Risk Factors for Cerebral Aneurysm Rupture in Mongolia

Abstract

Purpose Identification of country-specific demographic, medical, lifestyle, and geoenvironmental risk factors for cerebral aneurysm rupture in the developing Asian country of Mongolia. First-time estimation of the crude national incidence of aneurysmal subarachnoid hemorrhage (aSAH). Methods A retrospective analysis of all intracranial digital subtraction angiographies (DSA) acquired in Mongolia during the 2‑year period 2016–2017 (1714 examinations) was performed. During this period, DSA was used as primary diagnostic imaging modality for acute severe neurological symptoms in the sole hospital nationwide dedicated to neurological patients. The catchment area of the hospital included the whole country. Patients with incidental and ruptured aneurysms were reviewed with respect to their medical history and living conditions. The data was used to install a Mongolian aneurysm registry. Results The estimated annual crude incidence of cerebral aneurysm rupture was 6.71 for the country of Mongolia and 14.53 per 100,000 persons for the capital region of Ulaanbaatar. Risk factors common in developed countries also applied for the Mongolian population: A medical history of hypertension, smoking or the presence of multiple aneurysms led to a higher relative risk of rupture. In contrast, female gender was not associated with a higher risk in this national cohort. Males pursuing a traditional nomadic living may exhibit a specifically high risk of rupture. Conclusion Disease management of over 200 individuals/year with aSAH constitutes a socioeconomic burden in Mongolia. Efforts to raise awareness of the risk factors hypertension and smoking among the Mongolian population are desirable. Measures to improve the nationwide availability of modern neurovascular treatment options are currently under consideration.

Effect of Siphon Morphology on the Risk of C7 Segment Aneurysm Formation

“…A similar trend was also observed in the control group. Previous studies have reported that approximately 20–30% of patients with IA have multiple aneurysms [ 2 , 27 ]. The PCoA was frequently associated with multiple IAs and was found to be an independent predictor of rupture in multiple IAs [ 28 ].…”

A Computational Fluid Dynamics-Based Model for Assessing Rupture Risk in Cerebral Arteries with Varying Aneurysm Sizes

“…41%, 46%, and 60%, respectively [5]. In a recent study by Bechstein et al [6], it was reported that Mongolia reported a crude incidence of 14.53 ruptures per 100,000 persons.…”