Incidental Intracranial Aneurysms in Patients With Internal Carotid Artery Stenosis

Abstract

Background and Purpose-Smoking and hypertension are important risk factors for atherosclerotic carotid artery disease, but also for intracranial aneurysms. We studied the presence of aneurysms in a series of patients with internal carotid artery (ICA) stenosis and performed a systematic review of the literature to assess in patients with ICA stenosis the prevalence of intracranial aneurysms, gender differences in prevalence, and the size of the aneurysms found. Methods-In a prospectively collected series of patients with symptomatic ICA stenosis Ͼ50% on CTA we assessed the proportion with intracranial aneurysms. We performed "Embase" and "Pubmed" searches for studies on patients with ICA stenosis (domain) and intracranial aneurysms (outcome measurement). We calculated overall prevalence and relative risks for gender, both with corresponding 95% confidence intervals (CI). Results-We found an intracranial aneurysm in 8 of our 194 patients (4.1%; [95% CI 1.3 to 6.9]). The literature search resulted in 5 relevant and valid articles, totaling 4251 patients. The overall prevalence in all series combined was 3.2% (95% CI 2.7 to 3.7); the prevalence of aneurysms larger than 5 mm was 0.9% (95% CI 0.6 to 1.1). Women had a higher risk then men (relative risk 1.6; [59% CI 1.1 to 2.3]). Conclusion-About 1% of patients with a symptomatic ICA stenosis have an intracranial aneurysm with a higher than negligible risk of rupture, but in deciding aneurysms treatment the risk of cardiovascular diseases other than aneurismal rupture should be taken into account. The proportion of patients with aneurysms seems higher in series of patients with ICA stenosis than in the general population.

Incidental cerebral aneurysms in acute stroke patients: Comparison of asymptomatic healthy controls

“…Nevertheless, female patients had a higher coexistence of CA in our patients with BI or BH. A higher prevalence of CA also refers to female patients with ICA stenosis [10] and women in general populations [17,19,20]. Therefore, the female predominance of incidental CA could contribute to female hormonal factors rather than the atherosclerotic profile, such as smoking and hypertension.…”

“…Cerebral aneurysms (CA) are incidentally detected when brain MRA is performed in asymptomatic healthy volunteers [6,7]. Prevalence of incidental CA varies among atherosclerotic patients, including those with angina pectoris, ischemic cerebrovascular disease, and internal carotid artery (ICA) stenosis [8][9][10]. A systematic review of autopsy and angiography studies suggests that atherosclerotic diseases seem to increase the risk of incidental CA [11].…”

The Impact of Atherosclerotic Factors on Cerebral Aneurysm Is Location Dependent: Aneurysms in Stroke Patients and Healthy Controls

“…UIAs are incidentally found when a brain MRA is performed in asymptomatic healthy volunteers 6,7 ; UIAs in stroke patients are also incidentally detected 2,5,6,[8][9][10] . Some previous studies indicated that cerebrovascular diseases seem to increase the occurrence of UIAs 5,11 .…”

Systemic thrombolysis in acute ischemic stroke patients with unruptured intracranial aneurysms

“…35 In addition, a recent metaanalysis indicates that the overall prevalence of intracranial aneurysms in patients with internal carotid artery stenosis (3.2%) is higher than the reported prevalence of UIAs in the general population. 36 Moreover, a systematic review of autopsy and angiography studies suggests that atherosclerotic diseases Figure 2 Forest plot of symptomatic intracranial hemorrhage rates across case series reporting the safety of IV thrombolysis in acute ischemic stroke patients harboring unruptured intracranial aneurysms CI 5 confidence interval.…”