Development of multiple intracranial aneurysms: beyond the common risk factors

Thiemo F Dinger; Marvin Darkwah Oppong; Chikadibia Park; Maryam Said; Mehdi Chihi; Laurèl Rauschenbach; Oliver Gembruch; Cornelius Deuschl; Karsten H Wrede; Veronika Lenz; Christoph Kleinschnitz; Michael Forsting; Ulrich Sure; Ramazan Jabbarli

doi:10.3171/2021.11.JNS212325

Development of multiple intracranial aneurysms: beyond the common risk factors

J Neurosurg. 2022 Feb 4:1-8. doi: 10.3171/2021.11.JNS212325. Online ahead of print.

Affiliations

¹ 1Department of Neurosurgery and Spine Surgery, University Hospital, University of Duisburg-Essen, Essen, Germany.
² 2Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital, University of Duisburg-Essen, Essen, Germany.
³ 3Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany; and.
⁴ 4Department of Neurology and Center for Translational Neuroscience and Behavioral Science (C-TNBS), University Hospital, University of Duisburg-Essen, Essen, Germany.

PMID: 35120308
DOI: 10.3171/2021.11.JNS212325

Abstract

Objective: The prevalence of multiple intracranial aneurysms (MIAs) has increased over the last decades. Because MIAs have been identified as an independent risk factor for formation, growth, and rupture of intracranial aneurysms (IAs), a more profound understanding of the underlying pathophysiology of MIAs is needed. Therefore, the authors' extensive institutional aneurysm database was analyzed to elucidate differences between patients with a single IA (SIA) and those with MIAs.

Methods: A total of 2446 patients seen with or for IAs at the University Hospital of Essen, Essen, Germany, from January 2003 to June 2016 were included in this retrospective cohort study and were separated into MIA and SIA subgroups. Patient data were screened for sociodemographic and radiographic parameters, preexisting medical conditions, and results of blood examinations. These parameters were analyzed for their correlations with MIAs and absolute number of IAs.

Results: MIAs were identified in 853 (34.9%) patients. In multivariable analysis, MIAs were independently associated with female sex (p = 0.001), arterial hypertension (p = 0.023), tobacco abuse (p = 0.009), AB blood group (p = 0.010), and increased admission values for C-reactive protein (p = 0.006), mean corpuscular volume (p = 0.009), and total serum protein (p = 0.034), but not with diagnostic modality (3D vs 2D digital subtraction angiography, p = 0.912). Absolute number of IAs was independently associated with female sex (p < 0.001), arterial hypertension (p = 0.014), familial predisposition to IA (p = 0.015), tobacco consumption (p = 0.025), increased mean corpuscular volume (p = 0.002), and high platelet count (p = 0.007).

Conclusions: In this sizable consecutive series of patients with IAs, the authors confirmed the impact of common IA risk factors on the genesis of MIAs. In addition, specific hemorheological and hemocytological features may also contribute to the development of MIAs.

Keywords: SAH; multiple intracranial aneurysms; rheology; risk factor; subarachnoid hemorrhage; vascular disorders.