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TheScientificWorldJournal 2015The evolution of imaging techniques and their increased use in clinical practice have led to a higher detection rate of unruptured intracranial aneurysms. The diagnosis... (Review)
Review
The evolution of imaging techniques and their increased use in clinical practice have led to a higher detection rate of unruptured intracranial aneurysms. The diagnosis of an unruptured intracranial aneurysm is a source of significant stress to the patient because of the concerns for aneurysmal rupture, which is associated with substantial rates of morbidity and mortality. Therefore, it is important that decisions regarding optimum management are made based on the comparison of the risk of aneurysmal rupture with the risk associated with intervention. This review provides a comprehensive overview of the epidemiology, pathophysiology, natural history, clinical presentation, diagnosis, and management options for unruptured intracranial aneurysms based on the current evidence in the literature. Furthermore, the authors discuss the genetic abnormalities associated with intracranial aneurysm and current guidelines for screening in patients with a family history of intracranial aneurysms. Since there is significant controversy in the optimum management of small unruptured intracranial aneurysms, we provided a systematic approach to their management based on patient and aneurysm characteristics as well as the risks and benefits of intervention.
Topics: Disease Management; Humans; Intracranial Aneurysm; Prognosis; Risk; Treatment Outcome
PubMed: 26146657
DOI: 10.1155/2015/954954 -
Journal of Neurosurgical Anesthesiology Jul 2015Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of... (Review)
Review
Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome.
Topics: Aneurysm, Ruptured; Embolization, Therapeutic; Endovascular Procedures; Humans; Intracranial Aneurysm; Neurosurgical Procedures; Risk Factors; Subarachnoid Hemorrhage
PubMed: 25272066
DOI: 10.1097/ANA.0000000000000130 -
International Journal of Stroke :... Jan 2022Subarachnoid hemorrhage from rupture of an intracranial aneurysm (aneurysmal subarachnoid hemorrhage) is a devastating subset of stroke. Since brain damage from the... (Review)
Review
BACKGROUND
Subarachnoid hemorrhage from rupture of an intracranial aneurysm (aneurysmal subarachnoid hemorrhage) is a devastating subset of stroke. Since brain damage from the initial hemorrhage is a major cause for the poor outcome after aneurysmal subarachnoid hemorrhage, prevention of aneurysmal subarachnoid hemorrhage has the highest potential to prevent poor outcome from aneurysmal subarachnoid hemorrhage.
AIM
In this review, we describe the groups at high risk of aneurysmal subarachnoid hemorrhage who may benefit from preventive screening for unruptured intracranial aneurysms followed by preventive treatment of unruptured intracranial aneurysms found. Furthermore, we describe the advantages and disadvantages of screening and advise how to perform counseling on screening.
SUMMARY OF REVIEW
Modeling studies show that persons with two or more affected first-degree relatives with aneurysmal subarachnoid hemorrhage and patients with autosomal dominant polycystic kidney disease (ADPKD) are candidates for screening for unruptured intracranial aneurysms. One modeling study also suggests that persons with only one affected first-degree relative with aneurysmal subarachnoid hemorrhage are also likely candidates for screening. Another group who may benefit from screening are persons ≥35 years who smoke(d) and are hypertensive, given their high lifetime risk of aneurysmal subarachnoid hemorrhage of up to 7%, but the prevalence of unruptured intracranial aneurysms in such persons and the efficiency and cost-effectiveness of screening in this group are not yet known. The ultimate goal of screening is to increase the number of quality years of life of the screening candidates, and therefore the benefits but also many downsides of screening -such as risk of incidental findings, very small unruptured intracranial aneurysms that require regular follow-up, preventive treatment with inherent risk of complications and anxiety - should be discussed with the candidate so that an informed decision can be made before intracranial vessels are imaged.
CONCLUSIONS
Several groups of persons who may benefit from screening have been identified, but since these constitute only a minority of all aneurysmal subarachnoid hemorrhage patients, additional high-risk groups still need to be identified. Further research is also needed to identify persons at low or high risk of aneurysmal development and rupture within the groups identified thus far to improve the efficiency of screening. Moreover, if new medical treatment strategies that can reduce the risk of rupture of unruptured intracranial aneurysm become available, the groups of persons who may benefit from screening could increase considerably.
Topics: Aneurysm, Ruptured; Humans; Intracranial Aneurysm; Mass Screening; Polycystic Kidney, Autosomal Dominant; Stroke; Subarachnoid Hemorrhage
PubMed: 34042530
DOI: 10.1177/17474930211024584 -
British Journal of Hospital Medicine... Dec 2022True aneurysms are dilatations of blood vessels, bounded by the tunica intima, tunica media and tunica adventitia. False aneurysms are dilatations bounded by the tunica... (Review)
Review
True aneurysms are dilatations of blood vessels, bounded by the tunica intima, tunica media and tunica adventitia. False aneurysms are dilatations bounded by the tunica adventitia only, and are more common than true aneurysms. The femoral artery is the second most common location for true peripheral artery aneurysms, and the most common site of false aneurysms. If left untreated, devastating complications can occur, such as infection, rupture, ischaemia and limb loss. Femoral artery aneurysms should be identified early and managed by a vascular specialist. This article outlines the evidence for the epidemiology, investigation and management of femoral artery aneurysms.
Topics: Humans; Aneurysm, False; Femoral Artery; Aneurysm; Lower Extremity
PubMed: 36594777
DOI: 10.12968/hmed.2022.0258 -
Frontiers in Immunology 2021Aneurysmal subarachnoid hemorrhage (aSAH) is a highly fatal and morbid type of hemorrhagic strokes. Intracranial aneurysms (ICAs) rupture cause subarachnoid hemorrhage.... (Review)
Review
Aneurysmal subarachnoid hemorrhage (aSAH) is a highly fatal and morbid type of hemorrhagic strokes. Intracranial aneurysms (ICAs) rupture cause subarachnoid hemorrhage. ICAs formation, growth and rupture involves cellular and molecular inflammation. Macrophages orchestrate inflammation in the wall of ICAs. Macrophages generally polarize either into classical inflammatory (M1) or alternatively-activated anti-inflammatory (M2)-phenotype. Macrophage infiltration and polarization toward M1-phenotype increases the risk of aneurysm rupture. Strategies that deplete, inhibit infiltration, ameliorate macrophage inflammation or polarize to M2-type protect against ICAs rupture. However, clinical translational data is still lacking. This review summarizes the contribution of macrophage led inflammation in the aneurysm wall and discuss pharmacological strategies to modulate the macrophageal response during ICAs formation and rupture.
Topics: Aneurysm, Ruptured; Cell Polarity; Humans; Inflammation; Intracranial Aneurysm; Macrophages; Monocytes; NF-kappa B
PubMed: 33763073
DOI: 10.3389/fimmu.2021.630381 -
Neurologia Medico-chirurgica Sep 2016Most of cerebral aneurysms (CAs) are incidentally discovered without any neurological symptoms and the risk of rupture of CAs is relatively higher in Japanese... (Review)
Review
Most of cerebral aneurysms (CAs) are incidentally discovered without any neurological symptoms and the risk of rupture of CAs is relatively higher in Japanese population. The goal of treatments for patients with CAs is complete exclusion of the aneurysmal rupture risk for their lives. Since two currently available major treatments, microsurgical clipping and endovascular coiling, have inherent incompleteness to achieve cure of CAs with some considerable treatment risks, and there is no effective surgical or medical intervention to inhibit the formation of CAs in patients with ruptured and unruptured CAs, new treatment strategies with lower risk and higher efficacy should be developed to prevent the formation, growth, and rupture of CAs. Preemptive medicine for CAs should be designed to prevent or delay the onset of symptoms from CAs found in an asymptomatic state or inhibit the de novo formation of CAs, but we have no definite methods to distinguish rupture-prone aneurysms from rupture-resistant ones. Recent advancements in the research of CAs have provided us with some clues, and one of the new treatment strategies for CAs will be developed based on the findings that several inflammatory pathways may be involved in the formation, growth, and rupture of CAs. Preemptive medicine for CAs will be established with specific biomarkers and imaging modalities which can sensor the development of CAs.
Topics: Humans; Intracranial Aneurysm
PubMed: 27053328
DOI: 10.2176/nmc.st.2016-0063 -
Annual Review of Biomedical Engineering Jun 2020In the last two decades, numerous studies have conducted patient-specific computations of blood flow dynamics in cerebral aneurysms and reported correlations between... (Review)
Review
In the last two decades, numerous studies have conducted patient-specific computations of blood flow dynamics in cerebral aneurysms and reported correlations between various hemodynamic metrics and aneurysmal disease progression or treatment outcomes. Nevertheless, intra-aneurysmal flow analysis has not been adopted in current clinical practice, and hemodynamic factors usually are not considered in clinical decision making. This review presents the state of the art in cerebral aneurysm imaging and image-based modeling, discussing the advantages and limitations of each approach and focusing on the translational value of hemodynamic analysis. Combining imaging and modeling data obtained from different flow modalities can improve the accuracy and fidelity of resulting velocity fields and flow-derived factors that are thought to affect aneurysmal disease progression. It is expected that predictive models utilizing hemodynamic factors in combination with patient medical history and morphological data will outperform current risk scores and treatment guidelines. Possible future directions include novel approaches enabling data assimilation and multimodality analysis of cerebral aneurysm hemodynamics.
Topics: Aneurysm; Animals; Arteries; Biomechanical Phenomena; Blood Flow Velocity; Computer Simulation; Decision Making; Diagnostic Imaging; Disease Progression; Hemodynamics; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Intracranial Aneurysm; Models, Cardiovascular; Postoperative Period; Risk; Tomography, X-Ray Computed; Translational Research, Biomedical
PubMed: 32212833
DOI: 10.1146/annurev-bioeng-092419-061429 -
Presse Medicale (Paris, France : 1983) Feb 2018Degenerative aneurysms of the thoracic aorta are increasing in prevalence. The recognition of the decreased morbidity of this approach compared with open repair was... (Review)
Review
Degenerative aneurysms of the thoracic aorta are increasing in prevalence. The recognition of the decreased morbidity of this approach compared with open repair was readily apparent, as it avoided left thoracotomy, aortic cross-clamping, and left heart bypass. Repair of isolated descending thoracic aortic aneurysms using stent grafts was introduced in 1995, and in an anatomically suitable subgroup of patients with thoracic aortic aneurysm, repair with endovascular stent graft provides favorable outcomes, with decreased perioperative morbidity and mortality relative to open repair. The cornerstones of successful thoracic endovascular aneurysm repair are appropriate patient selection, thorough preprocedural planning, and cautious procedural execution. Since then, TEVAR is increasingly being used for other aortic pathologies such as complicated type B dissection, traumatic aortic transection, and aneurysmal disease extending into the arch or visceral segment, requiring debranching procedures.
Topics: Aortic Dissection; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Computed Tomography Angiography; Endovascular Procedures; Humans; Magnetic Resonance Angiography; Prosthesis Implantation
PubMed: 29482890
DOI: 10.1016/j.lpm.2017.12.004 -
International Journal of Molecular... Apr 2017Altered microRNA expression is implicated in cardiovascular diseases. Our objective was to determine microRNA signatures in thoracic aortic aneurysms (TAAs) and...
Altered microRNA expression is implicated in cardiovascular diseases. Our objective was to determine microRNA signatures in thoracic aortic aneurysms (TAAs) and abdominal aortic aneurysms (AAAs) compared with control non-aneurysmal aortic specimens. We evaluated the expression of fifteen selected microRNA in human TAA and AAA operative specimens compared to controls. We observed significant upregulation of miR-221 and downregulation of miR-1 and -133 in TAA specimens. In contrast, upregulation of miR-146a and downregulation of miR-145 and -331-3p were found only for AAA specimens. Upregulation of miR-126 and -486-5p and downregulation of miR-30c-2*, -155, and -204 were observed in specimens of TAAs and AAAs. The data reveal microRNA expression signatures unique to aneurysm location and common to both thoracic and abdominal pathologies. Thus, changes in miR-1, -29a, -133a, and -221 are involved in TAAs and miR-145, -146, and -331-3p impact AAAs. This work validates prior studies on microRNA expression in aneurysmal diseases.
Topics: Aged; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Case-Control Studies; Cluster Analysis; Computational Biology; Female; Gene Expression Profiling; Genetic Association Studies; Genetic Predisposition to Disease; Humans; Male; MicroRNAs; Middle Aged; Risk Factors; Transcriptome
PubMed: 28425970
DOI: 10.3390/ijms18040875 -
The Indian Journal of Medical Research Jan 2018The treatment of unruptured intracranial aneurysms (IAs) remains controversial; the ability to predict the risk of rupture for an aneurysm would be of clinical value....
BACKGROUND & OBJECTIVES
The treatment of unruptured intracranial aneurysms (IAs) remains controversial; the ability to predict the risk of rupture for an aneurysm would be of clinical value. The aim of this study was to determine and evaluate the predictive value of the risk factors of IA rupture.
METHODS
This retrospective study involved 379 consecutive patients with 441 aneurysms between August 2011 and July 2014. Based on clinical data and computed tomography angiography findings, the potential of risk factors to predict the aneurysmal rupture was assessed using statistical methods.
RESULTS
Age, hypertension, heart disease, diabetes mellitus, cerebral atherosclerosis, aneurysms located at the internal carotid artery (ICA) and neck width (N) correlated negatively with rupture risk. Aneurysms located at the anterior communicating artery, bifurcation, irregularity, with a daughter sac, aneurysm height, maximum size, aspect ratio (AR), height-to-width ratio and bottleneck factor were significantly and positively correlated with rupture risk. The multivariate logistic regression model revealed that bifurcation aneurysm, irregular aneurysm and high AR increased the rupture risk, while cerebral atherosclerosis, aneurysm located on the ICA and greater N decreased the risk. Receiver operating characteristic analysis of AR curve values differed according to circumstances.
INTERPRETATION & CONCLUSIONS
Cerebral atherosclerosis, location in the ICA and larger N were the protective factors against aneurysm rupture, and IAs located at bifurcations, irregular shape and increased AR indicated a greater rupture risk.
Topics: Adult; Aged; Aneurysm, Ruptured; Carotid Arteries; Computed Tomography Angiography; Diabetes Complications; Female; Humans; Hypertension; Intracranial Aneurysm; Intracranial Arteriosclerosis; Logistic Models; Male; Middle Aged; Risk Factors
PubMed: 29749361
DOI: 10.4103/ijmr.IJMR_1665_15