The Association of Intracranial Aneurysms in Women with Renal Artery Aneurysms

Ann Vasc Surg. 2019 Oct;60:147-155.e2. doi: 10.1016/j.avsg.2019.03.030. Epub 2019 Jun 12.

Abstract

Background: Renal artery aneurysms (RAAs) may reflect a systemic dysplastic arteriopathy, independent of a recognized connective tissue disease. It is hypothesized that RAAs are associated with an increased risk of intracranial aneurysms (IcAs). The objective of this study was to better define the association of IcAs in women with RAAs.

Methods: Women aged 20 to 60 years who presented with RAAs at the University of Michigan from 2001 to 2016 were included in the study. Their clinical status and radiologic images were retrospectively reviewed, with particular attention directed to the prevalence of IcAs. Phenotypic characteristics predictive of associated cerebrovascular lesions were assessed using various statistical analyses, including binomial logistic regression.

Results: Among 83 women with RAAs, the average age at the time of RAA detection was 45.3 ± 9.9 years (range, 20-60 years). Hypertension affected 56 (67.5%) patients and poorly controlled hypertension prompted imaging for suspected renal arterial disease in 12 (14.5%) patients. Multifocal fibromuscular dysplasia occurred in 12 (14.8%) of patients, and unifocal stenosis affected 7 (8.4%) patients. Imaging of the intracranial vasculature (n = 31) documented 12 aneurysms in 9 women, with the cavernous internal carotid artery being the most commonly affected artery. Among the study's patients, 20 (24.1%) had an "at-risk disorder for IcA formation," although the frequency of relevant "at-risk disorders" in those with and without IcAs was not statistically different (P = 0.21). Rupture risk defined by PHASES score was less than 1% for 10 IcAs, but 2 IcAs carried a 2.4% and 7.2% rupture risk, respectively, over a 5-year time period. Surgical management was pursued in 6 (50%) of the study's IcAs.

Conclusions: Coexisting RAAs and IcAs may reflect a systemic arteriopathy. IcAs appear to occur with greater frequency in women with RAAs than the general population. This observation warrants prospective investigation as to the clinical appropriateness and relevance of cerebrovascular imaging in women with RAAs. Furthermore, this study's findings prompt further investigation of the underlying pathogenesis of what appears to be a broader and more complex arterial disease than previously recognized.

MeSH terms

  • Adult
  • Aneurysm / diagnostic imaging
  • Aneurysm / epidemiology*
  • Female
  • Humans
  • Incidence
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / epidemiology*
  • Michigan / epidemiology
  • Middle Aged
  • Prevalence
  • Prognosis
  • Renal Artery* / diagnostic imaging
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Time Factors
  • Young Adult