51
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van Laarhoven CJHCM, Rots ML, Pourier VEC, Jorritsma NKN, Leiner T, Hendrikse J, Vergouwen MDI, de Borst GJ. Gadolinium Enhancement of the Aneurysm Wall in Extracranial Carotid Artery Aneurysms. AJNR Am J Neuroradiol 2020; 41:501-507. [PMID: 32115417 DOI: 10.3174/ajnr.a6442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/07/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE The natural history and optimal treatment of extracranial carotid artery aneurysms are unknown. Gadolinium enhancement of the aneurysm wall may reflect aneurysm wall inflammation and instability. In this study, we investigated the feasibility of extracranial carotid artery aneurysm wall imaging and explored a potential relationship of aneurysm wall enhancement with aneurysm growth and the presence of (silent) brain infarcts and white matter lesions. MATERIALS AND METHODS Fourteen conservatively treated patients with 15 asymptomatic extracranial carotid artery aneurysms underwent gadolinium-enhanced 3T MR imaging at 2 time points with a 12-month interval. Primary outcome was growth of the aneurysm sac (≥2.0 mm); secondary outcomes were the presence of (silent) brain infarcts and white matter lesions at baseline and follow-up. MR images were reviewed by 2 independent observers, and inter- and intraobserver reproducibility was assessed. RESULTS Seven (50%) patients were men; the median age was 55 years (range, 40-69 years). Eleven extracranial carotid artery aneurysms (73%) were saccular (median size, 11 mm; range, 5.0-38.5 mm), and 4 were fusiform (median size, 21.5 mm; range, 10.0-40.0 mm). Eleven of 15 aneurysms (73%) exhibited gadolinium enhancement at baseline. Four aneurysms (27%) showed growth at follow-up imaging, 2 gadolinium-positive (+) and 2 gadolinium-negative (-) (P = .245). Three patients (21%) had ipsilateral brain infarcts at baseline; 1 of them showed a new silent brain infarct at follow-up imaging (gadolinium+). Nine patients (64%) showed bilateral white matter lesions at baseline. In 3 patients, increased white matter lesion severity was observed at follow-up (2 gadolinium+). All observations showed excellent inter- and intraobserver reproducibility. CONCLUSIONS In this explorative study, we demonstrated that extracranial carotid artery aneurysm wall imaging was feasible. Future well-powered studies are needed to investigate whether extracranial carotid artery aneurysm gadolinium enhancement predicts aneurysm growth and thromboembolic complications.
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Affiliation(s)
- C J H C M van Laarhoven
- From the Departments of Vascular Surgery (C.J.H.C.M.v.L., M.L.R., V.E.C.P., N.K.N.J., G.J.d.B.)
| | - M L Rots
- From the Departments of Vascular Surgery (C.J.H.C.M.v.L., M.L.R., V.E.C.P., N.K.N.J., G.J.d.B.)
| | - V E C Pourier
- From the Departments of Vascular Surgery (C.J.H.C.M.v.L., M.L.R., V.E.C.P., N.K.N.J., G.J.d.B.)
| | - N K N Jorritsma
- From the Departments of Vascular Surgery (C.J.H.C.M.v.L., M.L.R., V.E.C.P., N.K.N.J., G.J.d.B.)
| | | | | | - M D I Vergouwen
- UMC Utrecht Brain Center (M.D.I.V.), Department of Neurology and Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - G J de Borst
- From the Departments of Vascular Surgery (C.J.H.C.M.v.L., M.L.R., V.E.C.P., N.K.N.J., G.J.d.B.)
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52
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Nevzati E, Rey J, Coluccia D, Grüter BE, Wanderer S, vonGunten M, Remonda L, Frosen J, Widmer HR, Fandino J, Marbacher S. Aneurysm wall cellularity affects healing after coil embolization: assessment in a rat saccular aneurysm model. J Neurointerv Surg 2019; 12:621-625. [DOI: 10.1136/neurintsurg-2019-015335] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 11/04/2022]
Abstract
Background and purposeDespite significant technical advances, recanalization rates after endovascular therapy of ruptured intracranial aneurysms (IAs) remain a clinical challenge. A histopathological hallmark of ruptured human IA walls is mural cell loss. Mural smooth muscle cells (SMCs) are known to promote intraluminal healing in thrombosed experimental aneurysms. In this rat model we assess the natural history and healing process after coil embolization in SMC-rich and decellularized aneurysms.MethodsSaccular aneurysms were created by end-to-side anastomosis of an arterial graft from the descending thoracic aorta of a syngeneic donor rat to the infrarenal abdominal aorta of recipient male Wistar rats. Untreated arterial grafts were immediately transplanted, whereas aneurysms with loss of mural cells were chemically decellularized before implantation. Aneurysms underwent coil implantation during aneurysm anastomosis. Animals were randomly assigned either to the non-decellularized or decellularized group and underwent macroscopic and histological analyses on days 3, 7, 21, or 90 post-coil implantation.ResultsA total of 55 rats underwent macroscopic and histologic analysis. After coil embolization, aneurysms with SMC-rich walls showed a linear course of thrombosis and neointima formation whereas decellularized aneurysms showed marked inflammatory wall degeneration with increased recanalization rates 21 days (p=0.002) and 90 days (p=0.037) later. The SMCs showed the ability to actively migrate into the intra-aneurysmal thrombus and participate in thrombus organization.ConclusionsCoil embolization of aneurysms with highly degenerated walls is prone to further wall degeneration, increased inflammation, and recanalization compared with aneurysms with vital SMC-rich walls.
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53
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Young CC, Bonow RH, Barros G, Mossa-Basha M, Kim LJ, Levitt MR. Magnetic resonance vessel wall imaging in cerebrovascular diseases. Neurosurg Focus 2019; 47:E4. [DOI: 10.3171/2019.9.focus19599] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cerebrovascular diseases manifest as abnormalities of and disruption to the intracranial vasculature and its capacity to carry blood to the brain. However, the pathogenesis of many cerebrovascular diseases begins in the vessel wall. Traditional luminal and perfusion imaging techniques do not provide adequate information regarding the differentiation, onset, or progression of disease. Intracranial high-resolution MR vessel wall imaging (VWI) has emerged as an invaluable technique for understanding and evaluating cerebrovascular diseases. The location and pattern of contrast enhancement in intracranial VWI provides new insight into the inflammatory etiology of cerebrovascular diseases and has potential to permit earlier diagnosis and treatment. In this report, technical considerations of VWI are discussed and current applications of VWI in vascular malformations, blunt cerebrovascular injury/dissection, and steno-occlusive cerebrovascular vasculopathies are reviewed.
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Affiliation(s)
| | | | | | | | - Louis J. Kim
- Departments of 1Neurological Surgery,
- 2Radiology, and
- 4Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
| | - Michael R. Levitt
- Departments of 1Neurological Surgery,
- 2Radiology, and
- 3Mechanical Engineering, and
- 4Stroke and Applied Neuroscience Center, University of Washington, Seattle, Washington
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54
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Omodaka S, Endo H, Niizuma K, Fujimura M, Inoue T, Endo T, Sato K, Sugiyama SI, Tominaga T. Circumferential wall enhancement in evolving intracranial aneurysms on magnetic resonance vessel wall imaging. J Neurosurg 2019; 131:1262-1268. [PMID: 30485237 DOI: 10.3171/2018.5.jns18322] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 05/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Recent MR vessel wall imaging studies have indicated intracranial aneurysms in the active state could show circumferential enhancement along the aneurysm wall (CEAW). While ruptured aneurysms frequently show CEAW, CEAW in unruptured aneurysms at the evolving state (i.e., growing or symptomatic) has not been studied in detail. The authors quantitatively assessed the degree of CEAW in evolving unruptured aneurysms by comparing it separately to that in stable unruptured and ruptured aneurysms. METHODS A quantitative analysis of CEAW was performed in 26 consecutive evolving aneurysms using MR vessel wall imaging. Three-dimensional T1-weighted fast spin echo sequences were obtained before and after contrast media injection, and the contrast ratio of the aneurysm wall against the pituitary stalk (CRstalk) was calculated as the indicator of CEAW. Aneurysm characteristics of evolving aneurysms were compared with those of 69 stable unruptured and 67 ruptured aneurysms. RESULTS The CRstalk values in evolving aneurysms were significantly higher than those in stable aneurysms (0.54 vs 0.34, p < 0.0001), and lower than those in ruptured aneurysms (0.54 vs 0.83, p < 0.0002). In multivariable analysis, CRstalk remained significant when comparing evolving with stable aneurysms (odds ratio [OR] 12.23, 95% confidence interval [CI] 3.53-42.41), and with ruptured aneurysms (OR 0.083, 95% CI 0.022-0.310). CONCLUSIONS The CEAW in evolving aneurysms was higher than those in stable aneurysms, and lower than those in ruptured aneurysms. The degree of CEAW may indicate the process leading to rupture of intracranial aneurysms, which can be useful additional information to determine an indication for surgical treatment of unruptured aneurysms.
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Affiliation(s)
| | - Hidenori Endo
- 2Department of Neurosurgery, Tohoku University Graduate School of Medicine; and
| | - Kuniyasu Niizuma
- 2Department of Neurosurgery, Tohoku University Graduate School of Medicine; and
| | | | - Takashi Inoue
- 3Department of Neurosurgery, Sendai Medical Center, Sendai, Japan
| | | | | | | | - Teiji Tominaga
- 2Department of Neurosurgery, Tohoku University Graduate School of Medicine; and
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55
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Gao G, Zhang Y, Chao Y, Niu C, Fu X, Wei J. miR-4735-3p regulates phenotypic modulation of vascular smooth muscle cells by targeting HIF-1-mediated autophagy in intracranial aneurysm. J Cell Biochem 2019; 120:19432-19441. [PMID: 31498485 DOI: 10.1002/jcb.29219] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 05/20/2019] [Indexed: 11/08/2022]
Abstract
Intracranial aneurysm (IA) is recognized as a lethal form of cerebrovascular disease mainly featured with a modulated phenotype of vascular smooth muscle cells (SMCs). It is generally believed that enhanced SMC proliferation and migration capabilities are the main characteristics in this process. In this study, we revealed that microRNA-4735 (miR-4735) participates in phenotypic modulation in a hypoxia-inducible factor-1 (HIF-1)-dependent manner of SMCs. miR-4735 targets the 3'-untranslated region of HIF-1. The downregulated expression of miR-4735 in IA tissues leads to elevated expression of HIF-1, which activates autophagy and promotes autophagy-mediated SMC proliferation and migration. Overexpression of miR-4735 suppressed HIF-1 expression and HIF-1-mediated autophagy, which led to impaired SMC proliferation and migration abilities. Forced expression of HIF-1 in miR-4735-overexpressed SMCs rescued the impaired SMC proliferation and migration abilities. In conclusion, miR-4735 plays an important role in phenotypic modulation in IA by regulating autophagy-promoted SMC proliferation and migration.
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Affiliation(s)
- Ge Gao
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, P.R. China
| | - Yang Zhang
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, P.R. China
| | - Yingjiu Chao
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, P.R. China
| | - Chaoshi Niu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, P.R. China
| | - Xianming Fu
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, P.R. China
| | - Jianjun Wei
- Department of Neurosurgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, P.R. China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui, P.R. China
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56
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Laarman MD, Ruigrok YM, Nierstrasz RCS, Spliet WGM, Van Hecke W, Algra A, Rinkel GJE. Histological Differences of the Vascular Wall Between Sites With High and Low Prevalence of Intracranial Aneurysm. J Neuropathol Exp Neurol 2019; 78:648-654. [PMID: 31058997 DOI: 10.1093/jnen/nlz036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intracranial aneurysms (IAs) develop more often on bifurcations compared with the rest of the circle of Willis (CoW). We investigated histological differences between 2 high IA prevalence sites (anterior communicating artery [AcomA] and basilar tip) and 2 corresponding low IA prevalence sites (anterior cerebral artery [ACA] and basilar artery [BA]) using histological sections of 10 CoWs without IAs. Medial defect density in the AcomA was 0.24 medial defects/mm compared with 0.02 for the A1 part and 0.03 for the A2 part of the ACA. In the basilar tip we found 0.15 medial defects/mm compared with 0.14 in the BA. Vascular smooth muscle cells (VSMCs) were more often disorganized in both high-prevalence sites (AcomA: 10/10, basilar tip: 5/10) compared with low-prevalence sites (both ACA and BA: 1/10). Intima thickening was more severe in the high-prevalence sites. Vascular wall thickness was not significantly different between high- and low-prevalence sites, but had a larger variance in high- compared with low-prevalence sites (AcomA vs ACA: p = 6.8E-12, basilar tip vs BA: p = 0.02). Disorganized VSMCs at high-prevalence sites likely result in a higher susceptibility to hemodynamic stress, leading to more vascular remodeling (such as intima thickening), which could increase the likelihood of IA formation.
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Affiliation(s)
- Melanie D Laarman
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht.,Hubrecht Institute-KNAW and University Medical Center Utrecht
| | - Ynte M Ruigrok
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht
| | - Renske C S Nierstrasz
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht
| | - Wim G M Spliet
- Department of Pathology, University Medical Center Utrecht
| | - Wim Van Hecke
- Department of Pathology, University Medical Center Utrecht.,Princess Máxima Center for Pediatric Oncology
| | - Ale Algra
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gabriël J E Rinkel
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht
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57
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Gareev IF, Safin SM. [The role of endogenous miRNAs in the development of cerebral aneurysms]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:112-118. [PMID: 30900695 DOI: 10.17116/neiro201983011112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cerebral aneurysms are characterized by pathological expansion and thinning of the wall of vessels on the brain base, which may lead to rupture and subarachnoid hemorrhage (SAH) that is a life-threatening condition. This dictates the need for identification of new biological markers that predict the presence of aneurysms and the risk of their rupture. In the last decade, the role of microRNAs (miRNAs), which are considered to be key regulators of biological processes, has been investigated. miRNAs have been shown to play a role in the development of aneurysms, but today there is little similar data. In this literature review, we analyze the existing data on the role of miRNAs in development, progression, and rupture of cerebral aneurysms. We describe the relationship between miRNA expression profiles and specific molecular and cellular processes leading to the development of aneurysms. Also, we discuss the potential clinical significance of miRNAs for predicting the risk of aneurysm rupture.
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Affiliation(s)
- I F Gareev
- Bashkir State Medical University, Ufa, Russia
| | - Sh M Safin
- Bashkir State Medical University, Ufa, Russia
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58
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Intracranial Aneurysms: Pathology, Genetics, and Molecular Mechanisms. Neuromolecular Med 2019; 21:325-343. [PMID: 31055715 DOI: 10.1007/s12017-019-08537-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/08/2019] [Indexed: 12/14/2022]
Abstract
Intracranial aneurysms (IA) are local dilatations in cerebral arteries that predominantly affect the circle of Willis. Occurring in approximately 2-5% of adults, these weakened areas are susceptible to rupture, leading to subarachnoid hemorrhage (SAH), a type of hemorrhagic stroke. Due to its early age of onset and poor prognosis, SAH accounts for > 25% of years lost for all stroke victims under the age of 65. In this review, we describe the cerebrovascular pathology associated with intracranial aneurysms. To understand IA genetics, we summarize syndromes with elevated incidence, genome-wide association studies (GWAS), whole exome studies on IA-affected families, and recent research that established definitive roles for Thsd1 (Thrombospondin Type 1 Domain Containing Protein 1) and Sox17 (SRY-box 17) in IA using genetically engineered mouse models. Lastly, we discuss the underlying molecular mechanisms of IA, including defects in vascular endothelial and smooth muscle cells caused by dysfunction in mechanotransduction, Thsd1/FAK (Focal Adhesion Kinase) signaling, and the Transforming Growth Factor β (TGF-β) pathway. As illustrated by THSD1 research, cell adhesion may play a significant role in IA.
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59
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Ling C, Liu Z, Song M, Zhang W, Wang S, Liu X, Ma S, Sun S, Fu L, Chu Q, Belmonte JCI, Wang Z, Qu J, Yuan Y, Liu GH. Modeling CADASIL vascular pathologies with patient-derived induced pluripotent stem cells. Protein Cell 2019; 10:249-271. [PMID: 30778920 PMCID: PMC6418078 DOI: 10.1007/s13238-019-0608-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/29/2018] [Indexed: 12/23/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare hereditary cerebrovascular disease caused by a NOTCH3 mutation. However, the underlying cellular and molecular mechanisms remain unidentified. Here, we generated non-integrative induced pluripotent stem cells (iPSCs) from fibroblasts of a CADASIL patient harboring a heterozygous NOTCH3 mutation (c.3226C>T, p.R1076C). Vascular smooth muscle cells (VSMCs) differentiated from CADASIL-specific iPSCs showed gene expression changes associated with disease phenotypes, including activation of the NOTCH and NF-κB signaling pathway, cytoskeleton disorganization, and excessive cell proliferation. In comparison, these abnormalities were not observed in vascular endothelial cells (VECs) derived from the patient's iPSCs. Importantly, the abnormal upregulation of NF-κB target genes in CADASIL VSMCs was diminished by a NOTCH pathway inhibitor, providing a potential therapeutic strategy for CADASIL. Overall, using this iPSC-based disease model, our study identified clues for studying the pathogenic mechanisms of CADASIL and developing treatment strategies for this disease.
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Affiliation(s)
- Chen Ling
- Advanced Innovation Center for Human Brain Protection, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
- Department of Neurology, Peking University First Hospital, Beijing, 100034, China
- National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China
| | - Zunpeng Liu
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Moshi Song
- State Key Laboratory of Membrane Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
- Institute for Stem cell and Regeneration, CAS, Beijing, 100101, China
| | - Weiqi Zhang
- Advanced Innovation Center for Human Brain Protection, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
- National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
- Institute for Stem cell and Regeneration, CAS, Beijing, 100101, China
| | - Si Wang
- Advanced Innovation Center for Human Brain Protection, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
- National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
- Institute for Stem cell and Regeneration, CAS, Beijing, 100101, China
| | - Xiaoqian Liu
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Shuai Ma
- National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
- Institute for Stem cell and Regeneration, CAS, Beijing, 100101, China
| | - Shuhui Sun
- National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Lina Fu
- National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Qun Chu
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Juan Carlos Izpisua Belmonte
- Gene Expression Laboratory, Salk Institute for Biological Studies, 10010 North Torrey Pines Road, La Jolla, CA, 92037, USA
| | - Zhaoxia Wang
- Department of Neurology, Peking University First Hospital, Beijing, 100034, China
| | - Jing Qu
- State Key Laboratory of Stem Cell and Reproductive Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Institute for Stem cell and Regeneration, CAS, Beijing, 100101, China.
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing, 100034, China.
| | - Guang-Hui Liu
- Advanced Innovation Center for Human Brain Protection, National Clinical Research Center for Geriatric Disorders, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
- National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing, 100101, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Institute for Stem cell and Regeneration, CAS, Beijing, 100101, China.
- Key Laboratory of Regenerative Medicine of Ministry of Education, Institute of Aging and Regenerative Medicine, Jinan University, Guangzhou, 510632, China.
- Beijing Institute for Brain Disorders, Capital Medical University, Beijing, 100069, China.
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60
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Focal Aneurysm Wall Enhancement on Magnetic Resonance Imaging Indicates Intraluminal Thrombus and the Rupture Point. World Neurosurg 2019; 127:e578-e584. [PMID: 30928597 DOI: 10.1016/j.wneu.2019.03.209] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The precise mechanism of aneurysm wall enhancement (AWE) in ruptured intracranial aneurysms on magnetic resonance vessel wall imaging (VWI) remains unclear. We explored patterns of VWI findings and correlations with intraoperative or histopathologic aneurysm wall architecture. METHODS Twenty-four patients were evaluated by VWI before microsurgical clipping or endovascular coiling. The patterns of AWE were categorized, and the contrast ratio of AWE area was measured relative to the pituitary stalk. A total of 13 aneurysms were microsurgically inspected of the aneurysm wall and 4 were available for histopathologic evaluation. RESULTS AWE was identified in 20 of 24 ruptured aneurysms. Among these 20 aneurysms, AWE was focal in 15 and circumferential in 5. Focal AWE showed significantly higher contrast ratio than circumferential AWE (P = 0.002). Histopathologic studies suggested that focal AWE indicating contrast ratio over 0.1 could be associated with fresh intraluminal thrombus at the rupture site. On the contrary, circumferential AWE suggested potential wall thickening with abundant neovascularization and inflammatory cells. CONCLUSIONS Two AWE patterns were seen in ruptured intracranial aneurysms. Focal AWE on magnetic resonance imaging might indicate the presence of intraluminal thrombus, and detection of this sign could be useful for identification of the rupture point before treatment.
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61
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Yang Z, Wang J, Zhang D, Wang S, Wang R, Zhao J. Hepatitis B virus infected patients show increased risk of cerebral aneurysm rupture: A retrospective analysis. J Clin Neurosci 2019; 63:155-159. [PMID: 30850179 DOI: 10.1016/j.jocn.2019.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/18/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The mechanism responsible for cerebral aneurysm (CA) formation and rupture remains unclear. Some studies showed vascular involvement could be observed in systemic vasculitis caused by Hepatitis B. Therefore, it is necessary to determine the possibility by which hepatitis B virus (HBV) infection might be associated with CA. METHODS AND RESULTS We retrospectively studied patient details and serological markers of HBV infection among 229 patients presenting with CA on admission to the Neurosurgery Department at Beijing Tiantan Hospital between March 2016 and February 2017. Clinical data, radiologic findings and clinical features of HBV infection were analyzed by SPSS. The results showed a significant association between HBsAg positive (p = 0.014), anti-HBc positive (p = 0.045) and CA rupture. Univariate analysis revealed patients that were HBsAg positive (OR: 4.828; 95% CI: 1.363-17.099; p = 0.015) and anti-HBc positive (OR: 1.804; 95% CI: 1.010-3.223; p = 0.046) were associated with CA rupture. Compared with other confounding risk factors for rupture in the statistical analysis, HBsAg positive status (OR: 4.085; 95% CI: 1.011-16.513; p = 0.048) remained positively associated with CA rupture. CONCLUSIONS Observation showed that HBsAg positivity was associated with CA rupture.
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Affiliation(s)
- Ziwen Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Jia Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China; China National Clinical Research Center for Neurological Diseases, Beijing, PR China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, PR China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, PR China.
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62
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Liu P, Shi Y, Fan Z, Zhou Y, Song Y, Liu Y, Yu G, An Q, Zhu W. Inflammatory Smooth Muscle Cells Induce Endothelial Cell Alterations to Influence Cerebral Aneurysm Progression via Regulation of Integrin and VEGF Expression. Cell Transplant 2018; 28:713-722. [PMID: 30497276 PMCID: PMC6686430 DOI: 10.1177/0963689718815824] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Cerebral aneurysm growth is characterized by vessel wall frailness, although the underlying cellular mechanisms are unclear. Here, we examined the relationship between inflammatory smooth muscle cells (SMCs) and endothelial cells (ECs) in cerebral aneurysms, including the mechanisms underlying inflammatory SMC-induced changes in ECs. Five saccular cerebral aneurysms were collected and five temporal artery samples were used as controls. Cells and cytokines were detected by immunohistochemistry and TUNEL (transferase dUTP nick end labeling) assays performed to evaluate apoptosis. Human umbilical vein endothelial cells (HUVECs) were seeded on collagen I, IV, and VI-coated plates for cell adhesion assays and inflammatory SMCs (iSMCs) were established by culture in flexible silicone chambers subjected to cyclic mechanical stretch. HUVECs were cultured in iSMC-conditioned medium, followed by evaluation of their viability, apoptosis, and function, and determination of VEGF (vascular endothelial growth factor) -A and integrin levels by western blotting. Aneurysm tissue contained fewer SMCs and lacked ECs. In aneurysm walls, more matrix metalloproteinase (MMP) -1, MMP-3, and apoptotic cells were detected, accompanied by decreased collagen IV and VI levels. Cell adhesion assays revealed that more HUVECs were attached in collagen IV and VI-coated plates compared with controls. iSMC-conditioned medium significantly reduced HUVEC viability and apoptosis showed an increased trend; however, the difference was not significant. iSMC medium also reduced tube formation and migration of HUVECs. Moreover, iSMC medium reduced HUVEC expression of VEGF-A, integrin α1, integrin α2, and integrin β. Our data demonstrate a lack of SMCs and ECs in aneurysm walls, accompanied by elevated MMP and decreased collagen levels. In vitro assays showed that iSMCs induced reduction in EC adhesion, and caused EC dysfunction. Understanding of the relationships among SMC, EC, and collagens during aneurysm progression provides an additional therapeutic option for prevention of cerebral aneurysm progression.
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Affiliation(s)
- Peixi Liu
- 1 Department of Neurosurgery, Huashan Hospital of Fudan University. Shanghai, China
| | - Yuan Shi
- 1 Department of Neurosurgery, Huashan Hospital of Fudan University. Shanghai, China
| | - Zhiyuan Fan
- 1 Department of Neurosurgery, Huashan Hospital of Fudan University. Shanghai, China
| | - Yingjie Zhou
- 2 Department of Hand surgery, Huashan Hospital of Fudan University. Shanghai, China
| | - Yaying Song
- 3 Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yingjun Liu
- 1 Department of Neurosurgery, Huashan Hospital of Fudan University. Shanghai, China
| | - Guo Yu
- 1 Department of Neurosurgery, Huashan Hospital of Fudan University. Shanghai, China
| | - Qingzhu An
- 1 Department of Neurosurgery, Huashan Hospital of Fudan University. Shanghai, China
| | - Wei Zhu
- 1 Department of Neurosurgery, Huashan Hospital of Fudan University. Shanghai, China
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63
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Oishi H, Teranishi K, Yatomi K, Fujii T, Yamamoto M, Arai H. Flow Diverter Therapy Using a Pipeline Embolization Device for 100 Unruptured Large and Giant Internal Carotid Artery Aneurysms in a Single Center in a Japanese Population. Neurol Med Chir (Tokyo) 2018; 58:461-467. [PMID: 30298832 PMCID: PMC6236209 DOI: 10.2176/nmc.oa.2018-0148] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Flow diverters (FDs) have been developed for intracranial aneurysms difficult to treat with conventional endovascular therapy and surgical clipping. We reviewed 94 patients with 100 large or giant unruptured internal carotid artery (ICA) aneurysms treated with Pipeline embolization device (PED) embolization from December 2012 to June 2017 at Juntendo University Hospital. The patients’ mean age was 63.4 years (range, 19–88), and there were 90 women 89.4%. Aneurysm locations were: C4 (45), C3 (4), and C2 (51) in ICA segments. Mean aneurysm size and neck width were 16.9 ± 6.8 mm and 8.3 ± 4.4 mm, respectively, in 40 symptomatic and 60 asymptomatic aneurysms. Follow-up catheter angiographies of 85 patients with 90 aneurysms showed no filling in 62 aneurysms (68.9%), entry remnant in 16 (17.8%), subtotal filling in 11 (12.2), and total filling in 1 (1.1%) with a mean follow-up of 10.2 ± 5.6 months. In-stent stenosis occurred in 1 patient and parent artery occlusion in 2 during follow-up. Hemorrhagic complications occurred in 4 (4.3%): delayed aneurysm rupture (2) and intraparenchymal hemorrhage (2). Ischemic complications with neurological symptoms occurred in 2 (2.1%): very delayed device occlusion (1) and intraprocedural distal embolism (1). Eighteen patients (45%) showed improvement in pre-existing cranial nerve dysfunction because of the aneurysm’s mass effect, 3 patients (7.5%) worsened. One patient died of systemic organ failure unassociated with the procedure. Morbidity and mortality rates were 4.3% and 1.1%, respectively. PED embolization for unruptured large and giant ICA aneurysms is safe and efficacious. Physicians should be observant of characteristic risks associated with FD therapy.
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Affiliation(s)
- Hidenori Oishi
- Department of Neurosurgery, Juntendo University Faculty of Medicine.,Department of Neuroendovascular Therapy, Juntendo University Faculty of Medicine
| | - Kosuke Teranishi
- Department of Neurosurgery, Juntendo University Faculty of Medicine
| | - Kenji Yatomi
- Department of Neurosurgery, Juntendo University Faculty of Medicine
| | - Takashi Fujii
- Department of Neurosurgery, Juntendo University Faculty of Medicine
| | | | - Hajime Arai
- Department of Neurosurgery, Juntendo University Faculty of Medicine
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64
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Lee SU, Kwak Y, Oh CW, Kwon OK, Ban SP, Kim T, Byoun HS, Choe G, Kim YD, Bang JS. Pathogenesis of dorsal internal carotid artery wall aneurysms based on histopathologic examination and microscopic configuration. J Clin Neurosci 2018; 58:181-186. [PMID: 30269959 DOI: 10.1016/j.jocn.2018.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 05/02/2018] [Accepted: 08/08/2018] [Indexed: 11/29/2022]
Abstract
Blood blister-like aneurysms (BBAs) are an important cause of subarachnoid hemorrhage (SAH), but proper treatment is uncertain due to the poor prognosis of these aneurysms. The pathogenesis of BBAs remains unclear and few studies have reported on histological examinations of BBAs because it is difficult to obtain a specimen due to a high risk of intraoperative bleeding. In this report, BBAs were histopathologically examined in two patients who presented with SAH due to rupture of a BBA that was treated with surgical trapping and bypass surgery. BBA specimens including the adjacent internal carotid artery (ICA) walls were obtained intraoperatively. We suggest the pathogenesis of BBAs based on histopathologic examination and microscopic configuration.
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Affiliation(s)
- Si Un Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Yoonjin Kwak
- Department of Pathology, Seoul National University College of Medicine, Seoul National University Hospital, Republic of Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - O-Ki Kwon
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Seung Pil Ban
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Tackeun Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Hyoung Soo Byoun
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Gheeyoung Choe
- Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Young Deok Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Republic of Korea
| | - Jae Seung Bang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Republic of Korea.
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Peschillo S, Tomasello A, Diana F, Hernandez D, Toccaceli G, Rosal-Fontana M, Esteves Coelho M, Missori P. Comparison of Subacute Vascular Damage Caused by ADAPT versus Stent Retriever Devices after Thrombectomy in Acute Ischemic Stroke: Histological and Ultrastructural Study in an Animal Model. INTERVENTIONAL NEUROLOGY 2018; 7:501-512. [PMID: 30410530 DOI: 10.1159/000491028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/19/2018] [Indexed: 12/13/2022]
Abstract
Objectives To assess the delayed (15 days) histological and ultrastructural changes occurring following endovascular treatment with a direct aspiration first pass technique (ADAPT) or stent retrievers (SRs) and to compare the findings in order to determine which is the least harmful technique and what changes occur. Materials and Methods Damage to the wall of swine extracranial arteries was evaluated after ADAPT with the Penumbra system or thrombectomy with various SRs. The procedures were performed using two pigs as animal models; extracranial cervical arteries were selected based on their diameters in order to reproduce the procedures as in human intracranial arteries, and endovascular thrombectomies were done after the injection of autologous thrombi. Two weeks later, the animals were euthanized, and 60 arterial samples were obtained for analysis by optical and electron microscopy. Results Optical and electron microscopy revealed that both techniques cause, in different way, alterations to the structure of the vessel wall. Conclusions Both techniques caused damage to the vessel wall. The main damages were localized at the level of the tunica media and adventitia, instead of the tunica intima as in the acute phase. Further investigation is required to better understand whether these alterations could have chronic consequences.
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Affiliation(s)
| | | | - Francesco Diana
- Interventional Neuroradiology, Policlinico Umberto I, Rome, Italy
| | - David Hernandez
- Interventional Neuroradiology, Vall d'Hebron Hospital, Barcelona, Spain
| | - Giada Toccaceli
- Endovascular Neurosurgery, Policlinico Umberto I, Rome, Italy
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66
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Funatsu N, Hayakawa M, Hashimoto T, Yamagami H, Satow T, Takahashi JC, Koga M, Nagatsuka K, Ishibashi-Ueda H, Iwama T, Toyoda K. Vascular wall components in thrombi obtained by acute stroke thrombectomy: clinical significance and related factors. J Neurointerv Surg 2018; 11:232-236. [DOI: 10.1136/neurintsurg-2018-014041] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/15/2018] [Accepted: 07/21/2018] [Indexed: 11/03/2022]
Abstract
Background and purposeVascular wall components (VWCs) are sometimes identified as collagen fibers in specimens retrieved by thrombectomy from acute stroke patients. However, their clinical significance and associated factors remain unclear. The purpose of this study was to clarify the factors associated with VWCs in retrieved thrombi.MethodsConsecutive acute stroke patients treated endovascularly using the Penumbra aspiration catheter or stent retrievers (SRs) at our institute from November 2013 to April 2016 were retrospectively reviewed, and the retrieved thrombi were evaluated histopathologically. VWCs were defined as banded collagen fibers with a distinct boundary observed at the rim or outside of the retrieved thrombi. Factors associated with the presence of VWCs were studied.ResultsA total of 150 specimens (76 specimens retrieved by the Penumbra, 74 by SRs) from 101 patients (47 women, age 74.9±11.1 years) were investigated. Applied thrombectomy devices were aspiration catheters in 42 patients, SRs in 21 patients, and both in 38 patients. VWCs were observed in 24 specimens (16%) from 22 patients. A low proportion of erythrocyte components (41.7±24.8% vs 55.0±26.3%, P=0.01), a high frequency of the devices reaching the M2/P2 (75% vs 50%, P=0.02), and a high number of device passages (P for trend=0.02) were associated with VWC positive thrombi. Successful recanalization (Treatment in Cerebral Ischemia ≥2b) tended to be less frequent in patients with VWC positive thrombi than in those without (73% vs 89%, P=0.06).ConclusionsThe histopathology of occlusive thrombi, arterial sites where devices reached, and number of device passages, might affect the presence of VWCs in retrieved thrombi.
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67
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Feng X, Peng F, Zhang B, Wang L, Guo E, Li Y, Jiang C, Wu Z, Liu A. Lower miR-143/145 and higher matrix metalloproteinase-9 levels in circulation may be associated with intracranial aneurysm formation and rupture: A pilot study. Clin Neurol Neurosurg 2018; 173:124-129. [PMID: 30121455 DOI: 10.1016/j.clineuro.2018.08.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/02/2018] [Accepted: 08/05/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We analyzed the relationship between plasma miR-143/145 and serum MMP-9 in patients with unruptured or ruptured intracranial aneurysms (IAs) to identify new biomarkers for predicting rupture in IAs. PATIENTS AND METHODS We prospectively enrolled 24 consecutive patients, including seven patients without IAs as a control group, nine patients with unruptured IAs, and eight patients with ruptured IAs (enrolled within 3 days after rupture). Plasma miR-143/145 and MMP-9 were measured in blood samples collected from the femoral artery. Spearman ρ values were used for correlation analyses. RESULTS The level of plasma miR-143/145 in patients with ruptured IAs was significantly lower than that of the control group. Moreover, patients with ruptured IAs had a significantly higher level of serum MMP-9 compared with that in patients with unruptured IAs and in control patients. A lower level of plasma miR-143 was significantly correlated with a lower level of plasma miR-145 (Spearman ρ = 0.771; P < 0.0001). CONCLUSION These findings showed that a lower of plasma miR-143/145 is potentially associated with IA formation, while higher serum MMP-9 levels may be associated with IA rupture and could serve as a useful biomarker for the evaluation of IA rupture.
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Affiliation(s)
- Xin Feng
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, China
| | - Fei Peng
- Beijing Neurosurgical Institute, Capital Medical University, 100050, China; Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100050, China
| | - Baorui Zhang
- Beijing Neurosurgical Institute, Capital Medical University, 100050, China; Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100050, China
| | - Luyao Wang
- Beijing Neurosurgical Institute, Capital Medical University, 100050, China; Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100050, China
| | - Erkang Guo
- Beijing Neurosurgical Institute, Capital Medical University, 100050, China; Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100050, China
| | - Youxiang Li
- Beijing Neurosurgical Institute, Capital Medical University, 100050, China; Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100050, China
| | - Chuhan Jiang
- Beijing Neurosurgical Institute, Capital Medical University, 100050, China; Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100050, China
| | - Zhongxue Wu
- Beijing Neurosurgical Institute, Capital Medical University, 100050, China; Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100050, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Capital Medical University, 100050, China; Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, 100050, China.
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68
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Kilic İD, Hakeem A, Marmagkiolis K, Paixao A, Grunwald I, Mutlu D, AbouSherif S, Gundogdu B, Kulaksizoglu S, Ates I, Wholey M, Goktekin O, Cilingiroglu M. Endovascular Therapy for Acute Ischemic Stroke: A Comprehensive Review of Current Status. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:424-431. [PMID: 30025660 DOI: 10.1016/j.carrev.2018.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/01/2018] [Accepted: 07/09/2018] [Indexed: 11/15/2022]
Abstract
Stroke remains among the leading causes of disability and death worldwide. Fibrinolytic therapy is associated with poor patency and functional outcomes. Recently, multiple randomized trials have been published that have consolidated the role of endovascular therapy for ischemic stroke due to large vessel occlusion in the anterior cerebral circulation. This manuscript reviews the current understanding of the endovascular management of acute stroke including technical aspects and current evidence base.
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Affiliation(s)
- İsmail D Kilic
- Pamukkale University Hospital, Department of Cardiology, Denizli, Turkey
| | - Abdul Hakeem
- University of Arkansas for Medical Sciences, Department of Cardiology, Little Rock, AR, USA
| | | | - Andre Paixao
- Arkansas Heart Hospital, Department of Cardiology, Little Rock, AR, USA.
| | - Iris Grunwald
- Anglia Ruskin University, Department of Neuroscience, Chelmsford, Essex, UK
| | - Deniz Mutlu
- Istanbul University, Cerrahpasa Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
| | - Sara AbouSherif
- Kings College London, Cardiovascular Research Division London, UK
| | - Betul Gundogdu
- University of Arkansas for Medical Sciences, Department of Neurology, Little Rock, AR, USA.
| | - Sibel Kulaksizoglu
- Antalya Education and Research Hospital, Department of Biochemistry, Antalya, Turkey
| | - Ismail Ates
- Medicalpark Hospital Complex, Department of Cardiology, Antalya, Turkey
| | - Mark Wholey
- University of Pittsburgh Medical Centre, Department of Cardiology, Pittsburgh, PA, USA.
| | - Omer Goktekin
- Bezmialem University, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Cilingiroglu
- University of Arkansas for Medical Sciences, Department of Cardiology, Little Rock, AR, USA; Arkansas Heart Hospital, Department of Cardiology, Little Rock, AR, USA; Koc University, School of Medicine, Istanbul, Turkey.
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69
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Anderson TCO, Ryo YWL, Fung MK, Man LW. MRI Vessel Wall Imaging and Treatment of an Aneurysm at the Atlanto-Axial Segment of an Aberrant Vertebral Artery. Neurointervention 2018. [PMID: 29535901 PMCID: PMC5847893 DOI: 10.5469/neuroint.2018.13.1.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report a case of unique location of an aneurysm at the atlanto-axial extradural segment of a unilateral aberrant vertebral artery. The MRI vessel wall imaging findings and possible mechanism of aneurysm formation were discussed. A 5 mm extracranial vertebral artery aneurysm located at the interlaminar space between C1 and C2 was diagnosed in a woman presenting with occipital headache. The index vertebral artery ran an aberrant course at the V3 segment, where it entered the dura between C1 and C2 instead of the usual atlanto-occipital space. MR vessel wall imaging showed homogenous wall enhancement of the aneurysm sac. We surmise the anomalous course of the vertebral artery subjected the V3 segment to repeated shearing force secondary to the atlanto-axial rotational neck movement. This led to vessel wall trauma and inflammation, and subsequent aneurysm formation. The aneurysm was successfully treated with endovascular coiling with resolution of symptoms.
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Affiliation(s)
- Tsang Chun On Anderson
- Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | | | - Mak Ka Fung
- Department of Diagnostic Radiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong
| | - Lui Wai Man
- Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong
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70
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Cooke DL, Bauer D, Sun Z, Stillson C, Nelson J, Barry D, Hetts SW, Higashida RT, Dowd CF, Halbach VV, Su H, Saeed MM. Endovascular biopsy: Technical feasibility of novel endothelial cell harvesting devices assessed in a rabbit aneurysm model. Interv Neuroradiol 2018; 21:120-8. [PMID: 25934786 DOI: 10.15274/inr-2014-10103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The lack of safe and reliable methods to sample vascular tissue in situ limits discovery of the underlying genetic and pathophysiological mechanisms of many vascular disorders, including aneurysms. We investigated the feasibility and comparable efficacy of in vivo vascular endothelial cell sampling using a spectrum of endovascular devices. Using the rabbit elastase carotid aneurysm model we evaluated the performance of existing aneurysmal coils, intracranial stents, and stent-like devices to collect vascular endothelial cells. Additionally, we modified a subset of devices to assess the effects of alterations to coil pitch, coil wire contour, and stent surface finishing. Device performance was evaluated by (1) the number of viable endothelial cells harvested, (2) the degree of vascular wall damage analyzed using digital subtraction angiography and histopathological analysis, and (3) the ease of device navigability and retrieval. Isolated cells underwent immunohistochemical analysis to confirm cell type and viability. Coil and stent specifications, technique, and endothelial cell counts were tabulated and statistical analysis performed. Using conventional detachable-type and modified aneurysm coils 11 of 14 (78.6%) harvested endothelial cells with a mean of 7.93 (±8.33) cells/coil, while 15 of 15 (100%) conventional stents, stent-like devices and modified stents harvested endothelial cells with a mean of 831.33 (±887.73) cells/device. Coil stiffness was significantly associated with endothelial cell count in univariate analysis (p = 0.044). For stents and stent-like devices univariate analysis demonstrated stent-to-aorta diameter ratios (p = 0.001), stent length (p = 0.049), and the use of a pulling retrieval technique (p = 0.019) significantly predictive of endothelial cell counts, though a multivariate model using these variables demonstrated only the stent-to-aorta diameter ratio (p = 0.029) predictive of endothelial cell counts. Modified devices did not significantly impact harvesting. The efficacy and safety of existing aneurysm coils, intracranial stents and stent-like devices in collecting viable endothelial cells was confirmed. The technique is reproducible and the quantity and quality of collected endothelial cells is adequate for targeted genetic analysis.
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Affiliation(s)
- Daniel L Cooke
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Diana Bauer
- Laboratory Animal Resource Center, University of California, San Francisco, CA, USA
| | - Zhengda Sun
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Carol Stillson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Jeffrey Nelson
- Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA
| | | | - Steven W Hetts
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Randall T Higashida
- Department of Radiology, Neurology, and Neurological Surgery, University of California, San Francisco, CA, USA
| | - Christopher F Dowd
- Department of Radiology, Neurology, and Neurological Surgery, University of California, San Francisco, CA, USA
| | - Van V Halbach
- Department of Radiology, Neurology, and Neurological Surgery, University of California, San Francisco, CA, USA
| | - Hua Su
- Department of Anesthesiology and Perioperative Care, University of California, San Francisco, CA, USA
| | - Maythem M Saeed
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
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Dmytriw AA, Adeeb N, Kumar A, Griessenauer CJ, Phan K, Ogilvy CS, Foreman PM, Shallwani H, Limbucci N, Mangiafico S, Michelozzi C, Krings T, Pereira VM, Matouk CC, Zhang Y, Harrigan MR, Shakir HJ, Siddiqui AH, Levy EI, Renieri L, Cognard C, Thomas AJ, Marotta TR. Flow Diversion for the Treatment of Basilar Apex Aneurysms. Neurosurgery 2018. [DOI: 10.1093/neuros/nyx628] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Adam A Dmytriw
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, Toronto, Ontario, Canada
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Nimer Adeeb
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Ashish Kumar
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Christoph J Griessenauer
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Kevin Phan
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Christopher S Ogilvy
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Paul M Foreman
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Hussain Shallwani
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York
| | - Nicola Limbucci
- Department of Interventional Neuroradiology, University of Florence, Florence, Italy
| | - Salvatore Mangiafico
- Department of Interventional Neuroradiology, University of Florence, Florence, Italy
| | - Caterina Michelozzi
- Department of Diagnostic and Therapeutic Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Timo Krings
- Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Charles C Matouk
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Yuchen Zhang
- Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Mark R Harrigan
- Department of Neurosurgery, University of Alabama at Birmingham, Alabama
| | - Hakeem J Shakir
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York
| | - Adnan H Siddiqui
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York
| | - Elad I Levy
- Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York
| | - Leonardo Renieri
- Department of Interventional Neuroradiology, University of Florence, Florence, Italy
| | - Christophe Cognard
- Department of Diagnostic and Therapeutic Neuroradiology, Toulouse University Hospital, Toulouse, France
| | - Ajith J Thomas
- Division of Diagnostic and Therapeutic Neuroradiology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Thomas R Marotta
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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72
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Aberrant expression of lncRNAs and mRNAs in patients with intracranial aneurysm. Oncotarget 2018; 8:2477-2484. [PMID: 27965470 PMCID: PMC5356817 DOI: 10.18632/oncotarget.13908] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 12/01/2016] [Indexed: 01/14/2023] Open
Abstract
Intracranial aneurysm (IA) is pathological dilatations of the cerebral artery and rupture of IAs can cause subarachnoid hemorrhage, which has a high ratio of fatality and morbidity. However, the pathogenesis of IAs remains unknown. We performed long noncoding RNA (lncRNA) and messenger RNA (mRNA) expression profiles in IA tissues and superficial temporal arteries (STAs). A total of 4129 differentially expressed lncRNAs and 2926 differentially expressed mRNAs were obtained from the microarrays (P < 0.05). Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses showed that up-regulated mRNAs were enriched in immune response, inflammatory response, regulation of immune response and lysosome, et al; while the down-regulated mRNAs were enriched in muscle contraction, smooth muscle contraction, cGMP-PKG signaling pathway and vascular smooth muscle contraction, et al. The lncRNA-mRNA co-expression networks were represented in immune response, inflammatory response, muscle contraction and vascular smooth muscle contraction. These findings may gain insight in the pathogenesis of IAs and provide clues to find key roles for IA patients.
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73
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Wu Y, Li Z, Shi Y, Chen L, Tan H, Wang Z, Yin C, Liu L, Hu J. Exome Sequencing Identifies LOXL2 Mutation as a Cause of Familial Intracranial Aneurysm. World Neurosurg 2018; 109:e812-e818. [DOI: 10.1016/j.wneu.2017.10.094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 12/27/2022]
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74
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Biological Models for Neurosurgical Training in Microanastomosis. COMPREHENSIVE HEALTHCARE SIMULATION: NEUROSURGERY 2018. [DOI: 10.1007/978-3-319-75583-0_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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75
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Macrophage Polarization in Cerebral Aneurysm: Perspectives and Potential Targets. J Immunol Res 2017; 2017:8160589. [PMID: 29445758 PMCID: PMC5763122 DOI: 10.1155/2017/8160589] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/20/2017] [Accepted: 11/13/2017] [Indexed: 12/19/2022] Open
Abstract
Cerebral aneurysms (CAs) have become a health burden not only because their rupture is life threatening, but for a series of devastating complications left in survivors. It is well accepted that sustained chronic inflammation plays a crucial role in the pathology of cerebral aneurysms. In particular, macrophages have been identified as critical effector cells orchestrating inflammation in CAs. In recent years, dysregulated M1/M2 polarization has been proposed to participate in the progression of CAs. Although the pathological mechanisms of M1/M2 imbalance in CAs remain largely unknown, recent advances have been made in the understanding of the molecular basis and other immune cells involving in this sophisticated network. We provide a concise overview of the mechanisms associated with macrophage plasticity and the emerging molecular targets.
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76
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Fan J, Yu L, Zhao J. Comparative transcriptome analysis reveals involvement of TLR-2 signaling in the pathogenesis of intracranial aneurysm. J Clin Neurosci 2017; 47:258-263. [PMID: 29066233 DOI: 10.1016/j.jocn.2017.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 05/01/2017] [Accepted: 07/11/2017] [Indexed: 01/18/2023]
Abstract
In this study, we collected and analyzed 15 aneurysmal and 17 superficial temporal artery (STA) specimens from 32 Chinese patients with intracranial aneurysm. Total RNA was extracted and reverse transcribed to cDNA, and genome-wide expression profiling was performed by using the Affymetrix Human Genome U133 Plus 2.0 Array which allows a total number of 38,500 genes to be analyzed at the same time. Real-time RT-PCR was performed to verify the expression level of 8 selected genes. We found significant up-regulation of the TLR-2 gene. This result suggests that TLR-2 plays a key role in the formation of intracranial aneurysm in a Chinese population. To our knowledge, this study is the first to use the Human Genome U133 Plus 2.0 Array to analyze the gene expression profiles in Chinese patients with intracranial aneurysm.
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Affiliation(s)
- Jinghan Fan
- Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, 6 Tiantan Xili, 100050 Beijing, China
| | - Lanbing Yu
- Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, 6 Tiantan Xili, 100050 Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, 6 Tiantan Xili, 100050 Beijing, China.
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Khan MO, Steinman DA, Valen-Sendstad K. Non-Newtonian versus numerical rheology: Practical impact of shear-thinning on the prediction of stable and unstable flows in intracranial aneurysms. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2017; 33:e2836. [PMID: 27696717 DOI: 10.1002/cnm.2836] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 09/28/2016] [Indexed: 06/06/2023]
Abstract
Computational fluid dynamics (CFD) shows promise for informing treatment planning and rupture risk assessment for intracranial aneurysms. Much attention has been paid to the impact on predicted hemodynamics of various modelling assumptions and uncertainties, including the need for modelling the non-Newtonian, shear-thinning rheology of blood, with equivocal results. Our study clarifies this issue by contextualizing the impact of rheology model against the recently demonstrated impact of CFD solution strategy on the prediction of aneurysm flow instabilities. Three aneurysm cases were considered, spanning a range of stable to unstable flows. Simulations were performed using a high-resolution/accuracy solution strategy with Newtonian and modified-Cross rheology models and compared against results from a so-called normal-resolution strategy. Time-averaged and instantaneous wall shear stress (WSS) distributions, as well as frequency content of flow instabilities and dome-averaged WSS metrics, were minimally affected by the rheology model, whereas numerical solution strategy had a demonstrably more marked impact when the rheology model was fixed. We show that point-wise normalization of non-Newtonian by Newtonian WSS values tended to artificially amplify small differences in WSS of questionable physiological relevance in already-low WSS regions, which might help to explain the disparity of opinions in the aneurysm CFD literature regarding the impact of non-Newtonian rheology. Toward the goal of more patient-specific aneurysm CFD, we conclude that attention seems better spent on solution strategy and other likely "first-order" effects (eg, lumen segmentation and choice of flow rates), as opposed to "second-order" effects such as rheology.
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Affiliation(s)
- M O Khan
- Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
- Simula Research Laboratory AS, Fornebu, Lysaker, Norway
| | - D A Steinman
- Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada
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Fu Q, Guan S, Liu C, Wang K, Cheng J. Clinical Significance of Circumferential Aneurysmal Wall Enhancement in Symptomatic Patients with Unruptured Intracranial Aneurysms: a High-resolution MRI Study. Clin Neuroradiol 2017; 28:509-514. [PMID: 28656370 DOI: 10.1007/s00062-017-0598-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 05/10/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The estimates on the risk of rupture of intracranial aneurysms remain a controversial topic. Circumferential aneurysmal wall enhancement (CAWE) on vessel wall magnetic resonance imaging (MRI) has been described in unstable aneurysms. Sentinel headaches and third nerve palsy are possible symptoms prior to the rupture of intracranial aneurysms. In this study, we aimed to demonstrate that CAWE could be associated with these symptoms. METHODS We performed a retrospective analysis of consecutive symptomatic or asymptomatic patients with unruptured intracranial aneurysms who were examined by high-resolution MRI from October 2014 to November 2016. Two experienced neurovascular radiologists read the images independently and determined whether there was CAWE of the unruptured intracranial aneurysms. Then, we compared variable factors between patients with and without symptoms through univariate comparison and multivariable logistic regression analyses. RESULTS A total of 45 unruptured intracranial aneurysms were detected in 37 patients. The agreement between 2 experienced readers for CAWE was good (kappa = 0.82; 95% confidence interval 0.66-0.99). CAWE of unruptured intracranial aneurysm was more frequently observed in symptomatic than in asymptomatic patients (16/23, 69.6% versus 6/22, 27.3%, respectively, P < 0.05). The CAWE was the only independent factor associated with symptoms in the multivariable logistic regression analysis (odds ratio 5.17; 95% confidence interval 1.30-20.52; P = 0.02). CONCLUSIONS Our study demonstrates that CAWE correlated with sentinel headaches and third nerve palsy caused by unruptured aneurysms, and this may be an additional clue to distinguish the cause of these symptoms.
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Affiliation(s)
- Qichang Fu
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, 450052, Zhengzhou, China
| | - Sheng Guan
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Liu
- Department of Interventional Neuroradiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Keyan Wang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, 450052, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, 450052, Zhengzhou, China.
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Omodaka S, Endo H, Niizuma K, Fujimura M, Endo T, Sato K, Sugiyama SI, Inoue T, Tominaga T. Circumferential Wall Enhancement on Magnetic Resonance Imaging is Useful to Identify Rupture Site in Patients with Multiple Cerebral Aneurysms. Neurosurgery 2017; 82:638-644. [DOI: 10.1093/neuros/nyx267] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/24/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Identification of rupture sites in patients with multiple intracranial aneurysms is largely based on aneurysm size, location, and shape. Finding circumferential enhancement along the aneurysm wall (CEAW) on magnetic resonance (MR) vessel wall imaging was recently shown to be indicative of ruptured aneurysm.
OBJECTIVE
To investigate the hypothesis that a higher degree of CEAW would identify the site of rupture in patients with multiple aneurysms.
METHODS
We prospectively performed quantitative analysis of CEAW in consecutive patients with both aneurysmal subarachnoid hemorrhage and multiple aneurysms (26 patients with a total of 62 aneurysms), using MR vessel wall imaging. Three-dimensional T1-weighted fast spin-echo sequences were obtained before and after injection of contrast media, and the wall enhancement index (WEI) was calculated. Aneurysm characteristics (size, location, irregular shape, aspect ratio [neck-to-dome length/neck width], and WEI) were compared between ruptured and unruptured aneurysms. Odds ratios with 95% confidence intervals for ruptures were calculated with conditional univariable logistic regression analysis. Analyses were repeated after adjustment for aneurysm size.
RESULTS
Large aneurysm size, high aspect ratio, WEI (above the median values), and irregular shape were significantly associated with aneurysm rupture. After adjustment for aneurysm size, WEI (adjusted odds ratio: 8.8; 95% confidence interval, 1.1-72.6) as well as irregular shape and aspect ratio showed a strong association with rupture.
CONCLUSION
CEAW is associated with rupture of intracranial aneurysm independent of aneurysm size and patient characteristics. Contrast-enhanced MR vessel wall imaging helps to identify the site of rupture in patients with multiple aneurysms.
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Affiliation(s)
| | - Hidenori Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Miki Fujimura
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Kohnan Hospital, Sendai, Japan
| | - Kenichi Sato
- Department of Neuroendovascular therapy, Kohnan Hospital, Sendai, Japan
| | | | - Takashi Inoue
- Department of Neurosurgery, Sendai Medical Center, Sendai, Japan
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Sarrami-Foroushani A, Lassila T, Frangi AF. Virtual endovascular treatment of intracranial aneurysms: models and uncertainty. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2017; 9. [PMID: 28488754 DOI: 10.1002/wsbm.1385] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/09/2017] [Accepted: 02/07/2017] [Indexed: 01/11/2023]
Abstract
Virtual endovascular treatment models (VETMs) have been developed with the view to aid interventional neuroradiologists and neurosurgeons to pre-operatively analyze the comparative efficacy and safety of endovascular treatments for intracranial aneurysms. Based on the current state of VETMs in aneurysm rupture risk stratification and in patient-specific prediction of treatment outcomes, we argue there is a need to go beyond personalized biomechanical flow modeling assuming deterministic parameters and error-free measurements. The mechanobiological effects associated with blood clot formation are important factors in therapeutic decision making and models of post-treatment intra-aneurysmal biology and biochemistry should be linked to the purely hemodynamic models to improve the predictive power of current VETMs. The influence of model and parameter uncertainties associated to each component of a VETM is, where feasible, quantified via a random-effects meta-analysis of the literature. This allows estimating the pooled effect size of these uncertainties on aneurysmal wall shear stress. From such meta-analyses, two main sources of uncertainty emerge where research efforts have so far been limited: (1) vascular wall distensibility, and (2) intra/intersubject systemic flow variations. In the future, we suggest that current deterministic computational simulations need to be extended with strategies for uncertainty mitigation, uncertainty exploration, and sensitivity reduction techniques. WIREs Syst Biol Med 2017, 9:e1385. doi: 10.1002/wsbm.1385 For further resources related to this article, please visit the WIREs website.
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Affiliation(s)
- Ali Sarrami-Foroushani
- Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), The University of Sheffield, Sheffield, UK
| | - Toni Lassila
- Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), The University of Sheffield, Sheffield, UK
| | - Alejandro F Frangi
- Center for Computational Imaging and Simulation Technologies in Biomedicine (CISTIB), The University of Sheffield, Sheffield, UK
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81
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Mankahla N, LeFeuvre D, Taylor A. Delayed massive epistaxis from traumatic cavernous carotid false aneurysms: A report of two unusual cases. Interv Neuroradiol 2017; 23:387-391. [PMID: 28485656 DOI: 10.1177/1591019917706053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Blunt head trauma can injure the cavernous segment of the internal carotid artery (ICA). This may result in a carotid cavernous fistula (CCF). Rarely, a traumatic aneurysm may bleed medially causing massive epistaxis. Case presentation We present two cases of traumatic intracavernous carotid pseudoaneurysms with delayed massive epistaxis. The patients were managed with endovascular treatment involving coil embolization with parent vessel sparing and detachable balloon occlusion with carotid sacrifice. Early clinical outcome was good in both patients. Wherever possible, the CARE1 guidelines were followed in the reporting. Conclusion These cases illustrate the delayed nature of traumatic aneurysms and the need for a high index of suspicion in the presence of skull base fractures. The use of endovascular detachable balloon occlusion and coil embolization treatment with parent vessel preservation is shown.
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Affiliation(s)
- Ncedile Mankahla
- 1 Department of Neurosurgery, Groote Schuur Hospital and University of Cape Town, South Africa
| | - David LeFeuvre
- 1 Department of Neurosurgery, Groote Schuur Hospital and University of Cape Town, South Africa.,2 Division of Neurointerventional and Cerebrovascular Surgery, Groote Schuur Hospital and University of Cape Town, South Africa
| | - Allan Taylor
- 1 Department of Neurosurgery, Groote Schuur Hospital and University of Cape Town, South Africa.,2 Division of Neurointerventional and Cerebrovascular Surgery, Groote Schuur Hospital and University of Cape Town, South Africa
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Ferracci FX, Gilard V, Cebula H, Magne N, Lejeune JP, Langlois O, Proust F. Growth of giant intracranial aneurysms: An aneurysmal wall disorder? Neurochirurgie 2017; 63:6-12. [DOI: 10.1016/j.neuchi.2017.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Revised: 12/13/2016] [Accepted: 01/01/2017] [Indexed: 10/20/2022]
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Chandran R, Mehta SL, Vemuganti R. Non-coding RNAs and neuroprotection after acute CNS injuries. Neurochem Int 2017; 111:12-22. [PMID: 28131900 DOI: 10.1016/j.neuint.2017.01.015] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Revised: 01/17/2017] [Accepted: 01/24/2017] [Indexed: 02/07/2023]
Abstract
Accumulating evidence indicates that various classes of non-coding RNAs (ncRNAs) including microRNAs (miRNAs), PIWI-interacting RNAs (piRNAs) and long non-coding RNAs (lncRNAs) play important roles in normal state as well as the diseases of the CNS. Interestingly, ncRNAs have been shown to interact with messenger RNA, DNA and proteins, and these interactions could induce epigenetic modifications and control transcription and translation, thereby adding a new layer of genomic regulation. The ncRNA expression profiles are known to be altered after acute CNS injuries including stroke, traumatic brain injury and spinal cord injury that are major contributors of morbidity and mortality worldwide. Hence, a better understanding of the functional significance of ncRNAs following CNS injuries could help in developing potential therapeutic strategies to minimize the neuronal damage in those conditions. The potential of ncRNAs in blood and CSF as biomarkers for diagnosis and/or prognosis of acute CNS injuries has also gained importance in the recent years. This review highlighted the current progress in the understanding of the role of ncRNAs in initiation and progression of secondary neuronal damage and their application as biomarkers after acute CNS injuries.
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Affiliation(s)
- Raghavendar Chandran
- Department of Neurological Surgery, University of Wisconsin-Madison and William S. Middleton Veterans Hospital, Madison, WI, USA
| | - Suresh L Mehta
- Department of Neurological Surgery, University of Wisconsin-Madison and William S. Middleton Veterans Hospital, Madison, WI, USA
| | - Raghu Vemuganti
- Department of Neurological Surgery, University of Wisconsin-Madison and William S. Middleton Veterans Hospital, Madison, WI, USA.
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Intracranial vessel wall imaging for evaluation of steno-occlusive diseases and intracranial aneurysms. J Neuroradiol 2016; 44:123-134. [PMID: 27836652 DOI: 10.1016/j.neurad.2016.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/18/2016] [Accepted: 10/04/2016] [Indexed: 01/23/2023]
Abstract
Cerebrovascular diseases have traditionally been classified, diagnosed and managed based on their luminal characteristics. However, over the past several years, several advancements in MRI techniques have ushered in high-resolution vessel wall imaging (HR-VWI), enabling evaluation of intracranial vessel wall pathology. These advancements now allow us to differentiate diseases which have a common angiographic appearance but vastly different natural histories (i.e. moyamoya versus atherosclerosis, reversible cerebral vasoconstriction syndrome versus vasculitis, stable versus unstable intracranial aneurysms). In this review, we detail the anatomical, histopathological and imaging characteristics of various intracranial steno-occlusive diseases and types of intracranial aneurysms and describe the role that HR-VWI can play in diagnosis, risk stratification and treatment.
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85
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Luo J, Jin H, Jiang Y, Ge H, Wang J, Li Y. Aberrant Expression of microRNA-9 Contributes to Development of Intracranial Aneurysm by Suppressing Proliferation and Reducing Contractility of Smooth Muscle Cells. Med Sci Monit 2016; 22:4247-4253. [PMID: 27824808 PMCID: PMC5108371 DOI: 10.12659/msm.897511] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND MiR-9 is reportedly involved with many diseases, such as acute myeloid leukemia and liver oncogenesis. In the present study we investigated the molecular mechanism, including the potential regulator and signaling pathways, of MYOCD, which is the gene that in humans encodes the protein myocardin. MATERIAL AND METHODS We searched the online miRNA database (www.mirdb.org) with the "seed sequence" located within the 3'-UTR of the target gene, and then validated MYOCD to be the direct gene via luciferase reporter assay system, and further confirmed it in cultured cells by using Western blot analysis and realtime PCR. RESULTS We established the negative regulatory relationship between miR-9 and MYOCD via studying the relative luciferase activity. We also conducted realtime PCR and Western blot analysis to study the mRNA and protein expression level of MYOCD between different groups (intracranial aneurysm vs. normal control) or cells treated with scramble control, miR-9 mimics, MYOCD siRNA, and miR-9 inhibitors, indicating the negative regulatory relationship between miR-9 and MYOCD. We also investigated the relative viability of smooth muscle cells when transfected with scramble control, miR-9 mimics, MYOCD siRNA, and miR-9 inhibitors to validate that miR-9 t negatively interferes with the viability of smooth muscle cells. We then investigated the relative contractility of smooth muscle cells when transfected with scramble control, miR-9 mimics, MYOCD siRNA, and miR-9 inhibitors, and the results showed that miR-9 weakened contractility. CONCLUSIONS Our findings show that dysregulation of miR-9 is responsible for the development of IA via targeting MYOCD. miR-9 and its direct target, MYOCD, might novel therapeutic targets in the treatment of IA.
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Affiliation(s)
- Jing Luo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Hengwei Jin
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Huijian Ge
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Jiwei Wang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (mainland)
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China (mainland)
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Etminan N, Rinkel GJ. Unruptured intracranial aneurysms: development, rupture and preventive management. Nat Rev Neurol 2016; 12:699-713. [DOI: 10.1038/nrneurol.2016.150] [Citation(s) in RCA: 233] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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87
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Wall enhancement on high-resolution magnetic resonance imaging may predict an unsteady state of an intracranial saccular aneurysm. Neuroradiology 2016; 58:979-985. [PMID: 27438805 DOI: 10.1007/s00234-016-1729-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The aneurysm wall has been reported to play a critical role in the formation, development, and even rupture of an aneurysm. We used high-resolution magnetic resonance imaging (HRMRI) to investigate the aneurysm wall in an effort to identify evidence of inflammation invasion and define its relationship with aneurysm behavior. METHODS Patients with intracranial aneurysms who were prospectively evaluated using HRMRI between July 2013 and June 2014 were enrolled in this study. The aneurysm's wall enhancement and evidence of inflammation invasion were determined. In addition, the relationship between aneurysm wall enhancement and aneurysm size and symptoms, including ruptured aneurysms, giant unruputred intracranial aneurysms (UIAs) presenting as mass effect, progressively growing aneurysms, and aneurysms associated with neurological symptoms, was statistically analyzed. RESULTS Twenty-five patients with 30 aneurysms were available for the current study. Fourteen aneurysms showed wall enhancement, including 6 ruptured and 8 unruptured aneurysms. Evidence of inflammation was identified directly through histological studies and indirectly through intraoperative investigations and clinical courses. The statistical analysis indicated no significant correlation between aneurysm wall enhancement and aneurysm size. However, there was a strong correlation between wall enhancement and aneurysm symptoms, with a kappa value of 0.86 (95 % CI 0.68-1). CONCLUSIONS Aneurysm wall enhancement on HRMRI might be a sign of inflammatory change. Symptomatic aneurysms exhibited wall enhancement on HRMRI. Wall enhancement had a high consistent correlation of symptomatic aneurysms. Therefore, wall enhancement on HRMRI might predict an unsteady state of an intracranial saccular aneurysm.
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88
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Omodaka S, Endo H, Niizuma K, Fujimura M, Inoue T, Sato K, Sugiyama SI, Tominaga T. Quantitative Assessment of Circumferential Enhancement along the Wall of Cerebral Aneurysms Using MR Imaging. AJNR Am J Neuroradiol 2016; 37:1262-6. [PMID: 26939634 DOI: 10.3174/ajnr.a4722] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 01/03/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The incidence of wall enhancement of cerebral aneurysms on vessel wall MR imaging has been described as higher in ruptured intracranial aneurysms than in unruptured intracranial aneurysms, but the difference in the degree of enhancement between ruptured and unruptured aneurysms is unknown. We compared the degree of enhancement between ruptured and unruptured intracranial aneurysms by using quantitative MR imaging measures. MATERIALS AND METHODS We performed quantitative analyses of circumferential enhancement along the wall of cerebral aneurysms in 28 ruptured and 76 unruptured consecutive cases by using vessel wall MR imaging. A 3D-T1-weighted fast spin-echo sequence was obtained before and after contrast media injection, and the wall enhancement index was calculated. We then compared characteristics between ruptured and unruptured aneurysms. RESULTS The wall enhancement index was significantly higher in ruptured than in unruptured aneurysms (1.70 ± 1.06 versus 0.89 ± 0.88, respectively; P = .0001). The receiver operating characteristic curve analysis found that the most reliable cutoff value of the wall enhancement index to differentiate ruptured from unruptured aneurysms was 0.53 (sensitivity, 0.96; specificity, 0.47). The wall enhancement index remained significant in the multivariate logistic regression analysis (P < .0001). CONCLUSIONS Greater circumferential enhancement along the wall of cerebral aneurysms correlates with the ruptured state. A quantitative evaluation of circumferential enhancement by using vessel wall MR imaging could be useful in differentiating ruptured from unruptured intracranial aneurysms.
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Affiliation(s)
- S Omodaka
- From the Departments of Neurosurgery (S.O., H.E.)
| | - H Endo
- From the Departments of Neurosurgery (S.O., H.E.)
| | - K Niizuma
- Department of Neurosurgery (K.N., M.F., T.T.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - M Fujimura
- Department of Neurosurgery (K.N., M.F., T.T.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - T Inoue
- Department of Neurosurgery (T.I.), Sendai Medical Center, Sendai, Japan
| | - K Sato
- Neuroendovascular Therapy (K.S.)
| | - S-I Sugiyama
- Neuroanesthesia (S.-i.S.), Kohnan Hospital, Sendai, Japan
| | - T Tominaga
- Department of Neurosurgery (K.N., M.F., T.T.), Tohoku University Graduate School of Medicine, Sendai, Japan
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Beez T, Steiger HJ, Hänggi D. Evolution of Management of Intracranial Aneurysms in Children: A Systematic Review of the Modern Literature. J Child Neurol 2016; 31:773-83. [PMID: 26516106 DOI: 10.1177/0883073815609153] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 08/24/2015] [Indexed: 11/17/2022]
Abstract
Pediatric intracranial aneurysms are rare. Management of their more common adult counterparts was profoundly influenced by recent high-quality clinical studies. The aim of this review was to aggregate the modern pediatric data published in the wake of these studies and to analyze their impact on management of aneurysms in children. A systematic PubMed search identified 135 publications published between 2000 and 2015, accounting for 573 children and 656 aneurysms. Descriptive statistical analyses revealed differences between children and adults concerning demographics and aneurysm characteristics. A significant proportion of patients were treated endovascularly, suggesting endovascular treatment has been established in the therapeutic armamentarium for pediatric aneurysms. However, these data highlight the unique nature of pediatric aneurysms, and neither this review nor generalization from adult data can replace high-quality clinical research. Multicenter registries and controlled trials are required to establish the natural history and evidence-based treatment of pediatric aneurysms.
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Affiliation(s)
- Thomas Beez
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-Universität, Düsseldorf, Germany Paediatric Neurosurgery, Royal Hospital for Children, Glasgow, UK
| | - Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich-Heine-Universität, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty, Universitätsmedizin Mannheim, Mannheim, Germany
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90
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Abas A, Mokhtar NH, Ishak MHH, Abdullah MZ, Ho Tian A. Lattice Boltzmann Model of 3D Multiphase Flow in Artery Bifurcation Aneurysm Problem. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2016; 2016:6143126. [PMID: 27239221 PMCID: PMC4864205 DOI: 10.1155/2016/6143126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 03/05/2016] [Accepted: 03/31/2016] [Indexed: 11/17/2022]
Abstract
This paper simulates and predicts the laminar flow inside the 3D aneurysm geometry, since the hemodynamic situation in the blood vessels is difficult to determine and visualize using standard imaging techniques, for example, magnetic resonance imaging (MRI). Three different types of Lattice Boltzmann (LB) models are computed, namely, single relaxation time (SRT), multiple relaxation time (MRT), and regularized BGK models. The results obtained using these different versions of the LB-based code will then be validated with ANSYS FLUENT, a commercially available finite volume- (FV-) based CFD solver. The simulated flow profiles that include velocity, pressure, and wall shear stress (WSS) are then compared between the two solvers. The predicted outcomes show that all the LB models are comparable and in good agreement with the FVM solver for complex blood flow simulation. The findings also show minor differences in their WSS profiles. The performance of the parallel implementation for each solver is also included and discussed in this paper. In terms of parallelization, it was shown that LBM-based code performed better in terms of the computation time required.
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Affiliation(s)
- Aizat Abas
- School of Mechanical Engineering, Universiti Sains Malaysia, Engineering Campus, 14300 Nibong Tebal, Penang, Malaysia
| | - N. Hafizah Mokhtar
- School of Mechanical Engineering, Universiti Sains Malaysia, Engineering Campus, 14300 Nibong Tebal, Penang, Malaysia
| | - M. H. H. Ishak
- School of Mechanical Engineering, Universiti Sains Malaysia, Engineering Campus, 14300 Nibong Tebal, Penang, Malaysia
| | - M. Z. Abdullah
- School of Aerospace Engineering, Universiti Sains Malaysia, Engineering Campus, 14300 Nibong Tebal, Penang, Malaysia
| | - Ang Ho Tian
- School of Mechanical Engineering, Universiti Sains Malaysia, Engineering Campus, 14300 Nibong Tebal, Penang, Malaysia
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91
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Hemodynamic alterations after stent implantation in 15 cases of intracranial aneurysm. Acta Neurochir (Wien) 2016; 158:811-819. [PMID: 26746828 DOI: 10.1007/s00701-015-2696-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Stent-assisted coiling technology has been widely used in the treatment of intracranial aneurysms. In the current study, we investigated the intra-aneurysmal hemodynamic alterations after stent implantation and their association with the aneurysm location. METHODS We first retrospectively studied 15 aneurysm cases [8 internal carotid artery-ophthalmic artery (ICA-OphA) aneurysms and 7 posterior communicating artery (PcoA) aneurysms] treated with Enterprise stents and coils. Then, based on the patient-specific geometries before and after stenting, we built virtual stenting computational fluid dynamics (CFD) simulation models. RESULTS Before and after the stent deployment, the average wall shear stress (WSS) on the aneurysmal sac at systolic peak changed from 7.04 Pa (4.14 Pa, 15.77 Pa) to 6.04 Pa (3.86 Pa, 11.13 Pa), P = 0.001; the spatially averaged flow velocity in the perpendicular plane of the aneurysm dropped from 0.5 m/s (0.28 m/s, 0.7 m/s) to 0.33 m/s (0.25 m/s, 0.49 m/s), P = 0.001, respectively. Post stent implantation, the WSS in ICA-OphA aneurysms and PcoA aneurysms decreased by 14.4 % (P = 0.012) and 16.6 % (P = 0.018), respectively, and the flow velocity also reduced by 10.3 % (P = 0.029) and 10.5 % (P = 0.013), respectively. Changes in the WSS, flow velocity, and pressure were not significantly different between ICA-OphA and PcoA aneurysms (P > 0.05). Stent implantation did not significantly change the peak systolic pressure in either aneurysm type. CONCLUSION After the stent implantation, both the intra-aneurysmal flow velocity and WSS decreased independently of aneurysm type (ICA-OphA and PcoA). Little change was observed in peak systolic pressure.
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92
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Matouk CC, Cord BJ, Yeung J, Malhotra A, Johnson MH, Minja FJ. High-resolution Vessel Wall Magnetic Resonance Imaging in Intracranial Aneurysms and Brain Arteriovenous Malformations. Top Magn Reson Imaging 2016; 25:49-55. [PMID: 27049241 DOI: 10.1097/rmr.0000000000000084] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Over the last several years, the advent of intracranial high-resolution vessel wall magnetic resonance imaging (VW-MRI) has provided a new lens with which to view cerebrovascular disease that has not previously been available with conventional imaging. It has already fundamentally changed the way that steno-occlusive diseases are evaluated at many academic centers. This review focuses on current and emerging applications of intracranial high-resolution VW-MRI in the clinical evaluation of intracranial aneurysms and brain arteriovenous malformations. Examples are provided from our clinical practice.
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Affiliation(s)
- Charles C Matouk
- *Department of Neurosurgery †Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT
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93
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Coloma M, Schaffer JD, Carare RO, Chiarot PR, Huang P. Pulsations with reflected boundary waves: a hydrodynamic reverse transport mechanism for perivascular drainage in the brain. J Math Biol 2016; 73:469-90. [PMID: 26729476 DOI: 10.1007/s00285-015-0960-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 12/14/2015] [Indexed: 01/25/2023]
Abstract
Beta-amyloid accumulation within arterial walls in cerebral amyloid angiopathy is associated with the onset of Alzheimer's disease. However, the mechanism of beta-amyloid clearance along peri-arterial pathways in the brain is not well understood. In this study, we investigate a transport mechanism in the arterial basement membrane consisting of forward-propagating waves and their reflections. The arterial basement membrane is modeled as a periodically deforming annulus filled with an incompressible single-phase Newtonian fluid. A reverse flow, which has been suggested in literature as a beta-amyloid clearance pathway, can be induced by the motion of reflected boundary waves along the annular walls. The wave amplitude and the volume of the annular region govern the flow magnitude and may have important implications for an aging brain. Magnitudes of transport obtained from control volume analysis and numerical solutions of the Navier-Stokes equations are presented.
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Affiliation(s)
- M Coloma
- Department of Mechanical Engineering, State University of New York at Binghamton, 4400 Vestal Parkway East, Binghamton, USA
| | - J D Schaffer
- College of Community and Public Affairs, State University of New York at Binghamton, 4400 Vestal Parkway East, Binghamton, USA
| | - R O Carare
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - P R Chiarot
- Department of Mechanical Engineering, State University of New York at Binghamton, 4400 Vestal Parkway East, Binghamton, USA
| | - P Huang
- Department of Mechanical Engineering, State University of New York at Binghamton, 4400 Vestal Parkway East, Binghamton, USA.
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94
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Raychev R, Tateshima S, Vinuela F, Sayre J, Jahan R, Gonzalez N, Szeder V, Duckwiler G. Predictors of thrombotic complications and mass effect exacerbation after pipeline embolization: The significance of adenosine diphosphate inhibition, fluoroscopy time, and aneurysm size. Interv Neuroradiol 2015; 22:34-41. [PMID: 26537850 DOI: 10.1177/1591019915609125] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/03/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The mechanisms leading to delayed rupture, distal emboli and intraparenchymal hemorrhage in relation to pipeline embolization device (PED) placement remain debatable and poorly understood. The aim of this study was to identify clinical and procedural predictors of these perioperative complications. METHODS We conducted a retrospective review of consecutive patients who underwent PED placement. We utilized a non-commercial platelet aggregation method measuring adenosine diphosphate (ADP)% inhibition for evaluation of clopidogrel response. To our knowledge, this is the first study to test ADP in neurovascular procedures. Multivariable regression analysis was used to identify the strongest predictor of three separate outcomes: (1) thrombotic complications, (2) hemorrhagic complications, and (3) aneurysm mass effect exacerbation RESULTS Permanent complication-related morbidity and mortality at 3 months was 6% (3/48). No specific predictors of hemorrhagic complications were identified. In the univariate analysis, the strongest predictors of thrombotic complications were: ADP% inhibition<49 (p=0.01), aneurysm size (p=0.04) and fluoroscopy time (p=0.002). In the final multivariate analysis, among all baseline variables, fluoroscopy time exceeding 52 min was the only factor associated with thrombotic complications (p=0.007). Aneurysm size≥18 mm was the single predictor of mass effect exacerbation (p=0.039). CONCLUSIONS Procedural complexity, reflected by fluoroscopy time, is the strongest predictor of thrombotic complications in this study. ADP% inhibition is a reliable method of testing clopidogrel response in neurovascular procedures and values of <50% may predict thrombotic complications. Interval mass effect exacerbation after PED placement may be anticipated in large aneurysms exceeding 18 mm.
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95
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Omodaka S, Endo H, Fujimura M, Niizuma K, Sato K, Matsumoto Y, Tominaga T. High-grade Cerebral Arteriovenous Malformation Treated with Targeted Embolization of a Ruptured Site: Wall Enhancement of an Intranidal Aneurysm as a Sign of Ruptured Site. Neurol Med Chir (Tokyo) 2015; 55:813-7. [PMID: 26369871 PMCID: PMC4663032 DOI: 10.2176/nmc.cr.2015-0052] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Partial targeted embolization of the ruptured site of cerebral arteriovenous malformations (AVMs) is considered effective to prevent rebleeding. The site of rupture is usually determined by morphological features, such as an intranidal aneurysm or a venous varix; however, the site can be difficult to identify in high-grade AVM with complicated angioarchitecture. The authors present a case of a 36-year-old woman with high-grade AVM presented with repeated hemorrhage. Cerebral angiography showed intranidal aneurysm, which was considered the ruptured site. The T1-weighted imaging with gadolinium enhancement demonstrated linear enhancement along the outer surface of the thickened wall of the intranidal aneurysm, which could be supplementary information to identify the ruptured site. Obliteration of the intranidal aneurysm was successfully achieved by emergent targeted embolization using N-butyl cyanoacrylate. The patient recovered and regained an independent status. The patient underwent volume-staged radiosurgery and experienced no further hemorrhage during the 26 months follow-up. Targeted embolization of the ruptured site is considered effective to prevent rebleeding in high-grade cerebral AVMs. Wall enhancement of the intranidal aneurysm, in addition to the structural characteristics, could be helpful in identifying the site of rupture embedded in the complicated angioarchitecture.
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96
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Gounis MJ, van der Marel K, Marosfoi M, Mazzanti ML, Clarençon F, Chueh JY, Puri AS, Bogdanov AA. Imaging Inflammation in Cerebrovascular Disease. Stroke 2015; 46:2991-7. [PMID: 26351362 DOI: 10.1161/strokeaha.115.008229] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/07/2015] [Indexed: 02/01/2023]
Abstract
Imaging inflammation in large intracranial artery pathology may play an important role in the diagnosis of and risk stratification for a variety of cerebrovascular diseases. Looking beyond the lumen has already generated widespread excitement in the stroke community, and the potential to unveil molecular processes in the vessel wall is a natural evolution to develop a more comprehensive understanding of the pathogenesis of diseases, such as ICAD and brain aneurysms.
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Affiliation(s)
- Matthew J Gounis
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester.
| | - Kajo van der Marel
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
| | - Miklos Marosfoi
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
| | - Mary L Mazzanti
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
| | - Frédéric Clarençon
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
| | - Ju-Yu Chueh
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
| | - Ajit S Puri
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
| | - Alexei A Bogdanov
- From the New England Center for Stroke Research (M.J.G., K.v.d.M., M.M., F.C., J.-Y.C., A.S.P.) and Laboratory of Molecular Imaging Probes (M.L.M., A.A.B.), Department of Radiology, University of Massachusetts Medical School, Worcester
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97
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Abstract
Cerebrospinal vascular malformations are a group of anomalies affecting the arterial wall, the capillary arteriovenous interface, or the venous and lymphatic structures. Heritability and family studies allow identification of mutations in single genes associated with rare familial conditions causing cerebral or spinal vascular malformations, as is the case in hemorrhagic hereditary telangiectasia diseases. This article reviews the genetic and epigenetic influences increasingly reported in recent years as causal factors or triggers involved in the formation and growth of cerebromedullary vascular malformations.
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Affiliation(s)
- Hortensia Alvarez
- Interventional Neuroradiology, UNC at Chapel Hill, Chapel Hill, NC 27516, USA
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98
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Ribeiro de Sousa D, Vallecilla C, Chodzynski K, Corredor Jerez R, Malaspinas O, Eker OF, Ouared R, Vanhamme L, Legrand A, Chopard B, Courbebaisse G, Zouaoui Boudjeltia K. Determination of a shear rate threshold for thrombus formation in intracranial aneurysms. J Neurointerv Surg 2015. [DOI: 10.1136/neurintsurg-2015-011737] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundParticular intra-aneurysmal blood flow conditions, created naturally by the growth of an aneurysm or induced artificially by implantation of a flow diverter stent (FDS), can potentiate intra-aneurysmal thrombosis. The aim of this study was to identify hemodynamic indicators, relevant to this process, which could be used as a prediction of the success of a preventive endovascular treatment.MethodA cross sectional study on 21 patients was carried out to investigate the possible association between intra-aneurysmal spontaneous thrombus volume and the dome to neck aspect ratio (AR) of the aneurysm. The mechanistic link between these two parameters was further investigated through a Fourier analysis of the intra-aneurysmal shear rate (SR) obtained by computational fluid dynamics (CFD). This analysis was first applied to 10 additional patients (4 with and 6 without spontaneous thrombosis) and later to 3 patients whose intracranial aneurysms only thrombosed after FDS implantation.ResultsThe cross sectional study revealed an association between intra-aneurysmal spontaneous thrombus volume and the AR of the aneurysm (R2=0.67, p<0.001). Fourier analysis revealed that in cases where thrombosis occurred, the SR harmonics 0, 1, and 2 were always less than 25/s, 10/s, and 5/s, respectively, and always greater than these values where spontaneous thrombosis was not observed.ConclusionsOur study suggests the existence of an SR threshold below which thrombosis will occur. Therefore, by analyzing the SR on patient specific data with CFD techniques, it may be potentially possible to predict whether or the intra-aneurysmal flow conditions, after FDS implantation, will become prothrombotic.
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99
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Robertson AM, Duan X, Aziz KM, Hill MR, Watkins SC, Cebral JR. Diversity in the Strength and Structure of Unruptured Cerebral Aneurysms. Ann Biomed Eng 2015; 43:1502-15. [PMID: 25632891 PMCID: PMC4497939 DOI: 10.1007/s10439-015-1252-4] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/13/2015] [Indexed: 11/28/2022]
Abstract
Intracranial aneurysms are pathological enlargements of brain arteries that are believed to arise from progressive wall degeneration and remodeling. Earlier work using classical histological approaches identified variability in cerebral aneurysm mural content, ranging from layered walls with intact endothelium and aligned smooth muscle cells, to thin, hypocellular walls. Here, we take advantage of recent advances in multiphoton microscopy, to provide novel results for collagen fiber architecture in 15 human aneurysm domes without staining or fixation as well as in 12 control cerebral arteries. For all aneurysm samples, the elastic lamina was absent and the abluminal collagen fibers had similar diameters to control arteries. In contrast, the collagen fibers on the luminal side showed great variability in both diameter and architecture ranging from dense fiber layers to sparse fiber constructs suggestive of ineffective remodeling efforts. The mechanical integrity of eight aneurysm samples was assessed using uniaxial experiments, revealing two sub-classes (i) vulnerable unruptured aneurysms (low failure stress and failure pressure), and (ii) strong unruptured aneurysms (high failure stress and failure pressure). These results suggest a need to refine the end-point of risk assessment studies that currently do not distinguish risk levels among unruptured aneurysms. We propose that a measure of wall integrity that identifies this vulnerable wall subpopulation will be useful for interpreting future biological and structural data.
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Affiliation(s)
- Anne M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA,
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100
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Regulation of smooth muscle contractility by competing endogenous mRNAs in intracranial aneurysms. J Neuropathol Exp Neurol 2015; 74:411-24. [PMID: 25868147 DOI: 10.1097/nen.0000000000000185] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Alterations in vascular smooth muscle cells (SMCs) contribute to the pathogenesis of intracranial aneurysms (IAs), but the genetic mechanisms underlying these alterations are unclear. We used microarray analysis to compare tissue small noncoding RNA and messenger RNA expression profiles in vessel wall samples from patients with late-stage IAs. We identified myocardin (MYOCD), a key contractility regulator of vascular SMCs, as a critical factor in IA progression. Using a multifaceted computational and experimental approach, we determined that depletion of competitive endogenous RNAs (ARHGEF12, FGF12, and ADCY5) enhanced factors that downregulate MYOCD, which induces the conversion of SMCs from differentiated contractile states into dedifferentiated phenotypes that exhibit enhanced proliferation, synthesis of new extracellular matrix, and organization of mural thrombi. These effects may lead to the repair and maintenance of IAs. This study presents guidelines for the prediction and validation of the IA regulator MYOCD in competitive endogenous RNA networks and facilitates the development of novel therapeutic and diagnostic tools for IAs.
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