The Importance of Proliferation of the Arterial Wall in Formation of Saccular Cerebral Aneurysms

2008 ◽  
Author(s):  
Y. Shimogonya ◽  
T. Ishikawa ◽  
Y. Imai ◽  
D. Mori ◽  
T. Yamaguchi
Keyword(s):  
Cerebral Aneurysm ◽  
Poor Prognosis ◽  
Arterial Wall ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Preventative Treatment ◽  
Unruptured Aneurysms ◽  
Unruptured Cerebral Aneurysm ◽  
Risk Of Rupture ◽  
Annual Risk

Cerebral aneurysms are an important cerebrovascular condition because aneurysm rupture is the most common cause of subarachnoid hemorrhage, which has a high mortality rate and a poor prognosis. Since the mechanism of cerebral aneurysm pathogenesis has not yet been understood, the preventative treatment for unruptured aneurysms is surgery only; however, the morbidity of the surgery is as high as over 10% [1]. On the other hand, the annual risk of rupture of cerebral aneurysms is not so high, reported to be 1.9% [2]. Consequently, it is difficult to judge whether a patient with an unruptured cerebral aneurysm should undergo surgery, when it is detected. Thus, it is important to develop a better understanding of the mechanism of cerebral aneurysm pathogenesis.

Size is the Most Important Predictor of Aneurysm Rupture Among Multiple Cerebral Aneurysms: Post Hoc Subgroup Analysis of Unruptured Cerebral Aneurysm Study Japan

Neurosurgery ◽  
2017 ◽  
Vol 82 (6) ◽  
pp. 864-869 ◽  
Author(s):  
Masaaki Shojima ◽  
Akio Morita ◽  
Hirofumi Nakatomi ◽  
Shinjiro Tominari
Keyword(s):  
Cerebral Aneurysm ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Ruptured Aneurysm ◽  
Clinical Value ◽  
Total Cohort ◽  
Unruptured Cerebral Aneurysm ◽  
Specific Factors ◽  
Unruptured Cerebral Aneurysms ◽  
Post Hoc

Abstract BACKGROUND Multiple cerebral aneurysms are encountered in approximately 15% to 35% of patients harboring unruptured cerebral aneurysms. It would be of clinical value to determine which of them is most likely to rupture. OBJECTIVE To characterize features of the ruptured aneurysm relative to other concomitant fellow aneurysms in patients with multiple cerebral aneurysms. METHODS From a total of 5720 patients who were prospectively registered in the Unruptured Cerebral Aneurysm Study in Japan, a subgroup of patients with multiple cerebral aneurysms who developed subarachnoid hemorrhage was extracted for this post hoc analysis. Intrapatient comparisons of each aneurysm were carried out using aneurysm-specific factors such as size, location, and shape to identify predictors of rupture among the fellow aneurysms in a patient with multiple cerebral aneurysms. RESULTS Twenty-five patients with 62 aneurysms were identified from the total cohort of 5720 patients. With the distinctiveness in size, which means the aneurysm was the single largest among the multiple aneurysms, the ruptured aneurysm in each case was discriminated from the other coexisting aneurysms with a sensitivity of 0.76 and specificity of 0.86. CONCLUSION Our results suggest that the largest aneurysm is likely to rupture among coexisting aneurysms in a patient with multiple cerebral aneurysms.

Abstract 2731: CFD Reveals Hemodynamic Differences Between Unruptured And Ruptured Intracranial Aneurysms During Observation

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Hiroyuki Takao ◽  
Yuichi Murayama ◽  
Toshihiro Ishibashi ◽  
Ichiro Yuki ◽  
Shinobu Otsuka ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Significant Risk ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Medium Size ◽  
Hemodynamic Parameters ◽  
Natural Risk ◽  
Risk Of Rupture ◽  
Significant Difference

Background and Purpose: Although various studies have been performed, the mechanism leading to the rupture of cerebral aneurysms has not yet been elucidated. Accurate assessment of cerebral aneurysm rupture risk is important because current treatments carry a small but significant risk that can exceed the small natural risk of rupture. Various hemodynamic parameters have been proposed for estimating the risk of rupture of cerebral aneurysms, with limited success. We evaluated several hemodynamic parameters to predict rupture in a dataset of initially unruptured aneurysms in which some aneurysms ruptured during follow-up observation. Methods: Geometry of the aneurysm and blood vessels was extracted from CTA images and analyzed using a mathematical formula for fluid flow under pulsatile blood flow conditions. Fifty side-wall internal carotid posterior communicating artery (ICA-pcom) aneurysms and fifty middle cerebral artery (MCA) bifurcation aneurysms of medium size were investigated for Energy loss (EL), Pressure Loss Coefficient (PLC), wall-shear-stress (WSS) and oscillatory shear index (OSI). During a follow-up observation period, 6 ICA-pcom and 7 MCA aneurysms ruptured (44 and 43 remained unruptured, respectively, with the same location and a similar size as the ruptured cases). Results: A significant difference in the minimum WSS between aneurysms that ruptured and those that remained unruptured was noted only in ICA aneurysms (P<0.001). EL showed higher tendency in ruptured aneurysms but statistically not significant. For PLC, a significant difference was noted in both ICA (P<0.001) and MCA (P<0.001) aneurysms. All other parameters did not show significant differences between the two groups. Conclusion: A significant difference was noted in WSSMIN only in ICA aneurysms. For PLC, a significant difference was noted in both ICA and MCA aneurysms, suggesting that PLC may be one, out of possibly other useful parameters to predict cerebral aneurysm rupture.

Hemodynamics of Ruptured and Unruptured Cerebral Aneurysms

2010 ◽  
Author(s):  
Juan Cebral ◽  
Fernando Mut ◽  
Christopher Putman
Keyword(s):  
Computational Models ◽  
Population Sample ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Rupture Risk ◽  
Natural Risk ◽  
Unruptured Aneurysms ◽  
Endovascular Interventions ◽  
Hemodynamic Variables ◽  
Risk Of Rupture

Because the prognosis of subarachnoid hemorrhage due to the rupture of a cerebral aneurysm is very poor, preventive surgery or endovascular interventions are performed on most aneurysms. However, the risk of the interventions can outweigh the natural risk of rupture of unruptured aneurysms. Therefore, it would be highly beneficial if the risk of rupture of cerebral aneurysms could be reliably determined in order to treat only those aneurysms at higher risk. Current assessment of aneurysm rupture risk is based on geometric parameters such as size and aspect ratio. But, it is known that small aneurysms also rupture. Previous studies have suggested the use of computational models to identify hemodynamic characteristics that could be used to better assess the rupture risk of cerebral aneurysms [1]. The current study extends these previous analyses to a larger population sample and quantitative hemodynamic variables.

scholarly journals Peri-Procedural Morbidity and Mortality Associated with Stent-Assisted Coiling for Intracranial Aneurysms

2013 ◽  
Vol 19 (1) ◽  
pp. 43-48 ◽  
Author(s):  
K. Wang ◽  
Y. Sun ◽  
A-M. Li
Keyword(s):  
Intracranial Aneurysms ◽  
Cerebral Aneurysms ◽  
Mortality Rates ◽  
Stent Migration ◽  
Aneurysm Rupture ◽  
Morbidity And Mortality ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Attractive Option ◽  
Technological Improvements

Despite experience and technological improvements, stent-assisted coiling for intracranial aneurysms still has inherent risks. We evaluated peri-procedural morbidity and mortality associated with stent-assisted coiling for intracranial aneurysms. Patients with cerebral aneurysms that were broad-based (>4 mm) or had unfavorable dome/neck ratios (<1.5) were enrolled in this study between February and November 2011 at our center. Aneurysms were treated with the self-expanding neurovascular stents with adjunctive coil embolization. Seventy-two consecutive patients (27 men and 45 women; 22–78 years of age; mean age, 52.8 years) underwent 13 procedures for 13 ruptured aneurysms and 64 procedures for 73 unruptured aneurysms. Nine [11.7%, 95% CI(4.5%–18.9%)] procedure-related complications occurred: one and eight with initial embolization of ruptured and unruptured aneurysms, respectively. Complications included six acute in-stent thromboses, one spontaneous stent migration, one post-procedural aneurysm rupture, and one perforator occlusion. Three complications had no neurologic consequences. Two caused transient neurologic morbidity, two persistent neurologic morbidity, and two death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 5.2% (95%CI, 0.2%–10.2%) and 2.6% (95%CI, 0%–6.2%); ruptured aneurysms, 7.7% (95%CI, 0%–36%) and 0% (95%CI, 0%–25%); unruptured aneurysms, 4.7% (95%CI, 0%–9.9%) and 3.1% (95%CI, 0%–7.3%). Combined procedure-related morbidity and mortality rates for ruptured and unruptured aneurysms were 7.7% (95%CI, 1.7%–13.7%) and 7.8% (95%CI, 1.8%–13.8%), respectively. Stent-assisted coiling is an attractive option for intracranial aneurysms. However, stent-assisted coiling for unruptured aneurysms is controversial for its comparable risk to natural history.

scholarly journals Risk Factors for Cerebral Aneurysm Rupture in Mongolia

2021 ◽  
Author(s):  
Matthias Bechstein ◽  
Amarjargal Gansukh ◽  
Boldbat Regzengombo ◽  
Oyun Byambajav ◽  
Lukas Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical History ◽  
Cerebral Aneurysm ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Imaging Modality ◽  
Treatment Options ◽  
Time Estimation ◽  
Developed Countries ◽  
Aneurysm Rupture ◽  
Risk Of Rupture

Abstract Purpose Identification of country-specific demographic, medical, lifestyle, and geoenvironmental risk factors for cerebral aneurysm rupture in the developing Asian country of Mongolia. First-time estimation of the crude national incidence of aneurysmal subarachnoid hemorrhage (aSAH). Methods A retrospective analysis of all intracranial digital subtraction angiographies (DSA) acquired in Mongolia during the 2‑year period 2016–2017 (1714 examinations) was performed. During this period, DSA was used as primary diagnostic imaging modality for acute severe neurological symptoms in the sole hospital nationwide dedicated to neurological patients. The catchment area of the hospital included the whole country. Patients with incidental and ruptured aneurysms were reviewed with respect to their medical history and living conditions. The data was used to install a Mongolian aneurysm registry. Results The estimated annual crude incidence of cerebral aneurysm rupture was 6.71 for the country of Mongolia and 14.53 per 100,000 persons for the capital region of Ulaanbaatar. Risk factors common in developed countries also applied for the Mongolian population: A medical history of hypertension, smoking or the presence of multiple aneurysms led to a higher relative risk of rupture. In contrast, female gender was not associated with a higher risk in this national cohort. Males pursuing a traditional nomadic living may exhibit a specifically high risk of rupture. Conclusion Disease management of over 200 individuals/year with aSAH constitutes a socioeconomic burden in Mongolia. Efforts to raise awareness of the risk factors hypertension and smoking among the Mongolian population are desirable. Measures to improve the nationwide availability of modern neurovascular treatment options are currently under consideration.

Abstract 107: Early Change in Ferumoxytol-Enhanced Magnetic Resonance Imaging Signal Suggests Unstable Human Cerebral Aneurysm. A Pilot Study

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
David M Hasan ◽  
donald hesitad
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Cerebral Aneurysm ◽  
Cerebral Aneurysms ◽  
Resonance Imaging ◽  
Unruptured Aneurysms ◽  
Ruptured Aneurysms ◽  
Cyclooxygenase 1 ◽  
Signal Changes ◽  
Cox 2

Background: Imaging with magnetic resonance imaging (MRI) 72 hours after infusion of ferumoxytol demonstrated maximal uptake by macrophages in the wall of human cerebral aneurysms. The clinical significance of early (i.e. within the first 24 hours) uptake of ferumoxytol by macrophages in the wall of human cerebral aneurysms is not clear. The purpose of this study was to determine whether early uptake of ferumoxytol which may indicate inflammation, suggests unstable cerebral aneurysm. Methods: 30 unruptured aneurysms in 22 patients were imaged with MRI 24 hours after infusion of ferumoxytol. Eighteen aneurysms were also imaged 72 hours after infusion of ferumoxytol. Aneurysm dome tissue was collected from four patients with early MRI signal changes, five patients with late signal changes, and five other patients with ruptured aneurysms. The tissue was immunostained for expression of cyclooxygenase-1 (COX-1), cyclooxygenase-2 (COX-2), microsomal-prostaglandin-E2 synthase-1 (mPGES-1) and macrophages. Findings: In 23% (7/30) of aneurysms, there was pronounced early uptake of ferumoxytol. Four aneurysms were clipped. The remaining three aneurysms which were managed conservatively with observation, all ruptured within six months. In 89% (16/18) of aneurysms, there was pronounced uptake of ferumoxytol at 72 hours. Nine aneurysms were surgically clipped and nine were managed conservatively; none ruptured or increased in size in six months. With immunostaining, expression of COX-2, mPGES-1, and macrophages was similar in unruptured aneurysms with early uptake of ferumoxytol and ruptured aneurysms. Expression of these inflammatory molecules was significantly higher in aneurysms with early uptake of ferumoxytol than in aneurysms with late uptake. Interpretation: Uptake of ferumoxytol in aneurysm walls within the first 24 hours strongly suggests aneurysm instability and probability of rupture within six months, and may warrant intervention. Larger clinical studies are indicated to validate this preliminary observation.

scholarly journals In vivo cerebral aneurysm models

2019 ◽  
Vol 47 (1) ◽  
pp. E20 ◽  
Author(s):  
John W. Thompson ◽  
Omar Elwardany ◽  
David J. McCarthy ◽  
Dallas L. Sheinberg ◽  
Carlos M. Alvarez ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Surgical Techniques ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Large Animal ◽  
Pharmacological Interventions ◽  
Large Animal Models ◽  
First Line Therapy ◽  
Endovascular Devices

Cerebral aneurysm rupture is a devastating event resulting in subarachnoid hemorrhage and is associated with significant morbidity and death. Up to 50% of individuals do not survive aneurysm rupture, with the majority of survivors suffering some degree of neurological deficit. Therefore, prior to aneurysm rupture, a large number of diagnosed patients are treated either microsurgically via clipping or endovascularly to prevent aneurysm filling. With the advancement of endovascular surgical techniques and devices, endovascular treatment of cerebral aneurysms is becoming the first-line therapy at many hospitals. Despite this fact, a large number of endovascularly treated patients will have aneurysm recanalization and progression and will require retreatment. The lack of approved pharmacological interventions for cerebral aneurysms and the need for retreatment have led to a growing interest in understanding the molecular, cellular, and physiological determinants of cerebral aneurysm pathogenesis, maturation, and rupture. To this end, the use of animal cerebral aneurysm models has contributed significantly to our current understanding of cerebral aneurysm biology and to the development of and training in endovascular devices. This review summarizes the small and large animal models of cerebral aneurysm that are being used to explore the pathophysiology of cerebral aneurysms, as well as the development of novel endovascular devices for aneurysm treatment.

scholarly journals Association between Circle of Willis Configuration and Rupture of Cerebral Aneurysms

Medicina ◽  
2019 ◽  
Vol 55 (7) ◽  
pp. 338
Author(s):  
Stojanović ◽  
Kostić ◽  
Mitić ◽  
Berilažić ◽  
Radisavljević
Keyword(s):  
Cerebral Aneurysm ◽  
Intracranial Hemorrhage ◽  
Lower Incidence ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Circle Of Willis ◽  
Type B ◽  
Brain Aneurysms

Background and Objectives: Intracranial hemorrhage caused by the rupture of brain aneurysms occurs in almost 10 per 100,000 people whereas the incidence of such aneurysms is significantly higher, accounting for 4–9%.Linking certain factors to cerebral aneurysm rupture could help in explaining the significantly lower incidence of their rupture compared to their presence. The aim of this study is to determine the association between the corresponding circle of Willis configurations and rupture of cerebral aneurysms. Materials and Methods: A group of 114 patients treated operatively for aruptured cerebral aneurysm and a group of 56 autopsied subjects were involved in the study. Four basic types of the circle of Willis configurations were formed—two symmetric types A and C, and two asymmetric types B and D. Results: A statistically significantly higher presence of asymmetry of the circle of Willis was determined in the group of surgically-treated subjects (p = 0.001),witha significant presence of asymmetric Type B in this group (p < 0.001). The changeson the A1 segment in the group of surgically-treated subjects showed a statistically significant presence compared to the group of autopsied subjects (p = 0.001). Analyzing the presence of symmetry of the circle of Willis between the two groups, that is, the total presence of symmetric types A and C, indicated their statistically significant presence in the group of autopsied patients (p < 0.001). Conclusions: Changes such as hypoplasia or aplasia of A1 and the resulting asymmetry of the circle of Willis directly affect the possibility of the rupture of cerebral aneurysms. Detection of the corresponding types of the circle of Willis after diagnostic examination can be the basis for the development of a protocol for monitoring such patients.

scholarly journals Influence of the Perianeurysmal Environment on Rupture of Cerebral Aneurysms Preliminary Observation

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 65-70 ◽  
Author(s):  
K. Sugiu ◽  
B. Jean ◽  
D. San Millan Ruiz ◽  
J-B. Martin ◽  
J. Delavelle ◽  
...  
Keyword(s):  
Direct Contact ◽  
Cranial Nerves ◽  
Cerebral Aneurysms ◽  
Average Diameter ◽  
Unruptured Aneurysms ◽  
Aneurysm Size ◽  
Risk Of Rupture ◽  
Significant Difference ◽  
Arteries And Veins ◽  
Aneurysm Shape

We evaluate the perianeurysmal environment and study parameters potentially influencing rupture of cerebral aneurysms. 101 consecutive aneurysm cases were retrospectively evaluated using radiological observation including imaging documents such as MR, CT and DSA studies. Aneurysm contact with perianeurysmal environment was classified and correlated with aneurysm shape, size, location and likely rupture point. Topographic relation of the aneurysm to the cisternal compartment was studied. Presence of contact with the surrounding structures was evaluated for bone, dura, brain, cranial nerves, arteries, and veins. The aneurysm shape and likely rupture point was found to be significantly influenced by the aneurysm environment. Depending on aneurysm type, location and size, the growth pattern also exhibited signs of interaction with the environment. Overall, there was no significant difference in the largest average diameter of the dome of ruptured (7.8 mm) and unruptured (6.7 mm) aneurysms. When compared to unruptured aneurysms (6/42), the presence of a bleb was more frequent in ruptured aneurysm (41/59). The perianeurysmal environment was found to have a significant influence on aneurysmal rupture pattern, whenever direct contact between the aneurysm and the anatomical structures in the perianeurysmal environment was visualized. This influence was independent of aneurysm size. Aneurysm size seems to be a poor indicator for the risk of rupture when compared to shape of the aneurysm and the degree of direct contact with the perianeurysmal environment.

scholarly journals Angiographical Change of Guglielmi Detachable Coils

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 161-166 ◽  
Author(s):  
Y. Nakai ◽  
M. Sonobe ◽  
T. Takigawa ◽  
T. Yamazaki ◽  
S. Okamoto ◽  
...  
Keyword(s):  
Cerebral Aneurysm ◽  
Medical Condition ◽  
Cerebral Aneurysms ◽  
Acute Stage ◽  
Guglielmi Detachable Coils ◽  
Unruptured Aneurysms ◽  
Detachable Coils

Acute angiographical changes for preventing acute rebleeding on GDC treated cerebral aneurysms were evaluated. From December 2000 to November 2002, 48 total aneurysms in 44 consecutive patients with acute SAH. Acute angiographical evaluations were carried out in 46 aneurysms, including 42 ruptured and 4 unruptured aneurysms. Two cases were excluded because of poor medical condition. In this series, there were no rebleeding cases in acute stage. In the initial embolization for the 46 aneurysms, CO was achieved in eight aneurysms, NR in 15 aneurysms and BF in 23 aneurysms. Acute angiographical observations showed progressive thrombosis in 17 aneurysms (37%). No changes were observed in remaining 29. No recanalization was observed in this series. Only one case of BF, inside the aneurysm bleb was still observed during follow up. Additional embolization was carried out. Progressive thrombosis was frequently observed in GDC treated cerebral aneurysms during acute stage. This angiographical finding seems to show prevention of rebleeding, which is considered important for the management of GDC treatment in acutely ruptured cerebral aneurysm.

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