Does Systemic Hypertension Impact Recanalization of Coiled Aneurysms?

Overview

Journal Clin Neuroradiol

Specialties Neurology
Radiology

Date 2019 Aug 31

PMID 31468079

Authors

Su Hwan Lee

Young Dae Cho

Jong Hyeon Mun

Dong Hyun Yoo

Eung Koo Yeon

Hyun-Seung Kang

Jeong Eun Kim

Won-Sang Cho

Moon Hee Han

Affiliations

Soon will be listed here.

Abstract

Purpose: It is well known that hypertension is a significant factor in the formation, growth, and rupture of aneurysms and recanalization of coiled aneurysms is affected by hemodynamic stress. At present, however, the impact of hypertension on recanalization of coiled aneurysms has not been adequately investigated. This study examined the relation between hypertension and subsequent outcomes of coiled aneurysms, using a matched patient analysis.

Methods: A total of 715 subjects undergoing coil embolization of intracranial aneurysms between 2011 and 2013 were selected for study. Time-of-flight magnetic resonance or conventional angiography was used (singly or together) to gauge degrees of occlusion after coiling, applying the Raymond classification in grading recanalization. Patients with hypertension were grouped as controlled or uncontrolled, based on blood pressure readings at outpatient clinics. Hypertensive and non-hypertensive subjects were matched (1:1) for several relevant variables.

Results: Overall, 484 patients (67.7%) were hypertensive (controlled 338; uncontrolled 146). During the follow-up period (28.6 ± 9.7 months), 129 aneurysms (18.0%) displayed recanalization (minor 58; major 71). Patient age, concomitant diabetes, hyperlipidemia, aneurysm size, neck size, depth-to-neck ratio, and aneurysm type differed significantly in hypertensive and non-hypertensive groups; however, group incidences of cumulative recanalization were similar (p = 0.297). After 1:1 matching the cumulative recanalization rate (13.5%) in hypertensive and non-hypertensive counterparts (14.3%) again proved similar (p = 0.578). In the hypertensive group, in addition, recanalization showed no relation to controlled and uncontrolled subgroup (odds ratio, OR = 1.000, p > 0.999).

Conclusion: Unlike other aspects of evolving aneurysms (e.g. formation, growth, or rupture), recanalization of coiled aneurysms seems to be unaffected by systemic hypertension.

References

Brisman J, Song J, Newell D . Cerebral aneurysms. N Engl J Med. 2006; 355(9):928-39. DOI: 10.1056/NEJMra052760. View

Chalouhi N, Hoh B, Hasan D . Review of cerebral aneurysm formation, growth, and rupture. Stroke. 2013; 44(12):3613-22. DOI: 10.1161/STROKEAHA.113.002390. View

Gallas S, Januel A, Pasco A, Drouineau J, Gabrillargues J, Gaston A . Long-term follow-up of 1036 cerebral aneurysms treated by bare coils: a multicentric cohort treated between 1998 and 2003. AJNR Am J Neuroradiol. 2009; 30(10):1986-92. PMC: 7051306. DOI: 10.3174/ajnr.A1744. View

Grunwald I, Papanagiotou P, Struffert T, Politi M, Krick C, Gul G . Recanalization after endovascular treatment of intracerebral aneurysms. Neuroradiology. 2006; 49(1):41-7. DOI: 10.1007/s00234-006-0153-5. View

Sluzewski M, Menovsky T, van Rooij W, Wijnalda D . Coiling of very large or giant cerebral aneurysms: long-term clinical and serial angiographic results. AJNR Am J Neuroradiol. 2003; 24(2):257-62. PMC: 7974128. View

Juvela S . Prevalence of and risk factors for intracranial aneurysms. Lancet Neurol. 2011; 10(7):595-7. DOI: 10.1016/S1474-4422(11)70125-9. View

Penn D, Komotar R, Connolly E . Hemodynamic mechanisms underlying cerebral aneurysm pathogenesis. J Clin Neurosci. 2011; 18(11):1435-8. DOI: 10.1016/j.jocn.2011.05.001. View

Schievink W . Intracranial aneurysms. N Engl J Med. 1997; 336(1):28-40. DOI: 10.1056/NEJM199701023360106. View

Taylor C, Yuan Z, Selman W, Ratcheson R, Rimm A . Cerebral arterial aneurysm formation and rupture in 20,767 elderly patients: hypertension and other risk factors. J Neurosurg. 1995; 83(5):812-9. DOI: 10.3171/jns.1995.83.5.0812. View

10.

Backes D, Rinkel G, Laban K, Algra A, Vergouwen M . Patient- and Aneurysm-Specific Risk Factors for Intracranial Aneurysm Growth: A Systematic Review and Meta-Analysis. Stroke. 2016; 47(4):951-7. DOI: 10.1161/STROKEAHA.115.012162. View

11.

Duprez D . Role of the renin-angiotensin-aldosterone system in vascular remodeling and inflammation: a clinical review. J Hypertens. 2006; 24(6):983-91. DOI: 10.1097/01.hjh.0000226182.60321.69. View

12.

Muller M, van den Beld A, Bots M, Grobbee D, Lamberts S, van der Schouw Y . Endogenous sex hormones and progression of carotid atherosclerosis in elderly men. Circulation. 2004; 109(17):2074-9. DOI: 10.1161/01.CIR.0000125854.51637.06. View

13.

Li C, Wang S, Chen J, Yu H, Zhang Y, Jiang F . Influence of hemodynamics on recanalization of totally occluded intracranial aneurysms: a patient-specific computational fluid dynamic simulation study. J Neurosurg. 2012; 117(2):276-83. DOI: 10.3171/2012.5.JNS111558. View

14.

Liu J, Jing L, Wang C, Paliwal N, Wang S, Zhang Y . Effect of hemodynamics on outcome of subtotally occluded paraclinoid aneurysms after stent-assisted coil embolization. J Neurointerv Surg. 2015; 8(11):1140-1147. PMC: 4882272. DOI: 10.1136/neurintsurg-2015-012050. View

15.

Liu J, Zhang Y, Wang A, Zhang Y, Li Y, Yang X . Haemodynamic analysis for recanalisation of intracranial aneurysms after endovascular treatment: an observational registry study in China. BMJ Open. 2017; 7(5):e014261. PMC: 5777470. DOI: 10.1136/bmjopen-2016-014261. View

16.

Luo B, Yang X, Wang S, Li H, Chen J, Yu H . High shear stress and flow velocity in partially occluded aneurysms prone to recanalization. Stroke. 2011; 42(3):745-53. DOI: 10.1161/STROKEAHA.110.593517. View

17.

Raymond J, Guilbert F, Weill A, Georganos S, Juravsky L, Lambert A . Long-term angiographic recurrences after selective endovascular treatment of aneurysms with detachable coils. Stroke. 2003; 34(6):1398-403. DOI: 10.1161/01.STR.0000073841.88563.E9. View

18.

Lee M, Wu C, Yu K, Chu C, Lee K, Sheu S . Association between wall shear stress and carotid atherosclerosis in patients with never treated essential hypertension. Am J Hypertens. 2009; 22(7):705-10. DOI: 10.1038/ajh.2009.77. View

19.

Hashimoto T, Meng H, Young W . Intracranial aneurysms: links among inflammation, hemodynamics and vascular remodeling. Neurol Res. 2006; 28(4):372-80. PMC: 2754184. DOI: 10.1179/016164106X14973. View

20.

Kwak R, Mizoi K, Katakura R, Suzuki J . The correlation between hypertension in past history and the incidence of cerebral aneurysms. Tohoku J Exp Med. 1979; 128(3):267-71. DOI: 10.1620/tjem.128.267. View