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

Werner, Cassidy; Mathkour, Mansour; Scullen, Tyler; McCormack, Erin; Dumont, Aaron S.; Amenta, Peter S.

doi:10.4103/bc.bc_1_20

Cited by 4 publications

(1 citation statement)

References 80 publications

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“…It is possible that this would mechanically weaken the vessel wall and predispose to aneurysmal degeneration (132). Notably, cerebral aneurysms are frequently associated with elevated shear stress, and occur more frequently in association with a carotid artery occlusion (130,(135)(136)(137). Given the irreplaceable nature of elastic fibers, aggressive diameter expansion risks exhausting local baseline elastin content which can create weakened and aneurysm prone collaterals.…”

Section: Implications Of Extensive Elastic Remodeling During Arteriogenesismentioning

confidence: 99%

Structural Remodeling of the Extracellular Matrix in Arteriogenesis: A Review

Kulkarni

Andraska

McEnaney

2021

Front. Cardiovasc. Med.

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Lower extremity arterial occlusive disease (AOD) results in significant morbidity and mortality for the population, with up to 10% of patients ultimately requiring amputation. An alternative method for non-surgical revascularization which is yet to be fully understood is the optimization of the body's own natural collateral arterial network in a process known as arteriogenesis. Under conditions of conductance vessel stenosis or occlusion resulting in increased flow, shear forces, and pressure gradients within collaterals, positive remodeling occurs to increase the diameter and capacity of these vessels. The creation of a distal arteriovenous fistula (AVF) will drive increased arteriogenesis as compared to collateral formation with the occlusion of a conductance vessel alone by further increasing flow through these arterioles, demonstrating the capacity for arteriogenesis to form larger, more efficient collaterals beyond what is spontaneously achieved after arterial occlusion. Arteries rely on an extracellular matrix (ECM) composed of elastic fibers and collagens that provide stability under hemodynamic stress, and ECM remodeling is necessary to allow for increased diameter and flow conductance in mature arterial structures. When positive remodeling occurs, digestion of lamella and the internal elastic lamina (IEL) by matrix metalloproteinases (MMPs) and other elastases results in the rearrangement and thinning of elastic structures and may be replaced with disordered elastin synthesis without recovery of elastic function. This results in transmission of wall strain to collagen and potential for aneurysmal degeneration along collateral networks, as is seen in the pancreaticoduodenal artery (PDA) after celiac occlusion and inferior mesenteric artery (IMA) with concurrent celiac and superior mesenteric artery (SMA) occlusions. Further understanding into the development of collaterals is required to both better understand aneurysmal degeneration and optimize collateral formation in AOD.

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Section: Implications Of Extensive Elastic Remodeling During Arteriogenesismentioning

confidence: 99%

Structural Remodeling of the Extracellular Matrix in Arteriogenesis: A Review

Kulkarni

Andraska

McEnaney

2021

Front. Cardiovasc. Med.

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Multiple aneurysms coexisting with carotid occlusion revealed by cerebral infarction: A case report

Mbodji¹,

Faye²,

Diassé³

et al. 2022

Radiology Case Reports

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Peculiarities of angiospasm and ischemic complications in ruptures of cerebral arterial aneurysms against the background of occlusive-stenotic lesions of cerebral arteries

Komarnytskyi,

Orlov

2024

Ukr Neurosurg J

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Objective – to determine the effect of occlusive-stenotic lesions of cerebral arteries on angiospasm and ischemic complications in patients with ruptured arterial aneurysms against the background of occlusive-stenotic lesions of cerebral arteries. Materials and methods. A retrospective study of the medical histories of 1,147 patients with cerebral artery aneurysms from 2006 to 2022 was conducted. 63 patients were included in the study group because they met the following criteria: surgical treatment; rupture of saccular aneurysms (SAs); the presence of occlusive-stenotic lesions was proven using instrumental examination methods. Patients of the control group had to meet the following criteria: surgical treatment; rupture of SAs; the absence of occlusive-stenotic lesions was proven by means of instrumental examination methods; the gender and age distribution had to match the study group. Of the 126 patients included in this study, there were 76 men (60.32%) and 50 women (39.68%). The age of the patients varied from 31 to 77 years. The average age of patients- 55.9±0.76 years; men – 54.3±0.94 years, women – 58.3±1.19 years. Results. A percentage predominance of patients with high cerebral blood flow velocity (>200 cm/s, which is equal to the velocity with severe grade III vasospasm of the cerebral arteries) in the study group (32.56%) compared with the control group (24.24%) was revealed. Conclusions. The predominance of men among patients of the study group (60.32%) was established. The average age of men with occlusive-stenotic lesions was younger than that of women (men – 54.3±0.94 years, women – 58.3±1.19 years). The difference in age is the largest in the 2nd subgroup of the study group where the severity of stenosis is 50-75% (men - 48.3 years; women - 62 years). Ruptures of arterial aneurysms of the middle cerebral artery occur more often in the presence of stenoses (study group - 25.4%, control group - 12.7%). The neurological status of patients with a hemorrhagic stroke, as a result of the rupture of an arterial aneurysm, is significantly aggravated by occlusive-stenotic lesions due to the occurrence of chronic brain ischemia. The worst prognosis for life and health was in men with a ruptured arterial aneurysm against the background of a 50-75% stenotic lesion and severe vasospasm of the cerebral arteries.

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

Cited by 4 publications

References 80 publications

Structural Remodeling of the Extracellular Matrix in Arteriogenesis: A Review

Structural Remodeling of the Extracellular Matrix in Arteriogenesis: A Review

Multiple aneurysms coexisting with carotid occlusion revealed by cerebral infarction: A case report

Peculiarities of angiospasm and ischemic complications in ruptures of cerebral arterial aneurysms against the background of occlusive-stenotic lesions of cerebral arteries

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