Difference in nature of ruptured and unruptured cerebral aneurysms

Kataoka, Keisuke; Taneda, Mamoru; Asai, Takeshi; Yamada, Yasufumi

doi:10.1016/s0140-6736(99)03881-7

Cited by 70 publications

(43 citation statements)

References 5 publications

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“…Histologic analyses of both unruptured and ruptured aneurysm specimens from autopsy studies have mirrored such phenotypical classification: [50][51][52][53][54] Small intracranial aneurysms (Ͻ10 mm) have a higher rate (48%) of having thin, transparent, and hypocellular walls; absent smooth muscle cells, and inflammatory cells. 53,54 Large intracranial aneurysms (Ͼ10 mm) have a low rate (6%) of thin-walled regions but a high rate of thick walls with atherosclerotic changes, proliferation of smooth muscle cells, and inflammatory cells.…”

Section: Relationship Between Hemodynamics and Aneurysm Developmentmentioning

confidence: 93%

“…53,54 Large intracranial aneurysms (Ͼ10 mm) have a low rate (6%) of thin-walled regions but a high rate of thick walls with atherosclerotic changes, proliferation of smooth muscle cells, and inflammatory cells. [51][52][53][54] These data suggest that intracranial aneurysm phenotypes exist on a spectrum: At one extreme is the small thin-walled phenotype (type I); at the other extreme is the large thick-walled phenotype (type II); and in between is a continuum representing an amalgamation of these 2 basic types. The recognition of different phenotypes in both incidentally discovered and ruptured aneurysms suggests that there may be a variety of nonconvergent hemodynamic-biologic pathways involved in the natural history of intracranial aneurysms.…”

Section: Relationship Between Hemodynamics and Aneurysm Developmentmentioning

confidence: 99%

“…68 Their walls lack inflammatory cells and other cell types, as demonstrated by intraoperative [47][48][49] and postmortem studies. [52][53][54] It is possible that they are formed by impinging flow through the high-WSS-driven degradation mechanisms, as illustrated on the left side of Fig 5. The resident mural cells produce matrix maetalloproteinases under high WSS conditions, leading to significant ECM degradation and cell death by anoikis (apoptosis due to loss of ECM anchorage). 69 This degradative process may deplete the sac of resident cells and elastin fibers and reduce collagen fibers, forcing the remaining ECM to stretch, creating a stiff thin wall.…”

Section: High and Low Wss Can Drive Different Mechanistic Pathways Ofmentioning

confidence: 99%

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High WSS or Low WSS? Complex Interactions of Hemodynamics with Intracranial Aneurysm Initiation, Growth, and Rupture: Toward a Unifying Hypothesis

Meng

Tutino

Xiang

et al. 2013

AJNR Am J Neuroradiol

747

590

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SUMMARY:Increasing detection of unruptured intracranial aneurysms, catastrophic outcomes from subarachnoid hemorrhage, and risks and cost of treatment necessitate defining objective predictive parameters of aneurysm rupture risk. Image-based computational fluid dynamics models have suggested associations between hemodynamics and intracranial aneurysm rupture, albeit with conflicting findings regarding wall shear stress. We propose that the "high-versus-low wall shear stress" controversy is a manifestation of the complexity of aneurysm pathophysiology, and both high and low wall shear stress can drive intracranial aneurysm growth and rupture. Low wall shear stress and high oscillatory shear index trigger an inflammatory-cell-mediated pathway, which could be associated with the growth and rupture of large, atherosclerotic aneurysm phenotypes, while high wall shear stress combined with a positive wall shear stress gradient trigger a mural-cell-mediated pathway, which could be associated with the growth and rupture of small or secondary bleb aneurysm phenotypes. This hypothesis correlates disparate intracranial aneurysm pathophysiology with the results of computational fluid dynamics in search of more reliable risk predictors. ABBREVIATIONS:CFD ϭ computational fluid dynamics; ECM ϭ extracellular matrix; WSS ϭ wall shear stress

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Section: Relationship Between Hemodynamics and Aneurysm Developmentmentioning

confidence: 93%

Section: Relationship Between Hemodynamics and Aneurysm Developmentmentioning

confidence: 99%

Section: High and Low Wss Can Drive Different Mechanistic Pathways Ofmentioning

confidence: 99%

See 1 more Smart Citation

High WSS or Low WSS? Complex Interactions of Hemodynamics with Intracranial Aneurysm Initiation, Growth, and Rupture: Toward a Unifying Hypothesis

Meng

Tutino

Xiang

et al. 2013

AJNR Am J Neuroradiol

747

590

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“…4,9,14,30,42,45) A pathological study revealed that the walls of ruptured and unruptured aneurysms differ with respect to endothelial damage, fragility, and macrophage invasion. 17) The anatomic relationship between the aneurysm and parent artery results in hemodynamic effects that may influence the outcome of endovascular embolization. 4,6,21) However, previous large series did not address the involvement of the hemodynamics in the GDCs for Unruptured Aneurysms anatomic and follow-up outcomes.…”

Section: Introductionmentioning

confidence: 99%

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Soeda

Sakai

et al. 2004

Neurol. Med. Chir.(Tokyo)

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The present study assessed the safety and efficacy of embolization using Guglielmi detachable coils (GDCs) in 100 asymptomatic cerebral aneurysms classified as sidewall (70) or terminal (30) aneurysms according to the parent artery (68 small aneurysms with a small neck, 21 small aneurysms with a wide neck, and 11 large aneurysms). A balloon-assisted technique was used in 49 aneurysms. Immediate angiography revealed that 71 aneurysms were completely obliterated. Transient deficits occurred in 19 patients, permanent deficits in four patients, and one patient died. Most complications occurred during or immediately after treatment and resolved within a few minutes to a few weeks. None of the surviving patients manifested significant morbidity at 1-year follow up. Follow-up angiographic study was performed in 79 aneurysms. Rates of recanalization and progressive thrombosis (total occlusion of the residual aneurysm at follow up) were 11% and 38%, respectively, in sidewall aneurysms, and 26% and 0%, respectively, in terminal aneurysms. Treatment with GDCs was effective for patients with small aneurysms with small necks, the morbidity was acceptable, and progressive thrombosis occurred during the follow-up period. GDC treatment achieved unsatisfactory results in patients with small terminal aneurysms with wide necks and in large aneurysms, because the obliteration rate was low, and the recanalization and complication rates were high. Multivariate analysis showed that complete occlusion was associated with small-necked aneurysms, and ischemic events tended to occur in terminal aneurysms and in aneurysms treated by the balloon-assisted technique.

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“…Alguns estudos sugerem apenas o tratamento de aneurismas não-rotos maiores que 10 mm 1 , outros relatam que aneurismas se rompem com maior freqüência entre 7-10 mm 5 , sendo ainda sugerido o tratamento cirúrgico de aneurismas não-rotos menores que 10 mm [18][19][20] . Outros estudos têm demonstrado, também, que essa diferença no tamanho crítico para ruptura entre aneurismas não-rotos e rotos se encontra na constituição de sua parede, o que permite ao primeiro maior resistência 21,22 . Para os autores, todos os aneurismas vistos em estudo angiográfico devem ser tratados, tendo em vista a incapacidade dos métodos propedêuticos em diferenciar a espessura da parede deles e predizer se eles serão ou não aneurismas mais resistentes ao sangramento.…”

Section: Resultsunclassified

Tratamento cirúrgico dos aneurismas não rotos da artéria cerebral média

Faleiro

Pimenta

Faleiro

et al. 2004

Arq. Neuro-Psiquiatr.

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Descrevemos nossa experiência no tratamento microcirúrgico de 34 pacientes portadores de aneurismas não rotos da artéria cerebral média. Houve prevalência no sexo masculino. Oitenta e três por cento dos aneurismas apresentava tamanho menor que 10 mm. Não houve óbito na presente série, com morbidade de 3% após 1 ano. Indicamos, portanto, microcirurgia como tratamento de escolha para os aneurismas não rotos da artéria cerebral média.

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Difference in nature of ruptured and unruptured cerebral aneurysms

Cited by 70 publications

References 5 publications

High WSS or Low WSS? Complex Interactions of Hemodynamics with Intracranial Aneurysm Initiation, Growth, and Rupture: Toward a Unifying Hypothesis

High WSS or Low WSS? Complex Interactions of Hemodynamics with Intracranial Aneurysm Initiation, Growth, and Rupture: Toward a Unifying Hypothesis

Endovascular Treatment of Asymptomatic Cerebral Aneurysms: Anatomic and Technical Factors Related to Ischemic Events and Coil Stabilization

Tratamento cirúrgico dos aneurismas não rotos da artéria cerebral média

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