Intracranial prevalence

In Caucasians, the vast majority of MCA occlusions are of embolic origin with emboli arising from a carotid stenosis, the aortic arch or the heart (Heinsius et al. 1998) or from the venous side in case of a patent foramen ovale. In black or Asian patients a higher prevalence of intracranial occlusive disease is found with subsequent thrombotic arterial occlusion or stenosis (Feldmann et al. 1990). 

Farb RI, Vanek I, Scott JN,Mikulis DJ,Willinski RA,Tomlinson G, terBrugge KG (2003) Idiopathic intracranial hypertension. The prevalence and morphology of sinovenous stenosis. Neurology 60 1418-1424... 

Intracranial vascular malformations are uncommon, probably congenital, and sometimes familial (Byrne 2005). Those in the dura, draining into the sinuses rather than cerebral veins, can also be caused by skull fracture, craniotomy or dural sinus thrombosis. The overall intracranial vascular malformations detection rate is approximately 3 per 100 000 population per annum and the prevalence is about 20 per 100 000 (Brown et al. 1996). 

Bornebroek M, Westemdorp RGJ, Haan J et al. (1997). Mortality from hereditary cerebral haemorrhage with amyloidosis Dutch type. The impact of sex parental transmission and year of birth. Brain 120 2243-2249 Brott T, Broderick J, Kothari R et al. (1997). Early haemorrhage growth in patients with intracerebral haemorrhage. Stroke 28 1-5 Brown RD, Wiebers DO, Torner JC et al. (1996). Incidence and prevalence of intracranial vascular malformations in Olmsted, County Minnesota 1965 to 1992. Neurology 46 949-952... 

Rinkel GJE, Djibuti M, AJgra A et al. (1998). Prevalence and risk of rupture of intracranial aneurysms a systematic review. Stroke 29 251-256... 

The incidence of SAH in the Western hemisphere is around 6-10 per 100,000 people per year, peaking in the sixth decade with risk for SAH increasing linearly with age. The incidence of SAH in some other countries like Finland or Japan is known to be higher - about 15/100,000 per year - although the prevalence of intracranial aneurysms in Finland is similar to other countries comparable Japanese data regarding prevalence of intracranial aneurysms are lacking. SAH accounts for a quarter of cerebrovascular deaths. 

Endovascular treatment of aneurysms has focused on the mechanical aspects of the procedures but the prevalence of endoleaks and incomplete obliteration of intracranial aneurysms indicates there is ample room for improvement. An integrated approach where the mechanical device also serves as a scaffold for drug delivery has been proposed. In this scheme, the coils deployed within the aneurysm might also be coated with a drug which promotes intimal hyperplasia and the intimal hyperplasia helps seal the aneurysm neck. 

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