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Continuum (Minneapolis, Minn.) Apr 2014Unruptured intracranial aneurysms are found commonly in the general public, and more frequently in certain populations. This article focuses on the epidemiology,... (Review)
Review
PURPOSE OF REVIEW
Unruptured intracranial aneurysms are found commonly in the general public, and more frequently in certain populations. This article focuses on the epidemiology, screening strategies, and management options for patients with unruptured aneurysms.
RECENT FINDINGS
Recent epidemiologic studies show the overall prevalence of intracranial aneurysms to be approximately 3%, with higher rates seen in familial aneurysm syndromes and in certain medical conditions, such as autosomal dominant polycystic kidney syndrome. Aneurysm treatment may include surgical or endovascular techniques, with increasing utilization of endovascular strategies over time. Increased aneurysm diameter, certain locations, and other anatomical considerations may be associated with higher risks of aneurysm rupture.
SUMMARY
Given the high morbidity and mortality associated with aneurysm rupture, screening for unruptured aneurysms is generally recommended for high-risk patients (patients who have at least two first-degree relatives with aneurysms, and patients with autosomal dominant polycystic kidney disease). Screening may be considered for other patients (eg, one first-degree relative with aneurysm) after discussion of the risks and benefits of imaging. Following identification of an aneurysm, decisions regarding observation or treatment should be based on patient characteristics, features of the aneurysm, and provider expertise.
Topics: Age Factors; Humans; Intracranial Aneurysm; Prevalence; Risk Factors
PubMed: 24699488
DOI: 10.1212/01.CON.0000446108.12915.65 -
Seminars in Neurology Jun 2023Unruptured intracranial aneurysms are often discovered incidentally on noninvasive imaging. As use of noninvasive imaging has increased, our understanding of the... (Review)
Review
Unruptured intracranial aneurysms are often discovered incidentally on noninvasive imaging. As use of noninvasive imaging has increased, our understanding of the presumed prevalence of intracranial aneurysms in adults has increased. Incidentally found aneurysms are often asymptomatic; however, they can rarely rupture and cause life-threatening illness. Elective treatment of intracranial aneurysms carries risks which need to be considered along with patient-specific factors (e.g., anatomy, medical comorbidities, personal preferences). In this article, we review the natural history, risk factors for cerebral aneurysm formation and rupture, evidence for medical management, and the safety profile and efficacy of available endovascular treatment options.
Topics: Adult; Humans; Intracranial Aneurysm; Prevalence; Risk Factors
PubMed: 37517406
DOI: 10.1055/s-0043-1771299 -
Zhurnal Voprosy Neirokhirurgii Imeni N.... 2016The problem of high disability and mortality due to subarachnoid hemorrhage (SAH) from cerebral aneurysms has led to the fact that surgical treatment of unruptured... (Review)
Review
The problem of high disability and mortality due to subarachnoid hemorrhage (SAH) from cerebral aneurysms has led to the fact that surgical treatment of unruptured aneurysms has been considered in Western Europe, Japan, and the United States as a method for prevention of subarachnoid hemorrhage for many years. The introduction of the so-called surgical SAH prophylaxis in Russia is a challenge that requires defining the principles of patient selection and choosing a treatment technique for unruptured cerebral aneurysms. The article highlights the modern approaches to treatment of asymptomatic unruptured cerebral aneurysms based on the concepts of aneurysm epidemiology and natural progression.
Topics: Humans; Intracranial Aneurysm; Subarachnoid Hemorrhage
PubMed: 28635698
DOI: 10.17116/neiro2016805136-142 -
Disease Markers 2022Intracranial aneurysm serves as a prevalent cerebral disorder leading to the low-quality life and financial burden of the patients. Flow diversion and coil embolization... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Intracranial aneurysm serves as a prevalent cerebral disorder leading to the low-quality life and financial burden of the patients. Flow diversion and coil embolization have been confirmed as common therapeutic strategies for intracranial aneurysms. In this work, we identified and compared the cost between the flow diversion and coil embolization in the treatment of intracranial aneurysms in a meta-analysis.
METHODS
We downloaded literatures that are published before Feb 2021 from Cochrane Library, Embase, and Pubmed using terms including "flow diversion", "pipeline embolization device", "coil embolization", "coiling", "Intracranial aneurysms", and "Cerebral aneurysms". The data were analyzed by STATA 15.1. Differences in treatment costs were determined by WMD (95% CI).
RESULTS
A total of 1332 articles were included in the search of the limited terms, and 8 were selected after eliminating duplicate and unwanted studies. Our data indicated that the total cost of flow diversion for intracranial aneurysms is significantly lower than coil embolization (WMD = -4419.12, 95% CI: -6292.21 to -2546.03, ≤ 0.001). In addition, we explored the retreatment hospitalization cost of flow diversion and coil embolization for intracranial aneurysms. We found that the retreatment hospitalization cost of flow diversion for intracranial aneurysms is significantly higher than coil embolization (WMD = 3203.85, 95% CI: 1904.60 to 4503.10, ≤ 0.001).
CONCLUSION
We concluded that the total cost was lower, and the retreatment hospitalization costs of flow diversion were higher than coil embolization for the treatment of intracranial aneurysms. Our finding provides valuable insights into the application of flow diversion and coil embolization in intracranial aneurysm therapy. Flow diversion may be applied as a major treatment with the consideration of retreatment.
Topics: Humans; Intracranial Aneurysm; Embolization, Therapeutic; Treatment Outcome; Costs and Cost Analysis; Retrospective Studies; Stents
PubMed: 36284988
DOI: 10.1155/2022/2925366 -
Translational Stroke Research Apr 2014The prevalence of unruptured intracranial aneurysms (UIAs) in the general population is up to 3%. Existing epidemiological data suggests that only a small fraction of... (Review)
Review
The prevalence of unruptured intracranial aneurysms (UIAs) in the general population is up to 3%. Existing epidemiological data suggests that only a small fraction of UIAs progress towards rupture over the lifetime of an individual, but the surrogates for subsequent rupture and the natural history of UIAs are discussed very controversially at present. In case of rupture of an UIA, the case fatality is up to 50%, which therefore continues to stimulate interest in the pathogenesis of cerebral aneurysm formation and progression. Actual data on the chronological development of cerebral aneurysm has been especially difficult to obtain and, until recently, the existing knowledge in this respect is mainly derived from animal or mathematical models or short-term observational studies. Here, we review the current data on cerebral aneurysm formation and progression as well as a novel approach to investigate the developmental chronology of cerebral aneurysms.
Topics: Disease Progression; Humans; Intracranial Aneurysm; Models, Theoretical; Risk Factors
PubMed: 24323717
DOI: 10.1007/s12975-013-0294-x -
Neurology India 2016Traumatic intracranial aneurysms (TICA) are rare in occurrence, constituting less than 1% of the total cases of intracranial aneurysms. Cervical posttraumatic aneurysms... (Review)
Review
Traumatic intracranial aneurysms (TICA) are rare in occurrence, constituting less than 1% of the total cases of intracranial aneurysms. Cervical posttraumatic aneurysms arising from major blood vessels supplying the brain are also extremely rare. Their variable locations, morphological variations and the presence of concomitant head injury makes their diagnosis and treatment a challenge. In this review, we discuss the epidemiology, etiology, classification and management issues related to TICA as well as traumatic neck aneurysms and review the pertinent literature.
Topics: Craniocerebral Trauma; Humans; Intracranial Aneurysm
PubMed: 26954962
DOI: 10.4103/0028-3886.178032 -
Annals of Biomedical Engineering Jul 2013Many factors that are either blood-, wall-, or hemodynamics-borne have been associated with the initiation, growth, and rupture of intracranial aneurysms. The... (Review)
Review
Many factors that are either blood-, wall-, or hemodynamics-borne have been associated with the initiation, growth, and rupture of intracranial aneurysms. The distribution of cerebral aneurysms around the bifurcations of the circle of Willis has provided the impetus for numerous studies trying to link hemodynamic factors (flow impingement, pressure, and/or wall shear stress) to aneurysm pathophysiology. The focus of this review is to provide a broad overview of such hemodynamic associations as well as the subsumed aspects of vascular anatomy and wall structure. Hemodynamic factors seem to be correlated to the distribution of aneurysms on the intracranial arterial tree and complex, slow flow patterns seem to be associated with aneurysm growth and rupture. However, both the prevalence of aneurysms in the general population and the incidence of ruptures in the aneurysm population are extremely low. This suggests that hemodynamic factors and purely mechanical explanations by themselves may serve as necessary, but never as necessary and sufficient conditions of this disease's causation. The ultimate cause is not yet known, but it is likely an additive or multiplicative effect of a handful of biochemical and biomechanical factors.
Topics: Brain; Cerebrovascular Circulation; Hemodynamics; Humans; Intracranial Aneurysm
PubMed: 23549899
DOI: 10.1007/s10439-013-0800-z -
Wiley Interdisciplinary Reviews.... Jul 2017Virtual endovascular treatment models (VETMs) have been developed with the view to aid interventional neuroradiologists and neurosurgeons to pre-operatively analyze the... (Review)
Review
Virtual endovascular treatment models (VETMs) have been developed with the view to aid interventional neuroradiologists and neurosurgeons to pre-operatively analyze the comparative efficacy and safety of endovascular treatments for intracranial aneurysms. Based on the current state of VETMs in aneurysm rupture risk stratification and in patient-specific prediction of treatment outcomes, we argue there is a need to go beyond personalized biomechanical flow modeling assuming deterministic parameters and error-free measurements. The mechanobiological effects associated with blood clot formation are important factors in therapeutic decision making and models of post-treatment intra-aneurysmal biology and biochemistry should be linked to the purely hemodynamic models to improve the predictive power of current VETMs. The influence of model and parameter uncertainties associated to each component of a VETM is, where feasible, quantified via a random-effects meta-analysis of the literature. This allows estimating the pooled effect size of these uncertainties on aneurysmal wall shear stress. From such meta-analyses, two main sources of uncertainty emerge where research efforts have so far been limited: (1) vascular wall distensibility, and (2) intra/intersubject systemic flow variations. In the future, we suggest that current deterministic computational simulations need to be extended with strategies for uncertainty mitigation, uncertainty exploration, and sensitivity reduction techniques. WIREs Syst Biol Med 2017, 9:e1385. doi: 10.1002/wsbm.1385 For further resources related to this article, please visit the WIREs website.
Topics: Animals; Endovascular Procedures; Humans; Intracranial Aneurysm; Models, Cardiovascular; Virtual Reality
PubMed: 28488754
DOI: 10.1002/wsbm.1385 -
Acta Neurochirurgica. Supplement 2015Intracranial aneurysm (IA) is a socially important disease both because it has a high prevalence and because of the severity of resultant subarachnoid hemorrhages after... (Review)
Review
Intracranial aneurysm (IA) is a socially important disease both because it has a high prevalence and because of the severity of resultant subarachnoid hemorrhages after IA rupture. The major concern of current IA treatment is the lack medical therapies that are less invasive than surgical procedures for many patients. The current situation is mostly caused by a lack of knowledge regarding the regulating mechanisms of IA formation. Hemodynamic stress, especially high wall shear stress, loaded on arterial bifurcation sites is recognized as a trigger of IA formation from studies performed in the field of fluid dynamics. On the other hand, many studies using human specimens have also revealed the presence of active inflammatory responses, such as the infiltration of macrophages, in the pathogenesis of IA. Because of these findings, recent experimental studies, mainly using animal models of IA, have revealed some of the molecular mechanisms linking hemodynamic stress and long-lasting inflammation in IA walls. Currently, we propose that IA is a chronic inflammatory disease regulated by a positive feedback loop consisting of the cyclooxygenase (COX)-2 - prostaglandin (PG) E2 - prostaglandin E receptor 2 (EP2) - nuclear factor (NF)-κB signaling pathway triggered under hemodynamic stress and macrophage infiltration via NF-κB-mediated monocyte chemoattractant protein (MCP)-1 induction. These findings indicate future directions for the development of therapeutic drugs for IAs.
Topics: Animals; Cerebrovascular Circulation; Disease Models, Animal; Drug Discovery; Humans; Inflammation; Intracranial Aneurysm; Stress, Mechanical
PubMed: 25366592
DOI: 10.1007/978-3-319-04981-6_2 -
The Neuroradiology Journal Dec 2021Endovascular treatment is the first-line therapy for most intracranial aneurysms; however, recanalisation remains a major limitation. Developments in bioengineering and... (Review)
Review
Endovascular treatment is the first-line therapy for most intracranial aneurysms; however, recanalisation remains a major limitation. Developments in bioengineering and material science have led to a novel generation of coil technologies for aneurysm embolisation that address clinical challenges of aneurysm recurrence. This review presents an overview of modified surface coil technologies and summarises the state of the art regarding their efficacy and limitations based on experimental and clinical results. We also present potential perspectives to develop biologically optimised devices.
Topics: Embolization, Therapeutic; Humans; Intracranial Aneurysm; Treatment Outcome
PubMed: 34210195
DOI: 10.1177/19714009211024631