HUS, Finland
| | - Jaakko Kaprio
- Department of Public Health, University of Helsinki, P.O. BOX 41, FI-00014 Helsinki, Finland
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Broggi M, Acerbi F. Intracranial Aneurysm Pathophysiology: To Bleed, or not To Bleed, That Is the Question. World Neurosurg 2015; 84:1553-5. [PMID: 26260941 DOI: 10.1016/j.wneu.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/01/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Morgan Broggi
- Department of Neurosurgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientfico Istituto Neurologico Carlo Besta, Milano, Italy.
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientfico Istituto Neurologico Carlo Besta, Milano, Italy
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Shin YW, Jung KH, Moon J, Lee ST, Lee SK, Chu K, Roh JK. Site-Specific Relationship Between Intracranial Aneurysm and Aortic Aneurysm. Stroke 2015; 46:1993-6. [PMID: 25991415 DOI: 10.1161/strokeaha.115.009254] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/24/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The high prevalence of intracranial aneurysms (IAs) in patients with a bicuspid aortic valve or coarctation of the aorta suggests a link between IA and aortic pathology. However, studies reporting this link do not sufficiently address the heterogeneity of IAs arising from different anatomic locations. This study aimed to explore whether a location-specific relationship exists between the 2 kinds of aneurysms. METHODS Retrospective institutional analysis of patients aged ≥18 years with both IA and an aortic aneurysm (AA) was performed from 2005 to 2014. IAs were categorized based on their locations: internal carotid artery, other anterior circulation, and posterior arteries. AAs were classified as ascending, descending, infrarenal, or multiple. We analyzed the clinical characteristics and the distribution of IA in each AA group. RESULTS Of 2375 patients, 660 with available intracranial angiography were screened for IA. We identified 71 patients with 97 IAs. The frequency of both anterior circulation-IAs and internal carotid artery-IAs differed significantly among the AA groups (P=0.001 and P=0.01, respectively). Anterior circulation-IAs were most frequently observed in ascending AA group and least frequently in infrarenal AA group. In contrast, internal carotid artery-IAs were found mostly in infrarenal AA group, least in ascending AA group. Proportions of patients having anterior circulation-IA and internal carotid artery-IA were also highest in ascending AA group and infrarenal AA group, respectively. The number of posterior arteries-IAs was too small to characterize. CONCLUSIONS The differing distribution patterns of IA among AA groups suggest a site-specific sharing of pathomechanism between the 2 types of aneurysms.
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Affiliation(s)
- Yong-Won Shin
- From the Department of Neurology, Seoul National University Hospital, Seoul, South Korea (Y.-W.S., K.-H.J., J.M., S.-T.L., S.K.L., K.C.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, Gyeunggido, South Korea (J.-K.R.)
| | - Keun-Hwa Jung
- From the Department of Neurology, Seoul National University Hospital, Seoul, South Korea (Y.-W.S., K.-H.J., J.M., S.-T.L., S.K.L., K.C.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, Gyeunggido, South Korea (J.-K.R.).
| | - Jangsup Moon
- From the Department of Neurology, Seoul National University Hospital, Seoul, South Korea (Y.-W.S., K.-H.J., J.M., S.-T.L., S.K.L., K.C.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, Gyeunggido, South Korea (J.-K.R.)
| | - Soon-Tae Lee
- From the Department of Neurology, Seoul National University Hospital, Seoul, South Korea (Y.-W.S., K.-H.J., J.M., S.-T.L., S.K.L., K.C.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, Gyeunggido, South Korea (J.-K.R.)
| | - Sang Kun Lee
- From the Department of Neurology, Seoul National University Hospital, Seoul, South Korea (Y.-W.S., K.-H.J., J.M., S.-T.L., S.K.L., K.C.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, Gyeunggido, South Korea (J.-K.R.)
| | - Kon Chu
- From the Department of Neurology, Seoul National University Hospital, Seoul, South Korea (Y.-W.S., K.-H.J., J.M., S.-T.L., S.K.L., K.C.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, Gyeunggido, South Korea (J.-K.R.).
| | - Jae-Kyu Roh
- From the Department of Neurology, Seoul National University Hospital, Seoul, South Korea (Y.-W.S., K.-H.J., J.M., S.-T.L., S.K.L., K.C.); and Department of Neurology, The Armed Forces Capital Hospital, Sungnam, Gyeunggido, South Korea (J.-K.R.)
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Huttunen J, Kurki MI, von und zu Fraunberg M, Koivisto T, Ronkainen A, Rinne J, Jaaskelainen JE, Kalviainen R, Immonen A. Epilepsy after aneurysmal subarachnoid hemorrhage: A population-based, long-term follow-up study. Neurology 2015; 84:2229-37. [DOI: 10.1212/wnl.0000000000001643] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/20/2015] [Indexed: 11/15/2022] Open
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16
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Etminan N, Macdonald RL. Computational Fluid Dynamics and Intracranial Aneurysms: Higher Mathematics Meets Complex Biology. World Neurosurg 2015; 83:1017-9. [PMID: 25731798 DOI: 10.1016/j.wneu.2015.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Nima Etminan
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
| | - R Loch Macdonald
- Division of Neurosurgery, St. Michael's Hospital, Keenan Research Centre for Biomedical Science and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Surgery, University of Toronto, Ontario, Canada
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Affiliation(s)
- Michael M McDowell
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Andrew F Ducruet
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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