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ID 115570
Title Alternative
MEDICAL TREATMENT OF UNRUPTURED CEREBRAL ANEURYSMS
Author
Kinouchi, Tomoya Tokushima University
Matsushita, Nobuhisa Tokushima University
Yamaguchi, Tadashi Tokushima University
Korai, Masaaki Tokushima University
Okayama, Yoshihiro Tokushima University
Kitazato, Keiko T. Tokushima University
Keywords
Mineralocorticoid receptor blocker
eplerenone
hypertension
unruptured cerebral aneurysms
Content Type
Journal Article
Description
Background: Currently there are no pharmacological therapies for patients with unruptured cerebral aneurysms. Elsewhere we showed that the mineralocorticoid receptor antagonist eplerenone prevented the formation of cerebral aneurysms in our ovariectomized hypertensive aneurysm rat model. The current pilot study evaluated whether it can be used to prevent the growth and rupture of cerebral aneurysms in hypertensive patients. Methods: Between August 2011 and May 2014, we enrolled 82 patients with 90 aneurysms in an open-label uncontrolled clinical trial. All provided prior informed consent for inclusion in this study, and all were treated with eplerenone (25-100 mg/d). The primary end points of our study were the rupture and enlargement of the cerebral aneurysms. Results: Of the 82 patients, 80 (88 unruptured aneurysms) were followed for a mean of 21.3 months (153.4 aneurysm-years); 12 patients (15.0%) permanently discontinued taking the drug. One month after the start of eplerenone administration and throughout the follow-up period, eplerenone kept the blood pressure within the normal range. Most notably, no aneurysms smaller than 9 mm ruptured or enlarged. However, of 2 large thrombosed aneurysms, 1 enlarged and the other ruptured. The overall annual rupture rate was .65%; it was 13.16% for aneurysms larger than 10 mm; the overall annual rate for reaching the primary end points was 1.30%. Conclusion: Our observations suggest that eplerenone may help to prevent the growth and rupture of unruptured cerebral aneurysms smaller than 9 mm. To assess its potential long-term clinical benefits, large clinical trials are needed.
Journal Title
Journal of Stroke and Cerebrovascular Diseases
ISSN
10523057
NCID
AA11543284
Publisher
Elsevier|National Stroke Association
Volume
27
Issue
8
Start Page
2134
End Page
2140
Published Date
2018-04-02
Rights
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
EDB ID
DOI (Published Version)
URL ( Publisher's Version )
FullText File
language
eng
TextVersion
Publisher
departments
University Hospital
Medical Sciences