Prevalence and predictors of intracranial aneurysms in patients with bicuspid aortic valve

Heart. 2017 Oct;103(19):1508-1514. doi: 10.1136/heartjnl-2016-311076. Epub 2017 Jun 8.

Abstract

Objective: To determine the prevalence and outcomes of intracranial aneurysm (IA) in patients with bicuspid aortic valve (BAV).

Methods: Retrospective review of patients with BAV who underwent brain MR angiography at the Mayo Clinic from 1994 to 2013.

Results: There were 678 patients included in this study-mean age 57±13 years, men 480 (71%), mean follow-up 10±3 years (5913 patient-years). Coarctation of aorta (COA) was present in 154 (23%) patients.There were 59 IAs identified in 52 of 678 patients (7.7%). IA was present in 20/154 patients (12.9%) with COA and 32/524 patients (5.7%) without COA (p<0.001). For the patients without COA, female gender and right-left cusp fusion were risks factors for IA in women after adjustment for all potential variables (HR 1.76, CI 1.31 to 2.68, p=0.03). There was no significant trend in the risk for IA across age tertiles: age ≤40 years versus 41-60 years (HR 1.19, p=0.34), and age 41-60 years versus 61-80 years (HR 1.06, p=0.56).Among the 52 patients with IA, enlargement occurred in three patients (6%), rupture in two patients (4%) and four patients (8%) underwent coil embolisation. For the 626 patients without IA at baseline, no patient developed IA over 7±2 years of imaging follow-up.

Conclusions: BAV is associated with a higher prevalence of IA compared to the general population, and this risk is higher in patients with COA, right-left cusp fusion and female gender.

Keywords: Bicuspid aortic valve; Coarctation of aorta; Intracranial aneurysm; Magnetic resonance angiography.

MeSH terms

  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Aortic Valve / abnormalities*
  • Bicuspid Aortic Valve Disease
  • Brain / diagnostic imaging
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Forecasting*
  • Heart Valve Diseases / complications*
  • Heart Valve Diseases / diagnosis
  • Humans
  • Intracranial Aneurysm / diagnosis
  • Intracranial Aneurysm / epidemiology*
  • Intracranial Aneurysm / etiology
  • Magnetic Resonance Angiography
  • Male
  • Middle Aged
  • Minnesota / epidemiology
  • Prevalence
  • Retrospective Studies
  • Risk Factors
  • Sex Distribution