Screening for brain aneurysm in the Familial Intracranial Aneurysm study: frequency and predictors of lesion detection

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  • 1 Departments of Neurology and
  • | 2 Neuroradiology, Mayo Clinic, Rochester, Minnesota;
  • | 3 Departments of Neurology
  • | 4 Environmental Health, and Center for Environmental Genetics, University of Cincinnati, Ohio and
  • | 5 Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana
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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 ≥ 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.

Abbreviations used in this paper:

ACoA = anterior communicating artery; CT = computed tomography; DICOM = Digital Information and Communications in Medicine; DS = digital subtraction; FDR = first-degree relative; FIA = Familial Intracranial Aneurysm; IA = intracranial aneurysm; ICA = internal carotid artery; MCA = middle cerebral artery; MR = magnetic resonance; OphA = ophthalmic artery; OR = odds ratio; PCoA = posterior communicating artery; SAH = subarachnoid hemorrhage.

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Contributor Notes

Address correspondence to: Robert D. Brown Jr., M.D., M.P.H., Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, Minnesota 55905. email: brown@mayo.edu.
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