The biophysical role of hemodynamics in the pathogenesis of cerebral aneurysm formation and rupture

Soldozy, Sauson; Norat, Pedro; Elsarrag, Mazin; Chatrath, Ajay; Costello, John S; Sokolowski, Jennifer D.; Tvrdík, Petr; Kalani, M. Yashar S.; Park, Min S

doi:10.3171/2019.4.focus19232

Cited by 76 publications

(60 citation statements)

References 64 publications

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“…In this review article, we reviewed 19 studies that collectively had 7269 patients and 9167 cases of IAs, of which 1701 had ruptured [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Fourteen studies were observational studies, three of them were review articles, one was a meta-analysis, and one was a case series.…”

Section: Resultsmentioning

confidence: 99%

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Role of Morphological and Hemodynamic Factors in Predicting Intracranial Aneurysm Rupture: A Review

Jirjees

Htun

Aldawudi

et al. 2020

Cureus

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Intracranial aneurysms (IAs) carry the risk of rupture, which will lead to subarachnoid hemorrhage, which has a high mortality and morbidity risk. However, the treatment of IA's carries mortality and morbidity risks too. There are well-known risk factors for the rupture of IAs like age, size, and site. However, choosing patients with unruptured IAs for treatment is still a big challenge. This review article aimed to find out the relationship between morphological and hemodynamic characters of IAs with their rupture and incorporate these factors with well-known factors to yield an accurate module for predicting the rupture of IAs and decision-making in the treatment of unruptured IAs. We searched in PubMed and Medline databases by using the following keywords: IAs, subarachnoid hemorrhage, and risk of rupture, morphology, and hemodynamic "mesh." A total of 19 studies with 7269 patients and 9167 IAs, of which 1701 had ruptured, were reviewed thoroughly. Some modules like population, hypertension, age, size, earlier subarachnoid hemorrhage, and site (PHASES) score that involve well-known risk factors can be used to assess the risk of rupture of IAs. However, decision making for treating unruptured IA needs more detailed and more accurate modules. Studying morphological and hemodynamic factors and incorporation of them with well-known risk factors to yield a more comprehensive module will be very helpful in treating unruptured IA. Among morphological factors, aspect ratio (AR), size ratio (SR), aneurysm height, and bottleneck factor showed significant effects on the growth and rupture of IA. Besides, wall shear stress (WSS), oscillatory shear index (OSI), and low wall shear stress area (LSA) as hemodynamic factors could have a substantial impact on the formation, shape, growth, and rupture of unruptured IA.

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Section: Resultsmentioning

confidence: 99%

“…Because of the living nature of blood vessels, mechanical stimuli are transduced into biological signals, triggering inflammatory cascades leading to blood vessel wall remodeling. For this reason, cerebral aneurysmal hemodynamics has a significant role in the aneurysmal biophysical pathogenesis, evolution, and risk of rupture [13].…”

Section: Introductionmentioning

confidence: 99%

Role of Morphological and Hemodynamic Factors in Predicting Intracranial Aneurysm Rupture: A Review

Jirjees

Htun

Aldawudi

et al. 2020

Cureus

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“…Reversely, inhibition of calpain activation increases p53 expression, leading to a further increase of apoptotic rate of VSMCs (Sedding et al, 2008). Additionally, flow-dependent No release inhibits the proliferation of VSMCs and may initiate apoptosis by activation of caspase 3 (Penn et al, 2014; Soldozy et al, 2019). Inflammation cytokines, such as IL-1β, interferon γ, and iNOS, also contribute to VSMC apoptosis.…”

Section: Inflammation and Intracranial Aneurysmmentioning

confidence: 99%

Potential Therapeutic Strategies for Intracranial Aneurysms Targeting Aneurysm Pathogenesis

Zhao

Ajimu

Yalikun³

et al. 2019

Front. Neurosci.

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Subarachnoid hemorrhage resulting from intracranial aneurysms (IAs) is associated with high rates of morbidity and mortality. Although trigger mechanisms in the pathogenesis of IAs have not been fully elucidated, accumulating evidence has demonstrated that inflammation acts as a critical contributor to aneurysm pathogenesis. IAs is initiated by disruption and dysfunction of endothelial cells (ECs) caused by abnormal wall shear stress (WSS). Subsequently, vascular inflammation can trigger a series of biochemical reactions resulting in vascular smooth muscle cell (VSMC) apoptosis and migration, accompanied by inflammatory cell infiltration, secretion of various cytokines, and inflammatory factors. These changes result in degradation of vascular wall, leading to the progression and eventual rupture of IAs. Increasing our knowledge of the pathogenesis of these lesions will offer physicians new options for prevention and treatment. In this study, we review aneurysmal pathogenesis to seek for safe, effective, and non-invasive therapeutic strategies.

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“…Moderate to significant arterial dilation and even flow-related aneurysms were also noted in the seizure cohort, suggesting that high-flow shunting may impart enough wall shear stress to initiate aneurysm formation, further contributing to AVM-associated epilepsy. 6,29,44 Shakur et al 41 also identified mean AVM flow to be significantly higher in patients with seizures (p < 0.001), with the presence of intranidal fistula, venous ectasia, and venous varix being associated with higher flow.…”

Section: Angiographymentioning

confidence: 98%

Arteriovenous malformation presenting with epilepsy: a multimodal approach to diagnosis and treatment

Soldozy¹,

Norat²,

Yağmurlu³

et al. 2020

Neurosurgical Focus

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Arteriovenous malformation (AVM) presenting with epilepsy significantly impacts patient quality of life, and it should be considered very much a seizure disorder. Although hemorrhage prevention is the primary treatment aim of AVM surgery, seizure control should also be at the forefront of therapeutic management. Several hemodynamic and morphological characteristics of AVM have been identified to be associated with seizure presentation. This includes increased AVM flow, presence of long pial draining vein, venous outflow obstruction, and frontotemporal location, among other aspects. With the advent of high-throughput image processing and quantification methods, new radiographic attributes of AVM-related epilepsy have been identified. With respect to therapy, several treatment approaches are available, including conservative management or interventional modalities; this includes microsurgery, radiosurgery, and embolization or a combination thereof. Many studies, especially in the domain of microsurgery and radiosurgery, evaluate both techniques with respect to seizure outcomes. The advantage of microsurgery lies in superior AVM obliteration rates and swift seizure response. In addition, by incorporating electrophysiological monitoring during AVM resection, adjacent or even remote epileptogenic foci can be identified, leading to extended lesionectomy and improved seizure control. Radiosurgery, despite resulting in reduced AVM obliteration and prolonged time to seizure freedom, avoids the risks of surgery altogether and may provide seizure control through various antiepileptic mechanisms. Embolization continues to be used as an adjuvant for both microsurgery and radiosurgery. In this study, the authors review the latest imaging techniques in characterizing AVM-related epilepsy, in addition to reviewing each treatment modality.

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The biophysical role of hemodynamics in the pathogenesis of cerebral aneurysm formation and rupture

Cited by 76 publications

References 64 publications

Role of Morphological and Hemodynamic Factors in Predicting Intracranial Aneurysm Rupture: A Review

Role of Morphological and Hemodynamic Factors in Predicting Intracranial Aneurysm Rupture: A Review

Potential Therapeutic Strategies for Intracranial Aneurysms Targeting Aneurysm Pathogenesis

Arteriovenous malformation presenting with epilepsy: a multimodal approach to diagnosis and treatment

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