Incidental detection of unruptured intracranial aneurysms (UIA) has increased in the recent years. There is a need in the clinical community to identify those that are prone to rupture and would require preventive treatment. Hemodynamics in cerebral blood vessels plays a key role in the lifetime cycle of intracranial aneurysms (IA). Understanding their initiation, growth, and rupture or stabilization may identify those hemodynamic features that lead to aneurysm instability and rupture. Modeling hemodynamics using computational fluid dynamics (CFD) could aid in understanding the processes in the development of IA. The neurosurgical approach during operation of IA allows direct visualization of the aneurysm sac and its sampling in many cases. Detailed analysis of the quality of the aneurysm wall under the microscope, together with histological assessment of the aneurysm wall and CFD modeling, can help in building complex knowledge on the relationship between the biology of the wall and hemodynamics. Detailed CFD analysis of the rupture point can further strengthen the association between hemodynamics and rupture. In this chapter we summarize current knowledge on CFD and intracranial aneurysms.
Background: Although indicators of surgical and medical treatment have been applied to patients with typical dissection (AD) of the descending thoracic aorta, the natural history of descending aortic intramural hematoma (AIH) is not yet clearly known.Objective: The goal of this study was to test the hypothesis that the absence of flow communication through the intimal tear in AIH involving the descending aorta has a different clinical course compared with AD.Methods: We prospectively evaluated clinical and echocardiographic data between AD (76 patients) and AIH (27 patients) of the descending thoracic aorta.Results: Patients had no differences In age, gender, or clinical presentation. The development of pleural effussion or periaortic hematoma was more frequent in patients with AIH than it was in patients with AD. AIH and AD had same predictors of complications at follow-up: aortic diameter (>5 cm) at diagnosis and persistent back pain. Although medical treatment was selected in the same proportion between groups, surgical treatment was more frequently selected in AD (39% vs. 22%, p < 0.01). AD patients who received surgical treatment had higher mortality than those with AIH (36% vs. 17%, p < 0.01). There was no difference in mortality between patients who received medical treatment (15% in AD vs 14% in AIH, p = 0.7). In follow-up imaging studies of 23 patients with AIH,6 patients (25%) showed complete resolution and 6 patients (25%) increased the descending aortic diameter. Typical AD developed in 3 patients (13%). A three-year survival rate did not show significant difference (82 ± 6% in AIH vs 75 ± 7% in AD, p = 0.37).Conclusion: AIH of the descending thoracic aorta have relatively frequent complications at follow-up including dissection and aneurysm formation. Medical treatment with very close imaging follow-up and timed elective surgery in cases with complications allow better management for patients with AIH of the descending thoracic aorta.
Background: Although indicators of surgical and medical treatment have been applied to patients with typical dissection (AD) of the descending thoracic aorta, the natural history of descending aortic intramural hematoma (AIH) is not yet clearly known.Objective: The goal of this study was to test the hypothesis that the absence of flow communication through the intimal tear in AIH involving the descending aorta has a different clinical course compared with AD.Methods: We prospectively evaluated clinical and echocardiographic data between AD (76 patients) and AIH (27 patients) of the descending thoracic aorta.Results: Patients had no differences In age, gender, or clinical presentation. The development of pleural effussion or periaortic hematoma was more frequent in patients with AIH than it was in patients with AD. AIH and AD had same predictors of complications at follow-up: aortic diameter (>5 cm) at diagnosis and persistent back pain. Although medical treatment was selected in the same proportion between groups, surgical treatment was more frequently selected in AD (39% vs. 22%, p < 0.01). AD patients who received surgical treatment had higher mortality than those with AIH (36% vs. 17%, p < 0.01). There was no difference in mortality between patients who received medical treatment (15% in AD vs 14% in AIH, p = 0.7). In follow-up imaging studies of 23 patients with AIH,6 patients (25%) showed complete resolution and 6 patients (25%) increased the descending aortic diameter. Typical AD developed in 3 patients (13%). A three-year survival rate did not show significant difference (82 ± 6% in AIH vs 75 ± 7% in AD, p = 0.37).Conclusion: AIH of the descending thoracic aorta have relatively frequent complications at follow-up including dissection and aneurysm formation. Medical treatment with very close imaging follow-up and timed elective surgery in cases with complications allow better management for patients with AIH of the descending thoracic aorta.
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