Lumen-oriented versus wall-oriented treatment strategies for intracranial aneurysms – A systematic review of suggested therapeutic concepts

2021 ◽  
pp. 0271678X2110574
Author(s):  
Basil E Grüter ◽  
Fabio von Faber-Castell ◽  
Serge Marbacher
Keyword(s):  
Systematic Review ◽  
Intracranial Aneurysms ◽  
Cell Injury ◽  
Treatment Strategies ◽  
Aneurysm Wall ◽  
Starting Point ◽  
Preclinical Treatment ◽  
Major Interest ◽  
Therapeutic Concepts ◽  
New Treatment

The development of new treatment strategies for intracranial aneurysms (IAs) has been and continues to be a major interest in neurovascular research. Initial treatment concepts were mainly based on a physical-mechanistic disease understanding for IA occlusion (lumen-oriented therapies). However, a growing body of literature indicates the important role of aneurysm wall biology (wall-oriented therapies) for complete IA obliteration. This systematic literature review identified studies that explored endovascular treatment strategies for aneurysm treatment in a preclinical setting. Of 5278 publications screened, 641 studies were included, categorized, and screened for eventual translation in a clinical trial. Lumen-oriented strategies included (1) enhanced intraluminal thrombus organization, (2) enhanced intraluminal packing, (3) bridging of the intraluminal space, and (4) other, alternative concepts. Wall-oriented strategies included (1) stimulation of proliferative response, (2) prevention of aneurysm wall cell injury, (3) inhibition of inflammation and oxidative stress, and (4) inhibition of extracellular matrix degradation. Overall, lumen-oriented strategies numerically still dominate over wall-oriented strategies. Among the plethora of suggested preclinical treatment strategies, only a small minority were translated into clinically applicable concepts (36 of 400 lumen-oriented and 6 of 241 wall-oriented). This systematic review provides a comprehensive overview that may provide a starting point for the development of new treatment strategies.

Republished: The first North American use of the Pipeline Flex flow diverter

2015 ◽  
Vol 8 (2) ◽  
pp. e8-e8 ◽  
Author(s):  
Edward AM Duckworth ◽  
Christopher Nickele ◽  
Daniel Hoit ◽  
Andrey Belayev ◽  
Christopher J Moran ◽  
...  
Keyword(s):  
Paradigm Shift ◽  
Intracranial Aneurysms ◽  
Second Generation ◽  
Relevant Literature ◽  
Treatment Strategies ◽  
Flow Diverter ◽  
Flow Diversion ◽  
Current State ◽  
The Usa ◽  
New Treatment

Flow diversion for the management of intracranial aneurysms represents a paradigm shift in how aneurysms are managed. The Pipeline embolization device (PED) is, to date, the only flow diverter approved for use in the USA by the Food and Drug Administration. Limitations and complications with new treatment strategies are inevitable, and with the PED there have been reports of complications, most commonly with challenging deployments. Once deployment has been initiated, the device is ‘one-way’; it can only be deployed further or removed. Yet, situations arise in which the ability to recapture or reposition the device would be advantageous. A second-generation Pipeline has been developed that addresses these concerns. We report the first use in North America of this second-generation Pipeline device: the Pipeline Flex. We discuss our rationale for using the device, our impressions of its operation, and the relevant literature concerning the current state of flow diversion.

scholarly journals Advances in asthma pathophysiology: stepping forward from the Maurizio Vignola experience

2015 ◽  
Vol 24 (135) ◽  
pp. 30-39 ◽  
Author(s):  
Maria R. Bonsignore ◽  
Mirella Profita ◽  
Rosalia Gagliardo ◽  
Loredana Riccobono ◽  
Giuseppina Chiappara ◽  
...  
Keyword(s):  
Treatment Strategies ◽  
Complex Interaction ◽  
Clinical Aspects ◽  
Significant Progress ◽  
Asthma Phenotypes ◽  
Biopsy Specimens ◽  
Major Interest ◽  
New Treatment ◽  
Personalised Treatment ◽  
Clinical Asthma

Maurizio Vignola was a superb and innovative researcher, who wrote seminal papers on the biology of airway epithelium in asthma. Inflammation and remodelling were the main topics of his research, mostly conducted in biopsy specimens from patients with asthma of variable severity, encompassing the entire spectrum of the disease from mild to severe asthma. His observations contributed to define the biology of asthma as we know it today, and opened the way to the personalised treatment of asthma. His group has successfully continued to investigate the biology and clinical aspects of bronchial asthma, with major interest in the clinical use of biomarkers to monitor disease activity, and in the development of new therapeutic perspectives. This review summarises the latest work on these topics proudly conducted by Maurizio's closest collaborators. The results indicate significant progress in our understanding of asthma in the last 10 years, in particular increased knowledge of the complex interaction between inflammatory and remodelling pathways, improved recognition of biological and clinical asthma phenotypes, and development of new treatment strategies, especially for patients with severe corticosteroid-resistant asthma.

scholarly journals Dendritic Cells and Antiphospholipid Syndrome: An Updated Systematic Review

Life ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. 801
Author(s):  
Kuo-Tung Tang ◽  
Hsin-Hua Chen ◽  
Tzu-Ting Chen ◽  
Nicole R. Bracci ◽  
Chi-Chien Lin
Keyword(s):  
Systematic Review ◽  
Dendritic Cells ◽  
Antiphospholipid Syndrome ◽  
Inflammatory Responses ◽  
Treatment Strategies ◽  
Vascular Thrombosis ◽  
Obstetrical Complications ◽  
Glycoprotein I ◽  
New Treatment

Antiphospholipid syndrome (APS) is an autoimmune disease characterized by autoreactive B and T cells against β2-glycoprotein I (B2GPI), with vascular thrombosis or obstetrical complications. Dendritic cells (DCs) are crucial in the generation of autoimmunity. Here, we conducted a comprehensive systematic review on the relationship between DC and APS. We performed a literature search of PubMed as of 26 March 2021. A total of 33 articles were extracted. DCs are pivotal in inducing inflammatory responses and orchestrating adaptive immunity. DCs contribute to the local inflammation regarding vascular thrombosis or obstetrical complications. Both B2GPI and antiphospholipid antibodies (aPL) can promote antigen presentation by DCs and the generation or maintenance of autoimmunity. In addition, plasmacytoid DC activation is enhanced by aPL, thereby augmenting the inflammatory response. In line with these findings, DC modulation appears promising as a future treatment for APS. In conclusion, our review indicated the crucial role of DCs in the pathogenesis of APS. Deeper understanding of the complex relationship would help in developing new treatment strategies.

Long-Term Efficacy of Clipping Versus Coiling of Intracranial Aneurysms: A Systematic Review and Meta-Analysis

2018 ◽  
Author(s):  
Alexander F. Hulsbergen ◽  
Lida Mirzaei ◽  
Arthur T. Van der Boog ◽  
Timothy R. Smith ◽  
Ivo S. Muskens ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Term Efficacy

Humoral Immunity in Heart Failure

2019 ◽  
Vol 19 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Amrita Sarkar ◽  
Khadija Rafiq
Keyword(s):  
Heart Failure ◽  
Humoral Immunity ◽  
Treatment Strategies ◽  
Pathophysiological Mechanism ◽  
Peripheral Vascular ◽  
Cardiac Inflammation ◽  
Humoral Immune ◽  
Humoral Immune System ◽  
New Treatment ◽  
Immunity Function

Cardiovascular Disease (CVD) is a class of diseases that involve disorders of heart and blood vessels, including hypertension, coronary heart disease, cerebrovascular disease, peripheral vascular disease, which finally lead to Heart Failure (HF). There are several treatments available all over the world, but still, CVD and heart failure became the number one problem causing death every year worldwide. Both experimental and clinical studies have shown a role for inflammation in the pathogenesis of heart failure. This seems related to an imbalance between pro-inflammatory and anti-inflammatory cytokines. Cardiac inflammation is a major pathophysiological mechanism operating in the failing heart, regardless of HF aetiology. Disturbances of the cellular and humoral immune system are frequently observed in heart failure. This review describes how B-cells play a specific role in the heart failure states. There is an urgent need to identify novel therapeutic targets and develop advanced therapeutic strategies to combat the syndrome of HF. Understanding and describing the elements of the humoral immunity function are essential and may suggest potential new treatment strategies.

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