Temporary Clipping in the Treatment of Cerebral Aneurysms

2002 ◽  
Vol 15 (5) ◽  
pp. 583-587
Author(s):  
M. Medina ◽  
A. Lucano ◽  
N. Serio ◽  
V. Meus ◽  
A. Lippiello ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Arterial Wall ◽  
Cerebral Aneurysms ◽  
Aneurysmal Wall ◽  
Temporary Clipping

Temporary clipping is very useful in the treatment of cerebral aneurysms since it permits a better approach and manipulation of the sac by reducing blood pressure on the aneurysmal wall. This procedure in not free of risks such as possible damage to the arterial wall and distal ischaemia. We evaluated retrospectively 107 cases treated between 1998 and 2001 in our unit and compared our results with literature reports.

scholarly journals Study of the Hemodynamics Effects of an Isolated Systolic Hypertension (ISH) Condition on Cerebral Aneurysms Models, Using FSI Simulations

2021 ◽  
Vol 11 (6) ◽  
pp. 2595
Author(s):  
José Barahona ◽  
Alvaro Valencia ◽  
María Torres
Keyword(s):  
Systolic Hypertension ◽  
Arterial Wall ◽  
Abrupt Change ◽  
Cerebral Aneurysms ◽  
Rupture Risk ◽  
Pressure Condition ◽  
Isolated Systolic Hypertension ◽  
Hemodynamic Changes ◽  
Physiological Conditions ◽  
Relative Residence Time

Hemodynamics is recognized as a relevant factor in the development and rupture of cerebral aneurysms, so further studies related to different physiological conditions in human represent an advance in understanding the pathology and rupture risk. In this paper, Fluid-structure interaction simulations (FSI) were carried out in six models of cerebral aneurysms, in order to study the hemodynamics effects of an isolated systolic hypertension (ISH) condition and compare it to a normal or normotensive pressure condition and a higher hypertension condition. Interestingly, the ISH condition showed, in general, the greatest hemodynamics changes, evidenced in the Time-Averaged Wall Shear Stress (TAWSS), Oscillatory Shear Index (OSI), and Relative Residence Time (RRT) parameters, with respect to a normal condition. These results could imply that a not high-pressure condition (ISH), characterized with a different shape and an abrupt change in its diastolic and systolic range may present more adverse hemodynamic changes compared to a higher-pressure condition (such as a hypertensive condition) and therefore have a greater incidence on the arterial wall remodeling and rupture risk.

Abstract W P73: Inside Intramural Thrombus Formation with Inflammatory Reactions Is Relevant to the Rupture of Cerebral Aneurysms

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Yusuke Shimoda ◽  
Naoki Nakayama ◽  
Masaaki Hokari ◽  
Takeo Abumiya ◽  
Hideo Shichinohe ◽  
...  
Keyword(s):  
Thrombus Formation ◽  
Cerebral Aneurysms ◽  
Histopathological Finding ◽  
Internal Elastic Lamina ◽  
Electron Microscopic ◽  
Inflammatory Reactions ◽  
Aneurysmal Wall ◽  
The Common ◽  
Collagen Layer ◽  
Elastic Lamina

Background and Purpose: Although recent researches on cerebral aneurysms (CAs) have been performed with the hydrodynamic or the molecular biological technique, the mechanisms of rupture are not fully understood. The aim of this study is to assess the mechanism by a comparison between ruptured and un-ruptured CAs with histopathological and electron-microscopic analysis. Methods: We analyzed 33 CAs (24 ruptured, 9 un-ruptured) collected surgically after neck clipping. As for the ruptured CAs, we operated them within 24 hours from the onset. HE staining, Elastica Masson staining, PTAH staining, and CD68 immunohistochemical staining were performed with paraffin sections. Morphological analysis with Scanning Electron Microscopy (SEM) was performed with 6 CAs (3 ruptured, 3 un-ruptured). Results: The common histopathological finding in both ruptured and un-ruptured CAs was that the aneurysmal wall consisted mostly of thick collagen layer without normal internal elastic lamina and media. The characteristic histopathological finding in ruptured CAs was inside intramural thrombus formation with infiltration of CD68 positive cells at the rupture point. The common SEM finding in both ruptured and un-ruptured CAs was the denudation of endothelial cells and the exposure of a subendothelial amorphous or a fibrous surface. The characteristic SEM finding in ruptured CAs was the cluster formation of thick fibrin fibers with incorporation of macrophages and platelets. Conclusions: While the endothelial denudation, the disappearance of internal elastic lamina and media, and the predominance of collagen layer in the aneurysmal wall were common in both ruptured and un-ruptured CAs, inside intramural thrombus formation with inflammatory reactions was characteristic only in ruptured CAs. This result suggests that thrombo-inflammatory reactions in CAs may act as a trigger for ruptures.

Cerebral oxygen and microdialysis monitoring during aneurysm surgery: effects of blood pressure, cerebrospinal fluid drainage, and temporary clipping on infarction

2002 ◽  
Vol 96 (6) ◽  
pp. 1013-1019 ◽  
Author(s):  
Rupert Kett-White ◽  
Peter J. Hutchinson ◽  
Pippa G. Al-Rawi ◽  
Marek Czosnyka ◽  
Arun K. Gupta ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cerebrospinal Fluid ◽  
Brain Tissue ◽  
Total Duration ◽  
Wilcoxon Test ◽  
Fisher Exact Test ◽  
Content Type ◽  
The Impact ◽  
Temporary Clipping ◽  
Fine Print

Object. The aim of this study was to investigate potential episodes of cerebral ischemia during surgery for large and complicated aneurysms, by examining the effects of arterial temporary clipping and the impact of confounding variables such as blood pressure and cerebrospinal fluid (CSF) drainage. Methods. Brain tissue PO2, PCO2, and pH, as well as temperature and extracellular glucose, lactate, pyruvate, and glutamate were monitored in 46 patients by using multiparameter sensors and microdialysis. Baseline data showed that brain tissue PO2 decreased significantly, below a mean arterial pressure (MAP) threshold of 70 mm Hg. Further evidence of its relationship with cerebral perfusion pressure was shown by an increase in mean brain tissue PO2 after drainage of CSF from the basal cisterns (Wilcoxon test, p < 0.01). Temporary clipping was required in 31 patients, with a mean total duration of 14 minutes (range 3–52 minutes), causing brain tissue PO2 to decrease and brain tissue PCO2 to increase (Wilcoxon test, p < 0.01). In patients in whom no subsequent infarction developed in the monitored region, brain tissue PO2 fell to 11 mm Hg (95% confidence interval 8–14 mm Hg). A brain tissue PO2 level below 8 mm Hg for 30 minutes was associated with infarction in any region (p < 0.05 according to the Fisher exact test); other parameters were not predictive of infarction. Intermittent occlusions of less than 30 minutes in total had little effect on extracellular chemistry. Large glutamate increases were only seen in two patients, in both of whom brain tissue PO2 during occlusion was continuously lower than 8 mm Hg for longer than 38 minutes. Conclusions. The brain tissue PO2 decreases with hypotension, and, when it is below 8 mm Hg for longer than 30 minutes during temporary clipping, it is associated with increasing extracellular glutamate levels and cerebral infarction.

scholarly journals The influence of temporary occlusion of parent vessel on outcome of surgical treatment of ruptured cerebral aneurysms

2020 ◽  
Vol 77 (11) ◽  
pp. 1142-1145
Author(s):  
Vesna Nikolov ◽  
Misa Radisavljevic ◽  
Boban Jelenkovic ◽  
Marija Andjelkovic-Apostolovic
Keyword(s):  
Surgical Treatment ◽  
Cerebral Aneurysms ◽  
Aneurysm Rupture ◽  
Neurological Deficits ◽  
Grading System ◽  
Parent Vessel ◽  
Current Topic ◽  
Temporary Occlusion ◽  
A Prospective Study ◽  
Temporary Clipping

Background/Aim. Aneurysm rupture followed by sub-arachnoid or intracerebral haemorrhage is always current topic and poses a great challenge to neurosurgeons. The aim of the study was to establish whether applying temporary occlusion before placing a final clip was justified. Methods. A prospective study was conducted on patients with aneurysm rupture, treated at Neurosurgical Clinic in Nis from January 2012 to December 2016. Patients belonging to I and II and 1, 2 and 3 grades according to the Hunt-Hess grading system and Fisher scale, respectively, were monitored. Results. In 85, out of total 182 bleeding aneurysms that were treated, a neurosurgeon decided to apply temporary clipping before placing the final clip. Temporary occlusion significantly influenced the presence of resulting neuro-logical deficit. Conclusion. The application of temporary occlusion facilitates placing the final clip but also affects the occurrence of neurological deficits. It is assumed that this is a consequence of caused vasospasm, considering that these are bleeding aneurysms.

Histologically verified cerebral aneurysm formation secondary to embolism from cardiac myxoma

1995 ◽  
Vol 83 (1) ◽  
pp. 170-173 ◽  
Author(s):  
Kazuhide Furuya ◽  
Tomio Sasaki ◽  
Yuhei Yoshimoto ◽  
Yoshifumi Okada ◽  
Takamitsu Fujimaki ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Cardiac Tumor ◽  
Arterial Wall ◽  
Cardiac Myxoma ◽  
Cerebral Aneurysms ◽  
Surgical Removal ◽  
Arterial Aneurysm ◽  
Content Type ◽  
Aneurysm Formation ◽  
Aneurysm Wall

✓ Multiple aneurysm formation secondary to an embolism from the cardiac myxoma is a well-known phenomenon. The cerebral arterial aneurysm formation process involved remains to be elucidated, although occupation of the arterial wall by tumor cells has been proven histologically. The authors present the case of a patient in whom tumor cells in the aneurysm wall were demonstrated and penetration of viable myxoma cells into the wall was also observed 19 months after surgical removal of the cardiac tumor. Such findings have never before been verified histologically. In light of the histological findings, the authors discuss the therapeutic problems associated with cerebral aneurysms resulting from cardiac myxoma.

scholarly journals Gene Transfer for Experimental Saccular Aneurysms

2001 ◽  
Vol 7 (1_suppl) ◽  
pp. 131-135
Author(s):  
T. Okamoto ◽  
S. Miyachi ◽  
M. Negoro ◽  
O. Suzuki ◽  
G. Otsuka ◽  
...  
Keyword(s):  
Gene Therapy ◽  
Experimental Study ◽  
Gene Transfer ◽  
Cerebral Aneurysms ◽  
Adenovirus Vector ◽  
Aneurysm Rupture ◽  
Systemic Complications ◽  
Aneurysmal Wall ◽  
Carotid Wall ◽  
Saccular Aneurysms

Reinforcing an aneurysmal wall is one possible way to prevent from aneurysm rupture. We preliminarily tried focal gene transfer against the wall of experimental aneurysms to aim the transgene remodeling of aneurysmal wall. Two experimental saccular aneurysms were created on canine common carotid artery with an artificial dissecting method, which resemble clinical aneurysms. Adenovirus vector (AxCALacZ, 108 pfu) was slowly injected into the aneurysm cavity for over 30 minutes under the condition of in-traaneurysmal flow arrest using balloon-assisted neck-plasty technique. The arteries and aneurysms were evaluated 48 hours after the transduction with X-gal staining, and β-galac-tosidase expression was detected mainly in the intima in both cases. No adverse effects on the normal carotid wall and no systemic complications were observed after the procedure. This experimental study suggests the possibility of gene therapy for cerebral aneurysms.

Effect of chronic ANG I-converting enzyme inhibition on aging processes. II. Large arteries

1994 ◽  
Vol 267 (1) ◽  
pp. R124-R135 ◽  
Author(s):  
J. B. Michel ◽  
D. Heudes ◽  
O. Michel ◽  
P. Poitevin ◽  
M. Philippe ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Smooth Muscle ◽  
Arterial Wall ◽  
Left Ventricular ◽  
Structure And Function ◽  
Wall Structure ◽  
Large Artery ◽  
Converting Enzyme ◽  
Wall Stiffness ◽  
And Function

The consequences of hypertension and aging on cardiovascular structure and function are reputed to be similar, suggesting that blood pressure plays a role in the aging process. However, the exact relationship between aging, blood pressure, and the arterial structure-function relationship has not been demonstrated. To test the effects of aging, renin-angiotensin system, and pressure on the arterial wall, 20 normotensive male WAG/Rij rats were killed at 6, 12, 24, and 30 mo of age and compared with similar groups treated with an angiotensin (ANG)-converting enzyme inhibitor (ACEI), perindopril. Arterial function was determined by a systemic hemodynamic study and by in situ measurement of carotid compliance. Arterial wall structure was determined by histomorphometric and biochemical methods. Aging did not significantly modify blood pressure, but ACE inhibition decreased blood pressure significantly from 6 to 30 mo. Plasma renin activity decreased with age and increased with ACEI. Plasma atrial natriuretic factor increased with age and was significantly decreased with ACEI. Absolute and relative left ventricular weight increased with age, and ACEI delayed these increases. Arterial wall stiffness increased with age, as shown by a significant decrease in systemic and local arterial compliance and by an increase in aortic characteristic impedance. The increase in carotid wall compliance after poisoning of smooth muscle contractile function (KCN) was greater in young (6- and 12-mo old) than in old (24- and 30-mo old) rats. Chronic ACEI treatment increased basal carotid compliance values slightly and did not change KCN carotid compliance. The aortic and carotid luminal size increased regularly with age. Aging was associated without any change in absolute elastin content. In contrast, collagen content increased with aging. Aging was also associated with an increase in medial thickness. Medial thickening was mainly due to smooth muscle hypertrophy. Aging was associated with intimal proliferation, which became progressively thicker and collagen rich. ACEI treatment did not prevent aortic lumen enlargement but significantly postponed the increase in medial and intimal thickening. Biochemical determinations of the aortic wall components confirmed the morphometric data. In conclusion, the age-dependent large artery enlargement and stiffening were observed both in normotensive rats and in those rats whose blood pressure was lowered by ACEI. This suggests that aging and blood pressure affect arterial wall structure and function by different mechanisms.

scholarly journals Does Smoking Act as a Friend or Enemy of Blood Pressure? Let Release Pandora's Box

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Aurelio Leone
Keyword(s):  
Blood Pressure ◽  
Carbon Monoxide ◽  
Passive Smoking ◽  
Chronic Exposure ◽  
Arterial Wall ◽  
Antihypertensive Drugs ◽  
Epidemiological Studies ◽  
Cardiovascular Damage ◽  
Long Run ◽  
Experimental Findings

In spite of the great number of observations which show the certainty of cardiovascular damage from smoking, the opinions on that are not yet unanimous. There is a discrepancy that could be attributed to the lack of reproducible data particularly in some epidemiological studies. On the contrary, experimental findings conducted on both animals and humans give evidence of exactly reproducible results of cardiovascular alterations and among these the course of Blood Pressure (BP). Findings identify an increase in BP of active smokers or non-smokers exposed to passive smoking, while a lot of others refer a lowering of BP due to smoking. This discrepancy could be explained as follows. Initially, a vasoconstriction mediated by nicotine causes acute but transient increase in systolic BP. This phase is followed by a decrease in BP as a consequence of depressant effects played chronically by nicotine itself. Simultaneously, carbon monoxide is acting directly on the arterial wall causing, in the long run, structurally irreversible alterations. At this time, there is a change in BP that increases again, and often constantly, its levels following chronic exposure. Changes in response to antihypertensive drugs have been observed in hypertensive smokers since smoking influences metabolic steps of the drugs.

Acoustics and Computational Models for Diagnosing Arterial Blockages

2013 ◽  
Author(s):  
M. A. Al-Rawi ◽  
A. M. Al-Jumaily
Keyword(s):  
Blood Pressure ◽  
Wave Propagation ◽  
Femoral Artery ◽  
Computational Models ◽  
Arterial Wall ◽  
Fluid Dynamic ◽  
Arterial Disease ◽  
Flow Profile ◽  
Cfd Model ◽  
Wall Displacement

Arterial blockages can occur in small or large arteries for a variety of reasons, such as obesity, stress, smoking and high cholesterol. This paper presents a feasibility study on a novel method to detect the behaviour of the blood pressure wave propagation for arteries in both healthy and diseased conditions in order to develop a relatively inexpensive method for early detection of arterial disease. The trend of this behaviour is correlated to the early development of the arterial blockage at various locations. Invasive sets of data (gathered from experiments performed on animals) are implemented into a 3D Computational Fluid Dynamic (CFD) model to determine how the arterial wall compliance changes when any abnormalities occur to the blood flow profile. At the same time, a 1D acoustical model is developed to transfer the information gathered (wave propagation for blood pressure, flow and arterial wall displacement) from the CFD model. Wave forms were collected at a location which was invasively accessible (the femoral artery). The computational and acoustical models are validated against the clinical trials and show good agreement. Any changes to the arterial wall displacement could be detected by systolic and diastolic blood pressure values at the femoral artery.

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