Dimethyl Fumarate Treatment for Intracranial Unruptured Aneurysms.

Intracranial aneurysm (IA) is a common cerebrovascular disease and the main cause of nontraumatic subarachnoid hemorrhage. Once ruptured, it will cause a high mortality rate, and nearly half of the survivors will also have disabilities. After comparing surgical risk and rupture risk, a significant proportion of patients with intracranial aneurysms choose conservative observation.

Previous studies suggest that inflammation of aneurysmal wall is a high-risk factor of rupture. Dimethyl fumarate (DMF) acts as an anti-inflammatory agent by activating nuclear factor erythroid 2-related factor 2(Nrf2) and other pathways. Animal experiments found dimethyl fumarate reduces the formation and rupture of intracranial aneurysms.

MRI High-resolution vessel wall imaging (HR-VWI) has become a valuable method to assess the Wall of unruptured intracranial aneurysms. Using HR-VWI, it may be possible to detect smaller or more subtle areas of signal enhancement and change, which may give a more precise understanding of the pathology.

In this study, DMF was evaluated for its ability to reduce inflammation of the aneurysm wall measured with High-resolution Vessel Wall Imaging (HR-VWI).

Inclusion criteria

• Male or female aged ≥18 years.
• Unruptured IA of ≥3mm identified on imaging (CT, MRI or digital subtraction angiography).
• Aneurysm wall enhancement identified by HR-VWI before treatment.
• Ability to understand the objective of the trial with provision of written informed consent.

Exclusion criteria

• MRI contraindications (metallic implant, contrast allergy, claustrophobia, etc).
• Planned treatment of the aneurysm within 6 months.
• Current treatment with drugs that might have an anti-inflammatory effect (aspirin, statins, immunosuppressive drugs, angiotensin converting enzyme, etc.).
• Severely impaired liver or renal function.
• Retreatment of recurrent aneurysm.
• Pregnant or lactating women.
• Malignant diseases (liver disease, kidney disease, congestive heart failure, malignant tumours, etc.).
• Poor compliance with treatment or follow--up (patients who refuse to take medication as prescribed, patients who decline imaging follow--up or blood test, etc).