Background
Previous studies suggest a coprevalence of intracranial aneurysms (IA) in patients
with infrarenal abdominal aortic aneurysms (AAA). We reviewed our multicenter experience
in the detection/treatment of IAs in patients with ascending thoracic aortic aneurysms
(ATAA) relative to patients without ATAA.
Methods
Surgical cases of ATAA repaired at 3 sites from January 1998 to December 2018 were
retrospectively reviewed. Out of these patients, those with intracranial vascular
imaging were selected for our study, and these individuals were concurrently randomly
matched with a control group of patients who underwent intracranial vascular imaging
without an ATAA in a 1:1 ratio by age, sex, smoking history, and year of intracranial
vascular imaging. Conditional logistic regression was used to calculate odds ratios
(OR).
Results
We reviewed 2176 ATAA repairs. 74% (n = 1,615) were men. Intracranial vascular imaging was available in 298 (13.7%) patients.
Ninteen patients were found to have 22 IAs for a prevalence of 6.4%. Mean size of
IA was 4.6 ± 3.3 mm; mean age at IA detection, 63.4 ± 12.1 years. IA was present on
head imaging in 4.7% of male and 12.5% of female patients. Eleven (58%) patients were
men. The OR of having IA in female versus male patients is 2.90, 95% confidence interval
[CI] [1.08–7.50], P = 0.029. Time from IA diagnosis to ATAA repair was 1.7 ± 116.2 months. Two patients
underwent treatment for IA, one ruptured and one unruptured. All were diagnosed before
ATAA repair. Treatment included 1 clipping and 1 coiling with subsequent reintervention
of the coiling using a flow diversion device. In the matched group of patients who
had intracranial vascular imaging without ATAA, the rate of IA is 5.0%. IA was detected
in 3.8% of males and 9.4% of female patients for an OR of 2.59, 95% CI [0.84–7.47],
P = 0.083. Association within our study and matched groups, the OR of developing an
IA with and without ATAA was not statistically significant 1.29, 95% CI [0.642.59],
P = 0.48. There was also no evidence of sex differences in the association of ATAA
with IA (interaction P = 0.88). The OR for the association of ATAA with IA was 1.33, 95% CI [0.46–3.84],
P = 0.59 in females and 1.25, 95% CI [0.49–3.17], P = 0.64 in males.
Conclusions
Our study found that IA was present in 6.4% of patients with ATAA who had intracranial
vascular imaging available. The odds of IA were 1.29 times higher than a matched cohort
of patients who had intracranial vascular imaging without ATAA but this failed to
achieve statistical significance. We found that the odds of IA were more than 2 times
higher in females than males for both those with ATAA (OR = 2.90) and those without
ATAA (OR = 2.59); however, it only reached statistical significance in those with
ATAA.
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Article info
Publication history
Published online: February 09, 2023
Accepted:
January 24,
2023
Received:
November 23,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
