Isabel C Hostettler1, Varinder S Alg1, Nichole Shahi1, Fatima Jichi2, Stephen Bonner3, Daniel Walsh4, Diederik Bulters5, Neil Kitchen6, Martin M Brown1, Henry Houlden7, Joan Grieve6, David J Werring1. 1. Stroke Research Centre, University College London, Institute of Neurology, London, UK. 2. Biostatistics Group, University College London Research Support Centre, University College London, UK. 3. Department of Anaesthesia, The James Cook University Hospital, Middlesbrough, UK. 4. Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK. 5. Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 6. Department of Neurosurgery, The National Hospital of Neurology and Neurosurgery, London, UK. 7. Neurogenetics Laboratory, The National Hospital of Neurology and Neurosurgery, London, UK.
Abstract
BACKGROUND: Only a minority of intracranial aneurysms rupture to cause subarachnoid hemorrhage. OBJECTIVE: To test the hypothesis that unruptured aneurysms have different characteristics and risk factor profiles compared to ruptured aneurysms. METHODS: We recruited patients with unruptured aneurysms or aneurysmal subarachnoid hemorrhages at 22 UK hospitals between 2011 and 2014. Demographic, clinical, and imaging data were collected using standardized case report forms. We compared risk factors using multivariable logistic regression. RESULTS: A total of 2334 patients (1729 with aneurysmal subarachnoid hemorrhage, 605 with unruptured aneurysms) were included (mean age 54.22 yr). In multivariable analyses, the following variables were independently associated with rupture status: black ethnicity (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.29-4.56, compared to white) and aneurysm location (anterior cerebral artery/anterior communicating artery [OR 3.21; 95% CI 2.34-4.40], posterior communicating artery [OR 3.92; 95% CI 2.67-5.74], or posterior circulation [OR 3.12; 95% CI 2.08-4.70], compared to middle cerebral artery). The following variables were inversely associated with rupture status: antihypertensive medication (OR 0.65; 95% CI 0.49-0.84), hypercholesterolemia (0.64 OR; 95% CI 0.48-0.85), aspirin use (OR 0.28; 95% CI 0.20-0.40), internal carotid artery location (OR 0.53; 95% CI 0.38-0.75), and aneurysm size (per mm increase; OR 0.76; 95% CI 0.69-0.84). CONCLUSION: We show substantial differences in patient and aneurysm characteristics between ruptured and unruptured aneurysms. These findings support the hypothesis that different pathological mechanisms are involved in the formation of ruptured aneurysms and incidentally detected unruptured aneurysms. The potential protective effect of aspirin might justify randomized prevention trials in patients with unruptured aneurysms.
BACKGROUND: Only a minority of intracranial aneurysms rupture to cause subarachnoid hemorrhage. OBJECTIVE: To test the hypothesis that unruptured aneurysms have different characteristics and risk factor profiles compared to ruptured aneurysms. METHODS: We recruited patients with unruptured aneurysms or aneurysmal subarachnoid hemorrhages at 22 UK hospitals between 2011 and 2014. Demographic, clinical, and imaging data were collected using standardized case report forms. We compared risk factors using multivariable logistic regression. RESULTS: A total of 2334 patients (1729 with aneurysmal subarachnoid hemorrhage, 605 with unruptured aneurysms) were included (mean age 54.22 yr). In multivariable analyses, the following variables were independently associated with rupture status: black ethnicity (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.29-4.56, compared to white) and aneurysm location (anterior cerebral artery/anterior communicating artery [OR 3.21; 95% CI 2.34-4.40], posterior communicating artery [OR 3.92; 95% CI 2.67-5.74], or posterior circulation [OR 3.12; 95% CI 2.08-4.70], compared to middle cerebral artery). The following variables were inversely associated with rupture status: antihypertensive medication (OR 0.65; 95% CI 0.49-0.84), hypercholesterolemia (0.64 OR; 95% CI 0.48-0.85), aspirin use (OR 0.28; 95% CI 0.20-0.40), internal carotid artery location (OR 0.53; 95% CI 0.38-0.75), and aneurysm size (per mm increase; OR 0.76; 95% CI 0.69-0.84). CONCLUSION: We show substantial differences in patient and aneurysm characteristics between ruptured and unruptured aneurysms. These findings support the hypothesis that different pathological mechanisms are involved in the formation of ruptured aneurysms and incidentally detected unruptured aneurysms. The potential protective effect of aspirin might justify randomized prevention trials in patients with unruptured aneurysms.
Authors: Jorge A Roa; Mario Zanaty; Daizo Ishii; Yongjun Lu; David K Kung; Robert M Starke; James C Torner; Pascal M Jabbour; Edgar A Samaniego; David M Hasan Journal: J Neurosurg Date: 2020-03-06 Impact factor: 5.115
Authors: Matthew J Morton; Isabel C Hostettler; Nabila Kazmi; Varinder S Alg; Stephen Bonner; Martin M Brown; Andrew Durnford; Benjamin Gaastra; Patrick Garland; Joan Grieve; Neil Kitchen; Daniel Walsh; Ardalan Zolnourian; Henry Houlden; Tom R Gaunt; Diederik O Bulters; David J Werring; Ian Galea Journal: J Neurol Neurosurg Psychiatry Date: 2020-01-14 Impact factor: 10.154
Authors: Martina Sebök; Isabel C Hostettler; Emanuela Keller; Ilari M Rautalin; Bert A Coert; William P Vandertop; René Post; Ali Sardeha; Maud A Tjerkstra; Luca Regli; Dagmar Verbaan; Menno R Germans Journal: Int J Stroke Date: 2021-07-29 Impact factor: 6.948
Authors: Isabel C Hostettler; Benjamin O'Callaghan; Enrico Bugiardini; Emer O'Connor; Jana Vandrovcova; Indran Davagnanam; Varinder Alg; Stephen Bonner; Daniel Walsh; Diederik Bulters; Neil Kitchen; Martin M Brown; Joan Grieve; David J Werring; Henry Houlden Journal: Neurology Date: 2020-10-26 Impact factor: 9.910