Hemodynamic relationship between intracranial aneurysm and carotid stenosis: review of clinical cases and numerical analyses

Jou, Liang Der; Shaltoni, Hashem; Morsi, H.; Mawad, Michel E.

doi:10.1179/016164110x12681290831522

Cited by 13 publications

(9 citation statements)

References 14 publications

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“…The rate of aneurysmal growth and rupture in patients with significant extracranial carotid artery stenosis was also low [ 36 ]. Wall shear stress at the aneurysm site appears to be influenced more by adjacent geometrical changes rather than by remote input [ 37 ].…”

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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Section: Pathophysiology Of a Cerebral Aneurysmmentioning

confidence: 99%

New Pathophysiological Considerations on Cerebral Aneurysms

Jung

2018

Neurointervention

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“…Prevalence of intracranial aneurysms is obviously higher in patients with ischemic cerebrovascular diseases compared with general population [ 7 ]. Carotid arterial stenosis or occlusion on one side increases blood flow of contralateral carotid artery and cerebral arterial circle, aggravates the impact force and shear force of blood flow on the vessel wall, and results in the occurrence and development of intracranial aneurysms [ 11 ]. In South Korean patients with ischemic cerebrovascular diseases, 47.4 and 52.6% of intracranial aneurysms located on the same and other side of arterial stenosis or occlusion, respectively [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical treatment and perioperative management of intracranial aneurysms in Chinese patients with ischemic cerebrovascular diseases: a case series

Zheng

2018

BMC Neurol

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BackgroundPatients with ischemic cerebrovascular diseases are more likely to suffer from intracranial aneurysms, and their surgical treatment has a growing controversy in this condition. The current case series was aimed at exploring surgical treatment and perioperative management of intracranial aneurysms in Chinese patients with ischemic cerebrovascular diseases.MethodsMinimally invasive surgical approach through small pterion or inferolateral forehead was applied in 31 patients. Anti-platelet drugs were withdrawn 1 week before surgical operation. Systolic blood pressure was controlled to be more than 110 mmHg and increased by 20% after the clipping of intracranial aneurysms. Branches of external carotid artery were spared to ensure collateral circulation. Temporary blocking was minimized and ischemic time was shortened during surgical operation.ResultsPatients had an average age of 66 (46–78) years, and proportion of males was 39% (12 males). There were 35 unruptured intracranial aneurysms with a diameter more than 5 mm. There were 20 posterior communicating and anterior choroidal aneurysms (57%), seveb middle cerebral aneurysms (20%), and eight anterior communicating aneurysms (23%), with 21 lobular aneurysms (60%). Twenty-nine patients had normal neurological function (Glasgow Outcome Scale [GOS] 5), one patient with mild neurological defect (GOS 4), and one patient with severe neurological defect (GOS 3) at discharge. Meanwhile, there were 26 patients with modified Rankin Scale (MRS) 0–1, 4 patient with MRS 2, and one patient with MRS 3 at discharge. There were four patients lost during the follow-up. During the follow-up, 26 patients had normal neurological function (GOS 5), and one patient with severe neurological defect (GOS 3). Meanwhile, there were 25 patients with MRS 0–1, one patient with MRS 2, and one patient with MRS 3. All patients had no recurrence of intracranial aneurysms after operation.ConclusionsThe current case series found that minimally invasive surgical approach and intraoperative monitoring, supplemented by effective management of cerebrovascular perfusion, circulation and coagulation, can promote the treatment of intracranial aneurysms and prevent the development of cerebral ischemia and aneurysm rupture in Chinese patients with ischemic cerebrovascular diseases. Future studies with large sample size will be needed to confirm the results from the current case series.

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“…[ 70 ] Additional studies have reported larger aneurysm sizes on the side contralateral to a stenotic ICA. [ 71 ] Our patient presented with an asymptomatic chronic right ICA occlusion and a large ACOM through which the entire right anterior circulation was fed by the left ICA. The left A1-A2 junction was also the site of the patient's largest aneurysm.…”

Section: Internal Carotid Artery Stenosis and Intracranial Aneurysm Fmentioning

confidence: 99%

Multiple flow-related intracranial aneurysms in the setting of contralateral carotid occlusion: Coincidence or association?

et al. 2020

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The prevalence of intracranial aneurysms (IAs) is higher in patients with internal carotid artery (ICA) stenosis, likely due to alterations in intracranial hemodynamics. Severe stenosis or occlusion of one ICA may result in increased demand and altered hemodynamics in the contralateral ICA, thus increasing the risk of contralateral IA formation. In this article, we discuss a relevant case and a comprehensive literature review as it pertains to the association of ICA stenosis and IA. Our patient was a 50-year-old female with a chronic asymptomatic right ICA occlusion who presented with diffuse subarachnoid hemorrhage. Emergent angiography revealed left-sided A1-A2 junction, paraclinoid, left middle cerebral artery (MCA) bifurcation, and left anterior temporal artery aneurysms. Brisk filling of the right anterior circulation through the anterior communicating artery was also identified, signifying increased demand on the left ICA circulation. Complete obliteration of all aneurysms was achieved with coil embolization and clipping. For our literature review, we searched the PubMed and EMBASE databases for case reports and case series, as well as references in previously published review articles that described patients with concurrent aneurysms and ICA stenosis. We selected articles that provided adequate information about the case presentations to compare aneurysm and patient characteristics. Our review revealed a higher number of patients with multiple aneurysms contralateral (25%) to rather than ipsilateral to (6%), the ICA stenosis. We discuss the pathogenesis and management of multiple flow-related IA in the context of the existing literature related to concurrent ICA stenosis and IA.

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Hemodynamic relationship between intracranial aneurysm and carotid stenosis: review of clinical cases and numerical analyses

Cited by 13 publications

References 14 publications

New Pathophysiological Considerations on Cerebral Aneurysms

New Pathophysiological Considerations on Cerebral Aneurysms

Surgical treatment and perioperative management of intracranial aneurysms in Chinese patients with ischemic cerebrovascular diseases: a case series

Multiple flow-related intracranial aneurysms in the setting of contralateral carotid occlusion: Coincidence or association?

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