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Yen PW, Chen YA, Wang W, Mao FS, Chao CT, Chiang CK, Lin SH, Tarng DC, Chiu YW, Wu MJ, Chen YC, Kao JTW, Wu MS, Lin CL, Huang JW, Hung KY. The screening, diagnosis, and management of patients with autosomal dominant polycystic kidney disease: A national consensus statement from Taiwan. Nephrology (Carlton) 2024; 29:245-258. [PMID: 38462235 DOI: 10.1111/nep.14287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/29/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited cause of end-stage kidney disease (ESKD) worldwide. Guidelines for the diagnosis and management of ADPKD in Taiwan remains unavailable. In this consensus statement, we summarize updated information on clinical features of international and domestic patients with ADPKD, followed by suggestions for optimal diagnosis and care in Taiwan. Specifically, counselling for at-risk minors and reproductive issues can be important, including ethical dilemmas surrounding prenatal diagnosis and pre-implantation genetic diagnosis. Studies reveal that ADPKD typically remains asymptomatic until the fourth decade of life, with symptoms resulting from cystic expansion with visceral compression, or rupture. The diagnosis can be made based on a detailed family history, followed by imaging studies (ultrasound, computed tomography, or magnetic resonance imaging). Genetic testing is reserved for atypical cases mostly. Common tools for prognosis prediction include total kidney volume, Mayo classification and PROPKD/genetic score. Screening and management of complications such as hypertension, proteinuria, urological infections, intracranial aneurysms, are also crucial for improving outcome. We suggest that the optimal management strategies of patients with ADPKD include general medical care, dietary recommendations and ADPKD-specific treatments. Key points include rigorous blood pressure control, dietary sodium restriction and Tolvaptan use, whereas the evidence for somatostatin analogues and mammalian target of rapamycin (mTOR) inhibitors remains limited. In summary, we outline an individualized care plan emphasizing careful monitoring of disease progression and highlight the need for shared decision-making among these patients.
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Affiliation(s)
- Pao-Wen Yen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Yung-An Chen
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Wei Wang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Fang-Sheng Mao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Chia-Ter Chao
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Min-Sheng General Hospital, Taoyuan City, Taiwan
| | - Chih-Kang Chiang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Shih-Hua Lin
- Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Wen Chiu
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Yung-Chang Chen
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Juliana Tze-Wah Kao
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang-Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- Division of Nephrology, Department of Internal Medicine, Fu-Jen Catholic University Hospital, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Mai-Szu Wu
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang-Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Liang Lin
- Division of Nephrology, Department of Internal Medicine, Chia-Yi Chang Gung Memorial Hospital, Chia-Yi County, Taiwan
| | - Jenq-Wen Huang
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Kuan-Yu Hung
- Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Medical University-Shuang-Ho Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan
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Gulati A, Watnick T. Vascular Complications in Autosomal Dominant Polycystic Kidney Disease: Perspectives, Paradigms, and Current State of Play. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:429-439. [PMID: 38097333 DOI: 10.1053/j.akdh.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 09/06/2023] [Accepted: 09/12/2023] [Indexed: 12/18/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the leading cause of inherited kidney disease with significant contributions to CKD and end-stage kidney disease. The underlying polycystin proteins (PC1 and PC2) have widespread tissue expression and complex functional roles making ADPKD a systemic disease. Vascular complications, particularly intracranial aneurysms (ICA) are the most feared due to their potential for devastating neurological complications and sudden death. Intracranial aneurysms occur in 8-12% of all patients with ADPKD, but the risk is intensified 4-5-fold in those with a positive family history. The basis for this genetic risk is not well understood and could conceivably be due to features of the germline mutation with a significant contribution of other genetic modifiers and/or environmental factors. Here we review what is known about the natural history and genetics of unruptured ICA in ADPKD including the prevalence and risk factors for aneurysm formation and subarachnoid hemorrhage. We discuss two alternative screening strategies and recommend a practical algorithm that targets those at highest risk for ICA with a positive family history for screening.
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Affiliation(s)
- Ashima Gulati
- Division of Nephrology, Children's National Hospital and Children's National Research Institute, Washington, DC
| | - Terry Watnick
- Division of Nephrology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD.
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Martinez AN, Tortelote GG, Pascale CL, McCormack IG, Nordham KD, Suder NJ, Couldwell MW, Dumont AS. Single-Cell Transcriptome Analysis of the Circle of Willis in a Mouse Cerebral Aneurysm Model. Stroke 2022; 53:2647-2657. [PMID: 35770669 DOI: 10.1161/strokeaha.122.038776] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The circle of Willis (CoW) is the most common location for aneurysms to form in humans. Although the major cell types of the intracranial vasculature are well known, the heterogeneity and relative contributions of the different cells in healthy and aneurysmal vessels have not been well characterized. Here, we present the first comprehensive analysis of the lineage heterogeneity and altered transcriptomic profiles of vascular cells from healthy and aneurysmal mouse CoW using single-cell RNA sequencing. METHODS Cerebral aneurysms (CAs) were induced in adult male mice using an elastase model. Single-cell RNA sequencing was then performed on CoW samples obtained from animals that either had aneurysms form or rupture 14 days post-induction. Sham-operated animals served as controls. RESULTS Unbiased clustering analysis of the transcriptional profiles from >3900 CoW cells identified 19 clusters representing ten cell lineages: vascular smooth muscle cells, endothelial cells fibroblasts, pericytes and immune cells (macrophages, T and B lymphocytes, dendritic cells, mast cells, and neutrophils). The 5 vascular smooth muscle cell subpopulations had distinct transcriptional profiles and were classified as proliferative, stress-induced senescent, quiescent, inflammatory-like, or hyperproliferative. The transcriptional signature of the metabolic pathways of ATP generation was found to be downregulated in 2 major vascular smooth muscle cell clusters when CA was induced. Aneurysm induction led to significant expansion of the total macrophage population, and this expansion was further increased with rupture. Both inflammatory and resolution-phase macrophages were identified, and a massive spike of neutrophils was seen with CA rupture. Additionally, the neutrophil-to-lymphocyte ratio (NLR), which originated from CA induction mirrored what happens in humans. CONCLUSIONS Our data identify CA disease-relevant transcriptional signatures of vascular cells in the CoW and is searchable via a web-based R/shiny interface.
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Affiliation(s)
- Alejandra N Martinez
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA. (A.N.M., C.L.P., I.G.M., K.D.N., N.J.S., M.W.C., A.S.D.)
| | - Giovane G Tortelote
- Department of Pediatrics and The Tulane Hypertension & Renal Center of Excellence, Tulane University School of Medicine, New Orleans, LA. (G.G.T.)
| | - Crissey L Pascale
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA. (A.N.M., C.L.P., I.G.M., K.D.N., N.J.S., M.W.C., A.S.D.)
| | - Isabella G McCormack
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA. (A.N.M., C.L.P., I.G.M., K.D.N., N.J.S., M.W.C., A.S.D.)
| | - Kristen D Nordham
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA. (A.N.M., C.L.P., I.G.M., K.D.N., N.J.S., M.W.C., A.S.D.)
| | - Natalie J Suder
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA. (A.N.M., C.L.P., I.G.M., K.D.N., N.J.S., M.W.C., A.S.D.)
| | - Mitchell W Couldwell
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA. (A.N.M., C.L.P., I.G.M., K.D.N., N.J.S., M.W.C., A.S.D.)
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, LA. (A.N.M., C.L.P., I.G.M., K.D.N., N.J.S., M.W.C., A.S.D.)
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Eker OF, Levrier O, Houdart E, Bonja M, Herbreteau D, Bonafé A, Desal H. Endovascular Treatment of Complex Intracranial Aneurysms With LEO+ Stents: The LEO II Cohort Study. Front Neurol 2022; 13:848683. [PMID: 35837225 PMCID: PMC9275550 DOI: 10.3389/fneur.2022.848683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionStent-assisted coiling is an established treatment option for intracranial aneurysms, particularly, wide neck aneurysms with complex anatomy. The purpose of the present study was to assess the safety and efficacy of LEO+ stents in the treatment of intracranial aneurysms.Materials and MethodsA prospective, observational, multicenter study including 12 centers was performed on patients with ruptured, unruptured, and recanalized intracranial aneurysms treated with LEO+ stents. The primary efficacy endpoint was the rate of complete aneurysmal occlusion at 18 months post-procedure, and the primary safety endpoint was the morbidity and mortality at 18 months post-procedure.ResultsFrom March 2015 to June 2017, 176 patients were enrolled (mean age of 54.8 ± 11.5 years; 65.9% women). The aneurysms were located mainly in the anterior communicating artery (29.2%) and the middle cerebral artery (28.6%). They were mostly saccular (94%), with a mean dome size of 5.3 ± 2.6 mm and a mean aspect ratio of 1.2 ± 1.0. In total, 3% of the aneurysms were treated in the acute phase of rupture. Complete/nearly complete aneurysmal occlusion and major recanalization were observed in 89% (n = 146/164) and 1.8% (n = 3/164) of patients at 18-month follow-up, respectively. The LEO+ related mortality rate was 0.6% (n = 1/170), the morbidity rate was 4.1% (n = 7/170), and these patients were mRS 0–2 at 18 months.ConclusionOur results reflecting the use of LEO+ stents in real-world conditions confirm the efficacy and safety of LEO+ stents in the management of complex intracranial aneurysms.
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Affiliation(s)
- Omer F. Eker
- Department of Neuroradiology, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- *Correspondence: Omer F. Eker
| | - Olivier Levrier
- Department of Interventional Neuroradiology, Polyclinique Clairval, Marseille, France
| | - Emmanuel Houdart
- Department of Neuroradiology, Hôpital Lariboisière, Paris, France
| | - Marianne Bonja
- Department of Clinical Affairs, Balt Extrusion, Montmorency, France
| | - Denis Herbreteau
- Department of Radio-Diagnostic and Medical Imaging, Centre Hospitalier Régional et Universitaire Bretonneau, Tours, France
| | - Alain Bonafé
- Department of Neuroradiology, Hôpital Gui-de-Chauliac, Montpellier, France
| | - Hubert Desal
- Department of Diagnostic and Interventional Neuroradiology, Hôpital Guillaume et René Laënnec, Nantes, France
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Epithelial-mesenchymal transition related genes in unruptured aneurysms identified through weighted gene coexpression network analysis. Sci Rep 2022; 12:225. [PMID: 34997174 PMCID: PMC8741966 DOI: 10.1038/s41598-021-04390-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/21/2021] [Indexed: 11/08/2022] Open
Abstract
Intracranial aneurysm (IA) can cause fatal subarachnoid hemorrhage (SAH) after rupture, and identifying patients with unruptured IAs is essential for reducing SAH fatalities. The epithelial-mesenchymal transition (EMT) may be vital to IA progression. Here, identified key EMT-related genes in aneurysms and their pathogenic mechanisms via bioinformatic analysis. The GSE13353, GSE75436, and GSE54083 datasets from Gene Expression Omnibus were analyzed with limma to identify differentially expressed genes (DEGs) among unruptured aneurysms, ruptured aneurysms, and healthy samples. The results revealed that three EMT-related DEGs (ADIPOQ, WNT11, and CCL21) were shared among all groups. Coexpression modules and hub genes were identified via weighted gene co-expression network analysis, revealing two significant modules (red and green) and 14 EMT-related genes. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses suggested that cytokine interactions were closely related. Gene set enrichment analysis revealed that unruptured aneurysms were enriched for the terms "inflammatory response" and "vascular endothelial growth". Protein-protein interaction analysis identified seven key genes, which were evaluated with the GSE54083 dataset to determine their sensitivity and specificity. In the external validation set, we verified the differential expression of seven genes in unruptured aneurysms and normal samples. Together, these findings indicate that FN1, and SPARC may help distinguish normal patients from patients with asymptomatic IAs.
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It.ÇÖs not always postdural puncture headache: a case report and note to the astute anesthesiologist. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2021; 73:108-111. [PMID: 34174280 PMCID: PMC9801191 DOI: 10.1016/j.bjane.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 05/16/2021] [Accepted: 06/04/2021] [Indexed: 02/01/2023]
Abstract
Dural puncture is either diagnosed by unexpectedly profound response to medication test dose or development of a postpartum postural headache. Epidural blood patch is the gold standard for treatment of PDPH when conservative management fails. However, postpartum headaches can be resistant to multiple epidural blood patches. In such cases, preexisting intracranial processes should be considered and ruled out. We report here the unique case of a pregnant patient who developed a resistant headache in the postpartum period related to an incidental intracranial aneurysm. Subsequent treatment with endovascular embolization adequately relieved her symptoms. Early surgical consultation and a multidisciplinary team approach involving neurology and neuroimaging is required for successful management of patients such as the one described here.
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Igase M, Igase K, Okada Y, Ochi M, Tabara Y, Sadamoto K, Ohyagi Y. Low Carotid Flow Pulsatility Index Correlates With the Presence of Unruptured Intracranial Aneurysms. J Am Heart Assoc 2021; 10:e018626. [PMID: 34155906 PMCID: PMC8403298 DOI: 10.1161/jaha.120.018626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background We assessed cases of incidental unruptured intracranial aneurysm (UIA) discovered on screening magnetic resonance angiography to identify hemodynamic and atherosclerotic risk factors. Methods and Results The data of 1376 healthy older subjects (age range, 31–91 years) without cerebro‐ or cardiovascular diseases who underwent brain magnetic resonance angiography as part of a medical checkup program at a health screening center were examined retrospectively. We looked for an increase in classical risk factors for UIAs (age, sex, hypertension, and smoking) and laboratory data related to lifestyle diseases among subjects with UIAs. Brachial‐ankle pulse wave velocity, central systolic blood pressure, radial augmentation index, and carotid flow pulsatility index were also compared between those with and without UIAs. We found UIAs in 79 (5.7%) of the subjects. Mean age was 67.1±9.0 years, and 55 (70%) were women. Of the 79 aneurysms, 75 (95%) were in the anterior circulation, with a mean diameter of 3.1 mm (range, 2.0–8.0 mm). Subjects with UIAs were significantly older and had more severe hypertension. The carotid flow pulsatility index was significantly lower in subjects with UIAs and negatively and independently correlated with UIAs. Tertile analysis stratified by carotid flow pulsatility index revealed that subjects with lower indices had higher levels of low‐density lipoprotein cholesterol. Conclusions The presence of UIAs correlated with lower carotid flow pulsatility index and elevated low‐density lipoprotein cholesterol in the data from a population of healthy older volunteers. A reduced carotid flow pulsatility index may affect low‐density lipoprotein cholesterol elevation by some molecular pathways and influence the development of cerebral aneurysms. This may guide aneurysm screening indications for institutions where magnetic resonance angiography is not routine.
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Affiliation(s)
- Michiya Igase
- Department of Antiaging MedicineEhime University Graduate School of MedicineToon, EhimeJapan
| | - Keiji Igase
- Department of Advanced NeurosurgeryEhime University Graduate School of MedicineToon, EhimeJapan
| | - Yoko Okada
- Department of Geriatric Medicine and NeurologyEhime University Graduate School of MedicineToon, EhimeJapan
| | - Masayuki Ochi
- Department of Geriatric Medicine and NeurologyEhime University Graduate School of MedicineToon, EhimeJapan
| | - Yasuharu Tabara
- The Center for Genomic MedicineKyoto University Graduate School of MedicineKyotoJapan
| | | | - Yasumasa Ohyagi
- Department of Geriatric Medicine and NeurologyEhime University Graduate School of MedicineToon, EhimeJapan
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Annese V, Frau C, Murdeu N, Gregorio M, Sanguigni S. Cerebral venous congestion correlates to acute aneurysm rupture: An illustrative case with Doppler ultrasonography study. eNeurologicalSci 2020; 19:100231. [PMID: 32181376 PMCID: PMC7066058 DOI: 10.1016/j.ensci.2020.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 01/01/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The objective of our description is to shed light on some new hemodynamic and clinical characteristics in the unstable cerebral aneurysm Case: We describe a 54 year old woman who presented a tension headache, that increasing for several days. A CT scan performed in ER suggests a possible arterial ectasia at the level of the circle of Willis. The patient is hospitalized. An angio CT shows an aneurysm of the anterior communicating artery, without signs of fixation and/or other instability. A subsequent TCCD examination with venous study shows clear congestion at the level of the spheno-parietal sinus. The Valsalva maneuver determines an increase in local congestion. In the light of the ultrasound picture, the patient was quickly received in Neurosurgery with success. CONCLUSION we describe a clinical case where the worsening tension headache was not secondary to the increase of volume of the aneurysm but was an epiphenomenon of venous congestion, explored with TCCD. The mass effect of the aneurysm determined venous sinus compression and changed the hemodynamic of the cerebral venous flow. We believe that venous outflow obstruction and a high intracranial venous pressure gradient may be a cerebral aneurysm rupture factor.
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Affiliation(s)
- Virginia Annese
- UOC of Neurology, Hospital Legnago, ULSS 9 Scaligera - Verona, Italy
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Colbert GB, Elrggal ME, Gaur L, Lerma EV. Update and review of adult polycystic kidney disease. Dis Mon 2020; 66:100887. [DOI: 10.1016/j.disamonth.2019.100887] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Miyamoto N, Ueno Y, Hira K, Kijima C, Nakajima S, Yamashiro K, Hattori N. Characteristics of Clinical Symptoms, Cerebral Images and Stroke Etiology in Vertebro-Basilar Artery Fenestration-Related Infarction. Brain Sci 2020; 10:brainsci10040243. [PMID: 32326077 PMCID: PMC7226259 DOI: 10.3390/brainsci10040243] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/17/2020] [Accepted: 04/19/2020] [Indexed: 11/22/2022] Open
Abstract
Cerebral artery fenestration is a rare variant of the vascular architecture, but its existence is well documented. The common site of fenestration is the vertebra-basilar artery and it may be found incidentally with subarachnoid hemorrhage. However, fenestration-related cerebral infarction is rare. We analyzed the clinical characteristics, stroke etiology, and image findings of fenestration-related cerebral infarction of the vertebrobasilar artery. We reviewed our hospital records and previously published reports to find cases of fenestration-related cerebral infarction. We excluded those with unknown clinical features or radiological findings. We retrieved 4 cases of fenestration-related infarction from our hospital, in which vascular change, headache, vertigo/dizziness, and dissection in stroke etiology were detected. In eight previously reported cases of fenestration-related infarction, similar vascular changes were noted, but they were mainly diagnosed as embolic stroke of undetermined source. However, based on the criteria for dissection in this study, dissection as the stroke etiology was suspected in the previously reported cases. Many hypotheses have been proposed for the development of dissection, thrombus, and aneurysms in fenestration. Although an embryological and morphological study is needed, clinicians must consider basilar artery fenestration-related infarction as a differential diagnosis and intensive non-invasive image study is recommended.
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Starke RM. Editorial. Assessment of the natural history of cerebral aneurysms in the setting of competing risk. J Neurosurg 2020; 132:1059-1061. [PMID: 30849764 DOI: 10.3171/2018.12.jns183135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hayman MW, Paleologos MS, Kam PCA. Interventional Neuroradiological Procedures—A Review for Anaesthetists. Anaesth Intensive Care 2019; 41:184-201. [DOI: 10.1177/0310057x1304100208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- M. W. Hayman
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Visiting Specialist Anaesthestist
| | - M. S. Paleologos
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Staff Specialist Anaesthetist, Director of Services
| | - P. C. A. Kam
- Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Nuffield Professor and Head, Departments of Anaesthetics, University of Sydney and Royal Prince Alfred Hospital
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Xu J, Yan S, Tan H, Ma L, Feng H, Han H, Pan M, Yu L, Fang C. The miR-143/145 cluster reverses the regulation effect of KLF5 in smooth muscle cells with proliferation and contractility in intracranial aneurysm. Gene 2018; 679:266-273. [DOI: 10.1016/j.gene.2018.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 08/21/2018] [Accepted: 09/06/2018] [Indexed: 11/15/2022]
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Lin N, Cahill KS, Frerichs KU, Friedlander RM, Claus EB. Treatment of ruptured and unruptured cerebral aneurysms in the USA: a paradigm shift. J Neurointerv Surg 2018; 10:i69-i76. [DOI: 10.1136/jnis.2011.004978.rep] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2011] [Revised: 04/24/2011] [Accepted: 05/06/2011] [Indexed: 11/04/2022]
Abstract
BackgroundIntegration of data from clinical trials and advancements in technology predict a change in selection for treatment of patients with cerebral aneurysm.ObjectiveTo describe patterns of use and in-hospital mortality associated with surgical and endovascular treatments of cerebral aneurysms over the past decade.Materials and methodsThe data are 34 899 hospital discharges with a diagnosis of ruptured or unruptured cerebral aneurysm from 1998 to 2007 identified from the Nationwide Inpatient Sample (NIS). The rates of endovascular coiling and surgical clipping and in-hospital mortality among patients with an aneurysm are examined over a decade by hospital and patient demographic characteristics.ResultsFrom 1998 to 2007, 20 134 discharges with a ruptured aneurysm and 14 765 discharges with an unruptured aneurysm were identified. Over this decade, the number of patients discharged with a ruptured aneurysm was stable while the number discharged with an unruptured aneurysm increased significantly. The use of endovascular coiling increased at least twofold for both groups of patient (p<0.001) with the majority of unruptured aneurysms treated with coiling by 2007. Although whites were more likely than non-whites to undergo coiling versus clipping for a ruptured aneurysm (OR=1.30; 95% CI 1.13 to 1.48) and men with unruptured aneurysms were more likely than women to undergo coiling (OR=1.26; 95% CI 1.13 to 1.40), by 2007 differences in treatment selection by gender and racial subgroups were decreased or statistically non-significant. Over time the use of coiling spread from primarily large, teaching hospitals to smaller, non-teaching hospitals.ConclusionsThe majority of unruptured aneurysms in the USA are now treated with endovascular coiling. Although surgical clipping is used for treatment of most ruptured aneurysms, its use is decreasing over time. Dissemination of endovascular procedures appears widespread across patient and hospital subgroups.
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He L, Pierce RW, Min W. Rare and Low-Frequency Variant of ARHGEF17 Is Associated With Intracranial Aneurysms. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2018; 11:e002248. [PMID: 29997229 PMCID: PMC6082391 DOI: 10.1161/circgen.118.002248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Li He
- Center for Translational Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (L.H., W.M.)
| | - Richard W Pierce
- The Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT (R.W.P., W.M.)
| | - Wang Min
- Center for Translational Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China (L.H., W.M.).
- The Vascular Biology and Therapeutics Program, Yale University School of Medicine, New Haven, CT (R.W.P., W.M.)
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Yang X, Li J, Fang Y, Zhang Z, Jin D, Chen X, Zhao Y, Li M, Huan L, Kent TA, Dong JF, Jiang R, Yang S, Jin L, Zhang J, Zhong TP, Yu F. Rho Guanine Nucleotide Exchange Factor ARHGEF17 Is a Risk Gene for Intracranial Aneurysms. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2018; 11:e002099. [PMID: 29997225 PMCID: PMC6141028 DOI: 10.1161/circgen.117.002099] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/22/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intracranial aneurysm (IA) is usually a late-onset disease, affecting 1% to 3% of the general population and leading to life-threatening subarachnoid hemorrhage. Genetic susceptibility has been implicated in IAs, but the causative genes remain elusive. METHODS We performed next-generation sequencing in a discovery cohort of 20 Chinese IA patients. Bioinformatics filters were exploited to search for candidate deleterious variants with rare and low allele frequency. We further examined the candidate variants in a multiethnic sample collection of 86 whole exome sequenced unsolved familial IA cases from 3 previously published studies. RESULTS We identified that the low-frequency variant c.4394C>A_p.Ala1465Asp (rs2298808) of ARHGEF17 was significantly associated with IA in our Chinese discovery cohort (P=7.3×10-4; odds ratio=7.34). It was subsequently replicated in Japanese familial IA patients (P=0.039; odds ratio=4.00; 95% confidence interval=0.832-14.8) and was associated with IA in the large Chinese sample collection comprising 832 sporadic IA-affected and 599 control individuals (P=0.041; odds ratio=1.51; 95% confidence interval=1.02-Inf). When combining the sequencing data of all familial IA patients from 4 different ethnicities (ie, Chinese, Japanese, European American, and French-Canadian), we identified a significantly increased mutation burden for ARHGEF17 (21/106 versus 11/306; P=8.1×10-7; odds ratio=6.6; 95% confidence interval=2.9-15.8) in cases as compared with controls. In zebrafish, arhgef17 was highly expressed in the brain blood vessel. arhgef17 knockdown caused blood extravasation in the brain region. Endothelial lesions were identified exclusively on cerebral blood vessels in the arhgef17-deficient zebrafish. CONCLUSIONS Our results provide compelling evidence that ARHGEF17 is a risk gene for IA.
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Affiliation(s)
- Xinyu Yang
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (X.Y., Z.Z., Y.Z., M.L., L.H., R.J., S.Y., J.Z., F.Y.)
| | - Jiani Li
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX (J.L., F.Y.)
| | - Yabo Fang
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Zhong Shan Hospital, Fudan University, Shanghai, China (Y.F., D.J., X.C., L.J., T.P.Z.)
- Shanghai Key Laboratory of Regulatory Biology, Institute of Molecular Medicine, East China Normal University School of Life Sciences (Y.F., D.J., L.J., T.P.Z.)
| | - Zhen Zhang
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (X.Y., Z.Z., Y.Z., M.L., L.H., R.J., S.Y., J.Z., F.Y.)
| | - Daqing Jin
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Zhong Shan Hospital, Fudan University, Shanghai, China (Y.F., D.J., X.C., L.J., T.P.Z.)
- Shanghai Key Laboratory of Regulatory Biology, Institute of Molecular Medicine, East China Normal University School of Life Sciences (Y.F., D.J., L.J., T.P.Z.)
| | - Xingdong Chen
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Zhong Shan Hospital, Fudan University, Shanghai, China (Y.F., D.J., X.C., L.J., T.P.Z.)
| | - Yan Zhao
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (X.Y., Z.Z., Y.Z., M.L., L.H., R.J., S.Y., J.Z., F.Y.)
| | - Mengqi Li
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (X.Y., Z.Z., Y.Z., M.L., L.H., R.J., S.Y., J.Z., F.Y.)
| | - Linchun Huan
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (X.Y., Z.Z., Y.Z., M.L., L.H., R.J., S.Y., J.Z., F.Y.)
- Department of Neurosurgery, Linyi People's Hospital, Shandong, China (L.H.)
| | - Thomas A Kent
- Engineering Medicine, Texas A&M Health Science Center and College of Engineering, Houston (T.A.K.)
| | - Jing-Fei Dong
- Blood Works Northwest Research Institute, Seattle, WA (J.-F.D.)
- Division of Hematology, Department of Medicine, University of Washington School of Medicine, Seattle (J.-F.D.)
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (X.Y., Z.Z., Y.Z., M.L., L.H., R.J., S.Y., J.Z., F.Y.)
| | - Shuyuan Yang
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (X.Y., Z.Z., Y.Z., M.L., L.H., R.J., S.Y., J.Z., F.Y.)
| | - Li Jin
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Zhong Shan Hospital, Fudan University, Shanghai, China (Y.F., D.J., X.C., L.J., T.P.Z.)
| | - Jianning Zhang
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (X.Y., Z.Z., Y.Z., M.L., L.H., R.J., S.Y., J.Z., F.Y.).
| | - Tao P Zhong
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Zhong Shan Hospital, Fudan University, Shanghai, China (Y.F., D.J., X.C., L.J., T.P.Z.).
- Shanghai Key Laboratory of Regulatory Biology, Institute of Molecular Medicine, East China Normal University School of Life Sciences (Y.F., D.J., L.J., T.P.Z.)
| | - Fuli Yu
- Department of Neurosurgery, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China (X.Y., Z.Z., Y.Z., M.L., L.H., R.J., S.Y., J.Z., F.Y.).
- Human Genome Sequencing Center, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX (J.L., F.Y.)
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Genome-wide association analysis identifies new candidate risk loci for familial intracranial aneurysm in the French-Canadian population. Sci Rep 2018. [PMID: 29531279 PMCID: PMC5847615 DOI: 10.1038/s41598-018-21603-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Intracranial Aneurysm (IA) is a common disease with a worldwide prevalence of 1–3%. In the French-Canadian (FC) population, where there is an important founder effect, the incidence of IA is higher and is frequently seen in families. In this study, we genotyped a cohort of 257 mostly familial FC IA patients and 1,992 FC controls using the Illumina NeuroX SNP-chip. The most strongly associated loci were tested in 34 Inuit IA families and in 32 FC IA patients and 106 FC controls that had been exome sequenced (WES). After imputation, one locus at 3p14.2 (FHIT, rs1554600, p = 4.66 × 10–9) reached a genome-wide significant level of association and a subsequent validation in Nunavik Inuit cohort further confirmed the significance of the FHIT variant association (rs780365, FBAT-O, p = 0.002839). Additionally, among the other promising loci (p < 5 × 10−6), the one at 3q13.2 (rs78125721, p = 4.77 × 10−7), which encompasses CCDC80, also showed an increased mutation burden in the WES data (CCDC80, SKAT-O, p = 0.0005). In this study, we identified two new potential IA loci in the FC population: FHIT, which is significantly associated with hypertensive IA, and CCDC80, which has potential genetic and functional relevance to IA pathogenesis, providing evidence on the additional risk loci for familial IA. We also replicated the previous IA GWAS risk locus 18q11.2, and suggested a potential locus at 8p23.1 that warrants further study.
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18
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Minami S, Hamano T, Iwatani H, Mizui M, Kimura Y, Isaka Y. Tolvaptan promotes urinary excretion of sodium and urea: a retrospective cohort study. Clin Exp Nephrol 2017; 22:550-561. [PMID: 29052786 DOI: 10.1007/s10157-017-1475-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Tolvaptan (TLV) promotes aquaresis; however, little is known about its effect on solute excretion in chronic kidney disease (CKD). METHODS We retrospectively studied CKD patients with decompensated heart failure (HF) or those with autosomal dominant polycystic kidney disease (ADPKD) receiving TLV. Patients with an increased urine volume of more than twice of daily variance were defined as "responders" in HF. We compared the ability of the urinary osmolality (U-OSM) change and urinary creatinine concentration ([U-Cr]) change to discriminate "responders". The fractional excretion of sodium (FeNa) and urea nitrogen (FeUN), and blood urea nitrogen (BUN) were monitored. RESULTS In 30 responders among 53 HF patients, TLV increased FeUN significantly from 36.1 to 44.2% after starting TLV, but not FeNa. Since U-OSM is determined partially by urinary UN concentration, the decrease of [U-Cr] after treatment outperformed the U-OSM decrement to discriminate responders, as shown in receiver operating characteristic curve analysis and significantly higher net reclassification index. In 13 ADPKD patients, TLV increased FeUN (34.8, 47.3%, p = 0.02), and significant decrease of BUN by 2.3 (95% confidence interval 0.4-4.2) mg/dL was observed even 3 months after the intervention. Systolic blood pressure decreased significantly by 14.2 (95% confidence interval 4.0-24.4) mmHg along with the increase in FeNa, leading to reduced dosage of antihypertensives in 6 patients. CONCLUSION TLV promotes the excretion of sodium and urea. The change in [U-Cr] is useful for early discrimination of responders. Hypotension should be carefully monitored during high-dose TLV therapy.
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Affiliation(s)
- Satoshi Minami
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takayuki Hamano
- Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, D11, 2-2 Yamadaoka, Suita, Osaka, Japan, 565-0871.
| | - Hirotsugu Iwatani
- Department of Nephrology, National Hospital Organization Osaka National Hospital, Chuo-ku, Osaka, Osaka, Japan
| | - Masayuki Mizui
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshiki Kimura
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Comparison of the Prevalence of Ruptured and Unruptured Cerebral Aneurysms in a Poor Urban Minority Population. J Stroke Cerebrovasc Dis 2017. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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20
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Zhou S, Ambalavanan A, Rochefort D, Xie P, Bourassa CV, Hince P, Dionne-Laporte A, Spiegelman D, Gan-Or Z, Mirarchi C, Zaharieva V, Dupré N, Kobayashi H, Hitomi T, Harada K, Koizumi A, Xiong L, Dion PA, Rouleau GA. RNF213 Is Associated with Intracranial Aneurysms in the French-Canadian Population. Am J Hum Genet 2016; 99:1072-1085. [PMID: 27745834 DOI: 10.1016/j.ajhg.2016.09.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 09/06/2016] [Indexed: 12/14/2022] Open
Abstract
Intracranial aneurysms (IAs) are the result of focal weakness in the artery wall and have a complex genetic makeup. To date, genome-wide association and sequencing studies have had limited success in identifying IA risk factors. Distinct populations, such as the French-Canadian (FC) population, have increased IA prevalence. In our study, we used exome sequencing to prioritize risk variants in a discovery cohort of six FC families affected by IA, and the analysis revealed an increased variation burden for ring finger protein 213 (RNF213). We resequenced RNF213 in a larger FC validation cohort, and association tests on further identified variants supported our findings (SKAT-O, p = 0.006). RNF213 belongs to the AAA+ protein family, and two variants (p.Arg2438Cys and p.Ala2826Thr) unique to affected FC individuals were found to have increased ATPase activity, which could lead to increased risk of IA by elevating angiogenic activities. Common SNPs in RNF213 were also extracted from the NeuroX SNP-chip genotype data, comprising 257 FC IA-affected and 1,988 control individuals. We discovered that the non-ancestral allele of rs6565666 was significantly associated with the affected individuals (p = 0.03), and it appeared as though the frequency of the risk allele had changed through genetic drift. Although RNF213 is a risk factor for moyamoya disease in East Asians, we demonstrated that it might also be a risk factor for IA in the FC population. It therefore appears that the function of RNF213 can be differently altered to predispose distinct populations to dissimilar neurovascular conditions, highlighting the importance of a population's background in genetic studies of heterogeneous disease.
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Affiliation(s)
- Sirui Zhou
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada; Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Amirthagowri Ambalavanan
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada; Department of Human Genetics, McGill University, Montréal, QC H3A 0G4, Canada
| | - Daniel Rochefort
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada
| | - Pingxing Xie
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada; Faculty of Medicine, McGill University, Montréal, QC H3A 0G4, Canada
| | - Cynthia V Bourassa
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada
| | - Pascale Hince
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada
| | | | - Dan Spiegelman
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada
| | - Ziv Gan-Or
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada; Department of Human Genetics, McGill University, Montréal, QC H3A 0G4, Canada; Department of Neurology and Neurosurgery, McGill University, Montréal, QC H3A 0G4, Canada
| | - Cathy Mirarchi
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada
| | - Vessela Zaharieva
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada
| | - Nicolas Dupré
- Department of Neurological Sciences, Centre Hospitalier Universitaire de Québec, Québec, QC G1V 0A6, Canada; Department of Medicine, Faculty of Medicine, Laval University, Québec, QC G1V 0A6, Canada
| | - Hatasu Kobayashi
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoecho, Kyoto 606-8501, Japan
| | - Toshiaki Hitomi
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoecho, Kyoto 606-8501, Japan
| | - Kouji Harada
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoecho, Kyoto 606-8501, Japan
| | - Akio Koizumi
- Department of Health and Environmental Sciences, Graduate School of Medicine, Kyoto University, Yoshida Konoecho, Kyoto 606-8501, Japan
| | - Lan Xiong
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada; Centre de Recherche, Institut Universitaire en Santé Mentale de Montréal, Montréal QC H1N 3M5, Canada
| | - Patrick A Dion
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada; Department of Neurology and Neurosurgery, McGill University, Montréal, QC H3A 0G4, Canada
| | - Guy A Rouleau
- Montreal Neurological Institute and Hospital, McGill University, Montréal, QC H3A 2B4, Canada; Department of Neurology and Neurosurgery, McGill University, Montréal, QC H3A 0G4, Canada.
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Guan N, Mu S, Wang L, Huo X, Jiang Y, Lv X, Li Y. Endovascular Treatment of 147 Cases of Cavernous Carotid Aneurysms: A Single-Center Experience. J Stroke Cerebrovasc Dis 2016; 25:1929-35. [PMID: 27185537 DOI: 10.1016/j.jstrokecerebrovasdis.2016.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/09/2016] [Accepted: 04/14/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cavernous carotid aneurysms (CCAs) are characterized by pain and neuro-ophthalmologic deficits. The optimal treatment remains unclear, especially for asymptomatic CCAs. This study investigated the efficacy of endovascular treatment for CCAs in our center. METHODS Data obtained from patients who underwent endovascular treatment for CCAs from July 2011 to July 2014 were reviewed. A retrospective analysis was conducted regarding the general condition, clinical presentation, aneurysm characteristics, therapeutic strategy, and prognosis of CCA patients. RESULTS One hundred forty-seven patients who exhibited 155 CCAs were included, which comprised 46 asymptomatic and 101 symptomatic CCA cases. Forty-eight cases presented with headache, 5 cases presented with subarachnoid hemorrhage, 20 cases presented with diplopia, 38 cases presented with cranial nerve palsy, and 27 cases presented with ischemic stroke. The mean aneurysm sizes were 15.3 ± 12.2 and 8.1 ± 7.1 mm in the symptomatic and asymptomatic groups, respectively. Different treatments were administered: coil occlusion (n = 15), stent/balloon-assisted coil occlusion (n = 123), and parent artery occlusion (PAO) (n = 17). The PAO-treated group exhibited the highest aneurysm occlusion rate. Follow-up data were available for 131 cases, which included 86 symptomatic and 45 asymptomatic cases. There were no deaths. Among the symptomatic patients, 40.7% improved, 58.1% remained stable, and 1.2% worsened; 12 patients exhibited regrowth and 6 patients had repeated endovascular treatment. The asymptomatic patients remained stable, including 5 patients who exhibited regrowth and 2 patients who had repeated endovascular treatment. CONCLUSION Endovascular treatment is safe and effective for CCAs and should be considered in patients with minimal complications, as well as in asymptomatic patients with stable symptoms.
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Affiliation(s)
- Ning Guan
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiqing Mu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linyuan Wang
- Department of Periodontics, The Second Affiliated Hospital of Liaoning Medical College, Jinzhou, Liaoning, China
| | - Xiaochuan Huo
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuhua Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Sawyer DM, Pace LA, Pascale CL, Kutchin AC, O'Neill BE, Starke RM, Dumont AS. Lymphocytes influence intracranial aneurysm formation and rupture: role of extracellular matrix remodeling and phenotypic modulation of vascular smooth muscle cells. J Neuroinflammation 2016; 13:185. [PMID: 27416931 PMCID: PMC4946206 DOI: 10.1186/s12974-016-0654-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/06/2016] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Intracranial aneurysms (IA) are increasingly recognized as a disease driven by chronic inflammation. Recent research has identified key mediators and processes underlying IA pathogenesis, but mechanistic understanding remains incomplete. Lymphocytic infiltrates have been demonstrated in patient IA tissue specimens and have also been shown to play an important role in abdominal aortic aneurysms (AAA) and related diseases such as atherosclerosis. However, no study has systematically examined the contribution of lymphocytes in a model of IA. METHODS Lymphocyte-deficient (Rag1) and wild-type (WT; C57BL/6 strain) mice were subjected to a robust IA induction protocol. Rates of IA formation and rupture were measured, and cerebral artery tissue was collected and utilized for histology and gene expression analysis. RESULTS At 2 weeks, the Rag1 group had significantly fewer IA formations and ruptures than the WT group. Histological analysis of unruptured IA tissue showed robust B and T lymphocyte infiltration in the WT group, while there were no differences in macrophage infiltration, IA diameter, and wall thickness. Significant differences in interleukin-6 (IL-6), matrix metalloproteinases 2 (MMP2) and 9 (MMP9), and smooth muscle myosin heavy chain (MHC) were observed between the groups. CONCLUSIONS Lymphocytes are key contributors to IA pathogenesis and provide a novel target for the prevention of IA progression and rupture in patients.
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Affiliation(s)
- David M Sawyer
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Ste. 1300, 8047, New Orleans, LA, 70112, USA
| | - Lauren A Pace
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Ste. 1300, 8047, New Orleans, LA, 70112, USA
| | - Crissey L Pascale
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Ste. 1300, 8047, New Orleans, LA, 70112, USA
| | - Alexander C Kutchin
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Ste. 1300, 8047, New Orleans, LA, 70112, USA
| | - Brannan E O'Neill
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Ste. 1300, 8047, New Orleans, LA, 70112, USA
| | - Robert M Starke
- Department of Neurosurgery, University of Miami, Miami, FL, USA
| | - Aaron S Dumont
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Ste. 1300, 8047, New Orleans, LA, 70112, USA.
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Liu H, Park D, Hwang SM, Lee GY, Lim OK, Kim M, Lee DH, Park W, Koo HW, Yang K, Suh DC. Outpatient Day-care Neuroangiography and Neurointervention of Unruptured Intracranial Aneurysms. Neurointervention 2016; 11:37-41. [PMID: 26958411 PMCID: PMC4781915 DOI: 10.5469/neuroint.2016.11.1.37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 02/26/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose Day-care management of unruptured intracranial aneurysms can shorten hospital stay, reduce medical cost and improve outcome. We present the process, outcome and duration of hospital stay for the management of unruptured intracranial aneurysms via a neurointervention clinic in a single center during the past four years. Materials and Methods We analyzed 403 patients who were referred to Neurointervention Clinic at Asan Medical Center for aneurysm evaluation between January 1, 2011 and December 31, 2014. There were 141 (41%) diagnostic catheter angiographies, 202 (59%) neurointerventional procedures and 2 (0.6%) neurointerventional procedures followed by operation. We analyzed the process, outcome of angiography or neurointervention, and duration of hospital stay. Results There was no aneurysm in 58 patients who were reported as having an aneurysm in MRA or CTA (14 %). Among 345 patients with aneurysm, there were 283 patients with a single aneurysm (82%) and 62 patients with multiple aneurysms (n=62, 18%). Aneurysm coiling was performed in 202 patients (59%), surgical clipping in 14 patients (4%), coiling followed by clipping in 2 patients (0.6%) and no intervention was required in 127 patients (37%). The hospital stay for diagnostic angiography was less than 6 hours and the mean duration of hospital stay was 2.1 days for neurointervention. There were 4 procedure-related adverse events (2%) including 3 minor and 1 major ischemic strokes. Conclusion Our study revealed that day-care management of unruptured intracranial aneurysms could be performed without an additional risk. It could enable rapid patient flow, shorten hospital stay and thus reduce hospital costs.
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Affiliation(s)
- Hairi Liu
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.; Department of Interventional Radiology, Taizhou People's Hospital, Taizhou, Jiangsu Province 225300, P. R. China
| | - Danbi Park
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sun Moon Hwang
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ga Young Lee
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ok Kyun Lim
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Minjae Kim
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Deok Hee Lee
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Wonhyoung Park
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hae-Won Koo
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Kuhyun Yang
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dae Chul Suh
- Departments of Radiology and Research Institute of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea
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Louis N, Marsh R. Simultaneous and sequential hemorrhage of multiple cerebral cavernous malformations: a case report. J Med Case Rep 2016; 10:36. [PMID: 26861488 PMCID: PMC4748525 DOI: 10.1186/s13256-016-0817-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/24/2016] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The etiology of cerebral cavernous malformation hemorrhage is not well understood. Causative physiologic parameters preceding hemorrhagic cavernous malformation events are often not reported. We present a case of an individual with sequential simultaneous hemorrhages in multiple cerebral cavernous malformations with a new onset diagnosis of hypertension. CASE PRESENTATION A 42-year-old white man was admitted to our facility with worsening headache, left facial and tongue numbness, dizziness, diplopia, and elevated blood pressure. His past medical history was significant for new onset diagnosis of hypertension and chronic seasonal allergies. Serial imaging over the ensuing 8 days revealed sequential hemorrhagic lesions. He underwent suboccipital craniotomy for resection of the lesions located in the fourth ventricle and right cerebellum. One month after surgery, he had near complete resolution of his symptoms with mild residual vertigo but symptomatic chronic hypertension. CONCLUSIONS Many studies have focused on genetic and inflammatory mechanisms contributing to cerebral cavernous malformation rupture, but few have reported on the potential of hemodynamic changes contributing to cerebral cavernous malformation rupture. Systemic blood pressure changes clearly have an effect on angioma pressures. When considering the histopathological features of cerebral cavernous malformation architecture, changes in arterial pressure could cause meaningful alterations in hemorrhage propensity and patterns.
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Affiliation(s)
- Nundia Louis
- Department of Neurosurgery, Cabell Huntington Hospital, Marshall University, 1600 Medical Center Drive, Huntington, WV, 25701, USA.
| | - Robert Marsh
- Department of Neurosurgery, Cabell Huntington Hospital, Marshall University, 1600 Medical Center Drive, Huntington, WV, 25701, USA.
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Heit JJ, Gonzalez RG, Sabbag D, Brouwers HB, Ordonez Rubiano EG, Schaefer PW, Hirsch JA, Romero JM. Detection and characterization of intracranial aneurysms: a 10-year multidetector CT angiography experience in a large center. J Neurointerv Surg 2015; 8:1168-1172. [PMID: 26553878 DOI: 10.1136/neurintsurg-2015-012082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 10/26/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND CT angiography (CTA) is increasingly used for the detection, characterization, and follow-up of intracranial aneurysms. A lower threshold to request a CT angiogram may render a patient population that differs from previous studies primarily evaluated with conventional angiography. Our objective was to broaden our knowledge of the factors associated with aneurysm rupture and patient mortality in this population. METHODS All CTA studies performed over a 10-year period at a large neurovascular referral center were reviewed for the presence of an intracranial aneurysm. Patient demographics, mortality, CTA indication, aneurysm location, size, and rupture status were recorded. RESULTS 2927 patients with aneurysms were identified among 29 003 CTAs. 17% of the aneurysms were ruptured at the time of imaging, 24% of aneurysms were incidentally identified, and multiple aneurysms were identified in 34% of patients. Aneurysms most commonly arose from the supraclinoid internal carotid artery (22%), the middle cerebral artery (18%), and the anterior communicating artery (13%). Male sex, age <50 years, aneurysms >6 mm, and aneurysms arising from the anterior communicating artery, posterior communicating artery, or the posterior circulation were independent predictors of aneurysm rupture. Independent mortality predictors included male sex, posterior circulation aneurysms, intraventricular hemorrhage, and intraparenchymal hemorrhage. CONCLUSIONS These results indicate that aneurysms detected on CTA that arise from the anterior communicating artery, posterior communicating artery, or the posterior circulation, measure >6 mm in size, occur in men, and in patients aged <50 years are associated with rupture.
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Affiliation(s)
- Jeremy J Heit
- Interventional Neuroradiology Division, Department of Radiology, Stanford University Hospital, Stanford, California, USA
| | - R Gilberto Gonzalez
- Neuroradiology Division, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David Sabbag
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - H Bart Brouwers
- Departments of Neurosurgery and Radiology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Pamela W Schaefer
- Neuroradiology Division, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joshua A Hirsch
- Neurointerventional Radiology Division, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Javier M Romero
- Neuroradiology Division, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Relationship between Aging and Enlargement of Intracranial Aneurysms. J Stroke Cerebrovasc Dis 2015; 24:2049-53. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.04.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 04/14/2015] [Accepted: 04/17/2015] [Indexed: 11/21/2022] Open
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Abstract
Aneurysmal subarachnoid hemorrhage (SAH) is a worldwide health burden with high fatality and permanent disability rates. The overall prognosis depends on the volume of the initial bleed, rebleeding, and degree of delayed cerebral ischemia (DCI). Cardiac manifestations and neurogenic pulmonary edema indicate the severity of SAH. The International Subarachnoid Aneurysm Trial (ISAT) reported a favorable neurological outcome with the endovascular coiling procedure compared with surgical clipping at the end of 1 year. The ISAT trial recruits were primarily neurologically good grade patients with smaller anterior circulation aneurysms, and therefore the results cannot be reliably extrapolated to larger aneurysms, posterior circulation aneurysms, patients presenting with complex aneurysm morphology, and poor neurological grades. The role of hypothermia is not proven to be neuroprotective according to a large randomized controlled trial, Intraoperative Hypothermia for Aneurysms Surgery Trial (IHAST II), which recruited patients with good neurological grades. Patients in this trial were subjected to slow cooling and inadequate cooling time and were rewarmed rapidly. This methodology would have reduced the beneficial effects of hypothermia. Adenosine is found to be beneficial for transient induced hypotension in 2 retrospective analyses, without increasing the risk for cardiac and neurological morbidity. The neurological benefit of pharmacological neuroprotection and neuromonitoring is not proven in patients undergoing clipping of aneurysms. DCI is an important cause of morbidity and mortality following SAH, and the pathophysiology is likely multifactorial and not yet understood. At present, oral nimodipine has an established role in the management of DCI, along with maintenance of euvolemia and induced hypertension. Following SAH, hypernatremia, although less common than hyponatremia, is a predictor of poor neurological outcome.
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Affiliation(s)
- Stanlies D'Souza
- Department of Neuroanesthesiology, Baystate Medical Center, Tufts University School of Medicine, Springfield, MA
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Xiang J, Damiano RJ, Lin N, Snyder KV, Siddiqui AH, Levy EI, Meng H. High-fidelity virtual stenting: modeling of flow diverter deployment for hemodynamic characterization of complex intracranial aneurysms. J Neurosurg 2015; 123:832-40. [PMID: 26090829 DOI: 10.3171/2014.11.jns14497] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Flow diversion via Pipeline Embolization Device (PED) represents the most recent advancement in endovascular therapy of intracranial aneurysms. This exploratory study aims at a proof of concept for an advanced device-modeling tool in conjunction with computational fluid dynamics (CFD) to evaluate flow modification effects by PED in actual, treated cases. METHODS The authors performed computational modeling of 3 PED-treated complex aneurysm cases. The patient in Case 1 had a fusiform vertebral aneurysm treated with a single PED. In Case 2 the patient had a giant internal carotid artery (ICA) aneurysm treated with 2 PEDs. Case 3 consisted of tandem ICA aneurysms (III-a and III-b) treated by a single PED. The authors' recently developed high-fidelity virtual stenting (HiFiVS) technique was used to recapitulate the clinical deployment process of PEDs in silico for these 3 cases. Pretreatment and posttreatment aneurysmal hemodynamics studies performed using CFD simulation were analyzed. Changes in aneurysmal flow velocity, inflow rate, wall shear stress (WSS), and turnover time were calculated and compared with the clinical outcome. RESULTS In Case 1 (occluded within the first 3 months), the aneurysm had the most drastic flow reduction after PED placement; the aneurysmal average velocity, inflow rate, and average WSS were decreased by 76.3%, 82.5%, and 74.0%, respectively, whereas the turnover time was increased to 572.1% of its pretreatment value. In Case 2 (occluded at 6 months), aneurysmal average velocity, inflow rate, and average WSS were decreased by 39.4%, 38.6%, and 59.1%, respectively, and turnover time increased to 163.0%. In Case 3, Aneurysm III-a (occluded at 6 months) had a decrease by 38.0%, 28.4%, and 50.9% in average velocity, inflow rate, and average WSS, respectively, and turnover time increased to 139.6%, which was quite similar to Aneurysm II. Surprisingly, the adjacent Aneurysm III-b had more substantial flow reduction (a decrease by 77.7%, 53.0%, and 84.4% in average velocity, inflow rate, and average WSS, respectively, and an increase to 213.0% in turnover time) than Aneurysm III-a, which qualitatively agreed with angiographic observation at 3-month follow-up. However, Aneurysm III-b remained patent at both 6 months and 9 months. A closer examination of the vascular anatomy in Case 3 revealed blood draining to the ophthalmic artery off Aneurysm III-b, which may have prevented its complete thrombosis. CONCLUSIONS This proof-of-concept study demonstrates that HiFiVS modeling of flow diverter deployment enables detailed characterization of hemodynamic alteration by PED placement. Posttreatment aneurysmal flow reduction may be correlated with aneurysm occlusion outcome. However, predicting aneurysm treatment outcome by flow diverters also requires consideration of other factors, including vascular anatomy.
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Affiliation(s)
- Jianping Xiang
- Toshiba Stroke and Vascular Research Center.,Department of Neurosurgery.,Department of Mechanical and Aerospace Engineering
| | - Robert J Damiano
- Toshiba Stroke and Vascular Research Center.,Department of Mechanical and Aerospace Engineering
| | - Ning Lin
- Department of Neurosurgery.,Department of Neurosurgery, Weill Cornell Medical Center and NewYork-Presbyterian Hospital, New York, New York
| | - Kenneth V Snyder
- Toshiba Stroke and Vascular Research Center.,Department of Neurosurgery.,Department of Radiology, University at Buffalo, The State University of New York, Buffalo; and
| | - Adnan H Siddiqui
- Toshiba Stroke and Vascular Research Center.,Department of Neurosurgery.,Department of Radiology, University at Buffalo, The State University of New York, Buffalo; and
| | - Elad I Levy
- Toshiba Stroke and Vascular Research Center.,Department of Neurosurgery.,Department of Radiology, University at Buffalo, The State University of New York, Buffalo; and
| | - Hui Meng
- Toshiba Stroke and Vascular Research Center.,Department of Neurosurgery.,Department of Mechanical and Aerospace Engineering.,Department of Biomedical Engineering, and
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Cho Y, Ahn J, Jung S, Kim C, Cho W, Kang HS, Kim J, Han M. Single-Stage Coil Embolization of Multiple Intracranial Aneurysms: Technical Feasibility and Clinical Outcomes. Clin Neuroradiol 2014; 26:285-90. [DOI: 10.1007/s00062-014-0367-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 12/07/2014] [Indexed: 10/24/2022]
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Brucki SMD. Approach to the anterior circulation aneurysms: does perfect head position matter? ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 72:824-5. [PMID: 25410446 DOI: 10.1590/0004-282x20140196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 09/29/2014] [Indexed: 11/22/2022]
Affiliation(s)
- Sonia M D Brucki
- Departamento de Neurologia, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, SP, Brazil
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Ars E, Bernis C, Fraga G, Martínez V, Martins J, Ortiz A, Rodríguez-Pérez JC, Sans L, Torra R. Spanish guidelines for the management of autosomal dominant polycystic kidney disease. Nephrol Dial Transplant 2014; 29 Suppl 4:iv95-105. [PMID: 25165191 DOI: 10.1093/ndt/gfu186] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent cause of genetic renal disease and accounts for 6-10% of patients on renal replacement therapy (RRT). Very few prospective, randomized trials or clinical studies address the diagnosis and management of this relatively frequent disorder. No clinical guidelines are available to date. This is a consensus statement presenting the recommendations of the Spanish Working Group on Inherited Kidney Diseases, which were agreed to following a literature search and discussions. Levels of evidence found were C and D according to the Centre for Evidence-Based Medicine (University of Oxford). The recommendations relate to, among other topics, the use of imaging and genetic diagnosis, management of hypertension, pain, cyst infections and bleeding, extra-renal involvement including polycystic liver disease and cranial aneurysms, management of chronic kidney disease (CKD) and RRT and management of children with ADPKD. Recommendations on specific ADPKD therapies are not provided since no drug has regulatory approval for this indication.
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Affiliation(s)
- Elisabet Ars
- Molecular Biology Laboratory, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Spain
| | - Carmen Bernis
- Nephrology Department, Hospital de la Princesa, REDinREN, Madrid, Spain
| | - Gloria Fraga
- Paediatric Nephrology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Judith Martins
- Nephrology Department, Hospital Universitario de Getafe, Universidad Europea de Madrid, Madrid, Spain
| | - Alberto Ortiz
- Nephrology Department, IIS-Fundacion Jiménez Diaz, Universidad Autónoma de Madrid, IRSIN, REDinREN, Madrid, Spain
| | - José Carlos Rodríguez-Pérez
- Nephrology Department, Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Laia Sans
- Nephrology Department, REDinREN, Hospital del Mar, Barcelona, Spain
| | - Roser Torra
- Inherited Kidney Diseases, Nephrology Department, Fundació Puigvert, Instituto de Investigaciones Biomédicas Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona, REDinREN, Instituto de Investigación Carlos III, Barcelona, Spain
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Cavernous carotid artery aneurysms: epidemiology, natural history, diagnostic and treatment. An experience of a single institution. Clin Neurol Neurosurg 2014; 125:32-5. [PMID: 25083803 DOI: 10.1016/j.clineuro.2014.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 06/12/2014] [Accepted: 07/13/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cavernous carotid aneurysms (CCA) account for 2-9% of all intracranial aneurysms. They have been considered benign lesions, most often asymptomatic, and to have a natural history with a low risk of life-threatening complications. These aneurysms are unique, their rupture can present in many different forms, they can suffer spontaneous thrombotic changes and the symptomatology related to the mass effect involves the neuro-ophthalmologic system. In this scenario the natural history and clinical presentation are largely different from other intracranial aneurysms. Some investigators advocate treatment of both symptomatic and asymptomatic CCAs, others recommend no treatment. The reason for this controversy relates to a lack of information on the long term natural history of these aneurysms, as well as on the long term results of treatment. METHODS In this article the authors discuss their single institution experience in diagnosis, natural history and management of 123 asymptomatic and oligosympotomatic aneurysms located in the cavernous portion of internal carotid artery. CONCLUSIONS According to our results asymptomatic or olygosymptomatic (pain) CCAs should be conservatively managed with serial images while the others presentations should be analyzed by a multidisciplinary team, involving the neuroendovascular and microsurgical services.
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Kanaan N, Devuyst O, Pirson Y. Renal transplantation in autosomal dominant polycystic kidney disease. Nat Rev Nephrol 2014; 10:455-65. [PMID: 24935705 DOI: 10.1038/nrneph.2014.104] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In patients with autosomal dominant polycystic kidney disease (ADPKD) evaluated for kidney transplantation, issues related to native nephrectomy, cystic liver involvement, screening for intracranial aneurysms and living-related kidney donation deserve special consideration. Prophylactic native nephrectomy is restricted to patients with a history of cyst infection or recurrent haemorrhage or to those in whom space must be made to implant the graft. Patients with liver involvement require pretransplant imaging. Selection of patients for pretransplant screening of intracranial aneurysms should follow the general recommendations for patients with ADPKD. In living related-donor candidates aged <30 years and at-risk of ADPKD, molecular genetic testing should be carried out when ultrasonography and MRI findings are normal or equivocal. After kidney transplantation, patient and graft survival rates are excellent and the volume of native kidneys decreases. However, liver cysts continue to grow and treatment with a somatostatin analogue should be considered in patients with massive cyst involvement. Cerebrovascular events have a marginal effect on post-transplant morbidity and mortality. An increased risk of new-onset diabetes mellitus and nonmelanoma skin cancers has been reported, but several studies have challenged these findings. Finally, no data currently support the preferential use of mammalian target of rapamycin inhibitors as immunosuppressive agents in transplant recipients with ADPKD.
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Affiliation(s)
- Nada Kanaan
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 Avenue Hippocrate, B-1200 Brussels, Belgium
| | - Olivier Devuyst
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 Avenue Hippocrate, B-1200 Brussels, Belgium
| | - Yves Pirson
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 Avenue Hippocrate, B-1200 Brussels, Belgium
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Štepán-Buksakowska IL, Accurso JM, Diehn FE, Huston J, Kaufmann TJ, Luetmer PH, Wood CP, Yang X, Blezek DJ, Carter R, Hagen C, Hořínek D, Hejčl A, Roček M, Erickson BJ. Computer-aided diagnosis improves detection of small intracranial aneurysms on MRA in a clinical setting. AJNR Am J Neuroradiol 2014; 35:1897-902. [PMID: 24924543 DOI: 10.3174/ajnr.a3996] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE MRA is widely accepted as a noninvasive diagnostic tool for the detection of intracranial aneurysms, but detection is still a challenging task with rather low detection rates. Our aim was to examine the performance of a computer-aided diagnosis algorithm for detecting intracranial aneurysms on MRA in a clinical setting. MATERIALS AND METHODS Aneurysm detectability was evaluated retrospectively in 48 subjects with and without computer-aided diagnosis by 6 readers using a clinical 3D viewing system. Aneurysms ranged from 1.1 to 6.0 mm (mean = 3.12 mm, median = 2.50 mm). We conducted a multireader, multicase, double-crossover design, free-response, observer-performance study on sets of images from different MRA scanners by using DSA as the reference standard. Jackknife alternative free-response operating characteristic curve analysis with the figure of merit was used. RESULTS For all readers combined, the mean figure of merit improved from 0.655 to 0.759, indicating a change in the figure of merit attributable to computer-aided diagnosis of 0.10 (95% CI, 0.03-0.18), which was statistically significant (F(1,47) = 7.00, P = .011). Five of the 6 radiologists had improved performance with computer-aided diagnosis, primarily due to increased sensitivity. CONCLUSIONS In conditions similar to clinical practice, using computer-aided diagnosis significantly improved radiologists' detection of intracranial DSA-confirmed aneurysms of ≤6 mm.
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Affiliation(s)
- I L Štepán-Buksakowska
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.) International Clinical Research Center (I.L.Š.-B., D.H., A.H.), St. Anne's University Hospital Brno, Brno, Czech Republic Department of Radiology (I.L.Š.-B., M.R.), Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - J M Accurso
- Department of Radiology (J.M.A.), Mayo Clinic, Jacksonville, Florida
| | - F E Diehn
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.)
| | - J Huston
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.)
| | - T J Kaufmann
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.)
| | - P H Luetmer
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.)
| | - C P Wood
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.)
| | - X Yang
- Department of Information Services (X.Y., D.J.B.), Mayo Clinic, Rochester, Minnesota
| | - D J Blezek
- Department of Information Services (X.Y., D.J.B.), Mayo Clinic, Rochester, Minnesota
| | - R Carter
- Division of Biomedical Statistics and Informatics (R.C., C.H.)
| | - C Hagen
- Division of Biomedical Statistics and Informatics (R.C., C.H.)
| | - D Hořínek
- International Clinical Research Center (I.L.Š.-B., D.H., A.H.), St. Anne's University Hospital Brno, Brno, Czech Republic Department of Neurosurgery (D.H., A.H.), Masaryk Hospital, Ústí nad Labem, Czech Republic Department of Neurosurgery (D.H.), Central Military Hospital, Prague, Czech Republic
| | - A Hejčl
- International Clinical Research Center (I.L.Š.-B., D.H., A.H.), St. Anne's University Hospital Brno, Brno, Czech Republic Department of Neurosurgery (D.H., A.H.), Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - M Roček
- Department of Radiology (I.L.Š.-B., M.R.), Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - B J Erickson
- From the Department of Radiology (I.L.Š.-B., F.E.D., J.H., T.J.K., P.H.L., C.P.W., B.J.E.)
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35
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Factors affecting formation and rupture of intracranial saccular aneurysms. Neurosurg Rev 2013; 37:1-14. [PMID: 24306170 DOI: 10.1007/s10143-013-0501-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 01/31/2013] [Accepted: 08/11/2013] [Indexed: 01/19/2023]
Abstract
Unruptured intracranial aneurysms represent a decisional challenge. Treatment risks have to be balanced against an unknown probability of rupture. A better understanding of the physiopathology is the basis for a better prediction of the natural history of an individual patient. Knowledge about the possible determining factors arises from a careful comparison between ruptured versus unruptured aneurysms and from the prospective observation and analysis of unbiased series with untreated, unruptured aneurysms. The key point is the correct identification of the determining variables for the fate of a specific aneurysm in a given individual. Thus, the increased knowledge of mechanisms of formation and eventual rupture of aneurysms should provide significant clues to the identification of rupture-prone aneurysms. Factors like structural vessel wall defects, local hemodynamic stress determined also by peculiar geometric configurations, and inflammation as trigger of a wall remodeling are crucial. In this sense the study of genetic modifiers of inflammatory responses together with the computational study of the vessel tree might contribute to identify aneurysms prone to rupture. The aim of this article is to underline the value of a unifying hypothesis that merges the role of geometry, with that of hemodynamics and of genetics as concerns vessel wall structure and inflammatory pathways.
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The impact of insurance status on the outcomes after aneurysmal subarachnoid hemorrhage. PLoS One 2013; 8:e78047. [PMID: 24205085 PMCID: PMC3812119 DOI: 10.1371/journal.pone.0078047] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/08/2013] [Indexed: 11/19/2022] Open
Abstract
Investigation into the association of insurance status with the outcomes of patients undergoing neurosurgical intervention has been limited: this is the first nationwide study to analyze the impact of primary payer on the outcomes of patients with aneurysmal subarachnoid hemorrhage who underwent endovascular coiling or microsurgical clipping. The Nationwide Inpatient Sample (2001–2010) was utilized to identify patients; those with both an ICD-9 diagnosis codes for subarachnoid hemorrhage and a procedure code for aneurysm repair (either via an endovascular or surgical approach) were included. Hierarchical multivariate regression analyses were utilized to evaluate the impact of primary payer on in-hospital mortality, hospital discharge disposition, and length of hospital stay with hospital as the random effects variable. Models were adjusted for patient age, sex, race, comorbidities, socioeconomic status, hospital region, location (urban versus rural), and teaching status, procedural volume, year of admission, and the proportion of patients who underwent ventriculostomy. Subsequent models were also adjusted for time to aneurysm repair and time to ventriculostomy; subgroup analyses evaluated for those who underwent endovascular and surgical procedures separately. 15,557 hospitalizations were included. In the initial model, the adjusted odds of in-hospital mortality were higher for Medicare (OR 1.23, p<0.001), Medicaid (OR 1.23, p<0.001), and uninsured patients (OR 1.49, p<0.001) compared to those with private insurance. After also adjusting for timing of intervention, Medicaid and uninsured patients had a reduced odds of non-routine discharge (OR 0.75, p<0.001 and OR 0.42, p<0.001) despite longer hospital stays (by 8.35 days, p<0.001 and 2.45 days, p = 0.005). Variations in outcomes by primary payer–including in-hospital post-procedural mortality–were more pronounced for patients of all insurance types who underwent microsurgical clipping. The observed differences by primary payer are likely multifactorial, attributable to varied socioeconomic factors and the complexities of the American healthcare delivery system.
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Vascular smooth muscle cells in cerebral aneurysm pathogenesis. Transl Stroke Res 2013; 5:338-46. [PMID: 24323713 DOI: 10.1007/s12975-013-0290-1] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/25/2013] [Indexed: 10/26/2022]
Abstract
Vascular smooth muscle cells (SMC) maintain significant plasticity. Following environmental stimulation, SMC can alter their phenotype from one primarily concerned with contraction to a pro-inflammatory and matrix remodeling phenotype. This is a critical process behind peripheral vascular disease and atherosclerosis, a key element of cerebral aneurysm pathology. Evolving evidence demonstrates that SMCs and phenotypic modulation play a significant role in cerebral aneurysm formation and rupture. Pharmacological alteration of smooth muscle cell function and phenotypic modulation could provide a promising medical therapy to inhibit cerebral aneurysm progression. This study reviews vascular SMC function and its contribution to cerebral aneurysm pathophysiology.
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Tumor necrosis factor-α modulates cerebral aneurysm formation and rupture. Transl Stroke Res 2013; 5:269-77. [PMID: 24323710 DOI: 10.1007/s12975-013-0287-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 09/03/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
Abstract
Inflammation is a critical process behind cerebral aneurysm formation and rupture. Tumor necrosis factor alpha (TNF-α) is a key immune modulator that has been implicated in cerebral aneurysm pathophysiology. This may occur through TNF-α-mediated endothelial injury, smooth muscle cell phenotypic modulation, recruitment of macrophages, activation of chemotactic cytokines, upregulation of matrix remodeling genes, production of free radicals leading to oxidative stress, and ultimately cellular apoptosis. Recent studies have indicated that TNF-α may be a potential target for the development of novel medical therapies, but additional experimental data is needed to clarify the intricacies of TNF-α activation and its critical downstream targets in cerebral aneurysms. This review provides an update on the mechanisms underlying TNF-α-induced molecular modulation in cerebral aneurysms.
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Starke RM, Chalouhi N, Ali MS, Jabbour PM, Tjoumakaris SI, Gonzalez LF, Rosenwasser RH, Koch WJ, Dumont AS. The role of oxidative stress in cerebral aneurysm formation and rupture. Curr Neurovasc Res 2013; 10:247-55. [PMID: 23713738 PMCID: PMC3845363 DOI: 10.2174/15672026113109990003] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/17/2013] [Accepted: 05/08/2013] [Indexed: 02/07/2023]
Abstract
Oxidative stress is known to contribute to the progression of cerebrovascular disease. Additionally, oxidative stress may be increased by, but also augment inflammation, a key contributor to cerebral aneurysm development and rupture. Oxidative stress can induce important processes leading to cerebral aneurysm formation including direct endothelial injury as well as smooth muscle cell phenotypic switching to an inflammatory phenotype and ultimately apoptosis. Oxidative stress leads to recruitment and invasion of inflammatory cells through upregulation of chemotactic cytokines and adhesion molecules. Matrix metalloproteinases can be activated by free radicals leading to vessel wall remodeling and breakdown. Free radicals mediate lipid peroxidation leading to atherosclerosis and contribute to hemodynamic stress and hypertensive pathology, all integral elements of cerebral aneurysm development. Preliminary studies suggest that therapies targeted at oxidative stress may provide a future beneficial treatment for cerebral aneurysms, but further studies are indicated to define the role of free radicals in cerebral aneurysm formation and rupture. The goal of this review is to assess the role of oxidative stress in cerebral aneurysm pathogenesis.
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Affiliation(s)
- Robert M. Starke
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
| | - Nohra Chalouhi
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Muhammad S. Ali
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Pascal M. Jabbour
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Stavropoula I. Tjoumakaris
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - L. Fernando Gonzalez
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Robert H. Rosenwasser
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Walter J. Koch
- Center for Translational Medicine and Department of Pharmacology, Temple University, Philadelphia, Pennsylvania USA
| | - Aaron S. Dumont
- Joseph and Marie Field Cerebrovascular Research Laboratory, Division of Neurovascular & Endovascular Surgery, Department of Neurological Surgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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40
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Gao LY, Guo X, Zhou JJ, Zhang Q, Fu J, Chen WJ, Yang YJ. Basilar artery fenestration detected with CT angiography. Eur Radiol 2013; 23:2861-7. [PMID: 23700115 DOI: 10.1007/s00330-013-2890-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/31/2013] [Accepted: 04/03/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To analyse the characteristics of basilar artery (BA) fenestrations and their coexistence with aneurysms and other anomalies in a massive cases by computed tomographic angiography (CTA). METHODS A total of 5,657 sequential cerebral CTA images performed from January 2006 to February 2012 were reviewed. CTA images were obtained from the raw datasets by using volume rendering and maximal intensity projection reconstruction. RESULTS One hundred and thirty-two (2.33 %) BA fenestrations were detected with CTA, and most common at the proximal segment (n = 124). BA fenestration-associated aneurysms were found in 34 cases and 7 located at the posterior circulation, and the frequency of posterior circulation aneurysms was significantly different in patients with and without BA fenestrations (P = 0.025). Other associated anomalies included arteriovenous malformation (n = 7) and moyamoya disease (n = 6). BA fenestrations were classified into Type I (74 cases), Type II (15 cases), Type III (41 cases) and Type IV (2 cases). A significant difference was observed between Types II + III associated with convex-lens-like and slit-like fenestrations (P = 0.008). CONCLUSIONS BA fenestrations were found in 2.33 % with CTA. They were significantly more often associated with posterior circulation aneurysms than those without BA fenestration. The anterior inferior cerebral artery (AICA) tends to originate more often from convex-lens-like fenestration than slit-like. KEY POINTS • Basilar artery fenestrations were found in 2.33 % of patients undergoing CT angiography. • Fenestrations were seen more often in the lower third with slit-like configurations. • No obvious relationship exists between basilar artery fenestration and aneurysm formation. • Basilar artery fenestrations perhaps predispose a patient to posterior circulation aneurysm formation. • The AICA tends to originate more often from convex-lens-like than slit-like fenestrations.
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Affiliation(s)
- Ling-Yun Gao
- Department of Radiology, First Affiliated Hospital, Wenzhou Medical College, Wenzhou, 325000, China
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Simulation of intra-aneurysmal blood flow by different numerical methods. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:527654. [PMID: 23662158 PMCID: PMC3639637 DOI: 10.1155/2013/527654] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/13/2013] [Accepted: 03/17/2013] [Indexed: 11/17/2022]
Abstract
The occlusional performance of sole endoluminal stenting of intracranial aneurysms is controversially discussed in the literature. Simulation of blood flow has been studied to shed light on possible causal attributions. The outcome, however, largely depends on the numerical method and various free parameters. The present study is therefore conducted to find ways to define parameters and efficiently explore the huge parameter space with finite element methods (FEMs) and lattice Boltzmann methods (LBMs). The goal is to identify both the impact of different parameters on the results of computational fluid dynamics (CFD) and their advantages and disadvantages. CFD is applied to assess flow and aneurysmal vorticity in 2D and 3D models. To assess and compare initial simulation results, simplified 2D and 3D models based on key features of real geometries and medical expert knowledge were used. A result obtained from this analysis indicates that a combined use of the different numerical methods, LBM for fast exploration and FEM for a more in-depth look, may result in a better understanding of blood flow and may also lead to more accurate information about factors that influence conditions for stenting of intracranial aneurysms.
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Cook SC, Hickey J, Maul TM, Zumberge N, Krieger EV, Valente AM, Zaidi AN, Daniels CJ. Assessment of the Cerebral Circulation in Adults with Coarctation of the Aorta. CONGENIT HEART DIS 2012; 8:289-95. [DOI: 10.1111/chd.12024] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/26/2022]
Affiliation(s)
- Stephen C. Cook
- The Adult Congenital Heart Disease Center; Children's Hospital of Pittsburgh of UPMC; Pittsburgh; Pa; USA
| | - Jenne Hickey
- Department of Cardiology; The Columbus Ohio Adult Congenital Heart Program (COACH); Columbus; Ohio; USA
| | - Timothy M. Maul
- Department of Cardiothoracic Surgery; University of Pittsburgh; Pittsburgh; Pa; USA
| | - Nicholas Zumberge
- Diagnostic Radiology; Nationwide Children's Hospital; Columbus; Ohio; USA
| | - Eric V. Krieger
- Department of Cardiology; Boston Adult Congenital Heart Program; Boston; Mass; USA
| | - Anne Marie Valente
- Department of Cardiology; Boston Adult Congenital Heart Program; Boston; Mass; USA
| | - Ali N. Zaidi
- Department of Cardiology; The Columbus Ohio Adult Congenital Heart Program (COACH); Columbus; Ohio; USA
| | - Curt J. Daniels
- Department of Cardiology; The Columbus Ohio Adult Congenital Heart Program (COACH); Columbus; Ohio; USA
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Radke R, Baumgartner H. Should coarctation patients routinely be screened for intracranial aneurysms? PROGRESS IN PEDIATRIC CARDIOLOGY 2012. [DOI: 10.1016/j.ppedcard.2012.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Intracerebral hemorrhage (ICH) remains a life-threatening disease that carries significant morbidity and mortality despite recent diagnostic and management advances. Various conditions are associated with increased risk of intracerebral hemorrhage. Understanding the etiology of these conditions and their pathophysiological contribution to ICH will likely lead to better therapeutic and preventative measures and improve the morbidity and mortality associated with intracerebral hemorrhage. We will review the current literature regarding important etiologies/risk factors of intracerebral hemorrhage.
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Byard RW. Giant basilar artery aneurysm and unexpected death. Forensic Sci Med Pathol 2012; 9:277-9. [PMID: 22983889 DOI: 10.1007/s12024-012-9381-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Roger W Byard
- Discipline of Anatomy and Pathology, School of Health Sciences, The University of Adelaide, Level 3 Medical School North Building, Frome Road, Adelaide, 5005, Australia.
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Vulev I, Klepanec A, Bazik R, Balazs T, Illes R, Steno J. Endovascular treatment of internal carotid and vertebral artery aneurysms using a novel pericardium covered stent. Interv Neuroradiol 2012; 18:164-71. [PMID: 22681731 DOI: 10.1177/159101991201800207] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 01/22/2012] [Indexed: 10/20/2022] Open
Abstract
Intracranial aneurysm is a fairly common (often asymptomatic) condition. Subarachnoid hemorrhage associated with aneurysmal rupture is a potentially lethal event with a mortality rate as high as 50 percent and a high rate of disability among those who survive the initial hemorrhage, such that recently published guidelines support treatment of intracerebral aneurysms. The current treatment options include surgical clipping and endovascular treatment, but these are not without significant problems. Despite the trend toward endovascular treatment the rate of recurrence and complications is high. Current published evidence of the use of covered stent is limited to stents covered with polytetrafluoroethylene. It is now recognized that mammalian extracellular matrix represents an excellent scaffold material suitable for many therapeutic applications and glutaraldehyde treated pericardium has been widely used for many years due to its desirable features such as low immunogenicity and durability. This report describes the first published experience with the Aneugraft Pericardium Covered Stent (ITGI Medical, OR Akiva, Israel) in the treatment of internal carotid and vertebral artery aneurysms in three patients. In all three cases, the implantation of this novel device has resulted in successful closure of aneurysms.
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Affiliation(s)
- I Vulev
- Department of Diagnostic and Interventional Radiology, National Institute of Cardiovascular Diseases, Bratislava, Slovakia.
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Macdonald RL. Editorial: on the persisting difficulty of making predictions, especially about the future. J Neurosurg 2012; 116:866-9; discussion 869-70. [PMID: 22242673 DOI: 10.3171/2011.9.jns111393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chalouhi N, Dumont AS, Randazzo C, Tjoumakaris S, Gonzalez LF, Rosenwasser R, Jabbour P. Management of incidentally discovered intracranial vascular abnormalities. Neurosurg Focus 2011; 31:E1. [DOI: 10.3171/2011.9.focus11200] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
With the widespread use of brain imaging studies, neurosurgeons have seen a marked increase in the number of incidental intracranial lesions, including vascular abnormalities. Specifically, the detection of incidentally discovered aneurysms, arteriovenous malformations, cavernous angiomas, developmental venous anomalies, and capillary telangiectasias has increased. The best management strategy for most of these lesions is controversial. Treatment options include observation, open surgery, endovascular procedures, and radiosurgery. Multiple factors should be taken into account when discussing treatment indications, including the natural history of the disease and the risk of the treatment. In this article, the authors focus on the natural history of these lesions and the risk of the treatment, and they give recommendations regarding the most appropriate management strategy based on the current evidence in the literature and their experience with intracranial vascular abnormalities.
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Zhang Y, Mu S, Chen J, Wang S, Li H, Yu H, Jiang F, Yang X. Hemodynamic analysis of intracranial aneurysms with daughter blebs. Eur Neurol 2011; 66:359-67. [PMID: 22134355 DOI: 10.1159/000332814] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 09/05/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Intracranial aneurysms with daughter blebs appear to have a higher risk of rupture. Whether hemodynamic factors are involved in this phenomenon is not clear. METHODS 54 patient-specific aneurysms harboring 69 daughter blebs were divided into ruptured and unruptured groups based on their clinical history. Realistic models were retrospectively constructed and analyzed by a computational fluid dynamic method. RESULTS There were no differences in the aspect ratio and morphology type of the aneurysms, the size of blebs or other common risk factors between the two groups. The wall shear stress (WSS) was significantly lower while the oscillatory shear index (OSI) was higher in the daughter blebs than in the primary aneurysms. Bleb-bearing aneurysms with a rupture history displayed significantly lower WSS in the daughter bleb. Of the daughter blebs, 73.9% were localized to the impingement region of the inflow jet. CONCLUSION These observations indicate that low WSS and high OSI in the daughter blebs might be involved in increasing the risk of rupture. The localized striking force caused by inflow jets may contribute to the development of daughter blebs. However, a precise role of hemodynamics in predicting the future rupture of daughter blebs needs further study.
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Affiliation(s)
- Ying Zhang
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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