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Original research article
Prevalence and predictors of intracranial aneurysms in patients with bicuspid aortic valve
  1. Alexander C Egbe1,
  2. Ratnasari Padang1,
  3. Robert D Brown2,
  4. Arooj R Khan1,
  5. Sushil A Luis1,
  6. John Huston III3,
  7. Emmanuel Akintoye4,
  8. Heidi M Connolly1
  1. 1 Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
  4. 4 Department of Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, Michigan, UK
  1. Correspondence to Dr Alexander C Egbe, Department of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; cegbe2001{at}


Objective To determine the prevalence and outcomes of intracranial aneurysm (IA) in patients with bicuspid aortic valve (BAV).

Methods Retrospective review of patients with BAV who underwent brain MR angiography at the Mayo Clinic from 1994 to 2013.

Results There were 678 patients included in this study—mean age 57±13 years, men 480 (71%), mean follow-up 10±3 years (5913 patient-years). Coarctation of aorta (COA) was present in 154 (23%) patients.

There were 59 IAs identified in 52 of 678 patients (7.7%). IA was present in 20/154 patients (12.9%) with COA and 32/524 patients (5.7%) without COA (p<0.001). For the patients without COA, female gender and right–left cusp fusion were risks factors for IA in women after adjustment for all potential variables (HR 1.76, CI 1.31 to 2.68, p=0.03). There was no significant trend in the risk for IA across age tertiles: age ≤40 years versus 41–60 years (HR 1.19, p=0.34), and age 41–60 years versus 61–80 years (HR 1.06, p=0.56).

Among the 52 patients with IA, enlargement occurred in three patients (6%), rupture in two patients (4%) and four patients (8%) underwent coil embolisation. For the 626 patients without IA at baseline, no patient developed IA over 7±2 years of imaging follow-up.

Conclusions BAV is associated with a higher prevalence of IA compared to the general population, and this risk is higher in patients with COA, right–left cusp fusion and female gender.

  • Bicuspid aortic valve
  • Coarctation of aorta
  • Intracranial aneurysm
  • Magnetic resonance angiography

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  • Contributors ACE, RP, ARK, EA: study design, data collection, data analysis, initial drafting, critical review, final revision. HMC, RDB, SAL, JH: data analysis, initial drafting, critical review, final revision. All authors reviewed and approved the final draft of this manuscript.

  • Competing interests None declared.

  • Ethics approval Mayo Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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