Intracranial Aneurysms in Patients With Coarctation of the Aorta: A Prospective Magnetic Resonance Angiographic Study of 100 Patients

doi:10.4065/78.12.1491

Mayo Clinic Proceedings

Volume 78, Issue 12, December 2003, Pages 1491-1499

https://doi.org/10.4065/78.12.1491 Get rights and content

Objective

To determine the frequency of intracranial aneurysms (IAs) detected in patients with coarctation of the aorta (CoA) with use of magnetic resonance angiography.

Patients and Methods

From January 1, 1980, to September 30, 2002, 277 adult patients with CoA were seen at the Mayo Clinic in Rochester, Minn, and were invited to participate in a study to detect IAs. Of these 277 patients (mean ± SD age, 41.6±16.5; 70 men), 100 underwent cranial magnetic resonance angiography.

Results

Ten patients had an IA (95% confidence interval, 5%-18%), with a mean diameter of 3.5 mm (range, 2.0-8.0 mm). The frequency of IA was significantly higher than that predicted in the general population (10% vs 2%; P<.001). One patient had surgical intervention. No clinical or geographical differences were found between patients with CoA and IA and patients with CoA and no IA.

Conclusions

The frequency of IA among patients with CoA is approximately 5-fold that of the general population. Although no risk factors were identified in this cohort, additional prospective evaluation is warranted. These data suggest that noninvasive cerebral imaging to screen for IA should be considered in patients with CoA.

Section snippets

PATIENTS AND METHODS

After approval from the Mayo Foundation Institutional Review Board, patients with a history of CoA evaluated at the Mayo Clinic in Rochester, Minn, from January 1, 1980, to September 30, 2002, were identified. A letter containing detailed information about the potential association of IA and CoA as well as possible indications for a noninvasive presymptomatic MRA evaluation was sent to the patients. Those interested in participating in the study contacted the investigators. All study

RESULTS

We contacted 277 patients with the diagnosis of CoA who had been evaluated at Mayo Clinic since 1980; 100 patients (70 men and 30 women) volunteered to be in the study (Table 1). The mean ± SD age at the time of MRA was 41.6±16.5 years. Eighty-six patients who had previous surgical repair for CoA underwent cranial MRA to determine the presence or absence of IA (Table 1). Coarctation of the aorta is more common among men than women, and our population reflects this bias. The initial diagnosis of

DISCUSSION

Intracranial aneurysms were detected with MRA in 10 (10%) of 100 patients with CoA. Because of referral and selection biases, as well as nonresponse bias, this frequency should be considered an approximation.

CONCLUSIONS

There is approximately a 5-fold increase in the frequency of IAs in patients with CoA compared with that of the general population. No risk factors for aneurysm were identified. In approximately 10% of patients with CoA, MRA screening detects an IA. Although most IAs detected were small and are being monitored, treatment was necessary in one patient. These data suggest that cerebral MRA or computed tomographic angiography screening should be considered for adults with CoA.

We thank A. Gabriela

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Original ArticleIntracranial Aneurysms in Patients With Coarctation of the Aorta: A Prospective Magnetic Resonance Angiographic Study of 100 Patients

Objective

Patients and Methods

Results

Conclusions

Section snippets

PATIENTS AND METHODS

RESULTS

DISCUSSION

CONCLUSIONS

Surg Neurol

Neurol Clin

Am J Cardiol

Am Heart J

J Pediatr

Surg Neurol

Am J Med

J Am Coll Cardiol

Stenosis aortae congenita seu isthmus persistans

Vjschr Prakt aheilk

Intracranial aneurysms and cervicocephalic arterial dissections associated with congenital heart disease

Neurosurgery