Biology of Saccular Cerebral Aneurysms: A Review of Current Understanding and Future Directions

Fennell, Vernard S.; Kalani, M. Yashar S.; Atwal, Gursant; Martirosyan, Nikolay L.; Spetzler, Robert F.

doi:10.3389/fsurg.2016.00043

Cited by 55 publications

(42 citation statements)

References 118 publications

(115 reference statements)

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“…Several inflammatory mediators synthesized and/or expressed by leukocyte, such as IL-1β, IL-6, TNF-α, TLR4, and matrix metalloproteinases, will further aggravate the local inflammatory response which is closely related to an adverse outcome 35 . Maiuri, et al .…”

Section: Discussionmentioning

confidence: 99%

Higher leukocyte count predicts 3-month poor outcome of ruptured cerebral aneurysms

Yao¹,

Chen²,

Xie³

et al. 2018

Sci Rep

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It is not fully established whether leukocyte can predict the poor outcome for ruptured cerebral aneurysms (CA) or not. Here, we retrospectively analyzed the clinical data of 428 patients with ruptured CA between 2010 and 2015. Patients’ demographic data, including gender, age, history of smoking, alcohol, hypertension, diabetes and hypercholesterolemia, Hunt-Hess and Fisher grade, occurrence of hydrocephalus, aneurysm location, time to surgery, delayed ischemic neurological deficit (DIND) and peak leukocyte of blood test from day 1 to 3 after aneurysmal rupture were recorded and analyzed. In the multivariable analysis model, gender, Fisher grade, time to surgery and hydrocephalus were not relevant to poor outcome. However, Hunt-Hess grade, DIND and preoperative leukocyte count (>13.84 × 109/L) were significantly associated with adverse outcome. The respective increased risks were 5.2- (OR 5.24, 95% CI 1.67–16.50, p = 0.005), 6.2-(OR 6.24, 95% CI 3.55–10.99, p < 0.001) and 10.9-fold (OR 10.93, 95% CI 5.98–19.97, p < 0.001). The study revealed that Hunt-Hess grade, DIND and preoperative leukocyte count (>13.84 × 109/L) were independent risk factors for poor outcome of ruptured CA at 3 months. Higher leukocyte count is a convenient and useful marker to predict 3-month poor outcome for ruptured CA.

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Section: Discussionmentioning

confidence: 99%

Higher leukocyte count predicts 3-month poor outcome of ruptured cerebral aneurysms

Yao¹,

Chen²,

Xie³

et al. 2018

Sci Rep

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“…The MMP produced from monocytes/macrophages and smooth muscle cells plays a role in extracellular matrix degradation and vascular remodeling. Interleukin (IL) 1β, IL6, tumor necrosis factor-α, TLR4, Fas, nitric oxide, and complement have been suggested to function as key molecules in the propagation of immune responses [ 39 , 44 ]. High concentrations of cytokines and chemokines have also been detected in the human plasma associated with cerebral aneurysms [ 45 ].…”

Section: Pathophysiology Of a Cerebral Aneurysmmentioning

confidence: 99%

New Pathophysiological Considerations on Cerebral Aneurysms

Jung

2018

Neurointervention

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Cerebral aneurysm is a common cerebrovascular disease that is sometimes complicated by rupture or an enlarged mass. We are now aggressively evaluating and managing unruptured cerebral aneurysms based on a significant concern for the high morbidity and mortality related to its associated complications. However, the actual rupture rate is very low and the diagnostic and treatment modalities are expensive and invasive, which may lead to unnecessary costs and potential medical complications. This disproportionate situation is related to a poor understanding of the natural course and pathophysiology of cerebral aneurysms. In consideration of the concept that not all cerebral aneurysms must be removed, we need to examine their course and progression more accurately. Cerebral aneurysms may follow a variety of pathophysiological scenarios over their lifetime, from formation to growth and rupture. The disease course and the final outcome can differ depending on the timing and intensity of the pathological signals acting on the cerebral vessel wall. We should delineate a method of predicting the stability and risk of rupture of the lesion based on a comprehensive knowledge of the vessel wall integrity. This review deals with the basic knowledge and advanced concepts underlying the pathophysiology of cerebral aneurysms.

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“…NF-κB can bind to the promoter regions of a variety of proinflammatory cytokines and immunomodulatory factors and is key player in the regulation of the expression of proinflammatory genes. After activation, NF-κB is transported into the nucleus to activate the expression of downstream target genes, which in turn induces macrophage aggregation in the aneurysm wall and the degradation of the extracellular matrix ( 20 , 21 ). The changes in indicator protein expression observed in this study demonstrated that microsurgical treatment can significantly reduce the degree of the inflammatory response and reduce the expression level of MMP-9.…”

Section: Discussionmentioning

confidence: 99%

The efficacy of microsurgery in the treatment of cerebral aneurysm rupture and its effect on NF-κB, MCP-1 and MMP-9

Zhang

Chen

Zheng

et al. 2017

Experimental and Therapeutic Medicine

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The clinical efficacy of microsurgical neck clipping for the treatment of cerebral aneurysm rupture and its effect on serum nuclear factor κ-light-chain-enhancer of activated β cells (NF-κB), monocyte chemoattractant protein-1 (MCP-1) and matrix metalloproteinase-9 (MMP-9) levels were investigated. A total of 56 patients with first occurrence of cerebral aneurysm rupture were enrolled from June 2015 to June 2016. These patients were divided into control (25 patients) and observation groups (31 patients) according to treatment received. The patients in the control group were treated with interventional embolization and extraventricular drainage, while the patients in the observation group were treated with microsurgical neck clipping. Serum NF-κB, MCP-1 and MMP-9 levels were measured by ELISA prior to the operation and at 6 h post-operation. Clinical effects were compared at the 6-month follow-up. There was no significant difference in the success rate of the operation between the two groups (p>0.05). The incidence of complications in the observation group was significantly lower than that in the control group (p<0.05). The Glasgow Outcome Scale score was significantly improved in the observation group (p<0.05) compared with the control group. Serum NF-κB, MMP-9 and MCP-1 were significantly decreased in both groups at 6 and 24 h after operation, but the observational group showed significantly lower levels for all three proteins than the control group (p<0.05). The application of early microsurgical neck clipping for the treatment of cerebral aneurysm rupture can reduce complications and improve clinical prognosis, and this may be related to a decrease in serum inflammatory response-related factors (NF-κB and MCP-1) and MMP-9.

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Biology of Saccular Cerebral Aneurysms: A Review of Current Understanding and Future Directions

Cited by 55 publications

References 118 publications

Higher leukocyte count predicts 3-month poor outcome of ruptured cerebral aneurysms

Higher leukocyte count predicts 3-month poor outcome of ruptured cerebral aneurysms

New Pathophysiological Considerations on Cerebral Aneurysms

The efficacy of microsurgery in the treatment of cerebral aneurysm rupture and its effect on NF-κB, MCP-1 and MMP-9

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