Intracranial aneurysms in sickle cell disease are associated with hemodynamic stress and anemia.

Autor:	Wang Y; Department of Neurology, Washington University School of Medicine, St. Louis, MO., Garland JS; Department of Neurology, Washington University School of Medicine, St. Louis, MO., Fellah S; Department of Neurology, Washington University School of Medicine, St. Louis, MO., Reis MN; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO., Parsons MS; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO., Guilliams KP; Department of Neurology, Washington University School of Medicine, St. Louis, MO.; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO.; Division of Pediatrics, Washington University School of Medicine, St. Louis, MO., Fields ME; Department of Neurology, Washington University School of Medicine, St. Louis, MO.; Division of Pediatrics, Washington University School of Medicine, St. Louis, MO., Mirro AE; Division of Pediatrics, Washington University School of Medicine, St. Louis, MO., Lewis JB; Department of Neurology, Washington University School of Medicine, St. Louis, MO., Ying C; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO., Cohen RA; Department of Neurology, Washington University School of Medicine, St. Louis, MO., Hulbert ML; Division of Pediatrics, Washington University School of Medicine, St. Louis, MO., King AA; Department of Medicine, Division of Hematology/Oncology, Washington University School of Medicine, St. Louis, MO., Chen Y; Department of Neurology, Washington University School of Medicine, St. Louis, MO., Lee JM; Department of Neurology, Washington University School of Medicine, St. Louis, MO.; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO., An H; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO., Ford AL; Department of Neurology, Washington University School of Medicine, St. Louis, MO.; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO.
Jazyk:	angličtina
Zdroj:	Blood advances [Blood Adv] 2024 Sep 24; Vol. 8 (18), pp. 4823-4831.
DOI:	10.1182/bloodadvances.2024013928
Abstrakt:	Abstract: Although hemodynamic stress plays a key role in aneurysm formation outside of sickle cell disease (SCD), its role is understudied in patients with SCD. We hypothesized that tissue-based markers of hemodynamic stress are associated with aneurysm presence in a prospective SCD cohort. Children and adults with SCD, with and without aneurysms, underwent longitudinal brain magnetic resonance imaging/magnetic resonance angiography (MRA) to assess cerebral blood flow (CBF) and oxygen extraction fraction (OEF). Baseline characteristics were recorded. In the subgroup of adults, stepwise mixed-effect logistic regression examined clinical variables, CBF, and OEF as predictors of aneurysm presence. Cumulative rates of new aneurysm formation were estimated using Kaplan-Meier analyses. Forty-three aneurysms were found in 27 of 155 patients (17%). Most aneurysms were ≤3 mm and in the intracranial internal carotid artery. On univariate analysis, older age (P = .07), lower hemoglobin (P = .002), higher CBF (P = .03), and higher OEF (P = .02) were associated with aneurysm presence. On multivariable analysis, age and CBF remained independently associated with aneurysm presence. Seventy-six patients (49% of enrollment) received follow-up MRAs (median, 3.5 years). No aneurysm grew or ruptured, however, 7 new aneurysms developed in 6 patients. The 3-year cumulative rate of aneurysm formation was 3.5%. In 155 patients with SCD, 17% had intracranial aneurysms. Three-year aneurysm formation rate was 3.5%, although limited by small longitudinal sample size and short follow-up duration. Aneurysm presence was associated with elevated CBF in adults, as a tissue-based marker of cerebral hemodynamic stress. Future studies may examine the predictive role of CBF in aneurysm development in SCD. (© 2024 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu