gms | German Medical Science

Objective: The prevalence of multiple intracranial aneurysms (MIA) has increased over the last decades. As MIA have shown a correlation with IA formation, growth and rupture risk, a more profound understanding of the underlying pathophysiology of MIA is needed. Our large institutional aneurysmal data base was analyzed to elucidate differences between single IA (SIA) and MIA carriers.

Methods: A total of 2453 patients were treated for IA at the University Hospital of Essen from 01/2003 to 06/2016. The patients’ data were retrospectively screened for socio-demographic parameters, imaging modalities, pre-existing medical conditions, blood and cerebrospinal-fluid examination and medical prescriptions. These parameters were analyzed for correlation with MIA.

Results: MIA were identified in 853 (34.8%) patients. An increasing trend in MIA prevalence (r=0,017; p=0,09) was detected over the study period, alongside with a statistically significant increase in patients suffering from arterial hypertension (AHT) and tobacco addiction (r=0,021; p=0,039 and r=0,035; p=0,002, respectively). In multivariate analyses (MVA), MIA were independently associated with female sex (p<0.001), arterial hypertension (p<0.05), tobacco abuse (p<0.05), C-reactive protein elevation (p<0.05), elevated mean corpuscular volume (MCV, p<0.01) and elevated total serum protein (p<0.01), but not with the diagnostic modality (2D vs. 3D digital subtraction angiography, p=0.0496). Absolute number of IA showed a statistically significant correlation in MVA with female sex (p<0.001), AHT (p<0.05), familial intracranial aneurysms (p<0.05), tobacco abuse (p<0.05), elevated MCV (p<0.01) and high platelet number (p<0.01). IA location also showed a statistically significant difference, with 18% of IA being located in the posterior circulation in MIA cases and 26% of IA in SIA cases compared to the anterior circulation (p<0.001).

Conclusion: MIA prevalence is increasing. Alongside with previously reported MIA predictors like age, female sex, arterial hypertension, tobacco abuse and ADPKD, we found also specific location pattern for MIA and independent associations between certain rheological factors and MIA risk. Our findings indicate to the need for further research of underlying mechanisms of IA formation.