title: Assessment of the cerebral circulation in adults with coarctation of the aorta.
abstract: OBJECTIVE
  There is a fivefold increase in the frequency of intracranial aneurysm (IA) in adults with coarctation of the aorta (CoA). Current guidelines for management of adults with CoA recommend computed tomography angiography (CTA) or magnetic resonance imaging of the intracranial vessels. However, this recommendation has not been universally accepted. The purpose of our study was to prospectively perform CTA of the intracranial vessels in adults with CoA to evaluate the prevalence and identify high-risk features of this complication.
  
  
  RESULTS
  From January 2008 to February 2011, adults ≥18 years of age with CoA were prospectively enrolled in a screening program with CTA of the intracranial vessels. Analyses of prognostic variables were performed with both Fisher's exact and two sample t-test. Forty-three patients (58% female, 33.55 ± 10.21 years) with CoA completed CTA of the intracranial vessels. Five patients (11%) were found to have IA. Patients with IA were older than those without (45.6 ± 8.17 vs. 30.89 ± 7.89, P = 0.0003). There were no statistically significant differences detected between measurements of fasting lipid profiles, C-reactive protein, brain natriuretic peptide, and homocysteine levels among CoA patients with and without IA (P = not significant).
  
  
  CONCLUSIONS
  Prospective screening of adults with CoA confirmed the increased prevalence of IA but also identified increased age as the sole risk factor. These data suggested that screening is justified particularly in the fourth and fifth decades of life. Further studies are required that focus on the development, natural history, and treatment of IA.
authors.affiliation: The Adult Congenital Heart Disease Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA 15224, USA. stephen.cook@chp.edu
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Cook
authors.forename: Jenne
authors.initials: J
authors.lastname: Hickey
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Maul
authors.forename: Nicholas
authors.initials: N
authors.lastname: Zumberge
authors.forename: Eric V
authors.initials: EV
authors.lastname: Krieger
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Valente
authors.forename: Ali N
authors.initials: AN
authors.lastname: Zaidi
authors.forename: Curt J
authors.initials: CJ
authors.lastname: Daniels
mesh_terms: D000328:Adult; D000367:Age Factors; D001017:Aortic Coarctation / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D002533:Cerebral Angiography / Q000379:methods; D002560:Cerebrovascular Circulation; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D002532:Intracranial Aneurysm / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D009820:Ohio / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D015415:Biomarkers
keywords: Coarctation of the Aorta; Computed Tomography; Congenital Heart Disease; Intracranial Aneurysm; Magnetic Resonance Imaging