Pathophysiological differences that underlie the development and subsequent growth of multiple aneurysms may exist. In this study, the authors assessed the factors associated with the occurrence of multiple aneurysms in patients presenting with aneurysmal subarachnoid hemorrhage (SAH).
Consecutive patients presenting with aneurysmal SAH between 1996 and 2012 were prospectively enrolled in the Subarachnoid Hemorrhage Outcome Project. Patients harboring 1, 2, or 3 or more aneurysms were stratified into groups, and the clinical and radiological characteristics of each group were compared using multivariate logistic regression.
Of 1277 patients with ruptured intracranial aneurysms, 890 had 1 aneurysm, 267 had 2 aneurysms, and 120 had 3 or more aneurysms. On multinomial regression using the single-aneurysm cohort as base case, risk factors for patients presenting with 2 aneurysms were female sex (relative risk ratio [RRR] 1.80, p < 0.001), higher body mass index (BMI) (RRR 1.02, p = 0.003), more years of smoking (RRR = 1.01, p = 0.004), and black race (RRR 1.83, p = 0.001). The risk factors for patients presenting with 3 or more aneurysms were female sex (RRR 3.10, p < 0.001), higher BMI (RRR 1.03, p < 0.001), aneurysm in the posterior circulation (RRR 2.59, p < 0.001), and black race (RRR 2.15, p = 0.001). Female sex, longer smoking history, aneurysms in the posterior circulation, BMI, and black race were independently associated with the development of multiple aneurysms in our adjusted multivariate multinomial model.
Significant demographic and clinical differences are found between patients presenting with single and multiple aneurysms in the setting of aneurysmal SAH. These predictors of multiple aneurysms likely reflect a predisposition toward inflammation and endothelial injury.
ABBREVIATIONSAPACHE = Acute Physiology and Chronic Health Evaluation; BMI = body mass index; mRS = modified Rankin Scale; NICU = neurological ICU; PKD = polycystic kidney disease; RRR = relative risk ratio; SAH = subarachnoid hemorrhage; SHOP = Subarachnoid Hemorrhage Outcomes Project.
AlbertMA, GlynnRJ, BuringJ, RidkerPM: C-reactive protein levels among women of various ethnic groups living in the United States (from the Women’s Health Study). 93:1238–1242, 200410.1016/j.amjcard.2004.01.06715135696)| false
BedersonJBConnollyESJrBatjerHHDaceyRGDionJEDiringerMN: Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. Stroke40:994–10252009
BedersonJB, ConnollyESJr, BatjerHH, DaceyRG, DionJE, DiringerMN, : Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association. 40:994–1025, 20091916480010.1161/STROKEAHA.108.191395)| false
ChungSLapointKMartinezKKennedyABoysen SandbergMMcIntoshMK: Preadipocytes mediate lipopolysaccharide-induced inflammation and insulin resistance in primary cultures of newly differentiated human adipocytes. Endocrinology147:5340–53512006
GoodpasterBH, KrishnaswamiS, HarrisTB, KatsiarasA, KritchevskySB, SimonsickEM, : Obesity, regional body fat distribution, and the metabolic syndrome in older men and women. 165:777–783, 200510.1001/archinte.165.7.77715824297)| false
HasanD, ChalouhiN, JabbourP, HashimotoT: Macrophage imbalance (M1 vs. M2) and upregulation of mast cells in wall of ruptured human cerebral aneurysms: preliminary results. 9:222, 201210.1186/1742-2094-9-22222999528)| false
MatterCM, HandschinC: RANTES (regulated on activation, normal T cell expressed and secreted), inflammation, obesity, and the metabolic syndrome. 115:946–948, 200710.1161/CIRCULATIONAHA.106.68523017325252)| false
RasmussenMLBroeRFrydkjaer-OlsenUOlsenBSMortensenHBPetoT: Microaneurysm count as a predictor of long-term progression in diabetic retinopathy in young patients with type 1 diabetes: the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987). Graefes Arch Clin Exp Ophthalmol253:199–2052015
RasmussenML, BroeR, Frydkjaer-OlsenU, OlsenBS, MortensenHB, PetoT, : Microaneurysm count as a predictor of long-term progression in diabetic retinopathy in young patients with type 1 diabetes: the Danish Cohort of Pediatric Diabetes 1987 (DCPD1987). 253:199–205, 201510.1007/s00417-014-2682-7)| false
TidswellP, DiasPS, SagarHJ, MayesAR, BattersbyRD: Cognitive outcome after aneurysm rupture: relationship to aneurysm site and perioperative complications. 45:875–882, 199510.1212/WNL.45.5.8767746400)| false