Study Confirms Aspirin Helps To Decrease Rate Of Intracranial Aneurysm Growth

An international study involving medical researchers from the US and Japan have concluded that Aspirin helps decrease the growth of Intracranial Aneurysm.



The researchers using big data analysis, conducted a database search to investigate whether aspirin can aid in the prevention of intracranial aneurysm rupture by hindering aneurysm growth. The researchers identified 146 patients harboring multiple intracranial aneurysms, five millimeters or less in diameter, that had been observed for at least five years. In this set of patients, the researchers found an association between aspirin use and a decreased rate of aneurysm growth.

Growth is important in intracranial aneurysms because it increases the risk of aneurysm rupture.

The researchers involved in the study were Drs Zanaty, Roa, Allan, Al Kasab, Limaye, Samaniego, Torner, and Dr David M Hassan all from the University of Iowa Hospitals ,Dr. Nakagawa from the University of Tokyo Hospital, Drs Chalouhi and Jabbour from the  Thomas Jefferson University Hospital, Philadelphia, and Dr. Ishii from the  Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.

An intracranial aneurysm is a cerebrovascular disorder in which the wall of an artery in the brain has weakened and bulges outward. The worry is that the weakened aneurysm wall might rupture, causing subarachnoid hemorrhage bleeding in the brain.

Statistics supplied by the Brain Aneurysm Foundation, in the United States an estimated 6.5 million people have an unruptured intracranial artery while globally more than 87 million have it. It is not unusual to have more than one. Many small aneurysms do not cause symptoms and are unlikely to rupture. We may only know that they exist because they are identified on imaging studies obtained for another reason.

However each year approximately 30,000 people in the United States and 940,000 individuals globally, experience aneurysm rupture. A ruptured aneurysm can result in substantial disability and even death.

Intracranial aneurysms larger than 7 mm are more likely to rupture than small ones. Unfortunately, some small aneurysms grow, increasing the risks that they may rupture. It is for this reason that physicians observe small, unruptured aneurysms over time by asking patients to undergo regularly scheduled imaging examinations. When it comes to the brain, intervention carries risks as well, and most neurosurgeons would prefer not to treat a small, unruptured aneurysm unless the risk of rupture meets or exceeds the risk of intervention.

To date, there is no medical treatment to arrest aneurysm growth and subsequent progression to rupture.

The researchers said that there has been some evidence that ;aspirin may reduce the risk of aneurysm rupture due to the drug's anti-inflammatory effect on the weakened aneurysm wall. Their aim in the study was to discover whether aspirin can protect against aneurysm growth in a population of patients harboring multiple small intracranial aneurysms.

The information and data collected by the researchers came from the medical records of 146 patients with multiple intracranial saccular aneurysms, who had undergone surgical or endovascular treatment by the senior author, David M. Hasan, M.D., initially for one aneurysm that had ruptured or was deemed at risk for rupture. Following treatment of this primary aneurysm, the patients still harbored a total of 229 intracranial aneurysms, all of which measured five millimeters or less. These 229 aneurysms are the focus of this paper. The patients periodically returned for follow-up appointments with Dr. Hasan, during which their remaining aneurysms were assessed for growth. Growth was defined as an increase in aneurysm size of at least one millimeter. If growth was identified, the aneurysm was treated. This occurred with 24 aneurysms.

At the end of the study period (July 2009-January 2019), each patient had been monitored for at least 5 years. None of the 229 aneurysms ruptured during the study period.

To determine what factors might lead to aneurysm growth or protect against aneurysm growth over time, the authors performed univariate and multivariate analyses on a variety of demographic and aneurysm-related information retrieved from the database. These included patient age and sex, family and patient medical history, present comorbidities, aneurysm size and location in the brain, status of the primary aneurysm (ruptured or unruptured) prior to treatment, type of procedure used to treat aneurysms, daily use of at least 81 milligrams aspirin, and use of another anticoagulant medication.

From the univariate analysis, significant predictors of aneurysm growth included a patient's history of ruptured aneurysm, drug abuse, hypertension, and polycystic kidney disease. There was an association between both aspirin use and one type of treatment, stent-assisted coil embolization, and a lower rate of aneurysm growth. In the multivariate analysis, the independent factors associated with aneurysm growth were again patient's history of ruptured aneurysm, drug abuse, hypertension, and polycystic kidney disease. Only aspirin use proved to be associated with a significant decreased rate of aneurysm growth.

From the statistical analyses, use of aspirin appears to exert a protective effect against aneurysm growth and very likely against future rupture.

The researchers are planning more studies to further prove the efficiency of aspirin on intracranial aneurysm.

Dr. Hasan M Hassan the lead researchers commented in an interview with Thailand Medical News, "This study is very promising, as it outlines for the first time the potential therapeutic effect of aspirin in decreasing aneurysm growth. If proven in a larger study, this could offer the first, cheap, effective over-the-counter therapeutic agent that could halt aneurysm growth and prevent rupture. Many disabilities, paralysis and deaths can be prevented cheaply.”

Thailand Medical News advocates that one should not start taking aspirin until one has consulted a physician and also had a proper health screening to ensure that you do not have any underlying problems that could be made worst by aspirin. Furthermore note that aspirin can trigger internal bleeding which can be fatal and taking aspirin along with other blood thinners like vitamin E, tumeric, ginseng, prescribed oral coagulants and certain herbs can aggravate and cause internal bleeding.

Reference:Aspirin associated with decreased rate of intracranial aneurysm growth. Zanaty M, Roa Jorge A, Nakagawa D, Chalouhi N, Allan L, Al Kasab S. Limaye K, Ishii D, Samaniego EA, Jabbour P, Torner JC, Hasan DM Journal of Neurosurgery, published online, ahead of print, October 29, 2019; DOI: 10.3171/2019.6.JNS191273.