Abstract W P81: Echocardiographic Evidence of Intrinsic Aortopathy in Patients With Intracranial Aneurysm

Abstract

Background: Intracranial aneurysms (IA) are outpouches of weakened arterial walls encompassing around 3% of general population. Until now, pathophysiology of formation, growth and rupture of the aneurysm is not fully understood, but former studies have shown that intrinsic arterial wall defect contribute to the aneurysmal pathogenesis. Prevalence of IA in patients with coarctation of aorta or bicuspid aortic valve is significantly higher than general population, which suggests common pathophysiology between IA and aortopathy. However, the relationship is difficult to generalize because of the rarity of coarctation of aorta and bicuspid aortic valve. We used common echocardiographic marker, aortic root dimension (ARD), to show the association. Methods: We reviewed all patients with IA and performed echocardiography (n=260) who admitted to our institution for coil embolization or for management of ischemic stroke. Patients aged <55 years and had at least one of rupture presentation, size ≥7mm, and multiple aneurysms were classified into eccentric group, and the others were categorized into non-eccentric group. We compared demographics, clinical features, and echocardiographic findings in these two groups. Results: Non-eccentric group had more cerebrovascular risk factors such as hypertension (p <0.001), diabetes mellitus (p = 0.009), hyperlipidemia (p <0.021), and more patients had a history of stroke or coronary artery disease (p = 0.013). Multivariate analysis revealed that eccentric group were younger (p <0.001) but had more dilated aortic root (p = 0.015). Subgroup analysis with patients aged <55 years showed similar result in ARD (p = 0.03), and hypertension was more associated with non-eccentric group (p = 0.005). Intriguingly, patients with short stature had a tendency to belong to the eccentric group, although it didn’t reach statistical significance (p=0.063). Conclusion: ARD was significantly large in eccentric group compared with non-eccentric group. In patients with IA, common intrinsic arterial wall defect exist between intracranial artery and ascending aorta, and it may be attributable to genetics or developmental process.