Autosomal Dominant Polycystic Kidney Disease and Intracranial Aneurysms: Is There an Increased Risk of Treatment?
- PMID: 26338918
- PMCID: PMC7959947
- DOI: 10.3174/ajnr.A4490
Autosomal Dominant Polycystic Kidney Disease and Intracranial Aneurysms: Is There an Increased Risk of Treatment?
Abstract
Background and purpose: Autosomal dominant polycystic kidney disease is associated with an increased risk of intracranial aneurysms. Our purpose was to assess whether there is an increased risk during aneurysm coiling and clipping.
Materials and methods: Data were obtained from the National Inpatient Sample (2000-2011). All subjects had an unruptured aneurysm clipped or coiled and were divided into polycystic kidney (n = 189) and control (n = 3555) groups. Primary end points included in-hospital mortality, length of stay, and total hospital charges. Secondary end points included the International Classification of Diseases, Ninth Revision codes for iatrogenic hemorrhage or infarction; intracranial hemorrhage; embolic infarction; and carotid and vertebral artery dissections.
Results: There was a significantly greater incidence of iatrogenic hemorrhage or infarction, embolic infarction, and carotid artery dissection in the patients with polycystic kidney disease compared with the control group after endovascular coiling. There was also a significantly greater incidence of iatrogenic hemorrhage or infarction in the polycystic kidney group after surgical clipping. However, the hospital stay was not longer in the polycystic kidney group, and the total hospital charges were not higher. Additional analysis within the polycystic kidney group revealed a significantly shorter length of stay but similar in-hospital costs when subjects underwent coiling versus clipping.
Conclusions: Patients with polycystic kidney disease face an increased risk during intracranial aneurysm treatment, whether by coiling or clipping. This risk, however, does not translate into longer hospital stays or increased hospital costs. Despite the additional catheterization-related risks of dissection and embolization, coiling results in shorter hospital stays and similar mortality compared with clipping.
© 2016 by American Journal of Neuroradiology.
Comment in
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Treatment of Unruptured Intracranial Aneurysms in Autosomal Dominant Polycystic Kidney Disease: Primum Non Nocere.AJNR Am J Neuroradiol. 2016 Feb;37(2):294-5. doi: 10.3174/ajnr.A4538. Epub 2015 Oct 15. AJNR Am J Neuroradiol. 2016. PMID: 26471752 Free PMC article. No abstract available.
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Reply.AJNR Am J Neuroradiol. 2016 Feb;37(2):296. doi: 10.3174/ajnr.A4657. Epub 2015 Dec 17. AJNR Am J Neuroradiol. 2016. PMID: 26680457 Free PMC article. No abstract available.
References
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- Schievink WI, Torres VE, Piepgras DG, et al. . Saccular intracranial aneurysms in autosomal dominant polycystic kidney disease. J Am Soc Nephrol 1992;3:88–95 - PubMed
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- Huston J 3rd, Torres VE, Sulivan PP, et al. . Value of magnetic resonance angiography for the detection of intracranial aneurysms in autosomal dominant polycystic kidney disease. J Am Soc Nephrol 1993;3:1871–77 - PubMed
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