Intracranial aneurysm is predicted by abdominal aortic calcification index: A retrospective case-control study

Ville Rantasalo,Jarmo Gunn,Tuomas Kiviniemi,Jussi Hirvonen,Ilkka Saarenpää,Juri Kivelev,Melissa Rahi,Elli Lassila,Jaakko Rinne,Dan Laukka

doi:10.1016/j.atherosclerosis.2021.08.027

Intracranial aneurysm is predicted by abdominal aortic calcification index: A retrospective case-control study

Ville Rantasalo, Jarmo Gunn + Show 8 more

Open Access

https://doi.org/10.1016/j.atherosclerosis.2021.08.027

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Journal: Atherosclerosis	Publication Date: Aug 15, 2021
Citations: 11	License type: cc-by

Affiliation: Turku University Hospital, University of Turku

Abstract

Background and aimsPatients with intracranial aneurysms (IA) have excess mortality for cardiovascular diseases, but little is known on whether atherosclerotic manifestations and IA coexist. We investigated abdominal aortic calcification index (ACI) association with unruptured and ruptured IAs. MethodsThis retrospective case-control study reviews all tertiary centers patients (n = 24,660) who had undergone head computed tomography angiography (CTA), magnetic resonance angiography (MRA) or digital subtraction angiography (DSA) for any reason between January 2003 and May 2018. Patients (n = 2020) with unruptured or ruptured IAs were identified, and patients with available abdominal CT were included. IA patients were matched by sex and age to controls (available abdomen CT, no IAs) in ratio of 1:3. ACI was measured from abdomen CT scans and patient records were reviewed. Results1720 patients (216 ruptured IA (rIA), 246 unruptured IA (UIA) and 1258 control) were included. Mean age was 62.9 ± 11.9 years and 58.2% were female. ACI (OR 1.02 per increment, 95%CI 1.01–1.03) and ACI>3 (OR 5.77, 95%CI 3.29–10.11) increased risk for rIA compared to matched controls. UIA patients' ACI was significantly higher but ACI did not increase odds for UIA compared to matched controls. History of coronary artery disease was less frequent in rIA patients. There was no calcification in aorta in 8.8% rIA and 13.6% UIA patients (matched controls 25.7% and 22.6% respectively, p < 0.01). ConclusionsAortic calcification is greater in rIA and UIA patients than matched controls. ACI increases risk for rIAs.

Highlights

The prevalence of unruptured intracranial aneurysms (UIA) is around 3% in the general population [1] and only a small portion of UIAs rupture during lifetime, as the incidence of ruptured IAs, is around 10/100,000 per year
The main finding of this study was that higher abdominal aortic calcification was associated with a higher risk of intracranial aneurysms overall
Mean aortic calcification index (ACI) was significantly higher in ruptured IAs (rIA) patients than matched controls and the risk for rIA increased with higher ACI when compared to matched controls

Summary

Introduction

The prevalence of unruptured intracranial aneurysms (UIA) is around 3% in the general population [1] and only a small portion of UIAs rupture during lifetime, as the incidence of ruptured IAs (rIA), is around 10/100,000 per year. Intracranial aneurysm wall and atherosclerotic plaque have many common inflammation-mediating cytokines and leucocytes [6,9]. It is suggested a shared underlying pathophysiology between atherosclerosis and intracranial aneurysms [8,10]. IA patients were matched by sex and age to controls (available abdomen CT, no IAs) in ratio of 1:3. Results: 1720 patients (216 ruptured IA (rIA), 246 unruptured IA (UIA) and 1258 control) were included. ACI (OR 1.02 per increment, 95%CI 1.01–1.03) and ACI>3 (OR 5.77, 95%CI 3.29–10.11) increased risk for rIA compared to matched controls. Conclusions: Aortic calcification is greater in rIA and UIA patients than matched controls.

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