Unruptured intracranial aneurysms in the Familial Intracranial Aneurysm and International Study of Unruptured Intracranial Aneurysms cohorts: differences in multiplicity and location

Clinical article

View More View Less
  • 1 Department of Neurology, Indiana University, Indianapolis, Indiana;
  • | 2 Departments of Neurology and
  • | 9 Radiology, Mayo Clinic, Rochester, Minnesota;
  • | 3 Departments of Neurology and
  • | 4 Emergency Medicine, University of Cincinnati, Ohio;
  • | 5 Department of Radiology, Johns Hopkins, Baltimore, Maryland;
  • | 6 The George Institute for International Health, University of Sydney, Australia;
  • | 7 Department of Neurosurgery, Columbia University, New York, New York;
  • | 8 Notre Dame Hospital, University of Montreal, Quebec, Canada; and
  • | 10 Department of Epidemiology, University of Iowa, Iowa City, Iowa
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
Print or Print + Online

Object

Familial predisposition is a recognized nonmodifiable risk factor for the formation and rupture of intracranial aneurysms (IAs). However, data regarding the characteristics of familial IAs are limited. The authors sought to describe familial IAs more fully, and to compare their characteristics with a large cohort of nonfamilial IAs.

Methods

The Familial Intracranial Aneurysm (FIA) study is a multicenter international study with the goal of identifying genetic and other risk factors for formation and rupture of IAs in a highly enriched population. The authors compared the FIA study cohort with the International Study of Unruptured Intracranial Aneurysms (ISUIA) cohort with regard to patient demographic data, IA location, and IA multiplicity. To improve comparability, all patients in the ISUIA who had a family history of IAs or subarachnoid hemorrhage were excluded, as well as all patients in both cohorts who had a ruptured IA prior to study entry.

Results

Of 983 patients enrolled in the FIA study with definite or probable IAs, 511 met the inclusion criteria for this analysis. Of the 4059 patients in the ISUIA study, 983 had a previous IA rupture and 657 of the remainder had a positive family history, leaving 2419 individuals in the analysis. Multiplicity was more common in the FIA patients (35.6% vs 27.9%, p < 0.001). The FIA patients had a higher proportion of IAs located in the middle cerebral artery (28.6% vs 24.9%), whereas ISUIA patients had a higher proportion of posterior communicating artery IAs (13.7% vs 8.2%, p = 0.016).

Conclusions

Heritable structural vulnerability may account for differences in IA multiplicity and location. Important investigations into the underlying genetic mechanisms of IA formation are ongoing.

Abbreviations used in this paper:

ACA = anterior cerebral artery; ACoA = anterior communicating artery; BA = basilar artery; CTA = CT angiography; FIA = Familial Intracranial Aneurysm; IA = intracranial aneurysm; ICA = internal carotid artery; ISUIA = International Study of Unruptured Intracranial Aneurysms; MCA = middle cerebral artery; MRA = MR angiography; OA = ophthalmic artery; PCoA = posterior communicating artery; SAH = subarachnoid hemorrhage; VA = vertebral artery.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $515.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $612.00
  • 1

    Bilguvar K, , Yasuno K, , Niemelä M, , Ruigrok YM, , von Und Zu Fraunberg M, & van Duijn CM, et al.: Susceptibility loci for intracranial aneurysm in European and Japanese populations. Nat Genet 40:14721477, 2008

    • Search Google Scholar
    • Export Citation
  • 2

    Broderick JP, , Brown RD Jr, , Sauerbeck L, , Hornung R, , Huston J III, & Woo D, et al.: Greater rupture risk for familial as compared to sporadic unruptured intracranial aneurysms. Stroke 40:19521957, 2009

    • Search Google Scholar
    • Export Citation
  • 3

    Broderick JP, , Sauerbeck LR, , Foroud T, , Huston J III, , Pankratz N, & Meissner I, et al.: The Familial Intracranial Aneurysm (FIA) study protocol. BMC Med Genet 6:17, 2005

    • Search Google Scholar
    • Export Citation
  • 4

    Helgadottir A, , Thorleifsson G, , Magnusson KP, , Grétarsdottir S, , Steinthorsdottir V, & Manolescu A, et al.: The same sequence variant on 9p21 associates with myocardial infarction, abdominal aortic aneurysm and intracranial aneurysm. Nat Genet 40:217224, 2008

    • Search Google Scholar
    • Export Citation
  • 5

    Huttunen T, , von und zu Fraunberg M, , Frösen J, , Lehecka M, , Tromp G, & Helin K, et al.: Saccular intracranial aneurysm disease: distribution of site, size, and age suggests different etiologies for aneurysm formation and rupture in 316 familial and 1454 sporadic eastern Finnish patients. Neurosurgery 66:631638, 2010

    • Search Google Scholar
    • Export Citation
  • 6

    International Study of Unruptured Intracranial Aneurysms Investigators: Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. N Engl J Med 339:17251733, 1998

    • Search Google Scholar
    • Export Citation
  • 7

    Kleindorfer DO, , Khoury J, , Moomaw CJ, , Alwell K, , Woo D, & Flaherty ML, et al.: Stroke incidence is decreasing in whites but not in blacks: a population-based estimate of temporal trends in stroke incidence from the Greater Cincinnati/Northern Kentucky Stroke Study. Stroke 41:13261331, 2010

    • Search Google Scholar
    • Export Citation
  • 8

    Lozano AM, & Leblanc R: Familial intracranial aneurysms. J Neurosurg 66:522528, 1987

  • 9

    Rinkel GJE, , Djibuti M, , Algra A, & van Gijn J: Prevalence and risk of rupture of intracranial aneurysms: a systematic review. Stroke 29:251256, 1998

    • Search Google Scholar
    • Export Citation
  • 10

    Ronkainen A, , Hernesniemi J, & Tromp G: Special features of familial intracranial aneurysms: report of 215 familial aneurysms. Neurosurgery 37:4347, 1995

    • Search Google Scholar
    • Export Citation
  • 11

    Ruigrok YM, & Rinkel GJ: From GWAS to the clinic: risk factors for intracranial aneurysms. Genome Med 2:61, 2010

  • 12

    Ruigrok YM, & Rinkel GJE: Genetics of intracranial aneurysms. Stroke 39:10491055, 2008

  • 13

    Vernooij MW, , Ikram MA, , Tanghe HL, , Vincent AJPE, , Hofman A, & Krestin GP, et al.: Incidental findings on brain MRI in the general population. N Engl J Med 357:18211828, 2007

    • Search Google Scholar
    • Export Citation
  • 14

    Weir B: Patients with small, asymptomatic, unruptured intracranial aneurysms and no history of subarachnoid hemorrhage should be treated conservatively: against. Stroke 36:410411, 2005

    • Search Google Scholar
    • Export Citation
  • 15

    Wiebers DO, , Whisnant JP, , Huston J III, , Meissner I, , Brown RD Jr, & Piepgras DG, et al.: Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362:103110, 2003

    • Search Google Scholar
    • Export Citation
  • 16

    Yasuno K, , Bilguvar K, , Bijlenga P, , Low SK, , Krischek B, & Auburger G, et al.: Genome-wide association study of intracranial aneurysm identifies three new risk loci. Nat Genet 42:420425, 2010

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 786 245 11
Full Text Views 181 25 3
PDF Downloads 143 28 3
EPUB Downloads 0 0 0