Lack of impact of polycystic kidney disease on the outcome of aneurysmal subarachnoid hemorrhage: a matched case-control study

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  • 1 Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio;
  • 2 School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio;
  • 3 Kuopio Health Center, Kuopio;
  • 4 Neurointensive Care and
  • 5 Department of Clinical Radiology, Kuopio University Hospital, Kuopio; and
  • 6 Transplantation and Liver Surgery Clinic, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
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OBJECTIVE

The authors set out to study whether autosomal dominant polycystic kidney disease (ADPKD), an established risk factor for intracranial aneurysms (IAs), affects the acute course and long-term outcome of aneurysmal subarachnoid hemorrhage (aSAH).

METHODS

The outcomes of 32 ADPKD patients with aSAH between 1980 and 2015 (median age 43 years; 50% women) were compared with 160 matched (age, sex, and year of aSAH) non-ADPKD aSAH patients in the prospectively collected Kuopio Intracranial Aneurysm Patient and Family Database.

RESULTS

At 12 months, 75% of the aSAH patients with ADPKD versus 71% of the matched-control aSAH patients without ADPKD had good outcomes (Glasgow Outcome Scale score 4 or 5). There was no significant difference in condition at admission. Hypertension had been diagnosed before aSAH in 69% of the ADPKD patients versus 27% of controls (p < 0.001). Multiple IAs were present in 44% of patients in the ADPKD group versus 25% in the control group (p = 0.03). The most common sites of ruptured IAs were the anterior communicating artery (47% vs 29%, p = 0.05) and the middle cerebral artery bifurcation (28% vs 31%), and the median size was 6.0 mm versus 8.0 mm (p = 0.02). During the median follow-up of 11 years, a second aSAH occurred in 3 of 29 (10%) ADPKD patients and in 4 of 131 (3%) controls (p = 0.11). A fatal second aSAH due to a confirmed de novo aneurysm occurred in 2 (6%) of the ADPKD patients but in none of the controls (p = 0.027).

CONCLUSIONS

The outcomes of ADPKD patients with aSAH did not differ significantly from those of matched non-ADPKD aSAH patients. ADPKD patients had an increased risk of second aSAH from a de novo aneurysm, warranting long-term angiographic follow-up.

ABBREVIATIONS AComA = anterior communicating artery; ADPKD = autosomal dominant polycystic kidney disease; aSAH = aneurysmal subarachnoid hemorrhage; GOS = Glasgow Outcome Scale; IA = intracranial aneurysm; KUH = Kuopio University Hospital; MCA = middle cerebral artery.

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Contributor Notes

Correspondence Heidi J. Nurmonen: Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland. heidi.nurmonen@kuh.fi.

INCLUDE WHEN CITING Published online July 3, 2020; DOI: 10.3171/2020.4.JNS20544.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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