In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Predictors of multiple aneurysms in patients with subarachnoid hemorrhage

    Final Number:
    1228

    Authors:
    Michael Maurice McDowell BS; Ravi Shah; Brianne Ryan BS; Sunjay Max Barton BA; Christopher P. Kellner MD; Eric S Sussman; Stephan A. Mayer MD; E. Sander Connolly MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2013 Annual Meeting

    Introduction: Intracranial aneurysms are a major cause of subarachnoid hemorrhage (SAH) and hemorrhagic stroke. Many patients have greater than one aneurysm on presentation, but the exact genetic or environmental factors that predispose a patient towards the development of multiple aneurysm are unclear. We sought to assess the factors predisposing a patient towards multiple aneurysms among patients presenting with subarachnoid hemorrhage.

    Methods: Patients presenting to the Columbia University Medical Center Neurological ICU were prospectively enrolled from 1996-2012. Patients with an aneurysm confirmed by angiography that appeared to be the source of the hemorrhage were assessed for clinical and radiographic characteristics that were associated (p<0.2) with one, two, or three or more aneurysms using univariate comparisons (Chi-squared, Mann-Whitney, and Student t-test). Multiple logistic regressions were performed on associated factors.

    Results: Of 1277 patients, 890 had one aneurysm, 267 had two aneurysms, and 120 had three or greater aneurysms. Amongst those presenting with SAH, factors associated with a single aneurysm were male gender (OR 1.78; p=0.0276), lower BMI (OR 0.976; p=0.0062). Patients of black ethnicity were less likely to present with a single aneurysm (OR 0.438; p=0.0012). Smoking alone predisposed patients to two aneurysms (OR 1.018/pack-year; p =0.423). In contrast, anti-platelet use was found to be protective (OR 0.342; p = 0.0399). Black ethnicity (OR 2.803; p=0.0003), history of polycystic kidney disease (OR 5.534; p = 0.038), and higher BMI (OR 1.023; p=0.0187) were found to be predictive of patients present with three or more aneurysms.

    Conclusions: Patients presenting with SAH and multiple aneurysms can be readily stratified by unique risk factors. Patients with two aneurysms appear to represent a group who is predisposed by environmental factors, whereas patients with three or more aneurysms appear to be predisposed predominantly by genetic factors. However, gender and BMI appear to play a role in all multiple aneurysms.

    Patient Care: This project demonstrates that aneurysmal pathogenesis is complex, but may be categorizable based on number. It also emphasizes several potential inflammatory mechanisms of aneurysmal development.

    Learning Objectives: 1) To understand the differential role that genetics and environment may play in aneursm development. 2) To recognize that genetic predispositions may play a greater role in those with greater than 2 aneurysms 3) To understand that the development of one or two aneurysms may be more secondary to environmental factors.

    References: 1. Weir, B., Unruptured intracranial aneurysms: a review. J Neurosurg, 2002. 96(1): p. 3-42. 2. Ostergaard, J.R. and E. Hog, Incidence of multiple intracranial aneurysms. Influence of arterial hypertension and gender. J Neurosurg, 1985. 63(1): p. 49-55. 3. Rinne, J., et al., Management outcome for multiple intracranial aneurysms. Neurosurgery, 1995. 36(1): p. 31-7; discussion 37-8. 4. Rinne, J., et al., Multiple intracranial aneurysms in a defined population: prospective angiographic and clinical study. Neurosurgery, 1994. 35(5): p. 803-8.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy