Inflammation promotes progression of thrombi in intracranial thrombotic aneurysms

Suzuki, Hime; Mikami, Takeshi; Tamada, Tomoaki; Ukai, Ryo; Akiyama, Yukinori; Yamamura, Akinori; Houkin, Kiyohiro; Mikuni, Nobuhiro

doi:10.1007/s10143-019-01184-3

Cited by 15 publications

(12 citation statements)

References 42 publications

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“…Inflammatory cell infiltration plays an important role in atherosclerosis. Intraluminal thrombus promotes inflammatory cell accumulation and microvascularization of the aneurysm wall ( 28 ). The repeated microbleeds from these new fragile vasa vasorum further promote inflammatory cell accumulation ( 28 ).…”

Section: Discussionmentioning

confidence: 99%

“…Intraluminal thrombus promotes inflammatory cell accumulation and microvascularization of the aneurysm wall ( 28 ). The repeated microbleeds from these new fragile vasa vasorum further promote inflammatory cell accumulation ( 28 ). Acute and chronic inflammatory cell accumulations accelerate aneurysm enlargement and induce aneurysm rupture ( 29 ).…”

Section: Discussionmentioning

confidence: 99%

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Hemodynamic Characteristic Analysis of Aneurysm Wall Enhancement in Unruptured Middle Cerebral Artery Aneurysm

Zhong

Kuang

et al. 2022

Front. Neurol.

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Background and PurposeAneurysm wall enhancement (AWE) on vessel wall magnetic resonance imaging has been suggested as a marker of the unstable status of intracranial aneurysm (IA) and may predict IA rupture risk. However, the role of abnormal hemodynamics in unruptured IAs with AWE remains poorly understood. This study aimed to determine the association between abnormal hemodynamics and AWE in unruptured middle cerebral artery (MCA) aneurysms.MethodsA total of 28 patients with 32 bifurcation aneurysms of the middle cerebral artery>3mm in size were retrospectively selected for this study. Vessel wall magnetic resonance images were reviewed, and the AWE pattern of each aneurysm was classified as no AWE, partial AWE, and circumferential AWE. Computational fluid dynamics were used to calculate the hemodynamic variables of each aneurysm. Univariate and multivariate analyses investigated the association between AWE and hemodynamic variables.ResultsAWE was present in 13 aneurysms (40.6%), with 7 (21.9%) showing partial AWE and 6 (18.7%) showing circumferential AWE. Kruskal–Wallis H analysis revealed that hemodynamic variables including wall shear stress (WSS), oscillatory shear index, aneurysm pressure (AP), relative residence time, and low shear area (LSA) were significantly associated with AWE (p < 0.05). Further ordinal logistic regression analysis found that WSS was the only factor with a significant association with AWE (p = 0.048); similar trends were identified for LSA (p = 0.055) and AP (p = 0.058). Spearman's correlation analysis showed that AWE was negatively correlated with WSS (rs = −0.622, p < 0.001) and AP (rs = −0.535, p = 0.002) but positively correlated with LSA (rs = 0.774, p < 0.001).ConclusionLow wall shear stress, low aneurysm pressure, and increased low shear area were associated with aneurysm wall enhancement on vessel wall magnetic resonance imaging in unruptured cerebral aneurysms. These abnormal hemodynamic parameters may induce inflammation and cause aneurysm wall enhancement. However, the association between these parameters and their underlying pathological mechanisms requires further investigation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hemodynamic Characteristic Analysis of Aneurysm Wall Enhancement in Unruptured Middle Cerebral Artery Aneurysm

Zhong

Kuang

et al. 2022

Front. Neurol.

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“…Inflammation may be another factor related to symptom improvement. Suzuki et al ( 37 ) suggested that microvascularization owing to microbleeds and inflammation from microvessels occur in a vicious cycle, which causes neurological symptoms. Moreover, repeated hemodynamic insults after dissecting aneurysm formation leads to periods of inflammation and thrombosis, which exacerbates this cascade.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of reconstructive endovascular treatment of vertebrobasilar dissecting aneurysms with intramural hematoma

Zhang

Peng²,

Zhou³

et al. 2022

Front. Neurol.

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BackgroundVertebrobasilar dissecting aneurysms (VBDAs) with an intramural hematoma (IMH) usually cause symptoms because of mass effect and grow in size over time. Clinical outcomes are generally poor.ObjectiveThis study aimed to examine outcomes of reconstructive endovascular treatment (EVT) in patients with VBDAs with IMH. Safety and effectiveness were compared between flow diverters (FDs) and conventional stents.MethodsWe retrospectively analyzed the clinical and radiological data of 36 VBDAs with IMH in 36 patients who underwent EVT with either FDs or conventional stents from January 2012 to December 2020 at our institution.ResultsAmong the 36 study patients, 20 were treated with FDs and 16 with conventional stents. Incidence of procedure-related complications did not significantly differ between the two stents. IMH growth occurred after EVT in a significantly higher proportion of conventional stent group aneurysms (zero vs. 31.3% [5/16]; p = 0.012). Among the five aneurysms with IMHs that grew, all recurred. Change in IMH size after EVT was significantly lower in the FD group (−2.7 vs. +8.1%, p = 0.036). However, after the recurrent aneurysms were removed from the conventional stent group, change in IMH size did not significantly differ between the two groups (−2.7 vs. +1.0%, p = 0.332). The proportion of patients who experienced an improvement in mRS score after EVT was significantly higher in the FD group (60 vs. 25%, p = 0.036).ConclusionIMHs in VBDAs stop growing after successful reconstructive EVT. Although both FD and conventional stent treatment are effective, FD treatment may be superior based on clinical outcomes and effect on IMH size.

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“…The importance of macrophage infiltration for the inflammatory remodeling leading to IA formation has been demonstrated by several studies [3,22,36,74,80], including the landmark experimental studies by Kanematsu et al, Shimada et al, and Aoki et al [3,36,74]. P. gingivalis can stay viable in human macrophages and dendritic cells [7,76,92] and thus possibly disseminate to IA wall via macrophage infiltration.…”

Section: Potential Role Of Periodontal Pathogens In the Pathobiology mentioning

confidence: 98%

Role of oral pathogens in the pathogenesis of intracranial aneurysm: review of existing evidence and potential mechanisms

et al. 2020

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Degeneration of intracranial aneurysm wall is under active research and recent studies indicate an increased risk of rupture of intracranial aneurysm among patients with periodontal diseases. In addition, oral bacterial DNA has been identified from wall samples of ruptured and unruptured aneurysms. These novel findings led us to evaluate if oral diseases could predispose to pathological changes seen on intracranial aneurysm walls eventually leading to subarachnoid hemorrhage. The aim of this review is to consider mechanisms on the relationship between periodontitis and aneurysm rupture, focusing on recent evidence.

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Inflammation promotes progression of thrombi in intracranial thrombotic aneurysms

Cited by 15 publications

References 42 publications

Hemodynamic Characteristic Analysis of Aneurysm Wall Enhancement in Unruptured Middle Cerebral Artery Aneurysm

Hemodynamic Characteristic Analysis of Aneurysm Wall Enhancement in Unruptured Middle Cerebral Artery Aneurysm

Outcomes of reconstructive endovascular treatment of vertebrobasilar dissecting aneurysms with intramural hematoma

Role of oral pathogens in the pathogenesis of intracranial aneurysm: review of existing evidence and potential mechanisms

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