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Polskie Archiwum Medycyny Wewnetrznej Dec 2008Coronary aneurysms represent anomalies identified in 0.15-4.9% of patients undergoing coronary angiography. At present there is no uniform definition of this pathology.... (Review)
Review
Coronary aneurysms represent anomalies identified in 0.15-4.9% of patients undergoing coronary angiography. At present there is no uniform definition of this pathology. According to current definitions, the term "aneurysm" refers to both diffuse over 150% dilation of the largest diameter of a coronary artery, and limited spherical or saccular dilation. Aneurysms are observed most commonly in the right coronary artery, and least frequently in the left main coronary artery. It has been demonstrated that atherosclerosis is the main cause of these anomalies in adults, and Kawasaki disease in children and adolescents. However, regardless of the pathogenesis of the aneurysm, pathology of the media of the blood vessel plays a major role in its formation. The most prevalent consequence of aneurysms in the coronary arteries is formation of a thrombus with distal embolization, vasospasm or vessel disruption at the site of wall injury. Therefore, therapeutic management in this anomaly involves both the prevention of thromboembolic complications and percutaneous or surgical closure of the aneurysm entry.
Topics: Angioplasty, Balloon, Coronary; Atherosclerosis; Coronary Aneurysm; Coronary Angiography; Coronary Artery Bypass; Coronary Thrombosis; Dilatation, Pathologic; Humans; Mucocutaneous Lymph Node Syndrome; Regional Blood Flow
PubMed: 19202953
DOI: No ID Found -
Journal of Neuropathology and... Oct 2021Saccular intracranial aneurysm (sIA) rupture leads to a disabling subarachnoid hemorrhage. Chronic inflammation and lipid accumulation in the sIA wall contribute to wall...
Saccular intracranial aneurysm (sIA) rupture leads to a disabling subarachnoid hemorrhage. Chronic inflammation and lipid accumulation in the sIA wall contribute to wall degenerative remodeling that precedes its rupture. A better understanding of the pathobiological process is essential for improved future treatment of patients carrying sIAs. Serum amyloid A (SAA) is an acute-phase protein produced in response to acute and chronic inflammation and tissue damage. Here, we studied the presence and the potential role of SAA in 36 intraoperatively resected sIAs (16 unruptured and 20 ruptured), that had previously been studied by histology and immunohistochemistry. SAA was present in all sIAs, but the extent of immunopositivity varied greatly. SAA immunopositivity correlated with wall degeneration (p = 0.028) and rupture (p = 0.004), with numbers of CD163-positive and CD68-positive macrophages and CD3-positive T lymphocytes (all p < 0.001), and with the expression of myeloperoxidase, matrix metalloproteinase-9, prostaglandin E-2 receptor, and cyclo-oxygenase 2 in the sIA wall. Moreover, SAA positivity correlated with the accumulation of apolipoproteins A-1 and B-100. In conclusion, SAA occurs in the sIA wall and, as an inflammation-related factor, may contribute to the development of a rupture-prone sIA.
Topics: Aneurysm; Aneurysm, Ruptured; Endothelium, Vascular; Humans; Inflammation Mediators; Intracranial Aneurysm; Serum Amyloid A Protein
PubMed: 34534311
DOI: 10.1093/jnen/nlab086 -
Acta Ophthalmologica Mar 2014Retinal arterial macroaneurysms are acquired saccular or fusiform dilatations of the large arterioles of the retina, usually within the first three orders of... (Review)
Review
Retinal arterial macroaneurysms are acquired saccular or fusiform dilatations of the large arterioles of the retina, usually within the first three orders of bifurcation. They are associated with systemic vascular conditions such as hypertension and arteriosclerotic disease occurring most commonly in elderly women. The primary reported symptom is a sudden loss of vision due to haemorrhage or oedema affecting the macula. Most of macroaneurysms regress without treatment and without causing decreased visual acuity. Poor visual outcome may occur secondary to foveal exudates and subfoveal haemorrhage.
Topics: Aneurysm; Diagnosis, Differential; Humans; Retinal Artery; Retinal Diseases; Risk Factors
PubMed: 23800325
DOI: 10.1111/aos.12210 -
Journal of Vascular Surgery. Venous and... Jul 2017Azygos vein aneurysms (AVAs) are uncommon and infrequently diagnosed. When confronted with a patient presenting with an AVA, physicians can rely on only a few case... (Review)
Review
OBJECTIVE
Azygos vein aneurysms (AVAs) are uncommon and infrequently diagnosed. When confronted with a patient presenting with an AVA, physicians can rely on only a few case reports after an extensive literature search. To date, no guideline, no rule, and no review on the optimal treatment strategy for these patients exist.
METHODS
A PubMed and MEDLINE database search for papers and case reports describing AVA was performed. Cases from our own institutions were also reviewed.
RESULTS
The literature search identified 57 published case reports that were reviewed for inclusion. Of those published cases, etiologic factors can be classified into idiopathic, acquired, and traumatic causes. Most AVAs are limited to the azygos arch, a congenital anatomic weak point. Clinical symptoms generally remain nonspecific. Computed or magnetic resonance tomography scans are effective diagnostic tools, although the optimal therapeutic plan remains unclear. Complications include rupture, thromboembolism, mediastinal mass effects, and pulmonary artery hypertension.
CONCLUSIONS
Conservative treatment along with oral anticoagulation may be reasonable for some AVAs, but to date, there is no clear guideline or evidence-based threshold for surgical or interventional therapy. In review of the existing data and from our clinical and scientific knowledge, interventional or surgical treatment should strongly be considered in cases with clinical symptoms, pulmonary embolism or pulmonary arterial hypertension, thrombus formation within the AVA in patients with oral anticoagulation or for patients with a contraindication to oral anticoagulants, considerable increase in diameter or compression of adjacent structures, saccular AVA, or an underlying connective tissue disease. The most common procedure is surgical ligation of the AVA, although endovascular occlusion of the aneurysms is becoming more frequent.
Topics: Aneurysm; Anticoagulants; Azygos Vein; Humans; Magnetic Resonance Imaging; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures; Watchful Waiting
PubMed: 28624000
DOI: 10.1016/j.jvsv.2016.12.012 -
Acta Neuropathologica Communications Sep 2022Saccular intracranial aneurysm (sIA) rupture leads to subarachnoid haemorrhage and is preceded by chronic inflammation and atherosclerotic changes of the sIA wall....
Saccular intracranial aneurysm (sIA) rupture leads to subarachnoid haemorrhage and is preceded by chronic inflammation and atherosclerotic changes of the sIA wall. Increased lymphangiogenesis has been detected in atherosclerotic extracranial arteries and in abdominal aortic aneurysms, but the presence of lymphatic vessels in sIAs has remained unexplored. Here we studied the presence of lymphatic vessels in 36 intraoperatively resected sIAs (16 unruptured and 20 ruptured), using immunohistochemical and immunofluorescence stainings for lymphatic endothelial cell (LEC) markers. Of these LEC-markers, both extracellular and intracellular LYVE-1-, podoplanin-, VEGFR-3-, and Prox1-positive stainings were detected in 83%, 94%, 100%, and 72% of the 36 sIA walls, respectively. Lymphatic vessels were identified as ring-shaped structures positive for one or more of the LEC markers. Of the sIAs, 78% contained lymphatic vessels positive for at least one LEC marker. The presence of LECs and lymphatic vessels were associated with the number of CD68+ and CD163+ cells in the sIA walls, and with the expression of inflammation indicators such as serum amyloid A, myeloperoxidase, and cyclo-oxygenase 2, with the presence of a thrombus, and with the sIA wall rupture. Large areas of VEGFR-3 and α-smooth muscle actin (αSMA) double-positive cells were detected in medial parts of the sIA walls. Also, a few podoplanin and αSMA double-positive cells were discovered. In addition, LYVE-1 and CD68 double-positive cells were detected in the sIA walls and in the thrombus revealing that certain CD68+ macrophages are capable of expressing LEC markers. This study demonstrates for the first time the presence of lymphatic vessels in human sIA walls. Further studies are needed to understand the role of lymphatic vessels in the pathogenesis of sIA.
Topics: Aneurysm, Ruptured; Biomarkers; Humans; Inflammation; Intracranial Aneurysm; Lymphatic Vessels; Thrombosis; Vascular Endothelial Growth Factor Receptor-3
PubMed: 36064651
DOI: 10.1186/s40478-022-01430-8 -
AIDS (London, England) Jun 2022To study biomarkers of inflammation in cerebrovascular disease, exploring modifiable and non-modifiable biochemical and clinical risk factors associated with the...
OBJECTIVE
To study biomarkers of inflammation in cerebrovascular disease, exploring modifiable and non-modifiable biochemical and clinical risk factors associated with the presence of intracranial saccular aneurysms (ISAs) in an HIV-positive cohort.
DESIGN
A cross-sectional community-based study was used to study blood biomarkers of inflammation as predictors of cerebrovascular disease, specifically the presence of ISAs in persons with HIV. Potential biochemical and clinical predictors of ISA presence were identified.
METHODS
Time of flight magnetic resonance angiography and magnetic resonance imaging data identified the presence of ISAs in an HIV-positive cohort. Quantitative assays for neuroinflammatory biomarkers were performed on plasma blood samples. Lasso regression models were used to identify neuroinflammatory biomarkers and clinical risk factors associated with ISAs.
RESULTS
Eight of 72 participants had radiographically identified ISAs. ISAs were more common in non-Hispanic black participants (18.5% vs. 0% presence in nonblack patients). Participants with well controlled HIV (defined as CD4+ count >200 cells/ml and undetectable viral load at time of magnetic resonance imaging) had lower odds of ISAs (odds ratio: 0.19, 95% confidence interval 0.05-0.79) independent of age, sex, ethnicity and vascular risk factors. Macrophage inflammatory protein-1 p, an HIV- suppressive factor detected in participant blood samples, was inversely associated with aneurysm presence.
CONCLUSION
Well controlled HIV is associated with fewer ISAs. The identification of non-modifiable and modifiable risk factors contributing to ISA formation may provide valuable insight to impact clinical practice and inform the pathophysiology underlying ISA formation.
Topics: Biomarkers; Cross-Sectional Studies; HIV Infections; Humans; Inflammation; Intracranial Aneurysm
PubMed: 35184070
DOI: 10.1097/QAD.0000000000003202 -
AJNR. American Journal of Neuroradiology Feb 2014Does the world need another ICA classification scheme? We believe so. The purpose of proposed angiography-driven classification is to optimize description of the carotid... (Review)
Review
Does the world need another ICA classification scheme? We believe so. The purpose of proposed angiography-driven classification is to optimize description of the carotid artery from the endovascular perspective. A review of existing, predominantly surgically-driven classifications is performed, and a new scheme, based on the study of NYU aneurysm angiographic and cross-sectional databases is proposed. Seven segments - cervical, petrous, cavernous, paraophthlamic, posterior communicating, choroidal, and terminus - are named. This nomenclature recognizes intrinsic uncertainty in precise angiographic and cross-sectional localization of aneurysms adjacent to the dural rings, regarding all lesions distal to the cavernous segment as potentially intradural. Rather than subdividing various transitional, ophthalmic, and hypophyseal aneurysm subtypes, as necessitated by their varied surgical approaches and risks, the proposed classification emphasizes their common endovascular treatment features, while recognizing that many complex, trans-segmental, and fusiform aneurysms not readily classifiable into presently available, saccular aneurysm-driven schemes, are being increasingly addressed by endovascular means. We believe this classification may find utility in standardizing nomenclature for outcome tracking, treatment trials and physician communication.
Topics: Angiography; Carotid Artery Diseases; Carotid Artery, Internal; Humans; Intracranial Aneurysm; Radiography, Interventional; Terminology as Topic; United States
PubMed: 23928138
DOI: 10.3174/ajnr.A3666 -
Journal of Ultrasound Dec 2022Portal vein aneurysms are rare abnormal dilations of the portal vein and represent less than 3% of all visceral aneurysms. They may be congenital or acquired,... (Review)
Review
Portal vein aneurysms are rare abnormal dilations of the portal vein and represent less than 3% of all visceral aneurysms. They may be congenital or acquired, symptomatic or asymptomatic, complicated or uncomplicated. Portal vein aneurysms may be fusiform or saccular and this last one has a low prevalence. Due to the small number of cases reported in the medical literature and the lack of specific guidelines, the management and treatment of this condition is still undefined. In this review, we report a case of saccular portal vein aneurysm in a 73-year old man with liver cirrhosis and discuss all cases of portal vein aneurysms reported in literature.
Topics: Male; Humans; Aged; Portal Vein; Aneurysm; Liver Cirrhosis
PubMed: 35113392
DOI: 10.1007/s40477-022-00659-2 -
Journal of Neurointerventional Surgery Mar 2021To investigate in situ decellularization of a large animal model of saccular aneurysm as a strategy for achieving aneurysmal growth and lasting inflammation.
OBJECTIVE
To investigate in situ decellularization of a large animal model of saccular aneurysm as a strategy for achieving aneurysmal growth and lasting inflammation.
METHODS
18 New Zealand White rabbits were randomized 2:1 to receive endoluminal sodium dodecyl sulfate infusion (SDS, 1% solution, 45 min) following elastase or elastase-only treatment (control). All aneurysms were measured by digital subtraction angiography every 2 weeks. Every 2 weeks, three of the rabbits (two elastase + SDS, one control) underwent MRI, followed by contrast injection with myeloperoxidase (MPO)-sensing contrast agent. MRI was repeated 3 hours after contrast injection and the enhancement ratio (ER) was calculated. Following MRI, aneurysms were explanted and subjected to immunohistopathology.
RESULTS
During follow-up MRI, the average ER for SDS-treated animals was 1.63±0.20, compared with 1.01±0.06 for controls (p<0.001). The width of SDS-treated aneurysms increased significantly in comparison with the elastase aneurysms (47% vs 20%, p<0.001). Image analysis of thin sections showed infiltration of MPO-positive cells in decellularized aneurysms and surroundings through the 12-week observation period while control tissue had 5-6 times fewer cells present 2 weeks after aneurysm creation. Immunohistochemistry demonstrated the presence of MPO-positive cells surrounding decellularized lesions at early time points. MPO-positive cells were found in the adventitia and in the thrombi adherent to the aneurysm wall at later time points.
CONCLUSIONS
In situ decellularization of a large animal model of saccular aneurysms reproduces features of unstable aneurysms, such as chronic inflammation (up to 12 weeks) and active aneurysm wall remodeling, leading to continued growth over 8 weeks.
Topics: Aneurysm; Angiography, Digital Subtraction; Animals; Disease Models, Animal; Endothelium, Vascular; Female; Image Processing, Computer-Assisted; Inflammation; Magnetic Resonance Imaging; Male; Rabbits; Random Allocation; Vascular Remodeling
PubMed: 33020207
DOI: 10.1136/neurintsurg-2020-016589 -
Neurosciences (Riyadh, Saudi Arabia) Oct 2018Neuro-behcets disease (NBD) is an uncommon, serious presentation of behcets disease (BD) causing long-term morbidity and mortality. Cerebral aneurysms are rare in BD,...
Neuro-behcets disease (NBD) is an uncommon, serious presentation of behcets disease (BD) causing long-term morbidity and mortality. Cerebral aneurysms are rare in BD, with only a handful of cases reported worldwide. A 39-year-old female experienced slurring of speech, numbness, and reduced sensation in the left face, arm, and leg 90 minutes prior to presentation. She provided a history of recurrent oral and genital ulcers associated with intermittent joints pain and blurring of vision. erythrocyte sedimentation rate was elevated, but all other autoimmune workup was negative. Neuro-behcets disease was diagnosed. Brain magnetic resonance imaging demonstrated acute right periventricular infarction. Magnetic resonance angiogram revealed M1 segment stenosis and right internal carotid artery saccular aneurysm. Catheter angiography confirmed its presence measuring 4.8 mm X 6.1 mm. She was stabilized after coiling of the aneurysm and was started on medical therapy. Brain imaging should be carried out in young patients with BD presenting with an ischemic event, and intervention may be lifesaving.
Topics: Adult; Behcet Syndrome; Brain; Embolization, Therapeutic; Female; Humans; Intracranial Aneurysm; Magnetic Resonance Imaging
PubMed: 30351294
DOI: 10.17712/nsj.2018.4.20180280