Cerebral Aneurysms in Patients with Coarctation of the Aorta….ppt

Cerebral Aneurysms in Patients with Coarctation of the Aorta: Prevalence and Need for ScreeningASNR 2012 Mortimer AM1, Curtis SL2,Wilde P2, Aw J2, Chakrabarti S2, Hamilton M2, Martin R2,Turner M2, Stuart GA2, Bradley M1 1Department of Neuroradiology, Frenchay Hospital, Bristol, UK 2Bristol Heart Institute, Bristol, UK # 502 Cerebral Aneurysms in Patients with Coarctation of the Aorta: Prevalence and Need for Screening No disclosures or conflicts of interest Background Incidence of aneurysms: Intracranial aneurysms (IAs) are found in approximately 2.3% of adults (0.4-6.0% in autopsy and angiography studies respectively) 1, 2 Studies using brain magnetic resonance angiography (MRA) has suggested rates ranging between 0.1-1.8% 3-5 However, in coarctation patients, studies have suggested a prevalence of up to 50%7-9 and in approximately 10% of those screened by MRA10. Background Rate of haemorrhage: Haemorrhagic stroke was originally thought to account for approximately 5% deaths in coarctation patients in the early surgical era8. However recent large studies of IAs have not found aortic coarctation to be an independent risk factor for their rupture1, 2,12,13. Background Screening recommendations in coarctation patients: These are variable. Recent guidelines from the American Heart Association (AHA), and American College of Cardiology for the management of patients with congenital heart disease in adulthood11 do not mention IAs in patients with coarctation. The 2010 European Society of Cardiology guidelines suggest that “attention is required” for IAs but note that most clinicians see no indication for their routine screening if patients are asymptomatic15. AHA guidelines for the management of patients with unruptured IAs do not recommend routine screening for asymptomatic low risk patients16. Purpose In our centre it has been standard practice to screen for IA in all patients with coarctation at the time of first performing MRI of their aorta after