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European Review For Medical and... May 2013Although Saccular intracranial aneurysm (sIA) is the most common type abnormality of all intracranial aneurysms, the biological mechanisms of sIA are not fully...
BACKGROUND
Although Saccular intracranial aneurysm (sIA) is the most common type abnormality of all intracranial aneurysms, the biological mechanisms of sIA are not fully understood.
METHODS
We downloaded microarray datasets from Gene Expression Omnibus (GEO) database which includes 11 ruptured intracranial aneurysm samples and 8 unruptured intracranial aneurysm samples. Significant Analysis of Microarray (SAM) was employed to identify the differentially expressed genes (DEGs) between ruptured and unruptured intracranial aneurysms.
RESULTS
We found 2129 genes differentially expressed in rupture sIA, of which 1062 genes up-regulated and 1057 genes down-regulated. Functional analysis demonstrated these genes were significantly associated with inflammatory response, wounding response and defense response. Protein-protein interaction (PPI) analysis revealed that these genes may play important roles in the pathogenesis of sIAs. Results suggested that four transcription factors (TFs) could cooperated with each other, together with several microRNAs play roles in the pathonegensis of ruptured sIAs.
CONCLUSIONS
All of above results indicate the existence of DEGs between ruptured and unruptured sIAs, which regulating the pathogenesis of ruptured sIAs. TFs and microRNAs may also play key roles in ruptured sIAs. This research hints a new thought to the therapy of ruptured sIAs.
Topics: Aneurysm, Ruptured; Gene Expression Profiling; Humans; Intracranial Aneurysm; MicroRNAs; Protein Interaction Maps; Transcription Factors
PubMed: 23740452
DOI: No ID Found -
Neurology India 2019Aneurysms arising from the proximal segment (A1) of the anterior cerebral artery (ACA) are relatively rare. Because of their small size, abnormal location in relation to...
BACKGROUND
Aneurysms arising from the proximal segment (A1) of the anterior cerebral artery (ACA) are relatively rare. Because of their small size, abnormal location in relation to the parent artery and the risk of damage to the surrounding perforators, their surgical management is a big challenge. We present our experience with 7 patients of A1 segment aneurysms.
SETTINGS AND DESIGN
Tertiary care referral center.
MATERIALS AND METHODS
Seven patients who were diagnosed with A1 aneurysms between 2009 and 2017 were included. Preoperative evaluation included Non-Contrast Computed Tomography (NCCT) head and angiography (Digital Subtraction Angiography with/without CT-Angiography). The clinicoradiological condition of the patients was graded as per World Federation of Neurological Surgeons (WFNS), Fisher and Hunt and Hess (H and H) Grading systems. A retrospective review of clinical features, radiological descriptions, surgical treatment, and outcomes was done.
RESULTS
All patients underwent microneurosurgical clipping. All aneurysms were saccular, ranging in size from 4 to 14 mm and neck size varied from 2 to10 mm. Most aneurysms 5 (71.4%) had a posterior direction. Anatomical variations were noticed in 3 (42.8%) patients. Posteroinferiorly directed aneurysms were difficult to clip. As per Glasgow Outcome scale (GOS), 6 (85.7%) patients had a good outcome, whereas 1 (14.2%) had poor outcome. As per the modified Rankin Scale (mRS) too, 6 (85.7%) had a favorable outcome. There were no deaths.
CONCLUSION
A1 aneurysms are frequently associated with vascular anomalies and generally rupture when small. A1 aneurysms with a superior and anterior direction are relatively easy to clip whereas those directed postero-inferiorly are difficult. Close association with critical perforators also compounds the situation. Due to the rarity of A1 aneurysms, large series are few in literature.
Topics: Adult; Aged; Aneurysm, Ruptured; Anterior Cerebral Artery; Female; Humans; Intracranial Aneurysm; Male; Microsurgery; Middle Aged; Neurosurgical Procedures; Surgical Instruments; Treatment Outcome
PubMed: 31744954
DOI: 10.4103/0028-3886.271266 -
Journal of the Neurological Sciences Mar 2021In management decisions on saccular unruptured intracranial aneurysms (UIAs) the risk of rupture is an important factor. The PHASES score, introduced in 2014, provides...
BACKGROUND
In management decisions on saccular unruptured intracranial aneurysms (UIAs) the risk of rupture is an important factor. The PHASES score, introduced in 2014, provides absolute 5-year risks of rupture based on six easily retrievable patient and aneurysm characteristics. We assessed whether management decisions on UIAs changed after implementation of the PHASES score.
PATIENT AND METHODS
We included all patients with UIAs who were referred to two Dutch tertiary referral centers for aneurysm care in the Netherlands (University Medical Center Utrecht (UMCU) and Leiden University Medical Center (LUMC)) between 2011 and 2017. Analyses were done on an aneurysm level. We calculated the overall proportion of UIAs with a decision to treat before and after PHASES implementation and studied the influence of age and center on post-implementation management changes.
RESULTS
We included 623 patients with 803 UIAs. The proportion of UIAs with a decision to treat was 123/360 (34.2%) before and 117/443 (26.4%) after PHASES implementation (absolute risk difference: -7.8%; 95% CI: -14.1 to -1.4). The decision to treat was made at a higher median PHASES score after implementation (7 points (IQR 5;10) pre- versus 8 points (IQR 5;10) post-implementation; p = 0.14). The reduced proportion with a treatment decision after implementation was most pronounced in patients <50 years (-22.3%; 95% CI: -39.2 to -3.4) and was restricted to treatment decisions made at the UMCU (-10.6%; 95% CI: -18.5 to -2.5).
DISCUSSION AND CONCLUSIONS
Management of UIAs changed following implementation of the PHASES score, but the impact of PHASES implementation on treatment decisions differed across age subgroups and centers.
Topics: Humans; Intracranial Aneurysm; Netherlands
PubMed: 33524781
DOI: 10.1016/j.jns.2021.117319 -
European Journal of Vascular and... Jun 2022The aim was to report short and midterm outcomes of a cohort of consecutive patients treated by endovascular aortic repair (EVAR) for saccular lesion of the abdominal... (Observational Study)
Observational Study
OBJECTIVE
The aim was to report short and midterm outcomes of a cohort of consecutive patients treated by endovascular aortic repair (EVAR) for saccular lesion of the abdominal aorta (sl-AA).
METHODS
This was a multicentre, retrospective, financially unsupported physician initiated, observational cohort study that involved tertiary referral from Italian hospitals. For this study, between January 2010 and December 2020, only those patients treated by EVAR for non-infected sl-AA, namely blister/ulcer like projection and/or penetrating aortic ulcer, were analysed. Primary outcomes of interest were overall survival and freedom from aorta related mortality (ARM).
RESULTS
The final cohort included 120 of 3 982 eligible aortic lesions. There were 103 (85.8%) males and 17 (14.2%) females. The median age was 76 years (interquartile range [IQR] 69, 80). Rupture on admission was observed in 10 (8.3%) cases. Early (≤ 30 days) death occurred in two (1.7%) patients. There were five (4.2%) complications requiring surgical re-intervention (iliac limb occlusion n = 4; groin haematoma, n = 1). The median duration of follow up was 20 months (IQR 4, 59.5): the estimated overall survival was 85.5% (standard error [SE] 0.035; 95% confidence interval [CI] 77.3 - 91.1) at 12 months, 78.7% (SE 0.044; 95% CI 69.0 - 86.0) at 36 months, and 74% (SE 0.050; 95% CI 63.2 - 82.5) at 60 months. Only one (0.8%) patient required aortic re-intervention during follow up because of a late endograft infection. The estimated freedom from ARM was 96% (SE 0.050; 95% CI 90.3 - 98.2) at 36 and 60 months. Cox's regression analysis identified that death was associated with age > 70 years (hazard ratio [HR] 1.10; 95% CI 1.04 - 1.17, p = .001), and coronary artery disease (HR 1.14; 95% CI 1.04 - 1.26, p = .006).
CONCLUSION
EVAR for sl-AA proved to be safe and effective. The mortality rate was low for a group of patients known to be at high risk from open repair, and EVAR remained stable with no ARM during midterm follow up, and an acceptably low 0.8% endograft related re-intervention rate.
Topics: Aged; Aorta, Abdominal; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Humans; Male; Retrospective Studies; Risk Factors; Treatment Outcome; Ulcer
PubMed: 35654637
DOI: 10.1016/j.ejvs.2022.03.004 -
AJNR. American Journal of Neuroradiology Jan 2017Saccular intracranial aneurysm is a common disease that may cause devastating intracranial hemorrhage. Hemodynamics, wall remodeling, and wall inflammation have been...
BACKGROUND AND PURPOSE
Saccular intracranial aneurysm is a common disease that may cause devastating intracranial hemorrhage. Hemodynamics, wall remodeling, and wall inflammation have been associated with saccular intracranial aneurysm rupture. We investigated how saccular intracranial aneurysm hemodynamics is associated with wall remodeling and inflammation of the saccular intracranial aneurysm wall.
MATERIALS AND METHODS
Tissue samples resected during a saccular intracranial aneurysm operation (11 unruptured, 9 ruptured) were studied with histology and immunohistochemistry. Patient-specific computational models of hemodynamics were created from preoperative CT angiographies.
RESULTS
More stable and less complex flows were associated with thick, hyperplastic saccular intracranial aneurysm walls, while slower flows with more diffuse inflow were associated with degenerated and decellularized saccular intracranial aneurysm walls. Wall degeneration (P = .041) and rupture were associated with increased inflammation (CD45+, P = .031). High wall shear stress (P = .018), higher vorticity (P = .046), higher viscous dissipation (P = .046), and high shear rate (P = .046) were associated with increased inflammation. Inflammation was also associated with lack of an intact endothelium (P = .034) and the presence of organized luminal thrombosis (P = .018), though overall organized thrombosis was associated with low minimum wall shear stress (P = .034) and not with the flow conditions associated with inflammation.
CONCLUSIONS
Flow conditions in the saccular intracranial aneurysm are associated with wall remodeling. Inflammation, which is associated with degenerative wall remodeling and rupture, is related to high flow activity, including elevated wall shear stress. Endothelial injury may be a mechanism by which flow induces inflammation in the saccular intracranial aneurysm wall. Hemodynamic simulations might prove useful in identifying saccular intracranial aneurysms at risk of developing inflammation, a potential biomarker for rupture.
Topics: Aneurysm, Ruptured; Hemodynamics; Humans; Immunohistochemistry; Inflammation; Intracranial Aneurysm; Stress, Mechanical; Vascular Remodeling
PubMed: 27686488
DOI: 10.3174/ajnr.A4951 -
A comparison of subjective clinical and objective judgement of abdominal aortic aneurysm morphology.International Angiology : a Journal of... Apr 2021We compared the subjective, clinical judgement of "saccular" morphology with the objective judgement of mechanical structural analysis.
BACKGROUND
We compared the subjective, clinical judgement of "saccular" morphology with the objective judgement of mechanical structural analysis.
METHODS
Using structural analysis with the finite element method, we previously created a simple model of abdominal aortic aneurysm (AAA) that visualized the distribution of the maximum principal stress (MPS) in the aortic wall and identified the area of prominent stress. AAA "saccular" morphology was determined according to the area showing MPS>0.03 MPa. AAAs with low aspect ratio (horizontally long AAA sac) and small fillet radius were defined as "saccular." Twelve vascular surgeons were recruited. First, they judged the AAA as saccular or fusiform with 3-dimensional images at their clinical impression (subjective "eyeball" judgement). Second, they applied the deformable figure tools on the simple AAA-shaped sagittal view in the application model for 30 AAA cases. From the data of the tools applied, the mechanical structural analysis was performed semi-automatically and the morphology was judged with the objective "simple application."
RESULTS
The structural analysis revealed that only one case was judged as saccular by 11 out of 12 surgeons and the other 29 AAAs were judged as fusiform by two-thirds or more of the surgeons. In contrast, 5 cases were subjectively judged as saccular by eight and more of the surgeons.
CONCLUSIONS
The clinical judgement of AAA saccular morphology by the vascular surgeons was different from the judgement derived from the mechanical structural analysis using the application model. The saccular morphology may be theoretically rare in AAAs.
Topics: Aortic Aneurysm, Abdominal; Aortic Rupture; Humans; Risk Assessment; Stress, Mechanical; Tomography, X-Ray Computed
PubMed: 33463976
DOI: 10.23736/S0392-9590.21.04591-0 -
Journal of Neurointerventional Surgery May 2017Non-saccular aneurysms of the posterior fossa are an uncommon pathology with no clear treatment strategy. The use of flow-diverting stents (FDS) has had mixed results.... (Review)
Review
BACKGROUND AND PURPOSE
Non-saccular aneurysms of the posterior fossa are an uncommon pathology with no clear treatment strategy. The use of flow-diverting stents (FDS) has had mixed results. We sought to evaluate our experience of FDS for the treatment of this pathology.
METHODS
We retrospectively reviewed our database of prospectively collected information for all patients treated only with flow diversion for an unruptured non-saccular aneurysm of the posterior circulation between February 2009 and April 2016. The aneurysms were classified as dolichoectasia, fusiform or transitional, and imaging characteristics including maximal diameter, disease vessel segment, MRI features (intra-aneurysmal thrombus, T1 hyperintensity in the aneurysmal wall, infarctions in the territory of the posterior circulation, and mass effect) were recorded alongside clinical and follow-up data.
RESULTS
We identified 56 patients (45 men) with 58 aneurysms. The average age of the patients was 63.5 years. Twenty-two patients were symptomatic from the aneurysms at presentation. The majority of the lesions were vertebrobasilar in location (44.8%) with isolated vertebral lesions representing 29.3% of aneurysms. Transitional aneurysms were the most common (48.2%). The mean maximal diameter of the aneurysms was 11 mm. Angiographic exclusion of the aneurysms was seen in 57.4% of aneurysms with follow-up (n=47). During the follow-up period nine patients died.
CONCLUSIONS
Treatment of non-saccular aneurysms of the posterior fossa is technically possible. Early treatment, particularly of the fusiform and transitional subtypes, is recognized, as is treatment prior to the development of symptoms. A 'watch and wait' strategy with regular imaging follow-up could be employed for asymptomatic dolichoectasia.
Topics: Aged; Aged, 80 and over; Angiography; Embolization, Therapeutic; Endovascular Procedures; Female; Follow-Up Studies; Humans; Intracranial Aneurysm; Magnetic Resonance Imaging; Male; Middle Aged; Prospective Studies; Retrospective Studies; Stents; Treatment Outcome
PubMed: 27836994
DOI: 10.1136/neurintsurg-2016-012781 -
World Neurosurgery Aug 2022Methamphetamine (MA) use is associated with poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). MA exerts both hemodynamic and inflammatory effects, but...
BACKGROUND
Methamphetamine (MA) use is associated with poor outcomes after aneurysmal subarachnoid hemorrhage (aSAH). MA exerts both hemodynamic and inflammatory effects, but whether these manifest with altered intracranial aneurysm (IA) remodeling is unknown. The objective of this study was to compare IA geometric and morphologic features in patients with and without MA detected on urine toxicology (Utox) at presentation.
METHODS
We retrospectively reviewed 160 consecutive patients with SAH and Utox at time of admission. Geometric-morphologic IA characteristics were assessed by blinded neuroradiologists. Studied features were maximum sac diameter, location, size, ellipsoid volume, aspect ratio, size ratio, volume: neck ratio, dome: neck ratio, bottleneck factor, morphology (saccular, fusiform/dissecting, blister, mycotic), and presence of bleb, vasculopathy, or additional unruptured IA.
RESULTS
Of 139/160 patients with aSAH, 23/139 (16.5%) were Utox MA+. There was no difference in aneurysm subtype frequency, presence of bleb, vasculopathy, or presence of an additional (unruptured) aneurysm with a trend toward posterior circulation location and higher Hunt and Hess grade (P = 0.09 for both) in the MA+ group. Maximum IA sac diameter, ellipsoid volume, dome-neck ratio, and size ratio were similar between groups. Only the aspect ratio (AR) differed between groups (MA+ = 2.20 vs. MA- = 1.74, P = 0.02). The AR remained a significant predictor of Utox MA+ in a multiple logistic regression analysis (odds ratio 1.87, 95% confidence interval 1.06-3.39).
CONCLUSIONS
Active use of methamphetamine is independently associated with larger AR in patients with ruptured IA. This may indicate hazardous remodeling due to hemodynamic and/or inflammatory changes.
Topics: Humans; Aneurysm, Ruptured; Intracranial Aneurysm; Methamphetamine; Retrospective Studies; Subarachnoid Hemorrhage
PubMed: 35552027
DOI: 10.1016/j.wneu.2022.05.006 -
Surgical exclusion of an idiopathic saccular aneurysm in the left main trunk of the coronary artery.Surgery Today Sep 2021A coronary artery aneurysm (CAA) can result in critical cardiac events such as thromboembolic complications or rupture. A saccular CAA located in the left main trunk...
PURPOSE
A coronary artery aneurysm (CAA) can result in critical cardiac events such as thromboembolic complications or rupture. A saccular CAA located in the left main trunk (LMT) is the most critical form of this pathology and its surgical repair is challenging. We conducted this single-center study to review the surgical outcomes of patients with a saccular CAA in the LMT.
METHODS
Between May, 2012 and June, 2020, five patients with a saccular CAA in the LMT underwent surgery at our center. The median age at operation was 66.5 (59.7-69) years and the median diameter of the CAA was 13.0 mm (IQR 11-14 mm).
RESULTS
The CAA was fully excluded by patch closure of the LMT orifice and direct closure of the distal LMT, supplemented by coronary artery bypass grafting with the exclusive use of arterial conduits. There was no in-hospital mortality, although one patient suffered graft spasm-related myocardial infarction with complete recovery. Post-operative angiography showed a fully excluded LMT in all patients. There was no mortality or adverse cardiac events during follow-up.
CONCLUSIONS
Our surgical policy for CAA in the LMT is feasible and safe; however, coronary blood flow is dependent on reliable bypasses.
Topics: Aged; Computed Tomography Angiography; Coronary Aneurysm; Coronary Angiography; Coronary Artery Bypass; Coronary Vessels; Feasibility Studies; Female; Follow-Up Studies; Humans; Male; Middle Aged; Safety; Treatment Outcome
PubMed: 33606095
DOI: 10.1007/s00595-021-02246-0 -
Stroke and Vascular Neurology Aug 2022The aim of this study was to compare complications and outcomes between intracranial aneurysms treated with the Pipeline embolisation device (PED) alone or with PED...
OBJECTIVES
The aim of this study was to compare complications and outcomes between intracranial aneurysms treated with the Pipeline embolisation device (PED) alone or with PED combined with coiling for different-sized aneurysms.
METHOD
Patients with aneurysms treated by PED were collected from the PED in China postmarket multicentre registry study. We performed a propensity match analysis to compare the efficacy and safety between PED alone and PED combined with coiling treatment, and then aneurysms were organised into three groups based on their size: small (≤7 mm), medium (≤15 mm to >7 mm) and large/giant (>15 mm). Complications and aneurysm occlusion rates in the aneurysm size groups were compared between PED alone and PED combined with coiling patients.
RESULT
A total of 1171 patients with 1322 aneurysms were included. All patients received clinical follow-up, while angiographic follow-up was available in 967 aneurysms. For small aneurysms, there was no difference in the aneurysm occlusion rate between two groups (79.1% vs 88.4%, respectively), while there was a significant increase in the ischaemic complication rate (8.3% vs 19.3%, respectively, p=0.0001). For medium and large/giant saccular aneurysms, PED combined with coiling significantly improved the occlusion rate (medium aneurysms: 74.7% vs 88.8%, respectively, p<0.0001; large/giant saccular aneurysms: 72.9% vs 86.9%, respectively, p=0.018), while there were no differences in the total complication rate. For large/giant non-saccular aneurysms, two groups showed no differences.
CONCLUSION
Use of the PED with adjunctive coils can significantly improve the occlusion rate of medium aneurysms, without increasing the total complication rate.
Topics: Embolization, Therapeutic; Humans; Intracranial Aneurysm; Retrospective Studies; Stents; Treatment Outcome
PubMed: 35387893
DOI: 10.1136/svn-2021-001258