The impact of hypertension and nicotine on the size of ruptured intracranial aneurysms
Résumé
Background and Purpose The goal of the present study was to analyze retrospectively the impact of risk factors for subarachnoid hemorrhage (SAH) on the size of ruptured intracranial aneurysms in order to identify variables which might influence the discrepancy between average sizes of ruptured and unruptured aneurysms. Methods The records and angiographies of 373 patients treated at our center due to aneurysmal SAH between 2004 and December 2008 were retrospectively analyzed. Modifiable and non-modifiable risk factors for SAH were correlated with exact measurement of aneurysm size using 3-dimensional rotational digital subtraction angiographies (3D-DSA). Results Average maximum aneurysm diameter in patients with combined history of hypertension and cigarette smoking was 5.47±3.22 mm [95% CI 4.71-6.24], thus significantly smaller (p<0.001) than in patients with hypertension only (6.27±3.28 mm, 95% CI 5.75-6.78), with cigarette smoking only (7.61± 4.29 mm, 95% CI 6.43-8.79) and patients with no history for risk factors (8.08±4.73mm, 95% CI 6.96- 9.21). Odds ratio for aneurysm size less than 7mm in patients with combined hypertension and cigarette smoking was 3.63 [95% CI 1.78-7.42], 3.09 [95% CI 1.95-4.92] in patients with hypertension only and 1.02 [95% CI 0.64-1.62] in patients with cigarette smoking only. Conclusions The present analysis demonstrates a distinct correlation between hypertension, smoking and the size of ruptured aneurysms in SAH patients. Arterial hypertension and cigarette smoking appear to destabilize cerebral aneurysms growth. Our data strongly suggests that these factors should also be considered, when treatment indications for small unruptured aneurysms are discussed.
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