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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 -
Stroke and Vascular Neurology Sep 2016Endovascular treatment of cerebral aneurysm continues to evolve with the development of new technologies. This review provides an overview of the recent major... (Review)
Review
Endovascular treatment of cerebral aneurysm continues to evolve with the development of new technologies. This review provides an overview of the recent major innovations in the neurointerventional space in recent years.
Topics: Animals; Cerebrovascular Circulation; Diffusion of Innovation; Endovascular Procedures; Humans; Intracranial Aneurysm; Treatment Outcome
PubMed: 28959469
DOI: 10.1136/svn-2016-000027 -
Roczniki Panstwowego Zakladu Higieny 2019Cerebral aneurysms (CAs) are dilations of the wall of an artery in the brain filled with blood. The prevalence of unrupted CA in general population is estimated at... (Review)
Review
Cerebral aneurysms (CAs) are dilations of the wall of an artery in the brain filled with blood. The prevalence of unrupted CA in general population is estimated at approximately 3%. Ruptured aneurysms are the cause of 85% of spontaneous subarachnoid hemorrhage (SAH) cases. The formation of cerebral aneurysms results from various factors, including chronic inflammation, hemodynamic stress and vascular wall remodeling. Reactive oxygen species may induce the endothelial dysfunction possibly through the activation of Nuclear Factor Kappa-B, which is a key regulator of the proinflammatory genes. Hypertension may additionally increase the hemodynamic stress and activate the local renin-angiotensin system. The aim of this review was to assess the role of selected diet-related factors in the formation and rupture of cerebral aneurysms. It appears that inadequate intake of dietary antioxidants, hyperhomocysteinemia, hypertension (including incidental elevated blood pressure) and alcohol consumption may increase the risk of intracranial aneurysms. Individuals at high risk of CA formation and/or rupture should consume adequate amounts of antioxidant vitamins (vitamin C, vitamin E and carotenoids), B vitamins (vitamin B6, vitamin B12 and folate), flavonoids and n-3 fatty acids, limit alcohol and caffeine consumption and regularly control their blood pressure. Vegetables, fruits, grains, pulses, nuts and fish, as well as herbs, spices and tea, should be the major components of the daily diet. Due to the synergistic effect of various dietary components on health, Mediterranean diet or Dietary Approach to Stop Hypertension (DASH) diet, as they meet abovementioned requirements and have high anti-inflammatory potential, are thus recommended for the prevention of cerebral aneurysm formation and rupture.
Topics: Aneurysm, Ruptured; Antioxidants; Diet; Humans; Hydrodynamics; Intracranial Aneurysm; Risk Factors
PubMed: 31215205
DOI: 10.32394/rpzh.2019.0061 -
Deutsches Arzteblatt International Apr 2020About 2 million adults in Germany harbor an unruptured intracranial aneurysm (IA). Rupture can lead to a life-threatening subarachnoid hemorrhage. If an IA is detected... (Review)
Review
BACKGROUND
About 2 million adults in Germany harbor an unruptured intracranial aneurysm (IA). Rupture can lead to a life-threatening subarachnoid hemorrhage. If an IA is detected incidentally in cranial imaging, it must be decided how to proceed.
METHODS
This review includes key publications that were identified by a selective search in the PubMed database using the search term "unruptured intracranial aneurysms," which was performed in July 2019, and based on information obtained from the German Federal Statistical Office on the frequency of the hospital discharge diagnosis "cerebral aneurysm," excluding the diagnosis "subarachnoid hemorrhage," in Germany from 2005 to 2017.
RESULTS
The number of patients in Germany who were admitted or treated for an unruptured IA increased by a factor of 2.3 from 2005 to 2017. The average 5-year rupture risk of approximately 3% must be weighed against the approximately 4% risk associated with an endovascular or microneurosurgical treatment. This emphasizes the need for more precise data on the risk of rupture and for algorithms enabling individualized decision-making for patients with unruptured IA. Risk factors such as IA morphology, arterial hypertension, active smoking, and alcohol consumption (>150 g/week) can markedly increase the risk of rupture, which is generally relatively low. Growing aneurysms are 12 times more likely to rupture than stable ones. Follow-up imaging is thus essential whenever observation rather than intervention is chosen as the initial management.
CONCLUSION
Patients with unruptured IA should be massessed and managed individually. It is also important that risk factors should be treated, if present. Eligible patients are currently being recruited for a phase III clinical trial on the efficacy of blood pressure reduction combined with acetylsalicylic acid intake to counteract inflammatory processes in the arterial wall.
Topics: Germany; Humans; Intracranial Aneurysm; Precision Medicine; Risk Factors
PubMed: 32449895
DOI: 10.3238/arztebl.2020.0235 -
Ugeskrift For Laeger Nov 2022New onset of seizures in children presenting with status epilepticus (SE) are rarely caused by intracranial aneurysms and haemorrhage, and the diagnosis is therefore...
New onset of seizures in children presenting with status epilepticus (SE) are rarely caused by intracranial aneurysms and haemorrhage, and the diagnosis is therefore challenging. This case report presents a ten-year-old healthy girl presenting with SE preceded by headache for two weeks. A CT-scan showed a subarachnoidal haemorrhage from a cerebral aneurysm. Intracranial pathology should be considered a differential diagnosis when receiving a child with new onset of seizures and SE. Early neuroimaging should be performed for correct treatment to be initiated without delay.
Topics: Child; Female; Humans; Subarachnoid Hemorrhage; Intracranial Aneurysm; Status Epilepticus; Headache; Seizures
PubMed: 36426817
DOI: No ID Found -
International Journal of Molecular... Jun 2023Aneurysmal subarachnoid hemorrhage (aSAH) is one of the most severe neurological disorders, with a high mortality rate and severe disabling functional sequelae. Systemic... (Review)
Review
Aneurysmal subarachnoid hemorrhage (aSAH) is one of the most severe neurological disorders, with a high mortality rate and severe disabling functional sequelae. Systemic inflammation following hemorrhagic stroke may play an important role in mediating intracranial and extracranial tissue damage. Previous studies showed that various systemic inflammatory biomarkers might be useful in predicting clinical outcomes. Anti-inflammatory treatment might be a promising therapeutic approach for improving the prognosis of patients with aSAH. This review summarizes the complicated interactions between the nervous system and the immune system.
Topics: Humans; Subarachnoid Hemorrhage; Intracranial Aneurysm; Inflammation; Biomarkers; Hemorrhagic Stroke
PubMed: 37446118
DOI: 10.3390/ijms241310943 -
The British Journal of Radiology Jan 2023While the rupture rate of cerebral aneurysms is only 1% per year, ruptured aneurysms are associated with significant morbidity and mortality, while aneurysm treatments... (Review)
Review
While the rupture rate of cerebral aneurysms is only 1% per year, ruptured aneurysms are associated with significant morbidity and mortality, while aneurysm treatments have their own associated risk of morbidity and mortality. Conventional markers for aneurysm rupture include patient-specific and aneurysm-specific characteristics, with the development of scoring systems to better assess rupture risk. These scores, however, rely heavily on aneurysm size, and their accuracy in assessing risk in smaller aneurysms is limited. While the individual risk of rupture of small aneurysms is low, due to their sheer number, the largest proportion of ruptured aneurysms are small aneurysms. Conventional imaging techniques are valuable in characterizing aneurysm morphology; however, advanced imaging techniques assessing the presence of inflammatory changes within the aneurysm wall, hemodynamic characteristics of blood flow within aneurysm sacs, and imaging visualization of irregular aneurysm wall motion have been used to further determine aneurysm instability that otherwise cannot be characterized by conventional imaging techniques. The current manuscript reviews conventional imaging techniques and their value and limitations in cerebral aneurysm characterization, and evaluates the applications, value and limitations of advanced aneurysm imaging and post-processing techniques including intracranial vessel wall MRA, 4D-flow, 4D-CTA, and computational fluid dynamic simulations.
Topics: Humans; Intracranial Aneurysm; Cerebral Angiography; Aneurysm, Ruptured; Hemodynamics
PubMed: 36400095
DOI: 10.1259/bjr.20220686 -
Stroke Feb 2022Sex differences in cerebral aneurysm occurrence and characteristics have been well described. Although sex differences in outcomes following ischemic stroke have been... (Review)
Review
Sex differences in cerebral aneurysm occurrence and characteristics have been well described. Although sex differences in outcomes following ischemic stroke have been identified, the effect of sex on outcomes following hemorrhagic stroke, and in particular, aneurysm treatment has been less studied. We describe the current state of knowledge regarding the impact of sex on treatment and outcomes of cerebral aneurysms. Although prior studies suggest that aneurysm prevalence and progression may be related to sex, we did not find clear evidence that outcomes following subarachnoid hemorrhage vary based on sex. Last, we identify areas for future research that could enhance understanding of the role sex plays in this context.
Topics: Aneurysm, Ruptured; Animals; Female; Humans; Intracranial Aneurysm; Male; Prevalence; Sex Characteristics; Subarachnoid Hemorrhage; Treatment Outcome
PubMed: 34983239
DOI: 10.1161/STROKEAHA.121.037147 -
Interventional Neuroradiology : Journal... Dec 2022Long-term compaction, compression, migration, and recurrence rates of the WovenEndoBridge devices remain unknown. The purpose of this study was to detect these rates and...
PURPOSE
Long-term compaction, compression, migration, and recurrence rates of the WovenEndoBridge devices remain unknown. The purpose of this study was to detect these rates and safety profiles of the WovenEndoBridge within 7 years period.
MATERIALS AND METHODS
Eighty-three aneurysms of 79 patients treated with the WovenEndoBridge device were retrospectively evaluated using an occlusion scale (e.g. complete occlusion, neck remnant, and aneurysm remnant) on angiography images.
RESULTS
The residual aneurysm was observed in 11 (13%) aneurysms. The mean and median diameters of the recurrent aneurysms were 6 and 7 mm. Most of the recurrent aneurysms were complex type and/or ruptured. Mean diameters and the neck-to-body ratios of all residual aneurysms in the preoperative imaging exams were above 4 mm and 0.6, respectively. The median values of preoperative height and neck measurements were higher in the recurrent aneurysms than in the adequate occlusion group ( = 0.006, = 0.019, respectively). There was a statistically significant positive relationship between preoperative height/neck measurements and the mean diameters of residual aneurysms (rs = 0.32 and = 0.003; rs = 0.28 and = 0.011, respectively). The WovenEndoBridge compaction/compression and migration were observed in 5 (45%) and 2 (18%) of the recurrent aneurysms. In 7 (64%) of the residual aneurysms, thrombosed areas were found within the aneurysm. In the follow-up period, four aneurysms (4.8%) were retreated due to widened residual aneurysm. Other aneurysms were improved or stable within 7 years.
DISCUSSION
Our adequate occlusion rate was 87%. Occlusion rates are less favorable than aneurysms with a long height, wide neck, or high neck-to-body ratio. Our study confirms the high safety and efficiency of the WovenEndoBridge. Compaction, compression, and/or migration of the WovenEndoBridge and the presence of intra-aneurysmal thrombosis are the main reasons for the recurrences.
Topics: Humans; Intracranial Aneurysm; Retrospective Studies; Endovascular Procedures; Cerebral Angiography; Treatment Outcome; Embolization, Therapeutic; Disease Progression
PubMed: 35098767
DOI: 10.1177/15910199211060970 -
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