Inflammatory changes in the aneurysm wall: a review

Rupture of a saccular intracranial artery aneurysm (IA) causes subarachnoid hemorrhage, a significant cause of stroke and death. The current treatment options, endovascular coiling and clipping, are invasive and somewhat risky. Since only some IAs rupture, those IAs at risk for rupture should be identified. However, to improve the imaging of rupture-prone IAs and improve IA treatment, IA wall pathobiology requires more thorough knowledge. Chronic inflammation has become understood as an important phenomenon in IA wall pathobiology, featuring inflammatory cell infiltration as well as proliferative and fibrotic remodulatory responses. We review the literature on what is known about inflammation in the IA wall and also review the probable mechanisms of how inflammation would result in the degenerative changes that ultimately lead to IA wall rupture. We also discuss current options in imaging inflammation and how knowledge of inflammation in IA walls may improve IA treatment.

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Direct carotid-cavernous fistula: A complication of, and treatment with, flow diversion

Interventional Neuroradiology ◽

10.1177/1591019916653255 ◽

2016 ◽

Vol 22 (5) ◽

pp. 569-576 ◽

Cited By ~ 13

Author(s):

Krishna Amuluru ◽

Fawaz Al-Mufti ◽

Chirag D Gandhi ◽

Charles J Prestigiacomo ◽

I Paul Singh

Keyword(s):

Treatment Options ◽

Artery Aneurysm ◽

Time Frame ◽

Current Treatment ◽

Flow Diversion ◽

Transvenous Embolization ◽

Carotid Artery Aneurysm ◽

Internal Carotid Artery Aneurysm ◽

Carotid Cavernous Fistulas ◽

Direct Carotid Cavernous Fistula

Direct carotid-cavernous fistulas (CCFs) are rare complications of flow diversion and have typically been documented in a subacute time frame after treatment. We present the first reported case of an intraprocedural direct CCF that developed immediately after flow diversion for treatment of a symptomatic paraclinoid right internal carotid artery aneurysm with a neck involving the cavernous segment. Endovascular treatment of such direct fistulas typically involves either transarterial obliteration of the fistulous site or transvenous embolization of the cavernous sinus. Our case was successfully treated with further immediate flow diversion without additional transvenous intervention. There are few reports on the use of flow diversion for treatment of such direct CCFs, and in all but one of these cases, flow diversion was combined with concomitant transvenous embolization. Thus, the presented case is not only the first reported case of an immediate CCF after flow diversion, but it is also only the second reported case of a direct fistula to be successfully treated using solely flow diversion, without additional transvenous intervention. We review the literature of direct CCFs after flow diversion, the pathophysiology of development of CCFs after flow diversion, the literature on treatment of CCFs with flow diversion as well as all other current treatment options.

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Early Rupture of a Giant Basilar Artery Aneurysm after LEO Stenting: Case Report and Review of the Literature

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0039-1693108 ◽

2020 ◽

Vol 81 (02) ◽

pp. 177-184

Author(s):

Fabio Strange ◽

Jenny Kienzler ◽

Beda Muehleisen ◽

Michael Diepers ◽

Javier Fandino ◽

...

Keyword(s):

Case Report ◽

Basilar Artery ◽

Clinical Course ◽

Treatment Options ◽

Artery Aneurysm ◽

Flow Diversion ◽

Intraluminal Thrombus ◽

Aneurysm Wall ◽

Basilar Artery Aneurysm ◽

Rupture Site

Background Advances in the endovascular armamentarium, such as flow diversion and stenting devices, provide treatment options for posterior circulation intracranial aneurysms (IAs) with complex angioarchitecture. Delayed IA rupture following flow diversion is a rare but often fatal complication. Giant IAs likely pose a higher risk because of the extensive clot formation and its suspected detrimental effect on the aneurysmal wall. However, mechanisms that lead to delayed rupture are poorly understood, and few cases provide thorough documentation of macroscopic and histologic findings. Clinical Presentation After our 60-year-old patient with a giant basilar aneurysm underwent treatment with a LEO stent, the postoperative clinical course remained uneventful until day 4 when he suffered an unexpected fatal subarachnoid hemorrhage (SAH). Autopsy demonstrated extensive hemorrhage, large intraluminal thrombus, and ruptured IA wall. The aneurysm, which ruptured linearly, was completely filled with a clot that seemed to have outgrown the thin aneurysm wall. Histologic specimens revealed thinning and degenerative changes of the aneurysm's wall, and sparse neutrophilic and histiocytic inflammatory infiltrate adjacent to the rupture site, a finding consistent with recently published cases of IA rupture. Conclusions Our case report highlighting the clinical course and autopsy findings of a fatal SAH shortly after stenting this giant basilar artery aneurysm adds to the few previously reported fatal cases of IA rupture after endovascular treatment. Our macroscopic and histologic findings suggested that multimodal changes of inflammation, wall sheer tress (mechanical), and recanalization were involved.

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Lack of Complement Inhibitors in the Outer Intracranial Artery Aneurysm Wall Associates with Complement Terminal Pathway Activation

American Journal Of Pathology ◽

10.2353/ajpath.2010.091172 ◽

2010 ◽

Vol 177 (6) ◽

pp. 3224-3232 ◽

Cited By ~ 24

Author(s):

Riikka Tulamo ◽

Juhana Frösen ◽

Anders Paetau ◽

Sanna Seitsonen ◽

Juha Hernesniemi ◽

...

Keyword(s):

Artery Aneurysm ◽

Intracranial Artery ◽

Complement Inhibitors ◽

Aneurysm Wall ◽

Pathway Activation

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Mast Cells, Neovascularization, and Microhemorrhages are Associated With Saccular Intracranial Artery Aneurysm Wall Remodeling

Journal of Neuropathology & Experimental Neurology ◽

10.1097/nen.0000000000000105 ◽

2014 ◽

Vol 73 (9) ◽

pp. 855-864 ◽

Cited By ~ 41

Author(s):

Eliisa Ollikainen ◽

Riikka Tulamo ◽

Juhana Frösen ◽

Satu Lehti ◽

Petri Honkanen ◽

...

Keyword(s):

Mast Cells ◽

Artery Aneurysm ◽

Intracranial Artery ◽

Aneurysm Wall

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Subarachnoid hemorrhage from a ruptured anterior cerebral artery aneurysm caused by polyarteritis nodosa

Journal of Neurosurgery ◽

10.3171/jns.2002.96.1.0132 ◽

2002 ◽

Vol 96 (1) ◽

pp. 132-134 ◽

Cited By ~ 29

Author(s):

Jun C. Takahashi ◽

Nobuyuki Sakai ◽

Koji Iihara ◽

Hideki Sakai ◽

Toshio Higashi ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Cerebral Artery ◽

Polyarteritis Nodosa ◽

Anterior Cerebral Artery ◽

Artery Aneurysm ◽

Aneurysm Rupture ◽

Inflammatory Infiltration ◽

Content Type ◽

Aneurysm Wall ◽

Visceral Arteries

✓ Polyarteritis nodosa (PAN) is a rare systemic necrotizing arteritis that involves small- and medium-sized arteries in various organs. Although aneurysm formation in visceral arteries is a typical finding in PAN, intracranial aneurysms are much less common, and only a few cases of aneurysm rupture associated with this disease have been documented. In this paper, the authors report on a ruptured PAN aneurysm of the anterior cerebral artery; the lesion was trapped and resected. On histological examination, extensive fibrinoid necrosis and an inflammatory infiltration of leukocytes were seen in the aneurysm wall. To the authors' knowledge this is the first report of subarachnoid hemorrhage from a histologically confirmed PAN aneurysm.

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Cognitive outcome after surgical clipping versus endovascular coiling in patients with subarachnoid hemorrhage due to ruptured anterior communicating artery aneurysm

Acta Neurologica Belgica ◽

10.1007/s13760-019-01245-w ◽

2019 ◽

Vol 120 (1) ◽

pp. 123-132 ◽

Cited By ~ 1

Author(s):

Kurt Beeckmans ◽

Cleo L. Crunelle ◽

June Van den Bossche ◽

Eva Dierckx ◽

Karla Michiels ◽

...

Keyword(s):

Subarachnoid Hemorrhage ◽

Artery Aneurysm ◽

Cognitive Outcome ◽

Endovascular Coiling ◽

Anterior Communicating Artery ◽

Surgical Clipping ◽

Anterior Communicating Artery Aneurysm

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Protocol to the induction of loco-regional mild hypothermia for temporay clipping in the surgery of the middle cerebral artery aneurysm

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v20i1.715 ◽

2018 ◽

Vol 20 (1) ◽

pp. 33-38

Author(s):

Mirto N Prandini ◽

Carlos H. Ribeiro ◽

Santino N. Lacanna ◽

Hamilton R Cavalcante

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Mild Hypothermia ◽

Brain Temperature ◽

Artery Aneurysm ◽

Aneurysm Rupture ◽

Endovascular Coiling ◽

Aneurysm Wall ◽

Ischemic Complications ◽

Temporary Clipping

Introduction: Less than 30% of Middle Cerebral Artery (MCA) aneurysms are amenable for endovascular coiling. Microvascular surgery still carries a large number of complications, since many perforators arteries arise near to the neck of the aneurysm and, in many cases, one or more branches of bifurcation or trifurcation of the MCA originate in the aneurysm wall. Temporary clipping of the proximal MCA avoids the aneurysmal rupture, facilitates the aneurysm dissection and clip placement but long term temporary clipping carries a great risk of ischemic complications. Objective: We developed a protocol of brain protection based on the neuroprotective properties of mild hypothermia which would intend to permit a more extended time of temporary clipping. Methods: Sixty-eight cases of MCA incidental aneurysms or after the 12nd day of hemorrhage were operated on. Brain temperature was dropped at levels that varied from 29.5ºC at 15mm parenchymal depth to 32.5ºC at ventricular level. There was no change in the patient’s body temperature. Temporary MCA clipping varied from 8 to 28 minutes. Results: There was no intraoperative aneurysm rupture. All 68 patients were alive and neurologically unchanged at the 90th and 180th follow-up days. Conclusion: Loco-regional mild hypothermia may be effective in protecting cerebral parenchyma in cases of temporary clipping over 8 minutes up to 28 minutes in MCA aneurysms surgery.

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An Overview of Dementias

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd21.3.75 ◽

2012 ◽

Vol 21 (3) ◽

pp. 75-84

Author(s):

Venkata Vijaya K. Dalai ◽

Jason E. Childress ◽

Paul E Schulz

Keyword(s):

Clinical Presentation ◽

Treatment Options ◽

Current Treatment ◽

Great Variability ◽

Health Concern ◽

Public Health Concern ◽

Life Threatening ◽

The Common ◽

Neurodegenerative Dementias ◽

Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

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