Presentation on theme: "S L I D E 0 Intracranial Aneurysm Patients May Harbor Thoracic Aortic Aneurysms 1 Yale University School of Medicine, New Haven, CT 2 Department of Neurosurgery,"— Presentation transcript:
S L I D E 0 Intracranial Aneurysm Patients May Harbor Thoracic Aortic Aneurysms 1 Yale University School of Medicine, New Haven, CT 2 Department of Neurosurgery, Yale-New Haven Hospital, New Haven CT 3 Aortic Institute at Yale-New Haven Hospital, New Haven, CT Gregory A. Kuzmik 1, Murat Gunel 2, Ketan Bulsara 2, Maryann Tranquilli 3, John A. Elefteriades 3
S L I D E 1 Background Thoracic aortic aneurysm (TAA) and intracranial aneurysm (ICA) share common pathogenic mediators (Koullias 2004, Kim 1997) There is increasing evidence of a common genetic basis for TAA and ICA (Ruigrok 2008, Regalado 2011[Am.J.Med.Genet.A.], Regalado 2011 [Circ.Res.])
S L I D E 2 Background Patients with TAA have a 9% rate of concurrent ICA (Kuzmik 2010) –9-fold higher ICA prevalence than the general population
S L I D E 3 Objective To determine the prevalence of concurrent thoracic aortic aneurysms (TAA) in patients with intracranial aneurysms (ICA).
S L I D E 4 Methods Retrospective review of all patients presenting within the past 6 years for evaluation or treatment of ruptured or unruptured ICA Radiographic records reviewed for recent thoracic imaging –Obtained for pre-operative work-up ( 64%) or unrelated reasons ( 36%) such as trauma or cancer screening TAA defined by official radiology reports documenting focal aortic dilation relative to the adjacent vessel rather than arbitrary size cut-offs
S L I D E 5 Results 1,224 patients with ICA 1,224 patients with ICA 359 with thoracic imaging 359 with thoracic imaging 4.7% (17) with concurrent TAA 4.7% (17) with concurrent TAA
S L I D E 6 Patient Characteristics All patients (n = 359) Thoracic Imaging CT: 146 (41%) Echo: 212 (59%) MRI: 1 (< 1%) Mean Age58.4 years Gender64.1% Female Ethnicity68.5% Caucasian; 16.4% African American; 13.1% Hispanic; 1.4% Asian; 0.6% Other Blood Pressure 57% Hypertensive Smoking56% Smokers ICA Presentation 64% Ruptured; 36% Unruptured Mean ICA Size6.54 mm ICA Location (75 patients with multiple ICA; 472 Total ICA) 34 ACA (7%) 94 Acom (20%) 30 Basilar (6%) 106 ICA (22%) 110 MCA (23%) 3 PCA (<1%) 66 Pcom (14%) 4 PICA (1%) 8 SCA (2%) 13 Vert (3%) 4 Other (1%) TAA patients (n = 17) Thoracic Imaging CT: 9 (53%) Echo: 8 (47%) Mean Age67.1 years Gender53% Female Ethnicity65% Caucasian 29% African American 6% Hispanic Blood Pressure 76% Hypertensive Smoking38% Smokers ICA Presentation 59% Ruptured; 41% Unruptured Mean ICA Size7.23 mm ICA Location (2 patients with multiple ICA; 19 Total ICA) 1 ACA (5%) 6 Acom (32%) 2 ICA (11%) 5 MCA (26%) 2 Pcom (11%) 2 Vert (11%) 1 Other (5%) (anterior spinal artery) ACA = anterior cerebral artery; Acom = anterior communicating artery; ICA = internal carotid artery; MCA = middle cerebral artery; PCA = posterior cerebral artery; Pcom = posterior communicating artery; PICA = posterior inferior cerebellar artery; SCA = superior cerebellar artery; Vert = vertebral artery
S L I D E 7 Results TAA Location: –Root/Ascending: 14 (82%) (mean 4.4 cm, range 3.6 – 6.3 cm) –Arch: 2 (12%) (mean 5.4 cm, range 4.8 – 6.0 cm) –Descending: 3 (18%) (mean 3.5 cm, range 2.9 – 4.3 cm ) (2 patients had multiple TAAs) 1,224 patients with ICA 1,224 patients with ICA 359 with thoracic imaging 359 with thoracic imaging 4.7% (17) with concurrent TAA 4.7% (17) with concurrent TAA
S L I D E 8 Results Patients with ICA > 4.0 mm had 6.4% rate of concurrent TAA and a significantly increased risk of TAA (p = 0.03) Patients > 70 years-old had 10.8% rate of concurrent TAA and a significantly increased risk of TAA (p = 0.01) Rate of Concurrent TAA Patients with ICA * * p = 0.03 p = 0.01
S L I D E 9 Results Gender, race, hypertension, and smoking status did not significantly affect risk of concurrent TAA Rate of Concurrent TAA Patients with ICA
S L I D E 10 Conclusions ICA patients have approximately a 5% rate of concurrent TAA Patients with ICA > 4.0 mm and > 70 years-old have an even higher risk of concurrent TAA We suggest that ICA patients be screened for silent TAA, which could jeopardize their longevity even after successful treatment of ICA
S L I D E 11 References 1. Koullias GJ, Ravichandran P, Korkolis DP, Rimm DL, Elefteriades JA. Increased tissue microarray matrix metalloproteinase expression favors proteolysis in thoracic aortic aneurysms and dissections, Ann Thorac Surg 2004;78:2106-10; discussion 2110-1. 2. Kim SC, Singh M, Huang J, Prestigiacomo CJ, Winfree CJ, Solomon RA, Connolly ES,Jr. Matrix metalloproteinase- 9 in cerebral aneurysms, Neurosurgery 1997;41:642-66; discussion 646-7. 3. Ruigrok YM, Elias R, Wijmenga C, Rinkel GJ. A comparison of genetic chromosomal loci for intracranial, thoracic aortic, and abdominal aortic aneurysms in search of common genetic risk factors, Cardiovasc Pathol 2008;17:40-47. 4. Regalado E, Medrek S, Tran-Fadulu V, Guo DC, Pannu H, Golabbakhsh H, Smart S, Chen JH, Shete S, Kim DH, Stern R, Braverman AC, Milewicz DM. Autosomal dominant inheritance of a predisposition to thoracic aortic aneurysms and dissections and intracranial saccular aneurysms, Am J Med Genet A 2011;155A:2125-2130. 5. Regalado ES, Guo DC, Villamizar C, Avidan N, Gilchrist D, McGillivray B, Clarke L, Bernier F, Santos-Cortez RL, Leal SM, Bertoli-Avella AM, Shendure J, Rieder MJ, Nickerson DA, NHLBI GO Exome Sequencing Project, Milewicz DM. Exome sequencing identifies SMAD3 mutations as a cause of familial thoracic aortic aneurysm and dissection with intracranial and other arterial aneurysms, Circ Res 2011;109:680-686. 6. Kuzmik GA, Feldman M, Tranquilli M, Rizzo JA, Johnson M, Elefteriades JA. Concurrent intracranial and thoracic aortic aneurysms, Am J Cardiol 2010;105:417-420.