Dr. med. Johannes Goldberg

Vascular Malformations: Bleeding risk of cerebral cavernous malformations in patients on statin medication

Cerebral cavernous malformations (CCMs) are the second most diagnosed vascular malformations of the brain after aneurysms. Most patients present with seizures, hemorrhage, focal neurologic deficits or are diagnosed incidentally. Overall annual hemorrhage rates are reported from 0.7% - 3.1% per patient-year in pooled meta-analyses. Recent findings suggest that familial and sporadic CCMs harbor mutations that cause activation of RhoA kinase, which results in uncontrolled endothelial cell and actin cytoskeleton formation. Preclinical findings showed that Fasudil and Atorvastatin, both inhibitors of RhoA kinase, decreased overall CCM lesion burden and CCM-related hemorrhage in mice. A retrospective trial recently showed that CCM-patients on a combined therapy of statin and antiplatelet medication were less likely to present with hemorrhage at diagnosis. The effect of statin medication on follow-up hemorrhage remains unclear. Pharmaceutical inhibition of RhoA kinase with statin medication is a promising pharmaceutical target in the treatment of patients with CCMs. The aim of this project is to analyze the risk of CCM-related hemorrhage (at diagnosis and during follow-up) in patients under long-term statin medication (consecutive cases from January 1980 until December 2020).

Aneurysms and SAH

• Unruptured intracranial aneurysms – treatment risk vs. natural history
• Unruptured intracranial aneurysms – risk factors for growing aneurysms
• Unruptured intracranial aneurysms under active surveillance – which control algorithm makes sense?

(These Aneurysm projects are currently planned, further descriptions will follow)