(Stroke. 2001;32:485.)
© 2001 American Heart Association, Inc.
Original Contributions |
Factors Affecting Formation and Growth of Intracranial Aneurysms
A Long-Term Follow-Up Study
From the Departments of Neurosurgery (S.J.) and Radiology (M.P., K.P.), Helsinki University Central Hospital (Finland).
Correspondence to Seppo Juvela, MD, Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, FIN-00260 Helsinki 26, Finland. E-mail seppo.juvela{at}helsinki.fi
Background and Purpose—We sought to investigate factors determining growth rate of unruptured intracranial aneurysms as well as formation of new (de novo) aneurysms in patients from a time period when unruptured aneurysms were not treated surgically.
Methods—Eighty-seven patients (79 had ruptured aneurysms clipped at start of follow-up) with 111 unruptured aneurysms as well as an additional 7 patients (2 with and 5 without unruptured aneurysms) who developed new aneurysms were followed from the 1950s to the 1970s until death or subarachnoid hemorrhage or until the last contact. Patients’ cerebral arteries were examined later either with conventional (control) angiography (n=38) and/or, for those alive during 1996–1998, with 3-dimensional CT angiography (n=57). In addition, 10 patients were studied at neuropathological autopsy.
Results—Mean±SD
duration of follow-up was 18.9±9.4 years (range, 1.2 to 38.9 years).
Unruptured aneurysms increased in size 
1 mm in 39 of the
87 patients (45%) and 3 mm in 31 (36%). New aneurysms
were found in 15 of the 89 patients and in 5 without an unruptured
aneurysm at the beginning of follow-up. Aneurysm
rupture was associated very significantly
(P<0.001) with
aneurysm growth during follow-up. Of several potential risk
factors tested, only cigarette smoking (odds ratio [OR], 3.92; 95%
CI, 1.29 to 11.93) and female sex (OR, 3.36; 95% CI, 1.11 to 10.22)
were, after adjustment for age, significant
(P<0.05) independent risk
factors for occurrence of aneurysm growth of 1 mm. Only
cigarette smoking (OR, 3.48; 95% CI, 1.14 to 10.64;
P<0.05) was associated with
growth of 3 mm. Age- and hypertension-adjusted risk factors for
aneurysm formation were female sex (OR, 4.73; 95% CI, 1.16 to
19.38) and cigarette smoking (OR, 4.07; 95% CI, 1.09 to
15.15).
Conclusions—Women and cigarette smokers are at increased risk for intracranial aneurysm formation and growth. Cigarette smoking in particular hastens aneurysm growth. Cessation of smoking is important for patients with unruptured aneurysms and possibly also for those with a prior subarachnoid hemorrhage.
Key Words: cerebral aneurysm • cigarette smoking • gender • natural history • subarachnoid hemorrhage
This article has been cited by other articles:
 |
|
 |
|
  L. M. Heman, L. M. Jongen, H. B. van der Worp, G. J.E. Rinkel, and J. Hendrikse Incidental Intracranial Aneurysms in Patients With Internal Carotid Artery Stenosis: A CT Angiography Study and a Metaanalysis Stroke, April 1, 2009; 40(4): 1341 - 1346. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.E. Sprengers, W.J. van Rooij, M. Sluzewski, G.J.E. Rinkel, B.K. Velthuis, G.A.P. de Kort, and C.B.L.M. Majoie MR Angiography Follow-Up 5 Years after Coiling: Frequency of New Aneurysms and Enlargement of Untreated Aneurysms AJNR Am. J. Neuroradiol., February 1, 2009; 30(2): 303 - 307. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. R. SCHONFELD and M. A McMULLEN Treatment of Brain Aneurysms Radiol. Technol., July 1, 2008; 79(6): 515 - 531. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Bassuk and J. E. Manson Lifestyle and Risk of Cardiovascular Disease and Type 2 Diabetes in Women: A Review of the Epidemiologic Evidence American Journal of Lifestyle Medicine, June 1, 2008; 2(3): 191 - 213. [Abstract] [PDF]
|
|
|
|
 |
|
 D. B. Zahuranec and L. B. Morgenstern Fear factor: Aneurysm screening after subarachnoid hemorrhage Neurology, May 27, 2008; 70(22): 2022 - 2023. [Full Text] [PDF]
|
|
|
|
|
|
M. J.H. Wermer, H. Koffijberg, I. C. van der Schaaf, and For the ASTRA Study Group Effectiveness and costs of screening for aneurysms every 5 years after subarachnoid hemorrhage Neurology, May 27, 2008; 70(22): 2053 - 2062. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Elijovich, R. T. Higashida, M. T. Lawton, G. Duckwiler, S. Giannotta, S. C. Johnston, and for The Cerebral Aneurysm Rerupture After Treatmen Predictors and Outcomes of Intraprocedural Rupture in Patients Treated for Ruptured Intracranial Aneurysms: The CARAT Study Stroke, May 1, 2008; 39(5): 1501 - 1506. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J.H. Wermer, I. C. van der Schaaf, A. Algra, and G. J.E. Rinkel Risk of Rupture of Unruptured Intracranial Aneurysms in Relation to Patient and Aneurysm Characteristics: An Updated Meta-Analysis Stroke, April 1, 2007; 38(4): 1404 - 1410. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Nair, J. Pettigrew Jr, and A. Mancuso Intracranial aneurysm as an incidental finding Dentomaxillofac. Radiol., February 1, 2007; 36(2): 107 - 112. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. R. Bendok, I. A. Awad, J. G. Adel, and H. H. Batjer How Frequently Should We Follow Small Asymptomatic Intracranial Aneurysms? Stroke, July 1, 2006; 37(7): 1650 - 1650. [Full Text] [PDF]
|
|
|
|
|
|
M. J.H. Wermer, I. C. van der Schaaf, B. K. Velthuis, C. B. Majoie, K. W. Albrecht, and G. J.E. Rinkel Yield of Short-Term Follow-up CT/MR Angiography for Small Aneurysms Detected at Screening Stroke, February 1, 2006; 37(2): 414 - 418. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. L. Feigin and M. Findlay Advances in Subarachnoid Hemorrhage Stroke, February 1, 2006; 37(2): 305 - 308. [Full Text] [PDF]
|
|
|
|
|
|
M. J.H. Wermer, P. Greebe, A. Algra, and G. J.E. Rinkel Incidence of Recurrent Subarachnoid Hemorrhage After Clipping for Ruptured Intracranial Aneurysms Stroke, November 1, 2005; 36(11): 2394 - 2399. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. H. Wermer, I. C. van der Schaaf, B. K. Velthuis, A. Algra, E. Buskens, and G. J. E. Rinkel Follow-up screening after subarachnoid haemorrhage: frequency and determinants of new aneurysms and enlargement of existing aneurysms Brain, October 1, 2005; 128(10): 2421 - 2429. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I.C. van der Schaaf, B.K. Velthuis, M.J.H. Wermer, C. Majoie, T. Witkamp, G. de Kort, N.J. Freling, G.J.E. Rinkel, and on behalf of the ASTRA Study Group New Detected Aneurysms on Follow-Up Screening in Patients With Previously Clipped Intracranial Aneurysms: Comparison With DSA or CTA at the Time of SAH Stroke, August 1, 2005; 36(8): 1753 - 1758. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Feigin, V. Parag, C. M. M. Lawes, A. Rodgers, I. Suh, M. Woodward, K. Jamrozik, H. Ueshima, and on behalf of the Asia Pacific Cohort Studies Colla Smoking and Elevated Blood Pressure Are the Most Important Risk Factors for Subarachnoid Hemorrhage in the Asia-Pacific Region: An Overview of 26 Cohorts Involving 306 620 Participants Stroke, July 1, 2005; 36(7): 1360 - 1365. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. S. Anderson, V. Feigin, D. Bennett, R.-B. Lin, G. Hankey, K. Jamrozik, and for the Australasian Cooperative Research on Subar Active and Passive Smoking and the Risk of Subarachnoid Hemorrhage: An International Population-Based Case-Control Study Stroke, March 1, 2004; 35(3): 633 - 637. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. D. Brown Jr. and D. G. Piepgras Screening for intracranial aneurysms after subarachnoid hemorrhage: Do our patients benefit? Neurology, February 10, 2004; 62(3): 354 - 356. [Full Text] [PDF]
|
|
|
|
|
|
M. J.H. Wermer, E. Buskens, I. C. van der Schaaf, P. M.M. Bossuyt, and G. J.E. Rinkel Yield of screening for new aneurysms after treatment for subarachnoid hemorrhage Neurology, February 10, 2004; 62(3): 369 - 375. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Juvela Treatment Options of Unruptured Intracranial Aneurysms Stroke, February 1, 2004; 35(2): 372 - 374. [Full Text] [PDF]
|
|
|
|
|
|
A. S. Dumont and N. F. Kassell Editorial Comment--Parity and Risk of Subarachnoid Hemorrhage: An Emerging Association Stroke, January 1, 2004; 35(1): 32 - 33. [Full Text] [PDF]
|
|
|
|
|
|
M. J.H. Wermer, G. J.E. Rinkel, and J. van Gijn Repeated Screening for Intracranial Aneurysms in Familial Subarachnoid Hemorrhage Stroke, December 1, 2003; 34(12): 2788 - 2791. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kurth, C. S. Kase, K. Berger, J. M. Gaziano, N. R. Cook, and J. E. Buring Smoking and Risk of Hemorrhagic Stroke in Women Stroke, December 1, 2003; 34(12): 2792 - 2795. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Obray, R. Clatterbuck, A. Olvi, R. Tamargo, K. J. Murphy, and P. Gailloud De Novo Aneurysm Formation 6 and 22 Months after Initial Presentation in Two Patients AJNR Am. J. Neuroradiol., October 1, 2003; 24(9): 1811 - 1813. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Juvela Prehemorrhage Risk Factors for Fatal Intracranial Aneurysm Rupture Stroke, August 1, 2003; 34(8): 1852 - 1857. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Ballard, K. T. Kreiter, J. Claassen, R. G. Kowalski, E. S. Connolly, and S. A. Mayer Risk Factors for Continued Cigarette Use After Subarachnoid Hemorrhage Stroke, August 1, 2003; 34(8): 1859 - 1863. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Findlay Editorial Comment--Prehemorrhage Risk Factors for Fatal Intracranial Aneurysm Rupture Stroke, August 1, 2003; 34(8): 1857 - 1858. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Vogel, R. Verreault, J.-F. Turcotte, M. Kiesmann, and M. Berthel Review Article. Intracerebral Aneurysms: A Review With Special Attention to Geriatric Aspects J. Gerontol. A Biol. Sci. Med. Sci., June 1, 2003; 58(6): M520 - 524. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Wills, A. Ronkainen, M. van der Voet, H. Kuivaniemi, K. Helin, E. Leinonen, J. Frosen, M. Niemela, J. Jaaskelainen, J. Hernesniemi, et al. Familial Intracranial Aneurysms: An Analysis of 346 Multiplex Finnish Families Stroke, June 1, 2003; 34(6): 1370 - 1374. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kurth, C. S. Kase, K. Berger, E. S. Schaeffner, J. E. Buring, and J. M. Gaziano Smoking and the Risk of Hemorrhagic Stroke in Men Stroke, May 1, 2003; 34(5): 1151 - 1155. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. Matheus and M. Castillo Development of De Novo Intracranial Aneurysm in Three Months: Case Report and Literature Review AJNR Am. J. Neuroradiol., April 1, 2003; 24(4): 709 - 710. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Yamada, M. Utsunomiya, K. Inoue, K. Nozaki, S. Miyamoto, N. Hashimoto, K. Takenaka, T. Yoshinaga, and A. Koizumi Absence of Linkage of Familial Intracranial Aneurysms to 7q11 in Highly Aggregated Japanese Families Stroke, April 1, 2003; 34(4): 892 - 900. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Juvela, B. Kissela, D. Woo, L. Sauerbeck, J. Broderick, R. Shukla, and C. Moomaw Risk Factors for Aneurysmal Subarachnoid Hemorrhage * Response Stroke, September 1, 2002; 33(9): 2152 - 2153. [Full Text] [PDF]
|
|
|
|
|
|
I. Wanke, A. Doerfler, U. Dietrich, T. Egelhof, B. Schoch, D. Stolke, and M. Forsting Endovascular Treatment of Unruptured Intracranial Aneurysms AJNR Am. J. Neuroradiol., May 1, 2002; 23(5): 756 - 761. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Zhang, S. Dhillon, I. Geary, W. M. Howell, F. Iannotti, I. N.M. Day, and S. Ye Polymorphisms in Matrix Metalloproteinase-1, -3, -9, and -12 Genes in Relation to Subarachnoid Hemorrhage Stroke, September 1, 2001; 32(9): 2198 - 2202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Juvela, K. Tsutsumi, K. Ueki, and T. Kirino Risk of Subarachnoid Hemorrhage From a De Novo Aneurysm Response Stroke, August 1, 2001; 32(8): 1933 - 1934. [Full Text] [PDF]
|
|