Bicuspid aortic valves and intracranial aneurysms: more than an incidental coexistence?

We read with great interest the manuscript by Egbe and coauthors from Mayo Clinic published in Heart.1 The authors focused on a clinically relevant manifestation of intracranial aneurysms (IAs) in patients diagnosed with a bicuspid aortic valve disease (BAV). A large institutional BAV cohort was retrospectively analysed while identifying those patients with BAV who had brain imaging with MRA. A total of 52 patients (7.7%) with IA were identified which were associated with seven adverse events during the follow-up (two aneurysm ruptures, four coil embolisations and three aneurysm enlargements >1 mm). Based on these findings, the authors stated an increased IA prevalence in patients with BAV, especially in those presenting with a concomitant aortic coarctation (ie, 12.9%). Furthermore, a clinically relevant association was revealed between proximal BAV-associated aortopathy and IA occurrence which may indicate a common pathophysiologic pathway in the aneurysm formation. Although the natural history of BAV-associated IA’s seems...