Miscellaneous
Concurrent Intracranial and Thoracic Aortic Aneurysms

https://doi.org/10.1016/j.amjcard.2009.09.049Get rights and content

The pathogeneses of both thoracic aortic aneurysm (TAA) and intracranial aneurysm (ICA) share common pathologic mediators. However, the prevalence of ICA in patients with TAA is not known. The present study investigated the prevalence of concurrent ICA to determine whether patients with TAA should be screened for ICA. The records of 212 patients with TAA and concurrent brain images (computed tomographic angiograms or magnetic resonance angiograms) were retrospectively analyzed. A bivariate statistical analysis (Fisher's exact test) was used to compare the subgroups. We found that patients with TAA had a 9.0% prevalence of ICA (19 of 212 patients), ninefold greater than that in the general population. Also, the location of the TAA influenced the prevalence of ICA. The prevalence of ICA in patients with a descending TAA was significantly greater—33% (5 of 15 patients)—than the prevalence (7.1%) in patients (14 of 197 patients) with an ascending TAA (p = 0.006). Hypertension also increased the prevalence of concurrent ICA: 18 (11.8%) of 153 patients with hypertension and a TAA had concurrent ICA, but only 1 (1.7%) of 59 normotensive patients with a TAA had an ICA (p = 0.03). A history of cigarette smoking increased the risk of an ICA. Race, age, and gender did not significantly affect the prevalence of concurrent ICA. In conclusion, patients with a TAA are at increased risk of having an ICA. We suggest that patients with a TAA be screened for an ICA.

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Methods

We retrospectively reviewed patient records from 1997 to 2009 in a large TAA database to identify patients with TAA who also had available high-quality intracranial images by either computed tomographic angiography or magnetic resonance angiography. We identified 212 such patients of approximately 1,560 patients who had undergone TAA repair during that period. The cerebral imaging scans had been ordered either as a preoperative screening test by our thoracic aortic team or before evaluation for

Results

Of the 212 patients with TAA, 19 (9.0%) had a concurrent ICA (Table 1). Of the 160 patients in the prospective patient group, 10 (6.3%) had a concurrent ICA. The ICAs ranged from 1.0 to 11.0 mm (mean 3.7, SD 2.6). Figure 1 shows a representative example.

Of the 9 patients with concurrent ICA from the nonprospective group, 5 had undergone cerebral imaging because of nonspecific symptoms of headache or neck pain, and the aneurysm had been an incidental finding. Of the remaining 4 patients, 2 had

Discussion

The results of the present study have shown that patients with a TAA have a greater prevalence of ICA than the general population: 9.0% of patients with a TAA had a concurrent ICA. Considering only the prospective group, the prevalence of ICA was 6.3%. Our comparison population was drawn from >10,000 autopsies and angiograms from studies that provided information on the prevalence of ICA in the general population.1, 4, 5 Several such studies found the general prevalence of ICA to be

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This research was supported by a National Institutes of Health, National Heart, Lung and Blood Institute Medical Student Research Fellowship (Bethesda, Maryland).

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