The role of circle of Willis anomalies in cerebral aneurysm rupture

Lazzaro, Marc A.; Ouyang, Bo; Chen, Michael

doi:10.1136/jnis.2010.004358

Cited by 53 publications

(51 citation statements)

References 23 publications

(27 reference statements)

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“…Numerous studies suggest a role for hormones in aneurysm pathogenesis via its effect on vascular remodeling and have shown the benefits of hormone replacement therapy (HRT) on reducing aneurysm formation and rupture (Stober et al, 1985; Mhurchu et al, 2001; Stirone et al, 2003; Harrod et al, 2006; Lazzaro et al, 2012). The increase in female prevalence of cerebral aneurysms and SAH peaks between 50 and 59 years of age, in correlation with the fall in estrogen levels.…”

Section: Discussionmentioning

confidence: 99%

Gender Differences in Cerebral Aneurysm Location

2012

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Background and Purpose: A limited number of studies consisting predominantly of ruptured aneurysms have looked at differences in anatomical distribution of aneurysms between male and females. Unlike all other causes of stroke, subarachnoid hemorrhages (SAH) occur more often in women and are thought to be a result of both hormonal influences and variation in wall shear stress. This paper retrospectively looks at a cohort of largely unruptured intracranial aneurysms to determine if there exists a gender discrepancy in the anatomic distribution of cerebral aneurysms. Methods: A retrospective review of consecutive patients with ruptured and unruptured intradural saccular cerebral aneurysms treated endovascularly was performed. Results: Six hundred eighty-two aneurysms were treated. Seventy-two percentage of the patients were women and 27% of patients presented with SAH. Among women, most aneurysms were located along the ICA (54%) while men the ACA (29%, compared to 15% in women), a discrepancy evident in both unruptured and ruptured groups. Females tended to present later in life (59 vs. 55 years), with multiple aneurysms (11 vs. 6% in men), and with SAH (28 vs. 23% in men) – the majority of these ruptured aneurysms were located at the ICA (42%), while men at the ACA (47%). Additionally, the majority (68%) of ruptured ICA aneurysms were PCOM. Conclusion: Understanding the natural history of aneurysms is imperative in treating incidentally found aneurysms. Significant differences exist between the genders in relation to aneurysm location, the most pronounced at the ICA and ACA. Previously described hormonal and hemodynamic theories behind cerebral aneurysm pathogenesis seem like plausible reasons to explain these differences.

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Section: Discussionmentioning

confidence: 99%

Gender Differences in Cerebral Aneurysm Location

2012

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“…The authors concluded that the configuration of the circle of Willis was not strongly correlated to rupture, but that moderate risk could not be excluded. A more recent study showed that anomalies of the circle of Willis were more frequently found in ruptured than in unruptured aneurysms of the ACOM or PCOM arteries 75 . Thus, the authors speculate that increased flow in combination with vascular configurations that do not minimize the energy expenditure at bifurcations may, via turbulent flows and increased WSS, contribute to intracranial aneurysm formation and progression.…”

Section: Locationmentioning

confidence: 98%

Suggested Connections Between Risk Factors of Intracranial Aneurysms: A Review

Cebral

Raschi

2012

Ann Biomed Eng

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The purpose of this article is to review studies of aneurysm risk factors and the suggested hypotheses that connect the different risk factors and the underlying mechanisms governing the aneurysm natural history. The result of this work suggests that at the center of aneurysm evolution there is a cycle of wall degeneration and weakening in response to changing hemodynamic loading and biomechanic stress. This progressive wall degradation drives the geometrical evolution of the aneurysm until it stabilizes or ruptures. Risk factors such as location, genetics, smoking, co-morbidities, and hypertension seem to affect different components of this cycle. However, details of these interactions or their relative importance are still not clearly understood.

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“…Any variations in it may cause a disturbance in its flow [3]. The variations of the anterior circulation of the brain may lead to some clinical conditions like Cerebrovascular diseases such as stroke, aneurysms, internal carotid artery occlusion, unilateral flow restrictive external carotid artery disease, and migraine [8][9][10]. In mentally challenged patients, a higher percentage of anomalies of the circle of Willis was also reported [11].…”

Section: Study On the Anatomical Variations Of The Anterior Part Of Tmentioning

confidence: 98%