Risk Factors Involved In The Formation Of Multiple Intracranial Aneurysms

Background and Purpose:The appearance of the multiple intracranial aneurysms(MIAs)may be a marker of significant risk factors for intracranial aneurysms(IAs)development that varies from those factors of aneurysm rupture.Although several studies reported risk factors for the formation of MIAs,the results are controversial.We aimed to identify risk factors for the formation of MIAs by analyzing our clinical data combined with a meta-analysis.Method:Reviewing the medical records of patients diagnosed with aneurysm by neurosurgery in Tianjin medical university general hospital,Hunan Yangzhou central hospital and Tangshan workers hospital from 2016 to 2019.The patients were divided into two categories,one is the patients with single intracranial aneurysms,and the other is the patients with multiple intracranial aneurysms.All patients received Computed Tomography Angiography(CTA),Digital Subtraction Angiography(DSA),Magnetic Resonance Angiography(MRA).All collected data included age,gender,smoking history,drinking history,history of essential hypertension,family history of high blood pressure,diabetes,hyperlipidemia,ischemic stroke history,history of subarachnoid hemorrhage,kidney disease history,history of infectious diseases,Hunt-Hess grade on admission,Fisher’s grade on admission,admission Glasgow Coma Scale(GCS)score.The single factor analysis was adopted to examine all variables,then determine the risk factors associated with MIAs formation the binary logistic regression analysis.Though many researches indicated that average age,gender,smoking history,history of primary hypertension,history of alcohol consumption and history of diabetes were independent risk factors for the formation of multiple intracranial aneurysms,a lot of literature pointed out that they were not the risk factors for it,which has always been controversial.In this study,Cochrane Library,Medline,Pub Med and other electronic databases were searched by computer to retrieve all randomized controlled trial(RCT),cohort study and case-control study(CCT)on factors related to the formation of multiple intracranial aneurysms from the establishment of the database to February 29,2020.In addition,all references included in the literature were manually screened for possible lost references.The two authors extracted data from the included studies.The extracted data(median,range,test size,standard deviation)were entered into the pre-designed standardized table.We used STATA version 11.0(STATA Corporation,College Station,Texas,USA)for statistical analysis.According to the Cochrane Handbook for Systematic Reviews of Interventions(version 5.1.0),no significant heterogeneity was found when I~2<50%,fixed effects model was used.Otherwise,using random effect model.Result:A total of 565 patients participated in our study,449 with SIAs and 116 with MIAs.Univariate analysis showed significant differences between SIAs group and MIAs group in female gender,smoking,essential hypertension,family history of hypertension,and history of subarachnoid hemorrhage.Binary logistic regression analysis showed that women(OR=1.624),the essential hypertension(OR=1.563),and the family history of hypertension(OR=2.496)were independent risk factors for MIAs formation(P<0.05).Meanwhile,our meta-analysis involved a total of 31 publications.The total number of patients with multiple intracranial aneurysms was10,419,while the total number of patients with single intracranial aneurysms was33,468.Our meta-analysis evaluated six results that showed that,compared to patients with SIAs,among the patients with MIAs,women[OR=1.609,95%ci(1.414,1.830),P<0.001],smoking[OR=0.512,95%ci(0.353,0742),P<0.001],essential hypertension[OR=1.510,95%ci(1.173,1.944),P=0.001],and age[WMD=2.133,95%ci(0.492,3.774),P=0.011]were significantly increased.However,no significant differences were found in alcohol consumption[OR=0.985,95%CI(0.837,1.160),P=0.859]and diabetes[OR=0.646,95%CI(0.323,1.290),P=216]between two groups.Conclusions:The results of the retrospective study illustrated that female,essential hypertension and family history of hypertension were independent risk factors for multiple intracranial aneurysms.The findings of the meta-analysis showed a higher incidence of multiple intracranial aneurysms in advanced age or female.In addition,the history of primary hypertension or family history of primary hypertension and smoking may affect the formation of MIAs.These risk factors should be monitored.