Junxia Yan

Intracranial aneurysm (IA) has an insidious onset, and once ruptured, it carries high rates of mortality and disability. Cardiometabolic factors may be associated with the formation and rupture of IA. This study aims to summarize the application of Mendelian randomization (MR) methods in research on cardiometabolic factors and IA, providing insights for further elucidation of IA etiology and pathogenesis. Literature about MR-based IA studies published up to February 21, 2024, was retrieved from PubMed, Embase, Web of Science, CNKI, and Wanfang. Two researchers independently performed literature screening, data extraction, and quality assessment. A narrative synthesis approach was used to conduct a qualitative systematic review of the included studies. A total of 11 MR-based studies on IA published between 2017 to 2024 were included, of which 4 were rated as high quality. These studies investigated the associations between blood pressure, blood lipids, blood glucose, obesity-related indicators, and inflammatory cytokines with IA and its subtypes, though issues of duplication were noted. Four MR studies based on the same European population but using different instrumental variable selection criteria, as well as another MR study in a different European cohort, consistently identified blood pressure as a risk factor for IA and its subtypes. Findings for blood lipids, blood glucose, obesity-related indicators, and inflammatory cytokines were inconsistent across MR studies. Blood pressure appears to increase the risk of IA and its subtypes. Associations between other cardiometabolic factors and IA/subtypes require further in-depth investigation. Given the inherent limitations of MR studies, causal inferences should be made cautiously in combination with other lines of evidence.

Objective: Flow diverter stents (FDSs) have attracted interest for intracranial aneurysm (IA) treatment; however, occlusion of side branches and related complications have been reported. This study aimed to investigate the effects of FDSs in IA management when different branches of intracranial arteries are covered. Materials and methods: A cross-sectional study was conducted using PUBMED, Embase, Web of Science, and Cochrane databases to include randomized or nonrandomized comparative-designed studies from January 2000 to August 2022 which reported outcomes of occlusion/narrowing of branches after IA treatment using FDSs. The PRISMA guidelines were used for our report. A random-effects meta-analysis was conducted to pool the outcomes, which included incidence rates of occlusion/narrowing of FDS-covered branches, branch occlusion-related symptoms, obliteration of IAs, and ideal clinical outcomes (modified Rankin Scale score ≤2). Results: The authors identified 57 studies involving 3789 patients with IA managed by FDSs covering different branches. During the median imaging follow-up at 12 months, the IA obliteration rate was satisfactory (>70%) when covering the ophthalmic artery (OA), posterior communicating artery (PComA), anterior choroidal artery (AChoA) or anterior cerebral artery (ACA), but not the middle cerebral artery-M2 segment (MCA-M2; 69.5%; 95% CI: 60.8–77.5%) and posterior inferior cerebellar artery (PICA; 59.1%, 13/22). The overall ideal clinical outcome was observed in 97.4% of patients (95% CI: 95.5–98.9%). Higher rates of occlusion/narrowing of branches were identified when FDSs covered the ACA (66.6%; 95% CI: 45.1–85.3%), PComA (44.3%; 95% CI: 34.2–54.6%), or MCA-M2 (39.2%; 95% CI: 24.5–54.7%); the risks were lower when covering the OA (11.8%; 95% CI: 8.8–15.1%), PICA (6.8%; 95% CI: 1.5–14.5%), and AchoA (0.5%; 95% CI: 0.0–2.9%). The risk of branch occlusion-related complications was low (incidence rate <5%) for each of the six evaluated branches. Conclusions: Acceptable outcomes were identified following treatment of IAs when FDSs were placed across each of the six studied cerebral arteries. Treatment decisions regarding FDS placement across branch arteries should be made with the risk of complications from branch occlusion in mind.

脑卒中已成为中国成人致死和致残的首要原因。本研究旨在分析2019年中国脑卒中及其亚型不同性别和年龄别的疾病负担及其相关危险因素，为针对性预防提供科学依据。 利用2019年全球疾病负担(Global Burden of Disease 2019，GBD2019)公开数据，采用伤残调整生命年(disability-adjusted life years，DALY)对2019年中国不同卒中亚型(缺血性脑卒中、颅内出血、蛛网膜下腔出血)的性别和年龄别疾病负担进行描述性分析，并探讨其相关危险因素归因负担。 2019年中国脑卒中亚型中以颅内出血疾病负担最重，所致DALY为2 221.06万人年，其次为缺血性脑卒中和蛛网膜下腔出血，所致DALY分别为2 139.39和234.47万人年。其中，除0~14岁年龄组外，其他各年龄组不同脑卒中亚型的疾病负担男性均高于女性；缺血性脑卒中的疾病负担在男性和女性中均随着年龄的增加而增加，70岁及以上年龄组疾病负担最重；而对于颅内出血及蛛网膜下腔出血，男性均为50~69岁组疾病负担最重，女性分别是50~69岁及70岁及以上组最重。不同脑卒中亚型中各年龄段的归因危险均以代谢因素为主，其中最主要的危险因素均为高收缩压；男性和女性的其他归因危险因素有所不同，男性以吸烟、高体重指数、高低密度脂蛋白及室外颗粒物污染为主，女性则以高体重指数、室外颗粒物污染、高空腹血糖为主；不同年龄组间主要归因危险因素也有差异。 2019年中国脑卒中疾病负担较重，不同性别、不同年龄组的疾病负担及归因危险因素不同，今后应针对不同人群的主要归因危险因素进行干预，以减轻脑卒中疾病负担。