Intracranial Aneurysms in Patients With Coarctation of the Aorta: A Prospective Magnetic Resonance Angiographic Study of 100 Patients (original) (raw)
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Management of incidentally discovered intracranial vascular abnormalities
Neurosurgical Focus, 2011
B rain vascular abnormalities including aneurysms, AVMs, CAs, DVAs, and capillary telangiectasias are common incidental findings on imaging studies. With brain imaging becoming available ubiquitously, these common lesions are expected to be discovered more and more in an asymptomatic stage. The management of most of these vascular abnormalities is still controversial. As a general rule, the natural history of these lesions should be balanced against the risk of morbidity and mortality that may result from treatment. With the conflicting results of recent studies, uncertainty remains concerning the natural history and the risk of treatment, further complicating the neurosurgeon's task. This article reviews the current evidence in the literature regarding the management of incidentally discovered aneurysms, AVMs, CAs, DVAs, and capillary telangiectasias and provides neurosurgeons with a decision-making paradigm for each of these lesions. Aneurysms The management of unruptured intracranial aneurysms has been a very controversial topic in neurosurgery. There is no clear consensus today as to when an incidental aneurysm should be treated and when it should be observed. Moreover, the magnitude of this problem is expected to increase in the future commensurate with increased detection due to advances in imaging quality and availability. The prevalence of aneurysms in the general population is thought to be somewhere between 1% and 7%. 63,67,102,118 However, aneurysmal SAH remains a rare event with an incidence of 6-20 cases per 100,000 persons per year. 49,60,92 This underscores the importance of patient selection for treatment. Because most aneurysms remain asymptomatic throughout the patient's life, it is crucial to weigh the risks of treatment against the natural history of these lesions. Treatment should only be offered to patients whose risk of SAH exceeds the risk of surgical or endovascular intervention. Natural History The natural history of intracranial aneurysms continues to be a controversial topic mainly because of the con
The Efficacy of Computed Tomographic Angiography in Identification of Intracranial Aneurysms
Life Science Journal, 2014
Objective: Computed tomographic angiography (CTA) has surfaced as a valuable non-invasive diagnostic modality in the management of intracranial aneurysms (IAs). In this study, the author reports the accuracy of CTA versus digital subtraction angiography (DSA) in the assessment of patients with IAs. Methods: A retrospective review was conducted for all patients investigated for IAs with both CTA and DSA using standard imaging protocols at king Abdulaziz university hospital between January 2008 and December 2013. Thirty-one patients with IAs underwent evaluation with CTA and DSA during the study period. Comparison between the two modalities included accuracy of detection of IAs was assessed. Results: Patient's age ranged from 17 and 70 years (average 42.8 ± 7.9 years), and 20 patients (64.5%) were females. SAH was the initial presentation in 20 patients (64.5%), five patients (16%) with headache and seizures disorder had a mass lesion on CT scans demonstrating a large IAs, and CT scans were normal in 6 patients (19.4%). Both of CTA and DSA studies detected 29 IAs in 28 patients (90.3%). Three patients had no IAs detected in both CTA and DSA examinations, in one patient operated for repeated SAH with intracerbral hematoma, a small internal carotid artery blister was detected intraoperatively and clipped. Twenty-two patients (78.6%) underwent craniotomy and microsurgical clipping of IAs, and endovascular coiling was performed in 6 patients. CTA was effective in the post-treatment follow up and evaluation of IAs; however, in two patients CTA was not accurate in assessing the recurrence of the aneurysms. Conclusion: CTA provides accurate and valuable information for patients with cerebral aneurysms. It can be used alone for the diagnosis, treatment planning, and post-treatment follow up of IAs.
Journal of vascular and interventional neurology, 2010
Hemodynamic changes in the cerebral circulation in presence of coarctation of aorta (CoA) and their significance in the increased intracranial aneurysms (IAs) formation in these patients remain unclear. In the present study, we measured the flow-rate waveforms in the cerebral arteries of a patient with CoA, followed by an analysis of different hemodynamic indices in a coexisting IA. Phase-contrast Magnetic Resonance (pc-MR) volumetric flow-rate (VFR) measurements were performed in cerebral arteries of a 51 years old woman with coexisting CoA, and five healthy volunteers. Numerical predictions of a number of relevant hemodynamic indices were performed in an IA located in sub-clinoid part of left internal carotid artery (ICA) of the patient. Computations were performed using Ansys(®)-CFX(™) solver using the VFR values measured in the patient as boundary conditions (BCs). A second analysis was performed using the average VFR values measured in healthy volunteers. The VFR waveforms meas...
Risk of Harboring an Unruptured Intracranial Aneurysm
Stroke, 1998
Background and Purpose-The purpose of the present study was to calculate the prevalence and relative risk of unruptured incidental intracranial aneurysms (IAs) among families with IA case(s) compared with the general population in one geographically defined area in East Finland and to identify the risk group that could benefit most from screening for IAs. We compared these results with our earlier study results of familial IA (FIA) cases, with two or more known IA cases in the same family. Methods-The study groups were collected from the catchment area of the University Hospital of Kuopio in East Finland. The inclusion criteria were age 30 to 70 years and unruptured incidental IAs Ն3 mm. Patients with previous subarachnoid hemorrhage or in whom a ruptured IA was found to be the cause of death were excluded from all study groups. During routine forensic autopsies the circle of Willis was studied for IAs to estimate the number of IAs in the general population. In the families with one known IA case and in FIA families, MR angiography was used as a preliminary screening method for IAs, followed by intra-arterial angiography to verify suspected IAs. Study populations were age and sex adjusted for the statistical calculations. Results-The relative risk for IAs among first-degree relatives in FIA families was 4.2 (95% confidence interval, 2.2 to 8.0) and among first-degree relatives in families with only one affected family member was 1.8 (95% confidence interval, 0.7 to 4.8) compared with the general population in East Finland. Conclusions-First-degree relatives in FIA families constitute a high-risk group for incidental IAs, and this group would benefit from screening studies for IAs. Screening for IAs in families with only one affected member or in the general population is not recommended. (Stroke. 1998;29:359-362.)
Intracranial aneurysms: current evidence and clinical practice
American family physician, 2002
Unruptured intracranial aneurysms occur in up to 6 percent of the general population. Most persons with these aneurysms remain asymptomatic and are usually unaware of their presence. Risk factors for the formation of aneurysms include a family history of aneurysm, various inherited disorders, age greater than 50 years, female gender, current cigarette smoking, and cocaine use. Because of the morbidity and mortality associated with surgical intervention, screening for aneurysms remains controversial. Two groups of patients may benefit from early detection: those with autosomal dominant polycystic kidney disease and those with a history of aneurysmal subarachnoid hemorrhage. These patients should undergo magnetic resonance angiography, followed by neurosurgical referral if an aneurysm is detected. Screening of patients who have two or more family members with intracranial aneurysms is controversial. Screening of patients who have one first-degree relative with an aneurysm does not app...
Diagnosis of Symptomatic Intracranial Atherosclerotic Disease
2015
Intracranial atherosclerotic stroke differs from extracranial atherosclerotic stroke in many aspects, including risk factors and stroke patterns. It occurs in association with in situ thrombotic occlusion, artery-to-artery embolism, branch occlusion, and hemodynamic insufficiency. Intracranial atherosclerotic stenosis (ICAS) could have only been diagnosed by transcranial Doppler (TCD) and transcranial color-coded sonography (TCCS), which are burdened by a risk of bias, or catheter angiography (DSA), which, on the contrary, is very precise, but rarely it is done in clinical practice due to its invasiveness. Computed tomography angiography (CT-A) and magnetic resonance imaging angiography (MR-A) have increased the identification of ICAS in a wider stroke population.
Computed Tomographic Angiography for the Evaluation of Aneurysmal Subarachnoid Hemorrhage
Academic Emergency Medicine, 2006
Objectives: Computed tomography (CT) followed by lumbar puncture (LP) is currently the criterion standard for diagnosing subarachnoid hemorrhage (SAH) in the emergency department (ED); however, this is based on studies involving a limited number of patients. The authors sought to assess the ability of CT angiography (CTA), a new diagnostic modality, in conjunction with CT/LP to detect SAH. Methods: Consecutive patients presenting to the ED with symptoms concerning for SAH were approached. All patients had an intravenous catheter placed and underwent a noncontrast head CT followed by CTA. Patients whose CT did not reveal evidence of SAH or other pathology underwent LP in the ED. CTAs were read within 24 hours by a neuroradiologist blinded to the patient's history. Results: A total of 131 patients were approached, 116 were enrolled, and 106 completed the study. In six of 116 patients (5.1%), aneurysm was found on CTA with normal CT and positive findings on LP; three had a positive CTA with normal CT and LP findings (one of which had a negative cerebral angiogram), and there was one false-positive CTA. Follow-up of all 131 patients showed no previously undiagnosed intracranial pathology. In this patient population, 4.3% (5/116) were ultimately found to have an SAH and/or aneurysm. Conclusions: In this pilot study, CTA was found to be useful in the detection of cerebral aneurysms and may be useful in the diagnosis of aneurysmal SAH. A larger multicenter study would be useful to confirm these results.
Prevalence of Intracranial Aneurysms in Patients with Aortic Aneurysms
American Journal of Neuroradiology
BACKGROUND AND PURPOSE: Previous studies have suggested an association between aortic aneurysms and intracranial aneurysms with a higher prevalence of intracranial aneurysms in patients with aortic aneurysms. The aims of the present study were to evaluate the incidence of intracranial aneurysms in a large cohort of patients with aortic aneurysms and to identify potential risk factors for intracranial aneurysms in this population. MATERIALS AND METHODS: We included all patients with aortic aneurysms (either abdominal and/or thoracic) who had available cerebral arterial imaging and were seen at our institution during a 15-year period. We identified patients with intracranial aneurysms. Patient demographics, comorbidities, and aortic aneurysm and intracranial aneurysm sizes and locations were analyzed. Univariate analysis was performed with a 2 test for categoric variables and a Student t test or ANOVA for continuous variables. RESULTS: A total of 1081 patients with aortic aneurysms were included. Of them, 440 (40.7%) had abdominal aortic aneurysms, 446 (41.3%) had thoracic aortic aneurysms, and 195 (18.0%) had both abdominal aortic and thoracic aortic aneurysms. The overall prevalence of associated intracranial aneurysms in patients with aortic aneurysms was 11.8% (128/1081), with 12.7% (56/440), 10.8% (48/446), and 12.3% (24/195), respectively, in patients with abdominal aortic aneurysms, thoracic aortic aneurysms, and both thoracic aortic aneurysms and abdominal aortic aneurysms. Female patients had a higher risk of associated intracranial aneurysms (OR ϭ 2.08; 95% CI, 1.49-3.03; P ϭ .0002). There was a slight association between abdominal aortic aneurysm size and the prevalence of intracranial aneurysms (OR ϭ 1.02; 95% CI, 1.01-1.03; P ϭ .045). There was no significant association between the locations of the aortic and intracranial aneurysms (P ϭ .93). CONCLUSIONS: The prevalence of intracranial aneurysms is high in patients with aortic aneurysms. Further studies examining the role and cost-effectiveness of intracranial aneurysm screening in patients are warranted. ABBREVIATIONS: AA ϭ aortic aneurysm; AAA ϭ abdominal aortic aneurysm; ADPKD ϭ autosomal dominant polycystic kidney disease; IA ϭ intracranial aneurysm; TAA ϭ thoracic aortic aneurysm