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Frösen J, Räisänen S, Lindgren A. Reply to the letter by Yin et al. 'Reevaluating the impact of antihypertensive medication on intracranial aneurysm formation: a call for clarification and further study'. Eur J Neurol 2024; 31:e16272. [PMID: 38445774 DOI: 10.1111/ene.16272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Juhana Frösen
- Department of Neurosurgery, Tampere University and University Hospital, Tampere, Finland
- Hemorrhagic Brain Pathology Research Group, Neurocenter, Kuopio University Hospital, Kuopio, Finland
| | - Sari Räisänen
- Hemorrhagic Brain Pathology Research Group, Neurocenter, Kuopio University Hospital, Kuopio, Finland
| | - Antti Lindgren
- Hemorrhagic Brain Pathology Research Group, Neurocenter, Kuopio University Hospital, Kuopio, Finland
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
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2
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Samaniego EA, Dabus G, Meyers PM, Kan PT, Frösen J, Lanzino G, Welch BG, Volovici V, Gonzalez F, Fifi J, Charbel FT, Hoh BL, Khalessi A, Marks MP, Berenstein A, Pereira VM, Bain M, Colby GP, Narayanan S, Tateshima S, Siddiqui AH, Wakhloo AK, Arthur AS, Lawton MT. Most Promising Approaches to Improve Brain AVM Management: ARISE I Consensus Recommendations. Stroke 2024; 55:1449-1463. [PMID: 38648282 DOI: 10.1161/strokeaha.124.046725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/01/2024] [Indexed: 04/25/2024]
Abstract
Brain arteriovenous malformations (bAVMs) are complex, and rare arteriovenous shunts that present with a wide range of signs and symptoms, with intracerebral hemorrhage being the most severe. Despite prior societal position statements, there is no consensus on the management of these lesions. ARISE (Aneurysm/bAVM/cSDH Roundtable Discussion With Industry and Stroke Experts) was convened to discuss evidence-based approaches and enhance our understanding of these complex lesions. ARISE identified the need to develop scales to predict the risk of rupture of bAVMs, and the use of common data elements to perform prospective registries and clinical studies. Additionally, the group underscored the need for comprehensive patient management with specialized centers with expertise in cranial and spinal microsurgery, neurological endovascular surgery, and stereotactic radiosurgery. The collection of prospective multicenter data and gross specimens was deemed essential for improving bAVM characterization, genetic evaluation, and phenotyping. Finally, bAVMs should be managed within a multidisciplinary framework, with clinical studies and research conducted collaboratively across multiple centers, harnessing the collective expertise and centralization of resources.
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Affiliation(s)
- Edgar A Samaniego
- Department of Neurology, Neurosurgery and Radiology, University of Iowa (E.A.S.)
| | - Guilherme Dabus
- Department of Neurosurgery, Baptist Health, Miami, FL (G.D.)
| | - Philip M Meyers
- Department of Radiology and Neurological Surgery, Columbia University, New York (P.M.M.)
| | - Peter T Kan
- Department of Neurological Surgery, University of Texas Medical Branch Galveston (P.T.K.)
| | - Juhana Frösen
- Department of Rehabilitation, Tampere University Hospital, Finland (J.F.)
| | | | - Babu G Welch
- Departments of Neurological Surgery and Radiology; The University of Texas Southwestern, Dallas (B.G.W.)
| | - Victor Volovici
- Department of Neurosurgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands (V.V.)
| | - Fernando Gonzalez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD (F.G.)
| | - Johana Fifi
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York (J.F., A.B.)
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago (F.T.C.)
| | - Brian L Hoh
- Department of Neurosurgery, College of Medicine, University of Florida, Gainesville (B.L.H.)
| | | | - Michael P Marks
- Interventional Neuroradiology Division, Stanford University Medical Center, Palo Alto, CA (M.P.M.)
| | - Alejandro Berenstein
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York (J.F., A.B.)
| | - Victor M Pereira
- Department of Neurosurgery, St. Michael's Hospital, Toronto, Canada (V.M.P.)
| | - Mark Bain
- Department of Neurological Surgery, Cleveland Clinic, OH (M.B.)
| | - Geoffrey P Colby
- Department of Neurosurgery, University of California Los Angeles (G.P.C.)
| | - Sandra Narayanan
- Neurointerventional Program and Comprehensive Stroke Program, Pacific Neuroscience Institute, Santa Monica, CA (S.N.)
| | - Satoshi Tateshima
- Division of Interventional Neuroradiology, Ronald Reagan UCLA Medical Center, Los Angeles (S.T.)
| | - Adnan H Siddiqui
- Department of Neurosurgery, Gates Vascular Institute, Buffalo, New York (A.H.S.)
| | - Ajay K Wakhloo
- Department of Radiology, Tufts University School of Medicine, Boston, MA (A.K.W.)
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Science Center, Memphis (A.S.A.)
| | - Michael T Lawton
- Neurosurgery, Barrow Neurological Institute, Phoenix, AZ (M.T.L.)
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Glavan M, Jelic A, Levard D, Frösen J, Keränen S, Franx BAA, Bras AR, Louet ER, Dénes Á, Merlini M, Vivien D, Rubio M. CNS-associated macrophages contribute to intracerebral aneurysm pathophysiology. Acta Neuropathol Commun 2024; 12:43. [PMID: 38500201 PMCID: PMC10946177 DOI: 10.1186/s40478-024-01756-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 03/06/2024] [Indexed: 03/20/2024] Open
Abstract
Intracerebral aneurysms (IAs) are pathological dilatations of cerebral arteries whose rupture leads to subarachnoid hemorrhage, a significant cause of disability and death. Inflammation is recognized as a critical contributor to the formation, growth, and rupture of IAs; however, its precise actors have not yet been fully elucidated. Here, we report CNS-associated macrophages (CAMs), also known as border-associated macrophages, as one of the key players in IA pathogenesis, acting as critical mediators of inflammatory processes related to IA ruptures. Using a new mouse model of middle cerebral artery (MCA) aneurysms we show that CAMs accumulate in the IA walls. This finding was confirmed in a human MCA aneurysm obtained after surgical clipping, together with other pathological characteristics found in the experimental model including morphological changes and inflammatory cell infiltration. In addition, in vivo longitudinal molecular MRI studies revealed vascular inflammation strongly associated with the aneurysm area, i.e., high expression of VCAM-1 and P-selectin adhesion molecules, which precedes and predicts the bleeding extent in the case of IA rupture. Specific CAM depletion by intracerebroventricular injection of clodronate liposomes prior to IA induction reduced IA formation and rupture rate. Moreover, the absence of CAMs ameliorated the outcome severity of IA ruptures resulting in smaller hemorrhages, accompanied by reduced neutrophil infiltration. Our data shed light on the unexplored role of CAMs as main actors orchestrating the progression of IAs towards a rupture-prone state.
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Affiliation(s)
- Martina Glavan
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France
- Department of Neuroscience, Yale School of Medicine, Yale University, 333 Cedar Street, New Haven, CT, 06510, USA
| | - Ana Jelic
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France
| | - Damien Levard
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital and AIV Institute for Molecular Medicine, University of Eastern Finland, Kuopio, Finland
- Dept of Neurosurgery, Tampere University Hospital and Hemorrhagic Brain Pathology Research Group, Tampere University, Tampere, Finland
| | - Sara Keränen
- Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital and AIV Institute for Molecular Medicine, University of Eastern Finland, Kuopio, Finland
- Dept of Neurosurgery, Tampere University Hospital and Hemorrhagic Brain Pathology Research Group, Tampere University, Tampere, Finland
| | - Bart A A Franx
- Translational Neuroimaging Group, Center for Image Sciences, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
| | - Ana-Rita Bras
- "Momentum" Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
- János Szentágothai Doctoral School of Neurosciences, Schools of PhD Studies, Semmelweis University, Budapest, Hungary
| | - Estelle R Louet
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France
| | - Ádám Dénes
- "Momentum" Laboratory of Neuroimmunology, Institute of Experimental Medicine, Budapest, Hungary
| | - Mario Merlini
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France
| | - Denis Vivien
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France
- Department of Clinical Research, Caen Normandie University Hospital, Caen, France
| | - Marina Rubio
- UNICAEN, INSERM U1237, Etablissement Français du Sang, Physiopathology and Imaging of Neurological Disorders (PhIND), Cyceron, Institut Blood and Brain @ Caen-Normandie (BB@C), PHIND Boulevard Henri Becquerel, Normandie University, 14000, Caen Cedex, Caen, France.
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4
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Raatikainen E, Kiiski H, Kuitunen A, Junttila E, Huhtala H, Kallonen A, Ala-Peijari M, Långsjö J, Saukkonen J, Valo T, Kauppila T, Raerinne S, Frösen J, Vahtera A. Increased blood coagulation is associated with poor neurological outcome in aneurysmal subarachnoid hemorrhage. J Neurol Sci 2024; 458:122943. [PMID: 38422781 DOI: 10.1016/j.jns.2024.122943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/14/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND AND PURPOSE Patients with aneurysmal subarachnoid hemorrhage (aSAH) have demonstrated increased blood coagulation which is thought to contribute to delayed cerebral ischemia (DCI) and to a worse outcome. Therefore, we sought to determine whether this increased blood coagulation, detectable with rotational thromboelastometry (ROTEM), was associated with DCI and neurological outcome. METHODS We conducted a prospective observational study of 60 consecutive adult aSAH patients. ROTEM's EXTEM and FIBTEM assays and D-dimer were analyzed at admission and post-bleed days (PBDs) 2-3, 4-5, 7-8, and 11-12. ROTEM's clot formation time (CFT) represents the stabilization of the clot, and the maximum clot firmness (MCF) the maximum clot strength. Glasgow Outcome Scale extended (GOSe) at three months determined the neurological outcome. RESULTS DCI incidence was 41.7%. EXTEM-CFT was significantly shorter in patients with unfavorable neurological outcome (GOSe 1-4) on PBDs 4-5 and 7-8, p < 0.05, respectively. FIBTEM-MCF was significantly higher in patients with unfavorable neurological outcomes on PBD 4-5 (p < 0.05), PBD 7-8 (p < 0.05), and PBD 11-12 (p < 0.05). EXTEM-CFT decreased, and FIBTEM-MCF rose during the study period in all patients. Patients with unfavorable neurological outcome had a higher D-dimer at all studied time points, p < 0.05. No difference was found in the ROTEM parameters or D-dimer when assessing patients with and without DCI. CONCLUSIONS Patients were in a state of increased blood coagulation after aSAH, with those with unfavorable neurological outcome being more coagulable than those with favorable outcome. However, increased blood coagulation was not associated with DCI. CLINICALTRIALS gov, NCT03985176.
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Affiliation(s)
- Essi Raatikainen
- Tampere University Hospital, Department of Intensive Care, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Heikki Kiiski
- Tampere University Hospital, Department of Intensive Care, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Anne Kuitunen
- Tampere University Hospital, Department of Intensive Care, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Eija Junttila
- Tampere University Hospital, Department of Anesthesia and Intensive Care, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Heini Huhtala
- Tampere University, Faculty of Social Sciences, Tampere, Finland
| | - Antti Kallonen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Marika Ala-Peijari
- Tampere University Hospital, Department of Intensive Care, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Jaakko Långsjö
- Tampere University Hospital, Department of Intensive Care, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Johanna Saukkonen
- Tampere University Hospital, Department of Radiology, Tampere, Finland
| | - Timo Valo
- Tampere University Hospital, Department of Radiology, Tampere, Finland
| | - Terhi Kauppila
- Tampere University Hospital, Department of Radiology, Tampere, Finland
| | - Sanni Raerinne
- Tampere University Hospital, Department of Radiology, Tampere, Finland
| | - Juhana Frösen
- Tampere University Hospital, Department of Neurosurgery, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Annukka Vahtera
- Tampere University Hospital, Department of Intensive Care, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
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5
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Denorme F, Frösen J, Jouppila A, Lindgren A, Resendiz-Nieves JC, Manninen H, De Meyer SF, Lassila R. Pretreatment with a dual antiplatelet and anticoagulant (APAC) reduces ischemia-reperfusion injury in a mouse model of temporary middle cerebral artery occlusion-implications for neurovascular procedures. Acta Neurochir (Wien) 2024; 166:137. [PMID: 38485848 PMCID: PMC10940479 DOI: 10.1007/s00701-024-06017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/14/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Several neurovascular procedures require temporary occlusion of cerebral arteries, leading to ischemia of unpredictable length, occasionally causing brain infarction. Experimental models of cerebral ischemia-reperfusion injury have established that platelet adhesion and coagulation play detrimental roles in reperfusion injury following transient cerebral ischemia. Therefore, in a model of cerebral ischemia-reperfusion injury (IRI), we investigated the therapeutic potential of a dual antiplatelet and anticoagulant (APAC) heparin proteoglycan mimetic which is able to bind to vascular injury sites. METHODS Brain ischemia was induced in mice by transient occlusion of the right middle cerebral artery for 60 min. APAC, unfractionated heparin (UFH) (both at heparin equivalent doses of 0.5 mg/kg), or vehicle was intravenously administered 10 min before or 60 min after the start of ischemia. At 24 h later, mice were scored for their neurological and motor behavior, and brain damage was quantified. RESULTS Both APAC and UFH administered before the onset of ischemia reduced brain injury. APAC and UFH pretreated mice had better neurological and motor functions (p < 0.05 and p < 0.01, respectively) and had significantly reduced cerebral infarct sizes (p < 0.01 and p < 0.001, respectively) at 24 h after transient occlusion compared with vehicle-treated mice. Importantly, no macroscopic bleeding complications were observed in either APAC- or UFH-treated animals. However, when APAC or UFH was administered 60 min after the start of ischemia, the therapeutic effect was lost, but without hemorrhaging either. CONCLUSIONS Pretreatment with APAC or UFH was safe and effective in reducing brain injury in a model of cerebral ischemia induced by transient middle cerebral artery occlusion. Further studies on the use of APAC to limit ischemic injury during temporary occlusion in neurovascular procedures are indicated.
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Affiliation(s)
- Frederik Denorme
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, Dept. of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Annukka Jouppila
- Helsinki University Central Hospital Clinical Research Institute, Helsinki, Finland
| | - Antti Lindgren
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
| | - Julio C Resendiz-Nieves
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Hannu Manninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Simon F De Meyer
- Laboratory for Thrombosis Research, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium
| | - Riitta Lassila
- Coagulation Disorders Unit, Departments of Hematology and Cancer Center, Helsinki University Hospital, Helsinki, Finland.
- Faculty of Medicine, Research Program in Systems Oncology, University of Helsinki, Helsinki, Finland.
- Aplagon Oy, Helsinki, Finland.
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Tarkiainen J, Pyysalo L, Hinkka T, Pienimäki JP, Ronkainen A, Frösen J. Stability of infundibular dilatations: a single center follow-up study and systematic review of the literature. Acta Neurochir (Wien) 2024; 166:48. [PMID: 38286939 PMCID: PMC10824818 DOI: 10.1007/s00701-024-05890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/15/2023] [Indexed: 01/31/2024]
Abstract
PURPOSE Although infundibular dilatations (IDs) have been thought to be benign anatomical variants, case reports suggest that they can grow and rupture. The aim of this study was to determine whether IDs have a tendency to grow or rupture. METHODS The study population was collected from the Tampere University Hospital (TAUH) Aneurysm Database. The presence of IDs was screened from the medical records and imaging studies of 356 intracranial aneurysm patients left to follow-up from 2005 to 2020. The imaging studies were reviewed to confirm the IDs, and their clinical course. Finally, we performed a systematic review of published cases of ID leading to aneurysmatic rupture from PubMed. RESULTS We found 97 typical IDs in 83 patients and 9 preaneurysmal lesions resembling ID in 9 patients. Out of the typical cone-shaped IDs, none grew or ruptured in a total follow-up of 409 patient-years. One preaneurysmal lesion ruptured during a follow-up: this lesion had components of both infundibular dilatation and aneurysm at the beginning of follow-up. In the systematic literature search, we found 20 cases of aneurysmatic SAHs originating from an ID. Of those, only 7 had imaging available prerupture. All 7 IDs were typically cone-shaped, but a branching vessel originating from the apex of ID was only seen in 4/7. CONCLUSION Typical infundibular dilatations seem to be benign anatomical variants that are stable and, thus, do not need prophylactic treatment or imaging follow-up. Likely, the SAHs reported from IDs were actually caused by misdiagnosed preaneurysmal lesions.
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Affiliation(s)
- Jeremias Tarkiainen
- Department of Neurosurgery, Tampere University Hospital and University of Tampere, Tampere, Finland.
- Hemorrhagic Brain Pathology Research Group, Faculty of Medical Technology and Health Sciences, Tampere University, Tampere, Finland.
| | - Liisa Pyysalo
- Hemorrhagic Brain Pathology Research Group, Faculty of Medical Technology and Health Sciences, Tampere University, Tampere, Finland
- Department of Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Tero Hinkka
- Department of Radiology, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Juha-Pekka Pienimäki
- Department of Radiology, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Antti Ronkainen
- Department of Neurosurgery, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Juhana Frösen
- Department of Neurosurgery, Tampere University Hospital and University of Tampere, Tampere, Finland
- Hemorrhagic Brain Pathology Research Group, Faculty of Medical Technology and Health Sciences, Tampere University, Tampere, Finland
- Tays Research Services, Wellbeing Services County of Pirkanmaa, Tampere University Hospital, Tampere, Finland
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Tarkiainen J, Hovi V, Pyysalo L, Ronkainen A, Frösen J. Correction to: The clinical course and outcomes of non-aneurysmal subarachnoid hemorrhages in a single-center retrospective study. Acta Neurochir (Wien) 2023; 165:3707. [PMID: 37878129 PMCID: PMC10739382 DOI: 10.1007/s00701-023-05834-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
Affiliation(s)
- Jeremias Tarkiainen
- Department of Neurosurgery, Tampere University Hospital and University of Tampere, Tampere, Finland.
- Hemorrhagic Brain Pathology Research Group, Faculty of Medical Technology and Health Sciences, Tampere University, Tampere, Finland.
| | - Valtteri Hovi
- Department of Neurosurgery, Tampere University Hospital and University of Tampere, Tampere, Finland
- Hemorrhagic Brain Pathology Research Group, Faculty of Medical Technology and Health Sciences, Tampere University, Tampere, Finland
| | - Liisa Pyysalo
- Hemorrhagic Brain Pathology Research Group, Faculty of Medical Technology and Health Sciences, Tampere University, Tampere, Finland
- Department of Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Antti Ronkainen
- Department of Neurosurgery, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Juhana Frösen
- Department of Neurosurgery, Tampere University Hospital and University of Tampere, Tampere, Finland
- Hemorrhagic Brain Pathology Research Group, Faculty of Medical Technology and Health Sciences, Tampere University, Tampere, Finland
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Tarkiainen J, Hovi V, Pyysalo L, Ronkainen A, Frösen J. The clinical course and outcomes of non-aneurysmal subarachnoid hemorrhages in a single-center retrospective study. Acta Neurochir (Wien) 2023; 165:2843-2853. [PMID: 37659045 PMCID: PMC10542109 DOI: 10.1007/s00701-023-05767-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/17/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Non-aneurysmal subarachnoid hemorrhages (SAHs) are thought to have a benign clinical course compared to aneurysmal SAHs. The aim of this study is to report the clinical course and outcomes of non-aneurysmal SAHs in a large single-center study. METHODS The patients with non-aneurysmal SAHs were screened from Tampere University Hospital from 2005 to 2020. The clinical data were collected from the patient's medical records and from the imaging studies. The primary interest was the neurological outcome assessed by dichotomized GOS at 2 months. Multivariable logistic regression was used to study the factors associated with unfavorable outcome. RESULTS We found 216 non-aneurysmal SAHs in 214 patients (2 patients with > 1 bleed). Ninety-seven percent of patients with a typical perimesencephalic bleeding pattern SAH (PSAH) (75/77) had a favorable outcome, while 86% of patients with non-perimesencephalic SAH (NPSAH) had a favorable outcome (84/98). In a multivariable logistic regression analysis, loss of consciousness (LOC) (aOR 214.67, 95% CI 17.62-2615.89) and Fisher grade 4 bleeding pattern (aOR 23.32, 95% CI 1.40-387.98) were associated with increased risk for unfavorable outcome (GOS 1-3). Vasospasm was seen in 20% of non-aneurysmal SAH patients, hydrocephalus in 17%, and 13% needed ventriculostomy. CONCLUSIONS Non-aneurysmal SAH seems to have a good prognosis for majority of patients, especially for patients with a PSAH. Non-aneurysmal SAH patients are however affected by vasospasm and hydrocephalus and have similar risk factors for poor outcome as patients with aneurysmal SAH. This suggests that it is the severity of the bleed rather than the etiology that associates with poor outcome.
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Affiliation(s)
- Jeremias Tarkiainen
- Department of Neurosurgery, Tampere University Hospital and University of Tampere, Tampere, Finland.
- Hemorrhagic Brain Pathology Research Group, Faculty of Medical Technology and Health Sciences, Tampere University, Tampere, Finland.
| | - Valtteri Hovi
- Department of Neurosurgery, Tampere University Hospital and University of Tampere, Tampere, Finland
- Hemorrhagic Brain Pathology Research Group, Faculty of Medical Technology and Health Sciences, Tampere University, Tampere, Finland
| | - Liisa Pyysalo
- Hemorrhagic Brain Pathology Research Group, Faculty of Medical Technology and Health Sciences, Tampere University, Tampere, Finland
- Department of Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Antti Ronkainen
- Department of Neurosurgery, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Juhana Frösen
- Department of Neurosurgery, Tampere University Hospital and University of Tampere, Tampere, Finland
- Hemorrhagic Brain Pathology Research Group, Faculty of Medical Technology and Health Sciences, Tampere University, Tampere, Finland
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9
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Natukka T, Haapasalo J, Kivioja T, Rajala L, Raitanen J, Nevalainen J, Lahtela SL, Nordfors K, Rauhala M, Jukkola A, Frösen J, Helén P, Auvinen A, Haapasalo H. Impact of timing of surgery and adjuvant treatment on survival of adult IDH-wildtype glioblastoma: a single-center study of 392 patients. World Neurosurg 2023:S1878-8750(23)00933-6. [PMID: 37423335 DOI: 10.1016/j.wneu.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND The purpose of our study was to analyze the impact of time interval from referral to surgery and from surgery to adjuvant treatment on survival of adult IDH-wildtype glioblastomas. METHODS Data on 392 IDH-wildtype glioblastomas diagnosed at the Tampere University Hospital in 2004-2016 were obtained from the electronic patient record system. Piecewise Cox regression was used to calculate hazard ratios for different time intervals between referral and surgery, as well as between surgery and adjuvant treatments. RESULTS The median survival time from primary surgery was 9.5 months (interquartile range: 3.8-16.0). Survival among patients with an interval exceeding four weeks from referral to surgery was no worse compared to <2 weeks (hazard ratio: 0.78; 95% confidence interval: 0.54-1.14). We found indications of poorer outcome when the interval from surgery to radiotherapy exceeded 30 days (hazard ratio: 1.42; 95% confidence interval: 0.91-2.21 for 31-44 days and 1.59; 0.94-2.67 for over 45 days). CONCLUSIONS Interval from referral to surgery in the range of 4-10 weeks was not associated with decreased survivals in IDH-wildtype glioblastomas. In contrast, delay exceeding 30 days from surgery to adjuvant treatment may decrease long-term survival.
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Affiliation(s)
- Tuomas Natukka
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
| | - Joonas Haapasalo
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Department of Neurosurgery, Tampere University Hospital, Tampere, Finland; Fimlab Laboratories Ltd, Tampere, Finland
| | - Tomi Kivioja
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Linnea Rajala
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Jani Raitanen
- Tampere University, Faculty of Social Sciences, Tampere, Finland; UKK Institute for Health Promotion Research, Tampere, Finland
| | | | | | - Kristiina Nordfors
- Tampere Center for Child Health Research, Tampere University, Tampere, Finland; Tays Cancer Center, Tampere University Hospital, Tampere, Finland
| | - Minna Rauhala
- Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Arja Jukkola
- Department of Oncology, Tampere University Hospital, Tampere, Finland; Tays Cancer Center, Tampere University Hospital, Tampere, Finland
| | - Juhana Frösen
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Pauli Helén
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Anssi Auvinen
- Tampere University, Faculty of Social Sciences, Tampere, Finland
| | - Hannu Haapasalo
- Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland; Fimlab Laboratories Ltd, Tampere, Finland
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10
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Laaksonen M, Rinne J, Rahi M, Posti JP, Laitio R, Kivelev J, Saarenpää I, Laukka D, Frösen J, Ronkainen A, Bendel S, Långsjö J, Ala-Peijari M, Saunavaara J, Parkkola R, Nyman M, Martikainen IK, Dickens AM, Rinne J, Valtonen M, Saari TI, Koivisto T, Bendel P, Roine T, Saraste A, Vahlberg T, Tanttari J, Laitio T. Effect of xenon on brain injury, neurological outcome, and survival in patients after aneurysmal subarachnoid hemorrhage-study protocol for a randomized clinical trial. Trials 2023; 24:417. [PMID: 37337295 DOI: 10.1186/s13063-023-07432-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Aneurysmal subarachnoid hemorrhage (aSAH) is a neurological emergency, affecting a younger population than individuals experiencing an ischemic stroke; aSAH is associated with a high risk of mortality and permanent disability. The noble gas xenon has been shown to possess neuroprotective properties as demonstrated in numerous preclinical animal studies. In addition, a recent study demonstrated that xenon could attenuate a white matter injury after out-of-hospital cardiac arrest. METHODS The study is a prospective, multicenter phase II clinical drug trial. The study design is a single-blind, prospective superiority randomized two-armed parallel follow-up study. The primary objective of the study is to explore the potential neuroprotective effects of inhaled xenon, when administered within 6 h after the onset of symptoms of aSAH. The primary endpoint is the extent of the global white matter injury assessed with magnetic resonance diffusion tensor imaging of the brain. DISCUSSION Despite improvements in medical technology and advancements in medical science, aSAH mortality and disability rates have remained nearly unchanged for the past 10 years. Therefore, new neuroprotective strategies to attenuate the early and delayed brain injuries after aSAH are needed to reduce morbidity and mortality. TRIAL REGISTRATION ClinicalTrials.gov NCT04696523. Registered on 6 January 2021. EudraCT, EudraCT Number: 2019-001542-17. Registered on 8 July 2020.
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Affiliation(s)
- Mikael Laaksonen
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, P.O. Box 52, FIN-20521, Turku, Finland.
| | - Jaakko Rinne
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Melissa Rahi
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Jussi P Posti
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ruut Laitio
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, P.O. Box 52, FIN-20521, Turku, Finland
| | - Juri Kivelev
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilkka Saarenpää
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Dan Laukka
- Neurocenter, Department of Neurosurgery and Turku Brain Injury Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Juhana Frösen
- Department of Neurosurgery, Faculty of Medicine and Health Technology, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Antti Ronkainen
- Department of Neurosurgery, Faculty of Medicine and Health Technology, Tampere University Hospital, University of Tampere, Tampere, Finland
| | - Stepani Bendel
- Department of Intensive Care, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Jaakko Långsjö
- Department of Anesthesiology and Intensive Care, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Marika Ala-Peijari
- Department of Anesthesiology and Intensive Care, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital and University of Turku, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - Mikko Nyman
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ilkka K Martikainen
- Department of Radiology, Tampere University Hospital and University of Tampere, Tampere, Finland
| | - Alex M Dickens
- Analysis of the metabolomics, University of Turku, Turku BioscienceTurku, Finland
| | - Juha Rinne
- Turku PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Mika Valtonen
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, P.O. Box 52, FIN-20521, Turku, Finland
| | - Teijo I Saari
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, P.O. Box 52, FIN-20521, Turku, Finland
| | - Timo Koivisto
- Department of Neurosurgery, Kuopio University Hospital, University of Eastern Finland, NeurocenterKuopio, Finland
| | - Paula Bendel
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Timo Roine
- Department of Neuroscience and Biomedical Engineering, Aalto University School of Science, Espoo, Finland
| | - Antti Saraste
- Heart Centre, Turku University Hospital, Turku University Hospital and University of Turku, Turku, Finland
| | - Tero Vahlberg
- Department of Biostatistics, University of Turku, Turku, Finland
| | - Juha Tanttari
- Technical Analysis, Elomatic Consulting & Engineering, Thane, India
| | - Timo Laitio
- Department of Perioperative Services, Intensive Care Medicine and Pain Management, Turku University Hospital and University of Turku, P.O. Box 52, FIN-20521, Turku, Finland
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11
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Järvelin P, Pekonen H, Koivisto T, Frösen J. Recurrence of arteriovenous malformations of the brain after complete surgical resection. Kuopio University Hospital experience and systematic review of the literature. Neurosurg Rev 2023; 46:99. [PMID: 37119280 PMCID: PMC10148763 DOI: 10.1007/s10143-023-02001-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/31/2023] [Accepted: 04/08/2023] [Indexed: 05/01/2023]
Abstract
Treatment for arteriovenous malformations of the brain (bAVMs) aims to achieve complete removal or occlusion of the lesion in order to eradicate the risk of rupture and subsequent morbidity associated with these lesions. Despite initially successful treatment, bAVMs may carry a risk of recurrence especially in younger patients. We studied the rate of recurrence of surgically treated bAVMs at Kuopio University Hospital (KUH) in 1981-2021. The study population was collected retrospectively from KUH databases and presented a cohort of 135 surgically treated bAVMs with complete occlusion of the lesion. We also performed a systematic literature review on this topic. In our series, 6 out of 135 (4.4%) patients with angiographically confirmed removal of the lesion later developed a recurrent bAVM with a median time to diagnosis of recurrence of 7.46 years. In pediatric patients, the rate was 5 out of 17 (29.4%). bAVM recurrence was associated with age (p = 0.001) and initial hemorrhagic presentation (p = 0.039). Median age of the study population was 37 years (min 0, max 70), and 51/135 (37.8%) of the patients were female. Seventeen (12.6%) of the 135 bAVM patients were considered pediatric (18 years old or younger) at the time of the operation. In the literature review, 79 of 1739 (4.5%) of surgically treated patients later developed a recurrence with a mean delay of 3.1 years until diagnosis of recurrence. Young surgically treated bAVM patients with a hemorrhagic presentation at initial diagnosis are at a relatively high risk of bAVM recurrence. Follow-up imaging should be arranged for these patients in order to prevent rupture from a recurrent bAVM and subsequent morbidity.
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Affiliation(s)
- Patrik Järvelin
- Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital and Tampere University, Tampere, Finland
| | - Henri Pekonen
- Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital and Tampere University, Tampere, Finland
| | - Timo Koivisto
- Dept of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital and Tampere University, Tampere, Finland.
- Dept of Neurosurgery, Tampere University Hospital, Tampere, Finland.
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12
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Hallikainen J, Pessi T, Vehkalahti M, Suominen AL, Pyysalo M, Frösen J. Unlike severe periodontitis, caries does not associate with intracranial aneurysms or aneurysmal subarachnoid hemorrhage. Acta Neurochir (Wien) 2023; 165:169-175. [PMID: 36416942 PMCID: PMC9840572 DOI: 10.1007/s00701-022-05406-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/26/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Periodontal diseases and caries are common oral diseases that predispose to tooth loss if untreated. In this study, we investigated whether loss of teeth or caries associate with intracranial aneurysm (IA) pathology similar to periodontal diseases. METHODS A total of 166 patients with either IA or aneurysmal subarachnoid hemorrhage (aSAH) underwent oral examination in Kuopio University Hospital and Tampere University Hospital. Findings were compared to geographically matched controls acquired from cross-sectional Health2000 survey. This study consisted of three sequential steps. First, we compared the number of missing teeth and prevalence of caries in IA and aSAH patients and geographically matched control population, second step was a multivariate analysis including other risk factors, and third step was a 13-year follow-up of the Health2000 survey participants with missing teeth or caries at baseline. RESULTS Loss of teeth did not significantly differ between IA patients and controls. In logistic regression model adjusted for known risk factors and demographic data, 1-4 caries lesions (OR: 0.40 95%Cl 0.2-0.9, p = 0.031) was associated with lack of IAs, while age (OR: 1.03 95%Cl 1.01.1 p = 0.024), current smoking (OR: 2.7 95%Cl 1.4-5.1, p = 0.003), and severe periodontitis (OR: 5.99 95%Cl 2.6-13.8, p < 0.001) associated to IA formation. In the cox-regression, severe periodontitis at baseline increased the risk of aSAH (HR: 14.3, 95%Cl 1.5-135.9, p = 0.020) during a 13-year follow-up, while caries or missing teeth did not. CONCLUSION Unlike severe periodontitis, caries does not increase the risk of IAs and aSAHs. However, cariogenic bacteria may participate to IA pathology by disseminating to circulation via inflamed gingival tissue.
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Affiliation(s)
- Joona Hallikainen
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland.
- Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.
- Oral and Maxillofacial Diseases, Central Finland Central Hospital, Helsinki, Finland.
| | - Tanja Pessi
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
| | - Miira Vehkalahti
- Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland
| | - Anna Liisa Suominen
- Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
| | - Mikko Pyysalo
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
- Oral Health Services, City of Tampere, Finland
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
- Neurosurgery, Tampere University Hospital, Tampere, Finland
- Department of Neurosurgery, Tampere University, Tampere, Finland
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13
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Frösen J. Association of blood lipid levels with the risk of intracranial aneurysm formation and rupture calls for further studies. A commentary on the article by Zhang et al. Eur J Neurol 2022; 29:2879-2880. [PMID: 35861121 PMCID: PMC9544045 DOI: 10.1111/ene.15514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, Dept of Neurosurgery, Tampere University and Tampere University Hospital, Tampere, Finland
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14
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Räisänen S, Huttunen J, Huuskonen TJ, von Und Zu Fraunberg M, Koivisto T, Jääskeläinen JE, Lindgren A, Frösen J. Risk factor management matters more than pharmaceutical cyclooxygenase-2 inhibition in the prevention of de novo intracranial aneurysms. Eur J Neurol 2022; 29:2734-2743. [PMID: 35678735 DOI: 10.1111/ene.15442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Pathophysiological studies of saccular intracranial aneurysm (sIA) disease have shown that inflammation plays a crucial role in sIA development. Pharmaceutical inhibition of COX-2-PGE2-NF-κB signaling (COX-2, cyclooxygenase-2; PGE2, prostaglandin E2; NF-κB, nuclear factor κB) has been shown in animal models to inhibit sIA formation and progression suggesting that use of medication inhibiting COX-2 could reduce intracranial aneurysm formation also in patients. METHODS The impact of COX-2 inhibition on de novo sIA formation was studied in two cohorts: in a previously described angiographically followed cohort of 1419 sIA patients and in a cohort of 117 sIA patients treated with stenting or stent-assisted embolization. Patients were identified from our population-based Kuopio Intracranial Aneurysm Database. Data on the use of anti-inflammatory medications and hospital diagnoses were obtained from national registries. Risk factors were identified by univariate and multivariate analyses. RESULTS De novo sIA patients were younger and more often smokers. Use of COX-2 selective inhibitors or nonsteroidal anti-inflammatory drugs did not significantly reduce de novo sIA formation, but the percentage of patients with de novo sIA formation was smaller in patients with prescribed regular acetylsalicylic acid medication (1.1% vs. 3.6%). In the multivariate analysis, however, neither acetylsalicylic acid use nor other type of pharmaceutical inhibition of COX-2 reduced the formation of de novo sIAs. The risk was mostly affected by age, smoking history and irregular usage of antihypertensive medication regardless of used COX-2 inhibition level. CONCLUSION For the prevention of de novo sIA formation, risk factor management with focus on cessation of smoking and treating hypertension adequately seems more important than pharmaceutical COX-2 inhibition.
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Affiliation(s)
- Sari Räisänen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Jukka Huttunen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Terhi J Huuskonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Neurosurgery at Neurocenter, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Timo Koivisto
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Antti Lindgren
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juhana Frösen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Department of Neurosurgery, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Medical Technology, Tampere University, Tampere, Finland
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15
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Räisänen S, Huttunen J, Huuskonen TJ, von Und Zu Fraunberg M, Koivisto T, Jääskeläinen JE, Frösen J, Lindgren A. Use of antihypertensive medication and formation of de novo intracranial aneurysms. Eur J Neurol 2022; 29:2708-2715. [PMID: 35652754 DOI: 10.1111/ene.15430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/17/2022] [Accepted: 05/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertension is a risk factor for subarachnoid hemorrhage and is also considered a risk factor for saccular intracranial aneurysm (sIA) formation. However, there is little direct evidence that antihypertensive medication would reduce sIA formation. METHODS We studied the impact of antihypertensive medication on de novo sIA formation in an angiographically followed cohort of 1419 patients. Patients were identified from our population-based Kuopio Intracranial Aneurysm Database, and data of the purchases of antihypertensive medication was obtained from a national registry. Univariate and multivariate analyses were used to investigate the risk factors. RESULTS Of the 966 sIA patients that were prescribed with antihypertensive medication, 841 patients used the medication regularly, 20 of them had de novo sIA. 125 patients used the medication irregularly and 12 of them developed de novo sIAs. 453 patients didn't use antihypertensive medication even though 27 of them had diagnosis of hypertension, and 10 of them developed de novo sIAs. In the multivariate analysis antihypertensive medication didn't significantly reduce de novo sIA formation (HR 1.60, 95% Cl 0.84-3.06). Age at primary diagnosis (HR 0.95, 95% Cl 0.93-0.98) and smoking history (HR 5.53, 95% Cl 2.77-11.05) were significant risk factors for de novo sIA formation. Also, irregular usage of antihypertensive medication was a significant risk factor (HR 3.84, 95% Cl 1.59-9.29) for de novo sIA formation. CONCLUSIONS Antihypertensive agents were not associated with a reduction of de novo sIA formation, but irregular use of antihypertensive agents was associated with an increased risk of de novo sIA formation.
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Affiliation(s)
- Sari Räisänen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital
| | - Jukka Huttunen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terhi J Huuskonen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital.,Department of Neurosurgery, Tampere University Hospital.,Faculty of Medicine and Medical Technology, Tampere University, Tampere, Finland
| | - Antti Lindgren
- Neurosurgery of NeuroCenter, Kuopio University Hospital, and Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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16
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Frösen J, Tarkiainen J, Kelahaara M, Pyysalo L, Ronkainen A. Reader Response: Substantial Within-Country Variation in the Incidence of Subarachnoid Hemorrhage: A Nationwide Finnish Study. Neurology 2022; 98:733-734. [PMID: 35470266 DOI: 10.1212/wnl.0000000000200509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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17
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Hackenberg KAM, Algra A, Al-Shahi Salman R, Frösen J, Hasan D, Juvela S, Langer D, Meyers P, Morita A, Rinkel G, Etminan N. Correction to: Definition and Prioritization of Data Elements for Cohort Studies and Clinical Trials on Patients with Unruptured Intracranial Aneurysms: Proposal of a Multidisciplinary Research Group. Neurocrit Care 2021; 35:924-926. [PMID: 34608597 DOI: 10.1007/s12028-021-01346-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Katharina A M Hackenberg
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Ale Algra
- Brain Center Rudolph Magnus, Department of Neurology and Neurosurgery, and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Edinburgh, UK
| | - Juhana Frösen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - David Hasan
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Seppo Juvela
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - David Langer
- Department of Neurosurgery, Hofstra Northwell School of Medicine, and Northwell Health, Lenox‑Hill Hospital, New York, NY, USA
| | - Philip Meyers
- Departments of Neurosurgery and Radiology, Columbia University Medical Center, New York, NY, USA
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Bunkyo‑ku, Tokyo, Japan
| | - Gabriel Rinkel
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
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18
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Hallikainen J, Pyysalo M, Keränen S, Kellokoski J, Koivisto T, Suominen AL, Pussinen P, Pessi T, Frösen J. Systemic immune response against the oral pathogens Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans is associated with the formation and rupture of intracranial aneurysms. Eur J Neurol 2021; 28:3089-3099. [PMID: 34145948 DOI: 10.1111/ene.14986] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/14/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Periodontal infections are associated with the formation and rupture of intracranial aneurysms (IAs). This study investigated the role of two key periodontal pathogens, Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans. METHODS Immunoglobulin A (IgA) and IgG antibodies against P. gingivalis and A. actinomycetemcomitans were measured with enzyme immune assay from the serum of 227 IA patients, of whom 64 also underwent clinical oral examination. As a control group, 1096 participants in a cross-sectional health survey, Health 2000, underwent serological studies and oral examination. Logistic regression was used for multivariate analysis. Immunohistochemistry was performed to demonstrate bacteria-derived epitopes in the IA wall. RESULTS Widespread gingivitis and severe periodontitis were more common in IA patients than in controls (2× and 1.5×, respectively). IgA antibodies against P. gingivalis and A. actinomycetemcomitans were 1.5× and 3-3.4× higher, respectively, in both unruptured and ruptured IA patients compared to controls (p ≤ 0.003). IgG antibodies against P. gingivalis were 1.8× lower in unruptured IA patients (p < 0.001). In multivariate analysis, high IgA, but low IgG, antibody levels against P. gingivalis (odds ratio [OR] = 1.4, 95% confidence interval [Cl] = 1.1-1.8 and OR = 1.5, 95% Cl = 1.1-1.9; OR = 0.6, 95% Cl = 0.4-0.7 and OR = 0.5, 95% Cl = 0.4-0.7) and against A. actinomycetemcomitans (OR = 2.3, 95% Cl = 1.7-3.1 and OR = 2.1, 95% Cl = 1.5-2.9; OR = 0.6, 95% Cl = 0.4-0.8 and OR = 0.6, 95% Cl = 0.5-0.9) were associated with the risk of IA formation and rupture. Immunohistochemistry showed P. gingivalis epitopes in the IA wall. CONCLUSIONS Exposure to the periodontal pathogens P. gingivalis and A. actinomycetemcomitans and dysfunctional acquired immune response against them may increase the risk of IA formation and IA rupture.
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Affiliation(s)
- Joona Hallikainen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
| | - Mikko Pyysalo
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
| | - Sara Keränen
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland.,A. I. Virtanen Institute, University of Eastern Finland, Kuopio, Finland
| | - Jari Kellokoski
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koivisto
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Anna Liisa Suominen
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Pirkko Pussinen
- Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tanja Pessi
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland.,Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
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19
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Salimi Ashkezari SF, Mut F, Chung BJ, Robertson AM, Frösen J, Cebral JR. Analysis of hemodynamic changes from aneurysm inception to large sizes. Int J Numer Method Biomed Eng 2021; 37:e3415. [PMID: 33205887 PMCID: PMC8991439 DOI: 10.1002/cnm.3415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/30/2020] [Accepted: 11/15/2020] [Indexed: 06/11/2023]
Abstract
While previous studies have identified many risk factors for the progression and rupture of cerebral aneurysms, the changes in aneurysm flow characteristics during its evolution are not fully understood. This work analyzes the changes in the aneurysm hemodynamic environment from its initial development to later stages when the aneurysm has substantially enlarged. A total of 88 aneurysms at four locations were studied with image based computational fluid dynamics (CFD). Two synthetic sequences representing the aneurysm geometry at three earlier stages were generated by shrinking the aneurysm sac while keeping the neck fixed or shrinking the neck simultaneously. The flow conditions were then quantitatively compared between these two modes of evolution. As aneurysms enlarged, the inflow rate increased in growing neck sequences, but decreased in fixed neck sequences. The inflow jet became more concentrated in both sequences. The mean aneurysm flow velocity and wall shear stress decreased in both sequences, but they decreased faster in enlarging aneurysms if the neck was fixed. Additionally, the intra-aneurysmal flows became more complex and more unstable, wall shear stress distribution became more oscillatory, and the area under low wall shear stress increased for both sequences. The evolution of flow characteristics of aneurysms with fixed and growing necks are different. The observed trends suggest that fixed neck aneurysms may evolve towards a flow environment characteristic of stable aneurysms faster than aneurysms with growing necks, which could also evolve towards a more disfavorable environment.
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Affiliation(s)
| | - Fernando Mut
- Bioengineering Department, George Mason University, Fairfax, Virginia, USA
| | - Bong Jae Chung
- Department of Mathematical Sciences, Montclair State University, Montclair, New Jersey, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Juan R Cebral
- Bioengineering Department, George Mason University, Fairfax, Virginia, USA
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20
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Keränen S, Suutarinen S, Mallick R, Laakkonen JP, Guo D, Pawlikowska L, Jahromi BR, Rauramaa T, Ylä-Herttuala S, Marchuk D, Krings T, Koivisto T, Lawton M, Radovanovic I, Kim H, Faughnan ME, Frösen J. Cyclo-oxygenase 2, a putative mediator of vessel remodeling, is expressed in the brain AVM vessels and associates with inflammation. Acta Neurochir (Wien) 2021; 163:2503-2514. [PMID: 34185176 PMCID: PMC8357659 DOI: 10.1007/s00701-021-04895-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 05/26/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Brain arteriovenous malformations (bAVM) may rupture causing disability or death. BAVM vessels are characterized by abnormally high flow that in general triggers expansive vessel remodeling mediated by cyclo-oxygenase-2 (COX2), the target of non-steroidal anti-inflammatory drugs. We investigated whether COX2 is expressed in bAVMs and whether it associates with inflammation and haemorrhage in these lesions. METHODS Tissue was obtained from surgery of 139 bAVMs and 21 normal Circle of Willis samples. The samples were studied with immunohistochemistry and real-time quantitative polymerase chain reaction (RT-PCR). Clinical data was collected from patient records. RESULTS COX2 expression was found in 78% (109/139) of the bAVMs and localized to the vessels' lumen or medial layer in 70% (95/135) of the bAVMs. Receptors for prostaglandin E2, a COX2-derived mediator of vascular remodeling, were found in the endothelial and smooth muscle cells and perivascular inflammatory cells of bAVMs. COX2 was expressed by infiltrating inflammatory cells and correlated with the extent of inflammation (r = .231, p = .007, Spearman rank correlation). COX2 expression did not associate with haemorrhage. CONCLUSION COX2 is induced in bAVMs, and possibly participates in the regulation of vessel wall remodelling and ongoing inflammation. Role of COX2 signalling in the pathobiology and clinical course of bAVMs merits further studies.
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Affiliation(s)
- Sara Keränen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland
| | - Santeri Suutarinen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland
| | - Rahul Mallick
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland
| | - Johanna P Laakkonen
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland
| | - Diana Guo
- Center for Cerebrovascular Research, Dept of Anesthesiology and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Ludmila Pawlikowska
- Center for Cerebrovascular Research, Dept of Anesthesiology and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Behnam Rezai Jahromi
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland
| | - Tuomas Rauramaa
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Department of Pathology, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Seppo Ylä-Herttuala
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland
| | - Doug Marchuk
- Division of Human Genetics, Duke University School of Medicine, Durham, NC, USA
| | - Timo Krings
- Department of Neuroradiology, University Hospital Network Toronto, Toronto, Canada
| | - Timo Koivisto
- Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Michael Lawton
- Department of Neurosurgery, Barrow Brain and Spine Institute, Phoenix, AZ, USA
| | - Ivan Radovanovic
- Department of Neurosurgery, University Hospital Network Toronto, Toronto, Canada
| | - Helen Kim
- Center for Cerebrovascular Research, Dept of Anesthesiology and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Marie E Faughnan
- Toronto HHT Centre, St. Michael's Hospital and Li Ka Shing Knowledge Institute, Toronto, Canada
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Joensuu, Kuopio, Finland.
- Department of Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
- Department of Neurosurgery, Tampere University Hospital and University of Tampere, Elämänaukio 2, PoBox 33521, Tampere, Finland.
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21
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Salimi Ashkezari SF, Mut F, Chung BJ, Yu AK, Stapleton CJ, See AP, Amin-Hanjani S, Charbel FT, Rezai Jahromi B, Niemelä M, Frösen J, Maiti S, Robertson AM, Cebral JR. Hemodynamics in aneurysm blebs with different wall characteristics. J Neurointerv Surg 2020; 13:642-646. [PMID: 33020208 PMCID: PMC8294199 DOI: 10.1136/neurintsurg-2020-016601] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Blebs are important secondary structures of intracranial aneurysms associated with increased rupture risk and can affect local wall stress and hemodynamics. Mechanisms of bleb development and evolution are not clearly understood. We investigate the relationship between blebs with different wall characteristics and local hemodynamics and rupture sites. METHODS Blebs with different wall appearances in intra-operative videos were analyzed with image-based computational fluid dynamics. Thin red blebs were compared against thick atherosclerotic/hyperplastic white/yellow blebs. Rupture points were identified in videos of ruptured aneurysms harboring blebs. RESULTS Thin blebs tended to be closer to the inflow than atherosclerotic blebs of the same aneurysm (P=0.0234). Blebs near the inflow had higher velocity (P=0.0213), vorticity (P=0.0057), shear strain rate (P=0.0084), wall shear stress (WSS) (P=0.0085), and WSS gradient (P=0.0151) than blebs far from the inflow. In a subset of 12 ruptured aneurysms harboring blebs, rupture points were associated with thin blebs in 42% of aneurysms, atherosclerotic blebs in 25%, and were away from blebs in the remaining 33%. CONCLUSIONS Not all blebs are equal; some have thin translucent walls while others have thick atherosclerotic walls. Thin blebs tend to be located closer to the inflow than atherosclerotic blebs. Blebs near the inflow are exposed to stronger flows with higher and spatially variable WSS than blebs far from the inflow which tend to have uniformly lower WSS. Aneurysms can rupture at thin blebs, atherosclerotic blebs, and even away from blebs. Further study of wall failure in aneurysms with different bleb types is needed.
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Affiliation(s)
| | - Fernando Mut
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Bong Jae Chung
- Department of Mathematical Sciences, Montclair State University, Montclair, New Jersey, USA
| | - Alexander K Yu
- Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | - Alfred P See
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Behnam Rezai Jahromi
- Neurosurgery Research Group, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
| | - Mika Niemelä
- Neurosurgery Research Group, Biomedicum Helsinki, University of Helsinki, Helsinki, Finland
| | - Juhana Frösen
- Department of Neurosurgery, University of Tampere, Tampere, Finland.,Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Spandan Maiti
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Juan R Cebral
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA.,Department of Mechanical Engineering, George Mason University, Fairfax, Virginia, USA
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22
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Frösen J, Cebral J, Robertson AM, Aoki T. Flow-induced, inflammation-mediated arterial wall remodeling in the formation and progression of intracranial aneurysms. Neurosurg Focus 2020; 47:E21. [PMID: 31261126 DOI: 10.3171/2019.5.focus19234] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/01/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Unruptured intracranial aneurysms (UIAs) are relatively common lesions that may cause devastating intracranial hemorrhage, thus producing considerable suffering and anxiety in those affected by the disease or an increased likelihood of developing it. Advances in the knowledge of the pathobiology behind intracranial aneurysm (IA) formation, progression, and rupture have led to preclinical testing of drug therapies that would prevent IA formation or progression. In parallel, novel biologically based diagnostic tools to estimate rupture risk are approaching clinical use. Arterial wall remodeling, triggered by flow and intramural stresses and mediated by inflammation, is relevant to both. METHODS This review discusses the basis of flow-driven vessel remodeling and translates that knowledge to the observations made on the mechanisms of IA initiation and progression on studies using animal models of induced IA formation, study of human IA tissue samples, and study of patient-derived computational fluid dynamics models. RESULTS Blood flow conditions leading to high wall shear stress (WSS) activate proinflammatory signaling in endothelial cells that recruits macrophages to the site exposed to high WSS, especially through macrophage chemoattractant protein 1 (MCP1). This macrophage infiltration leads to protease expression, which disrupts the internal elastic lamina and collagen matrix, leading to focal outward bulging of the wall and IA initiation. For the IA to grow, collagen remodeling and smooth muscle cell (SMC) proliferation are essential, because the fact that collagen does not distend much prevents the passive dilation of a focal weakness to a sizable IA. Chronic macrophage infiltration of the IA wall promotes this SMC-mediated growth and is a potential target for drug therapy. Once the IA wall grows, it is subjected to changes in wall tension and flow conditions as a result of the change in geometry and has to remodel accordingly to avoid rupture. Flow affects this remodeling process. CONCLUSIONS Flow triggers an inflammatory reaction that predisposes the arterial wall to IA initiation and growth and affects the associated remodeling of the UIA wall. This chronic inflammation is a putative target for drug therapy that would stabilize UIAs or prevent UIA formation. Moreover, once this coupling between IA wall remodeling and flow is understood, data from patient-specific flow models can be gathered as part of the diagnostic workup and utilized to improve risk assessment for UIA initiation, progression, and eventual rupture.
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Affiliation(s)
- Juhana Frösen
- 1Department of Neurosurgery, and.,2Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland
| | - Juan Cebral
- 3Bioengineering Department, Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - Anne M Robertson
- 4Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, Pennsylvania; and
| | - Tomohiro Aoki
- 5Department of Molecular Pharmacology, Research Institute, and.,6Core Research for Evolutional Science and Technology (CREST) from Japan Agency for Medical Research and Development (AMED), National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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23
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Detmer FJ, Hadad S, Chung BJ, Mut F, Slawski M, Juchler N, Kurtcuoglu V, Hirsch S, Bijlenga P, Uchiyama Y, Fujimura S, Yamamoto M, Murayama Y, Takao H, Koivisto T, Frösen J, Cebral JR. Extending statistical learning for aneurysm rupture assessment to Finnish and Japanese populations using morphology, hemodynamics, and patient characteristics. Neurosurg Focus 2020; 47:E16. [PMID: 31261120 DOI: 10.3171/2019.4.focus19145] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Incidental aneurysms pose a challenge for physicians, who need to weigh the rupture risk against the risks associated with treatment and its complications. A statistical model could potentially support such treatment decisions. A recently developed aneurysm rupture probability model performed well in the US data used for model training and in data from two European cohorts for external validation. Because Japanese and Finnish patients are known to have a higher aneurysm rupture risk, the authors' goals in the present study were to evaluate this model using data from Japanese and Finnish patients and to compare it with new models trained with Finnish and Japanese data. METHODS Patient and image data on 2129 aneurysms in 1472 patients were used. Of these aneurysm cases, 1631 had been collected mainly from US hospitals, 249 from European (other than Finnish) hospitals, 147 from Japanese hospitals, and 102 from Finnish hospitals. Computational fluid dynamics simulations and shape analyses were conducted to quantitatively characterize each aneurysm's shape and hemodynamics. Next, the previously developed model's discrimination was evaluated using the Finnish and Japanese data in terms of the area under the receiver operating characteristic curve (AUC). Models with and without interaction terms between patient population and aneurysm characteristics were trained and evaluated including data from all four cohorts obtained by repeatedly randomly splitting the data into training and test data. RESULTS The US model's AUC was reduced to 0.70 and 0.72, respectively, in the Finnish and Japanese data compared to 0.82 and 0.86 in the European and US data. When training the model with Japanese and Finnish data, the average AUC increased only slightly for the Finnish sample (to 0.76 ± 0.16) and Finnish and Japanese cases combined (from 0.74 to 0.75 ± 0.14) and decreased for the Japanese data (to 0.66 ± 0.33). In models including interaction terms, the AUC in the Finnish and Japanese data combined increased significantly to 0.83 ± 0.10. CONCLUSIONS Developing an aneurysm rupture prediction model that applies to Japanese and Finnish aneurysms requires including data from these two cohorts for model training, as well as interaction terms between patient population and the other variables in the model. When including this information, the performance of such a model with Japanese and Finnish data is close to its performance with US or European data. These results suggest that population-specific differences determine how hemodynamics and shape associate with rupture risk in intracranial aneurysms.
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Affiliation(s)
| | | | - Bong Jae Chung
- 2Department of Mathematical Sciences, Montclair State University, Montclair, New Jersey
| | | | - Martin Slawski
- 3Statistics Department, George Mason University, Fairfax, Virginia
| | - Norman Juchler
- 4Institute of Applied Simulation, ZHAW University of Applied Sciences, Wädenswil, Switzerland.,5The Interface Group, Institute of Physiology, University of Zürich, Switzerland
| | - Vartan Kurtcuoglu
- 5The Interface Group, Institute of Physiology, University of Zürich, Switzerland
| | - Sven Hirsch
- 4Institute of Applied Simulation, ZHAW University of Applied Sciences, Wädenswil, Switzerland
| | - Philippe Bijlenga
- 6Clinical Neurosciences Department, University of Geneva, Switzerland
| | - Yuya Uchiyama
- 7Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan.,Departments of8Innovation for Medical Information Technology and
| | - Soichiro Fujimura
- 7Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan.,Departments of8Innovation for Medical Information Technology and
| | - Makoto Yamamoto
- 9Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan; and
| | - Yuichi Murayama
- 10Neurosurgery, The Jikei University of Medicine, Tokyo, Japan
| | - Hiroyuki Takao
- 7Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan.,Departments of8Innovation for Medical Information Technology and.,10Neurosurgery, The Jikei University of Medicine, Tokyo, Japan
| | - Timo Koivisto
- 11Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Juhana Frösen
- 11Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
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24
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Salimi Ashkezari SF, Detmer FJ, Mut F, Chung BJ, Yu AK, Stapleton CJ, See AP, Amin-Hanjani S, Charbel FT, Rezai Jahromi B, Niemelä M, Frösen J, Zhou J, Maiti S, Robertson AM, Cebral JR. Blebs in intracranial aneurysms: prevalence and general characteristics. J Neurointerv Surg 2020; 13:226-230. [PMID: 32680877 PMCID: PMC8294207 DOI: 10.1136/neurintsurg-2020-016274] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Blebs are rupture risk factors in intracranial aneurysms (IAs), but their prevalence, distribution, and associations with clinical factors as well as their causes and effects on aneurysm vulnerability remain unclear. METHODS A total of 122 blebs in 270 IAs selected for surgery were studied using patient-specific vascular reconstructions from 3D angiographic images. Bleb geometry, location on the aneurysm, and frequency of occurrence in aneurysms at different locations were analyzed. Associations between gender, age, smoking, hypertension, hormone therapy, dental infection, and presence of blebs were investigated. RESULTS Of all aneurysms with blebs, 77% had a single bleb and 23% had multiple blebs. Only 6% of blebs were at the neck, while 46% were in the body and 48% in the dome. Aneurysms with blebs were larger (p<0.0001), more elongated (p=0.0002), and with wider necks than aneurysms without blebs. Bleb presence was associated with dental infection (p=0.0426) and negatively associated with hormone therapy (p=0.0426) in women. Anterior and posterior communicating arteries had larger percentages of aneurysms with blebs than internal carotid arteries. Patients with a history of hypertension tended to have a larger percentage of aneurysms with blebs. However, these trends did not reach significance in this sample. CONCLUSIONS Blebs are common in IAs, and most aneurysms harboring blebs have a single bleb. Blebs in the aneurysm neck are rare, but they are equally common in the body and dome. The presence of blebs in IAs was associated with dental infection, and negatively associated with hormone replacement therapy.
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Affiliation(s)
| | - Felicitas J Detmer
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Fernando Mut
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA
| | - Bong Jae Chung
- Department of Mathematical Sciences, Montclair State University, Montclair, New Jersey, USA
| | - Alexander K Yu
- Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | | | - Alfred P See
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Behnam Rezai Jahromi
- Neurosurgery Research Group, Biomedicum Helsinki, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Mika Niemelä
- Neurosurgery Research Group, Biomedicum Helsinki, University of Helsinki, Helsinki, Uusimaa, Finland
| | - Juhana Frösen
- Department of Neurosurgery, University of Tampere, Tampere, Pirkanmaa, Finland.,Department of Neurosurgery, Tampere University Hospital, Tampere, Finland
| | - Ji Zhou
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Spandan Maiti
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Anne M Robertson
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Juan R Cebral
- Department of Bioengineering, George Mason University, Fairfax, Virginia, USA.,Department of Mechanical Engineering, George Mason University, Fairfax, Virginia, USA
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25
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Järvelin P, Wright R, Pekonen H, Keränen S, Rauramaa T, Frösen J. Histopathology of brain AVMs part I: microhemorrhages and changes in the nidal vessels. Acta Neurochir (Wien) 2020; 162:1735-1740. [PMID: 32399691 PMCID: PMC7295831 DOI: 10.1007/s00701-020-04391-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/30/2020] [Indexed: 02/04/2023]
Abstract
Background Arteriovenous malformations of the brain (bAVM) may rupture from aneurysms or ectasias of the feeding, draining, or nidal vessels. Moreover, they may rupture from the immature, fragile nidal vessels that are characteristic to bAVMs. How the histopathological changes of the nidal vessels associate with clinical presentation and hemorrhage of the lesion is not well known. Materials and methods We investigated tissue samples from surgically treated bAVMs (n = 85) using standard histological and immunohistochemical stainings. Histological features were compared with the clinical presentation of the patient. Results Microhemorrhages from nidal vessels were found both in bAVMs with a history of clinically evident rupture and in bAVMs considered unruptured. These microhemorrhages were associated with presence of immature, pathological nidal vessels (p = 0.010) and perivascular inflammation of these vessels (p = 0.001), especially with adhesion of neutrophils (p < 0.001). In multivariate analysis, perivascular inflammation (OR = 19, 95% CI 1.6 to 230), neutrophil infiltration of the vessel wall (OR = 13, 95% CI 1.9 to 94), and rupture status (OR = 0.13, 95% CI 0.017 to 0.92) were significantly associated with microhemorrhages. Conclusions Clinically silent microhemorrhages from nidal vessels seem to be very common in bAVMs, and associate with perivascular inflammation and neutrophil infiltration. Further studies on the role of perivascular inflammation in the clinical course of bAVMs are indicated. Electronic supplementary material The online version of this article (10.1007/s00701-020-04391-w) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Patrik Järvelin
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Roosa Wright
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Henri Pekonen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Sara Keränen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Dept of Molecular Medicine, AIV-Institute, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Rauramaa
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Dept of Pathology, Kuopio University Hospital, Kuopio, Finland
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
- Dept of Molecular Medicine, AIV-Institute, University of Eastern Finland, Kuopio, Finland.
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland.
- Dept of Neurosurgery, Tampere University Hospital, Teiskontie 35, PO Box 33521, Tampere, Finland.
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Wright R, Järvelin P, Pekonen H, Keränen S, Rauramaa T, Frösen J. Histopathology of brain AVMs part II: inflammation in arteriovenous malformation of the brain. Acta Neurochir (Wien) 2020; 162:1741-1747. [PMID: 32306161 PMCID: PMC7295713 DOI: 10.1007/s00701-020-04328-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/04/2020] [Indexed: 12/22/2022]
Abstract
Background Hemorrhage from an arteriovenous malformation of the brain (bAVM) has been associated with focal inflammation of the bAVM. Intrigued by the possibility of anti-inflammatory drug therapy to stabilize bAVMs and prevent hemorrhage, we investigated the association of bAVM inflammation with other histological features and clinical presentation. Materials and methods Tissue samples from 85 surgically treated bAVMs were studied with histology and CD45 immunostainings. The histological data was compared with the clinical history of the patient. Univariate analysis and logistic regression were performed. Results Inflammation was found in all studied bAVMs and did not associate with rupture (p = 0.442). While multiple types of inflammatory cells were present, macrophages were clearly the dominant inflammatory cell type, especially in samples with strong inflammation (87% of the samples). Of those bAVMs that had strong inflammation, only 56% had presented with clinically evident rupture. However, hemosiderin which is a sign of prior hemorrhage was detected in 78.4% (58/74) of samples with strong inflammation and was associated with it (p = 0.003). Inflammation in the nidus and parenchyma was associated with perivascular inflammation (p < 0.001). Multivariate analysis did not reveal any independent histological or clinical risk factor for inflammation. Conclusions Since strong inflammation is present in both unruptured and ruptured bAVMs, it is not just a reaction to rupture. Our observations suggest that inflammation of the bAVM may indeed predispose to fragility and hemorrhage of the nidal vessels. Further studies in the role of inflammation in the untreated clinical course of bAVMs are indicated. Electronic supplementary material The online version of this article (10.1007/s00701-020-04328-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roosa Wright
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Patrik Järvelin
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Henri Pekonen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Sara Keränen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- AIV-Institute, University of Eastern Finland, Kuopio, Finland
| | - Tuomas Rauramaa
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Department of Pathology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.
- AIV-Institute, University of Eastern Finland, Kuopio, Finland.
- Hemorrhagic Brain Pathology Research Group, University of Tampere, Tampere, Finland.
- Department of Neurosurgery, Tampere University Hospital, Teiskontie 35, PoBox 33521, Tampere, Finland.
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Hackenberg KAM, Algra A, Salman RAS, Frösen J, Hasan D, Juvela S, Langer D, Meyers P, Morita A, Rinkel G, Etminan N. Definition and Prioritization of Data Elements for Cohort Studies and Clinical Trials on Patients with Unruptured Intracranial Aneurysms: Proposal of a Multidisciplinary Research Group. Neurocrit Care 2020; 30:87-101. [PMID: 31102238 DOI: 10.1007/s12028-019-00729-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Variability in usage and definition of data characteristics in previous cohort studies on unruptured intracranial aneurysms (UIA) complicated pooling and proper interpretation of these data. The aim of the National Institute of Health/National Institute of Neurological Disorders and Stroke UIA and Subarachnoid Hemorrhage (SAH) Common Data Elements (CDE) Project was to provide a common structure for data collection in future research on UIA and SAH. METHODS This paper describes the development and summarization of the recommendations of the working groups (WGs) on UIAs, which consisted of an international and multidisciplinary panel of cerebrovascular specialists on research and treatment of UIAs. Consensus recommendations were developed by review of previously published CDEs for other neurological diseases and the literature on UIAs. Recommendations for CDEs were classified by priority into 'Core,' 'Supplemental-Highly Recommended,' 'Supplemental,' and 'Exploratory.' RESULTS Ninety-one CDEs were compiled; 69 were newly created and 22 were existing CDEs. The CDEs were assigned to eight subcategories and were classified as Core (8), Supplemental-Highly Recommended (23), Supplemental (25), and Exploratory (35) elements. Additionally, the WG developed and agreed on a classification for aneurysm morphology. CONCLUSION The proposed CDEs have been distilled from a broad pool of characteristics, measures, or outcomes. The usage of these CDEs will facilitate pooling of data from cohort studies or clinical trials on patients with UIAs.
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Affiliation(s)
- Katharina A M Hackenberg
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Ale Algra
- Brain Center Rudolph Magnus, Department of Neurology and Neurosurgery, and the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rustam Al-Shahi Salman
- Centre for Clinical Brain Sciences, University of Edinburgh, Chancellor's Building, Edinburgh, UK
| | - Juhana Frösen
- Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - David Hasan
- Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Seppo Juvela
- Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - David Langer
- Department of Neurosurgery, Hofstra Northwell School of Medicine, and Northwell Health, Lenox-Hill Hospital, New York, NY, USA
| | - Philip Meyers
- Departments of Neurosurgery and Radiology, Columbia University Medical Center, New York, NY, USA
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Gabriel Rinkel
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Nima Etminan
- Department of Neurosurgery, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany
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Morel S, Karol A, Graf V, Pelli G, Richter H, Sutter E, Braunersreuther V, Frösen J, Bijlenga P, Kwak BR, Nuss KM. Sex-related differences in wall remodeling and intraluminal thrombus resolution in a rat saccular aneurysm model. J Neurosurg 2019; 134:58-71. [PMID: 31881533 DOI: 10.3171/2019.9.jns191466] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 09/24/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intracranial aneurysms (IAs) are more often diagnosed in women. Hormones and vessel geometry, which influences wall shear stress, may affect pathophysiological processes of the arterial wall. Here, the authors investigated sex-related differences in the remodeling of the aneurysm wall and in intraluminal thrombus resolution. METHODS A well-characterized surgical side-wall aneurysm model was used in female, male, and ovariectomized rats. Decellularized grafts were used to model highly degenerated and decellularized IA walls and native grafts to model healthy IA walls. Aneurysm growth and thrombus composition were analyzed at 1, 7, 14, and 28 days. Sex-related differences in vessel wall remodeling were compared with human IA dome samples of men and pre- and postmenopausal women. RESULTS At 28 days, more aneurysm growth was observed in ovariectomized rats than in males or non-ovariectomized female rats. The parent artery size was larger in male rats than in female or ovariectomized rats, as expected. Wall inflammation increased over time in all groups and was most severe in the decellularized female and ovariectomized groups at 28 days compared with the male group. Likewise, in these groups the most elastin fragmentation was seen at 28 days. In female rats, on days 1, 7, and 14, the intraluminal thrombus was mainly composed of red blood cells and fibrin. On days 14 and 28, macrophage and smooth muscle cell invasion inside the thrombus was shown, leading to the removal of red blood cells and deposition of collagen and elastin. On days 14 and 28, similar profiles of thrombus reorganization were observed in male and ovariectomized female rats. However, collagen content in thrombi and vessel wall macrophage content were higher in aneurysms of male rats at 28 days than in those of female rats. On day 28, thrombus coverage by endothelial cells was lower in ovariectomized than in female or male rats. Finally, analysis of human IA domes showed that endothelial cell coverage was lower in men and postmenopausal women than in younger women. CONCLUSIONS Aneurysm growth and intraluminal thrombus resolution show sex-dependent differences. While certain processes (endothelial cell coverage and collagen deposition) point to a strong hormonal dependence, others (wall inflammation and aneurysm growth) seem to be influenced by both hormones and parent artery size.
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Affiliation(s)
- Sandrine Morel
- 1Department of Pathology and Immunology and
- 2Division of Neurosurgery, Department of Clinical Neurosciences, Faculty of Medicine, and
| | | | | | | | - Henning Richter
- 4Diagnostic Imaging Research Unit, Vetsuisse Faculty, University of Zürich, Switzerland; and
| | | | | | - Juhana Frösen
- 6Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Philippe Bijlenga
- 2Division of Neurosurgery, Department of Clinical Neurosciences, Faculty of Medicine, and
| | - Brenda R Kwak
- 1Department of Pathology and Immunology and
- 7Department of Medical Specializations-Cardiology, Faculty of Medicine, University of Geneva
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29
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Frösen J, Hallikainen J, Pyysalo M. Letter to the Editor. Periodontitis as a risk factor for formation, progression, and rupture of intracranial aneurysms. J Neurosurg 2019; 132:1305-1306. [PMID: 31585419 DOI: 10.3171/2019.5.jns191198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Juhana Frösen
- 1Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland.,2Tampere University Hospital, Tampere, Finland
| | - Joona Hallikainen
- 1Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland.,3University of Eastern Finland, Kuopio, Finland
| | - Mikko Pyysalo
- 3University of Eastern Finland, Kuopio, Finland.,4Oral Health Services, City of Tampere, Tampere, Finland
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30
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Räisänen S, Frösen J, Kurki MI, Huttunen T, Huttunen J, Koivisto T, Helin K, von Und Zu Fraunberg M, Jääskeläinen JE, Lindgren AE. Impact of Young Age on the Presentation of Saccular Intracranial Aneurysms: Population-Based Analysis of 4082 Patients. Neurosurgery 2019; 82:815-823. [PMID: 28605505 DOI: 10.1093/neuros/nyx305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 05/04/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Formation and rupture of saccular intracranial aneurysms (sIAs) may have different pathobiologies in patients with younger age at first diagnosis of sIA disease. OBJECTIVE To study the phenotype of sIA disease and formation of new (de novo) sIAs in patients below 40 yr. METHODS A population-based cohort study was conducted in 613 young (<40 yr) sIA patients with first diagnosis between 1980 and 2014 and total angiographic follow-up of 3768 yr. RESULTS Of the 613 sIA patients <40 yr, 508 had aneurysmal subarachnoid hemorrhage (sIA-SAH) and 105 unruptured sIA(s) at first sIA diagnosis. Hypertension was 2 times less common among <40 than >40-yr-old patients (unruptured and ruptured). Smoking was very prevalent in <40-yr-old patients (33% in SAH, 68% unruptured). SAH patients <40 yr more often had family history of sIA, and lower PHASES scores (age omitted, P < .001). Ruptured sIAs were small (<7 mm) in 33% of 39 to 30 yr patients, in 44% of 29 to 20 yr patients, and 57% of <19 yr patients. Their shape was irregular in 90%, 94%, and 95%, respectively. Smoking history (hazard ratio [HR] 2.8, 95% confidence interval [CI] 1.2-7.0), family history for sIAs (HR 3.1, 95% CI 1.3-7.7), and age at presentation (HR .91 per year, 95% CI .85-.98) were risk factors for de novo sIA formation, diagnosed in 4% even after 20 yr (median 11.8 yr). CONCLUSION Smoking and family history are risk factors for sIA formation and aneurysmal SAH at young age. Young aneurysmal SAH patients had lower PHASES scores and often rupture from a small sIA, suggesting need for more aggressive management.
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Affiliation(s)
- Sari Räisänen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland
| | - Juhana Frösen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mitja I Kurki
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Terhi Huttunen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Jukka Huttunen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koivisto
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Katariina Helin
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mikael von Und Zu Fraunberg
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti E Lindgren
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland
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31
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Gade PS, Tulamo R, Lee KW, Mut F, Ollikainen E, Chuang CY, Jae Chung B, Niemelä M, Rezai Jahromi B, Aziz K, Yu A, Charbel FT, Amin-Hanjani S, Frösen J, Cebral JR, Robertson AM. Calcification in Human Intracranial Aneurysms Is Highly Prevalent and Displays Both Atherosclerotic and Nonatherosclerotic Types. Arterioscler Thromb Vasc Biol 2019; 39:2157-2167. [PMID: 31462093 PMCID: PMC6911659 DOI: 10.1161/atvbaha.119.312922] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although the clinical and biological importance of calcification is well recognized for the extracerebral vasculature, its role in cerebral vascular disease, particularly, intracranial aneurysms (IAs), remains poorly understood. Extracerebrally, 2 distinct mechanisms drive calcification, a nonatherosclerotic, rapid mineralization in the media and a slower, inflammation driven, atherosclerotic mechanism in the intima. This study aims to determine the prevalence, distribution, and type (atherosclerotic, nonatherosclerotic) of calcification in IAs and assess differences in occurrence between ruptured and unruptured IAs. Approach and Results: Sixty-five 65 IA specimens (48 unruptured, 17 ruptured) were resected perioperatively. Calcification and lipid pools were analyzed nondestructively in intact samples using high resolution (0.35 μm) microcomputed tomography. Calcification is highly prevalent (78%) appearing as micro (<500 µm), meso (500 µm-1 mm), and macro (>1 mm) calcifications. Calcification manifests in IAs as both nonatherosclerotic (calcification distinct from lipid pools) and atherosclerotic (calcification in the presence of lipid pools) with 3 wall types: Type I-only calcification, no lipid pools (20/51, 39%), Type II-calcification and lipid pools, not colocalized (19/51, 37%), Type III-calcification colocalized with lipid pools (12/51, 24%). Ruptured IAs either had no calcifications or had nonatherosclerotic micro- or meso-calcifications (Type I or II), without macro-calcifications. CONCLUSIONS Calcification in IAs is substantially more prevalent than previously reported and presents as both nonatherosclerotic and atherosclerotic types. Notably, ruptured aneurysms had only nonatherosclerotic calcification, had significantly lower calcification fraction, and did not contain macrocalcifications. Improved understanding of the role of calcification in IA pathology should lead to new therapeutic targets.
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Affiliation(s)
- Piyusha S Gade
- From the Department of Bioengineering (P.S.G., K.L., A.M.R.), University of Pittsburgh, PA
| | - Riikka Tulamo
- Department of Vascular Surgery (R.T.), Helsinki University Hospital, University of Helsinki, Finland
| | - Kee-Won Lee
- From the Department of Bioengineering (P.S.G., K.L., A.M.R.), University of Pittsburgh, PA
| | - Fernando Mut
- Department of Bioengineering, George Mason University, Fairfax, VA (F.M., J.R.C.)
| | - Eliisa Ollikainen
- Department of Mechanical Engineering and Materials Science (E.O., C.-Y.C., A.M.R.), University of Pittsburgh, PA.,Department of Neurosurgery (E.O., M.N., B.R.J.), Helsinki University Hospital, University of Helsinki, Finland
| | - Chih-Yuan Chuang
- Department of Mechanical Engineering and Materials Science (E.O., C.-Y.C., A.M.R.), University of Pittsburgh, PA
| | - Bong Jae Chung
- Department of Mathematical Sciences, Montclair State University, NJ (B.J.C.)
| | - Mika Niemelä
- Department of Neurosurgery (E.O., M.N., B.R.J.), Helsinki University Hospital, University of Helsinki, Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery (E.O., M.N., B.R.J.), Helsinki University Hospital, University of Helsinki, Finland
| | - Khaled Aziz
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA (K.A., A.Y.)
| | - Alexander Yu
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, PA (K.A., A.Y.)
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago (F.T.C., S.A.-H.)
| | | | - Juhana Frösen
- Department of Neurosurgery, Kuopio University Hospital, Finland (J.F.)
| | - Juan R Cebral
- Department of Bioengineering, George Mason University, Fairfax, VA (F.M., J.R.C.)
| | - Anne M Robertson
- From the Department of Bioengineering (P.S.G., K.L., A.M.R.), University of Pittsburgh, PA.,Department of Mechanical Engineering and Materials Science (E.O., C.-Y.C., A.M.R.), University of Pittsburgh, PA
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32
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Frösen J, Joutel A. Smooth muscle cells of intracranial vessels: from development to disease. Cardiovasc Res 2019; 114:501-512. [PMID: 29351598 DOI: 10.1093/cvr/cvy002] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/12/2018] [Indexed: 02/02/2023] Open
Abstract
Cerebrovascular diseases that cause ischaemic or haemorrhagic stroke with subsequent loss of life or functional capacity due to damage of the brain tissue are among the leading causes of human suffering and economic burden inflicted by diseases in the developed world. Diseases affecting intracranial vessels are significant contributors to ischaemic and haemorrhagic strokes. Brain arteriovenous malformations, which are a collection of abnormal blood vessels connecting arteries to veins, are the most common cause of intracranial haemorrhage in children and young adults. Saccular intracranial aneurysms, which are pathological saccular dilations mainly occurring at bifurcations of the large intracranial arteries near the circle of Willis, are highly prevalent in the middle-aged population, causing significant anxiety and concern; their rupture, although rare, is a significant cause of intracranial haemorrhage in those past middle age that is associated with a very sinister prognosis. Cerebral small-vessel disease, which comprise all pathological processes affecting vessels <500 microns in diameter, account for the majority of intracerebral haemorrhages and ∼25% of ischaemic strokes and 45% of dementias in the elderly. In this review, we summarize the developmental, structural, and functional features of intracranial vessels. We then describe the role of smooth muscle cells in brain arteriovenous malformations, intracranial aneurysms, and small-vessel diseases, and discuss how the peculiar ontogeny, structure, and function of intracranial vessels are related to the development of these diseases.
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Affiliation(s)
- Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio 70029, Finland.,Department of Neurosurgery, Kuopio University Hospital, Kuopio 70029, Finland
| | - Anne Joutel
- Genetics and Pathogenesis of Cerebrovascular Diseases, INSERM, Université Paris Diderot-Paris 7, 10 av de Verdun, Paris 75010, France.,DHU NeuroVasc, Sorbonne Paris Cité, Paris 75010, France
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33
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Ollikainen E, Tulamo R, Lehti S, Hernesniemi J, Niemelä M, Kovanen PT, Frösen J. Myeloperoxidase Associates With Degenerative Remodeling and Rupture of the Saccular Intracranial Aneurysm Wall. J Neuropathol Exp Neurol 2019; 77:461-468. [PMID: 29718300 DOI: 10.1093/jnen/nly028] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Rupture of a saccular intracranial aneurysm (sIA) is often fatal. Thus, early detection of rupture-prone sIAs is vital. Myeloperoxidase (MPO), derived mainly from neutrophils, associates with sIA rupture, and therefore its role in sIA pathogenesis warrants further studies. We analyzed MPO and its association with other histological markers in 36 (16 unruptured and 20 ruptured) sIA samples by immunohistochemistry. MPO was present in all studied sIAs, and its expression associated with wall inflammatory cell infiltrations (r = 0.50, 0.63, and 0.75, all p ≤ 0.002), degenerative remodeling (p = 0.002) and rupture (p = 0.003). MPO associated strongly with the presence of organized luminal thrombi (p < 0.001), which also stained positive for MPO. Polymorphonuclear MPO+ cells were detected in the sIA walls, indicating neutrophils as MPO-source. MPO correlated strongly with accumulation of oxidized lipids (r = 0.67, p < 0.001) and loss of smooth muscle cells (r = -0.68, p < 0.001), suggesting that MPO is a relevant source of oxidative stress leading to cell death in the sIA wall. Furthermore, MPO associated with erythrocyte fragmentation (r = 0.74, p < 0.001) and iron deposition (p = 0.041), 2 outcomes known to amplify MPO-dependent oxidative stress. Taken together, these results suggest that MPO associates with degenerative remodeling predisposing to sIA wall rupture and may serve as a biomarker of a rupture-prone sIA wall.
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Affiliation(s)
- Eliisa Ollikainen
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland.,Wihuri Research Institute, Biomedicum, Helsinki, Finland
| | - Riikka Tulamo
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland.,Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Finland
| | - Satu Lehti
- Wihuri Research Institute, Biomedicum, Helsinki, Finland
| | - Juha Hernesniemi
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland.,Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Department of Neurosurgery, Henan Province People's Hospital, Zhengzhou, China
| | - Mika Niemelä
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland.,Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Juhana Frösen
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland.,Department of Neurosurgery, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland
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34
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Prestigiacomo CJ, Gounis MJ, Gonzalez LF, Frösen J. Introduction. Formation, growth, and rupture: the biology and physics of cerebral aneurysms. Neurosurg Focus 2019; 47:E1. [PMID: 31261113 DOI: 10.3171/2019.4.focus19333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Matthew J Gounis
- 2Division of Neuroimaging and Intervention, and New England Center for Stroke Research, Department of Radiology, University of Massachusetts, Worcester, Massachusetts
| | | | - Juhana Frösen
- 4Department of Neurosurgery, Kuopio University, Kuopio, Finland
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35
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Frösen J, Frisk O, Raj R, Hernesniemi J, Tukiainen E, Barner-Rasmussen I. Outcome and rational management of civilian gunshot injuries to the brain-retrospective analysis of patients treated at the Helsinki University Hospital from 2000 to 2012. Acta Neurochir (Wien) 2019; 161:1285-1295. [PMID: 31129782 PMCID: PMC6581925 DOI: 10.1007/s00701-019-03952-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 05/08/2019] [Indexed: 11/25/2022]
Abstract
Background Treatment of gunshot wounds of the brain (GSWB) remains controversial and there is high variation in reported survival rates (from < 10 to > 90%) depending on the etiology and country. We retrospectively analyzed the outcome of a series of consecutive GSWB patients admitted alive to a level 1 trauma center in a safe high-income welfare country with a low rate of homicidal gun violence. Methods Patients admitted due to a GSWB to the HUS Helsinki University Hospital during 2000–2012 were identified from hospital discharge registry and log books of the emergency room and ICU. CT scans and medical records of these patients were reviewed. Univariate analysis and backward logistic regression were performed, and their results compared with that of a systematic literature review of factors related to the outcome of GSWB patients. Results Sixty-four patients admitted alive after GSWB were identified. Eighty percent had self-inflicted GSWB, 81% were contact shots, and 70% were caused by handguns. In-hospital mortality was 72%. Factors associated with mortality in our series were low GCS (≤ 8) at admission, transventricular bullet trajectory, and associated damage to deep brain structures, as reported before in the literature. Of the 64 patients admitted alive, 42% (27/64) were admitted to ICU, 34% (22/64) underwent surgery, and in 25% (16/64), craniotomy and hematoma evacuation was performed. Mortality in the surgically treated group was 32% but near 100% without surgery and ICU treatment. Median GOS in the surgically treated patients was 3 (range 1–5). Conclusions GSWB caused by contact shot from handguns has a high mortality rate, but can be survived with reasonable outcome if limited to lobar injury without significant damage to deep brain structures or brain stem. In such GSWB patients, initial aggressive resuscitation, ICU admission, and surgery seem indicated. Electronic supplementary material The online version of this article (10.1007/s00701-019-03952-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Juhana Frösen
- Department of Neurosurgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
| | - Oskari Frisk
- Department of Plastic Surgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Hernesniemi
- Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
| | - Erkki Tukiainen
- Department of Plastic Surgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ian Barner-Rasmussen
- Department of Plastic Surgery, HUS Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Frösen J, Hallikainen J, Pyysalo M, Koivisto T, Lindgren A. Letter by Frösen et al Regarding Article "Potential Influences of Gut Microbiota on the Formation of Intracranial Aneurysm". Hypertension 2019; 74:e22-e23. [PMID: 31230537 DOI: 10.1161/hypertensionaha.119.13253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland
| | - Joona Hallikainen
- Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland
| | - Mikko Pyysalo
- City of Tampere Oral Health Services, Tampere, Finland
| | - Timo Koivisto
- Dept of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
| | - Antti Lindgren
- Dept of Neurosurgery, Kuopio University Hospital, Kuopio, Finland
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Hallikainen J, Lindgren A, Savolainen J, Selander T, Jula A, Närhi M, Koivisto T, Kellokoski J, Ylöstalo P, Suominen AL, Frösen J. Periodontitis and gingival bleeding associate with intracranial aneurysms and risk of aneurysmal subarachnoid hemorrhage. Neurosurg Rev 2019; 43:669-679. [PMID: 30972514 PMCID: PMC7186244 DOI: 10.1007/s10143-019-01097-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/13/2019] [Accepted: 03/19/2019] [Indexed: 12/20/2022]
Abstract
Oral bacteria DNA has been found in intracranial aneurysms (IA) and a high prevalence of periodontitis was reported in IA patients. We investigated whether periodontitis associates with IA formation and aneurysmal subarachnoid hemorrhage (aSAH). First, we compared in a case-control setting the prevalence of periodontal disease in IA patients (42 unruptured IA, 34 ruptured IA) and in age- and gender-matched controls (n = 70) from the same geographical area (Health 2000 Survey, BRIF8901). Next, we investigated whether periodontitis at baseline associated with aSAH in a 13-year follow-up study of 5170 Health 2000 Survey participants. Follow-up data was obtained from national hospital discharge and cause of death registries. Univariate analysis, logistic regression, and Cox-regression were used. Periodontitis (≥ 4mm gingival pocket) and severe periodontitis (≥ 6mm gingival pocket) were found in 92% and 49% of IA patients respectively and associated with IAs (OR 5.3, 95%CI 1.1–25.9, p < 0.000 and OR 6.3, 95%CI 1.3–31.4, p < 0.001, respectively). Gingival bleeding had an even stronger association, especially if detected in 4–6 teeth sextants (OR 34.4, 95%CI 4.2–281.3). Severe periodontitis in ≥ 3 teeth or gingival bleeding in 4–6 teeth sextants at baseline increased the risk of aSAH during follow-up (HR 22.5, 95%CI 3.6–139.5, p = 0.001 and HR 8.3, 95%CI 1.5–46.1, p = 0.015, respectively). Association of periodontitis and gingival bleeding with risk of IA development and aSAH was independent of gender, smoking status, hypertension, or alcohol abuse. Periodontitis and gingival bleeding associate with increased risk for IA formation and eventual aSAH. Further epidemiological and mechanistic studies are indicated.
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Affiliation(s)
- Joona Hallikainen
- Department of Dentistry, University of Eastern Finland, Kuopio, Finland.,Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland
| | - Antti Lindgren
- Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland.,Department of Neurosurgery, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Jarno Savolainen
- Department of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - Tuomas Selander
- Science Service Center, Kuopio University Hospital, Kuopio, Finland
| | - Antti Jula
- National Institute for Health and Welfare, Helsinki, Finland
| | - Matti Närhi
- Department of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Biomedicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Department of Neurosurgery, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Jari Kellokoski
- Department of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
| | - Pekka Ylöstalo
- Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
| | - Anna Liisa Suominen
- Department of Dentistry, University of Eastern Finland, Kuopio, Finland.,Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland.,National Institute for Health and Welfare, Helsinki, Finland
| | - Juhana Frösen
- Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland. .,Department of Neurosurgery, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland.
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38
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Cebral JR, Detmer F, Chung BJ, Choque-Velasquez J, Rezai B, Lehto H, Tulamo R, Hernesniemi J, Niemela M, Yu A, Williamson R, Aziz K, Shakur S, Amin-Hanjani S, Charbel F, Tobe Y, Robertson A, Frösen J. Local Hemodynamic Conditions Associated with Focal Changes in the Intracranial Aneurysm Wall. AJNR Am J Neuroradiol 2019; 40:510-516. [PMID: 30733253 DOI: 10.3174/ajnr.a5970] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/25/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Aneurysm hemodynamics has been associated with wall histology and inflammation. We investigated associations between local hemodynamics and focal wall changes visible intraoperatively. MATERIALS AND METHODS Computational fluid dynamics models were constructed from 3D images of 65 aneurysms treated surgically. Aneurysm regions with different visual appearances were identified in intraoperative videos: 1) "atherosclerotic" (yellow), 2) "hyperplastic" (white), 3) "thin" (red), 4) rupture site, and 5) "normal" (similar to parent artery), They were marked on 3D reconstructions. Regional hemodynamics was characterized by the following: wall shear stress, oscillatory shear index, relative residence time, wall shear stress gradient and divergence, gradient oscillatory number, and dynamic pressure; these were compared using the Mann-Whitney test. RESULTS Hyperplastic regions had lower average wall shear stress (P = .005) and pressure (P = .009) than normal regions. Flow conditions in atherosclerotic and hyperplastic regions were similar but had higher average relative residence time (P = .03) and oscillatory shear index (P = .04) than thin regions. Hyperplastic regions also had a higher average gradient oscillatory number (P = .002) than thin regions. Thin regions had lower average relative residence time (P < .001), oscillatory shear index (P = .006), and gradient oscillatory number (P < .001) than normal regions, and higher average wall shear stress (P = .006) and pressure (P = .009) than hyperplastic regions. Thin regions tended to be aligned with the flow stream, while atherosclerotic and hyperplastic regions tended to be aligned with recirculation zones. CONCLUSIONS Local hemodynamics is associated with visible focal wall changes. Slow swirling flow with low and oscillatory wall shear stress was associated with atherosclerotic and hyperplastic changes. High flow conditions prevalent in regions near the flow impingement site characterized by higher and less oscillatory wall shear stress were associated with local "thinning" of the wall.
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Affiliation(s)
- J R Cebral
- From the Department of Bioengineering (J.R.C., F.D., B.J.C.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - F Detmer
- From the Department of Bioengineering (J.R.C., F.D., B.J.C.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - B J Chung
- From the Department of Bioengineering (J.R.C., F.D., B.J.C.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - J Choque-Velasquez
- Neurosurgery Research Group (J.C.-V., B.R., H.L., R.T., J.H., M.N.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - B Rezai
- Neurosurgery Research Group (J.C.-V., B.R., H.L., R.T., J.H., M.N.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - H Lehto
- Neurosurgery Research Group (J.C.-V., B.R., H.L., R.T., J.H., M.N.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - R Tulamo
- Neurosurgery Research Group (J.C.-V., B.R., H.L., R.T., J.H., M.N.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Department of Vascular Surgery (R.T.), Helsinki University Central Hospital, Helsinki, Finland
| | - J Hernesniemi
- Neurosurgery Research Group (J.C.-V., B.R., H.L., R.T., J.H., M.N.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - M Niemela
- Neurosurgery Research Group (J.C.-V., B.R., H.L., R.T., J.H., M.N.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - A Yu
- Department of Neurosurgery (A.Y., R.W., K.A.), Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - R Williamson
- Department of Neurosurgery (A.Y., R.W., K.A.), Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - K Aziz
- Department of Neurosurgery (A.Y., R.W., K.A.), Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - S Shakur
- Department of Neurosurgery (S.S., S.A.-H., F.C.), University of Illinois at Chicago, Chicago, Illinois
| | - S Amin-Hanjani
- Department of Neurosurgery (S.S., S.A.-H., F.C.), University of Illinois at Chicago, Chicago, Illinois
| | - F Charbel
- Department of Neurosurgery (S.S., S.A.-H., F.C.), University of Illinois at Chicago, Chicago, Illinois
| | - Y Tobe
- Mechanical Engineering and Materials Science and Department of Bioengineering (Y.T., A.R.), Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - A Robertson
- Mechanical Engineering and Materials Science and Department of Bioengineering (Y.T., A.R.), Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - J Frösen
- Hemorrhagic Brain Pathology Research Group (J.F.), Neurocenter, Kuopio University Hospital, Kuopio, Finland
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Tulamo R, Frösen J, Hernesniemi J, Niemelä M. Inflammatory changes in the aneurysm wall: a review. J Neurointerv Surg 2018; 10:i58-i67. [DOI: 10.1136/jnis.2009.002055.rep] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/17/2009] [Accepted: 12/18/2009] [Indexed: 02/06/2023]
Abstract
Rupture of a saccular intracranial artery aneurysm (IA) causes subarachnoid hemorrhage, a significant cause of stroke and death. The current treatment options, endovascular coiling and clipping, are invasive and somewhat risky. Since only some IAs rupture, those IAs at risk for rupture should be identified. However, to improve the imaging of rupture-prone IAs and improve IA treatment, IA wall pathobiology requires more thorough knowledge. Chronic inflammation has become understood as an important phenomenon in IA wall pathobiology, featuring inflammatory cell infiltration as well as proliferative and fibrotic remodulatory responses. We review the literature on what is known about inflammation in the IA wall and also review the probable mechanisms of how inflammation would result in the degenerative changes that ultimately lead to IA wall rupture. We also discuss current options in imaging inflammation and how knowledge of inflammation in IA walls may improve IA treatment.
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40
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Ollikainen E, Tulamo R, Kaitainen S, Honkanen P, Lehti S, Liimatainen T, Hernesniemi J, Niemelä M, Kovanen PT, Frösen J. Macrophage Infiltration in the Saccular Intracranial Aneurysm Wall as a Response to Locally Lysed Erythrocytes That Promote Degeneration. J Neuropathol Exp Neurol 2018; 77:890-903. [DOI: 10.1093/jnen/nly068] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Eliisa Ollikainen
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland
- Wihuri Research Institute, Biomedicum, Helsinki, Finland
| | - Riikka Tulamo
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland
- Department of Vascular Surgery, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | - Petri Honkanen
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland
| | - Satu Lehti
- Wihuri Research Institute, Biomedicum, Helsinki, Finland
| | - Timo Liimatainen
- Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Juha Hernesniemi
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland
- Department of Neurosurgery, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
- Department of Neurosurgery, Henan Province People's Hospital, Zhengzhou, China
| | - Mika Niemelä
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland
- Department of Neurosurgery, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | - Juhana Frösen
- Neurosurgery Research Group, Biomedicum, Helsinki, Finland
- Department of Neurosurgery
- Hemorrhagic Brain Pathology Research Group
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Björkman J, Frösen J, Tähtinen O, Huttunen T, Huttunen J, Kurki MI, von und zu Fraunberg M, Koivisto T, Manninen H, Jääskeläinen JE, Lindgren AE. Aneurysm Size is the Strongest Risk Factor for Intracranial Aneurysm Growth in the Eastern Finnish Population. Neurosurgery 2018; 84:1098-1103. [DOI: 10.1093/neuros/nyy161] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 04/04/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Saccular intracranial aneurysm (sIA) growth during follow-up is associated with high risk for subsequent rupture. Finnish patients have been suggested to have higher risk for subarachnoid hemorrhage, but follow-up studies of sIA growth in the Finnish population are scarce.
OBJECTIVE
To identify the strongest risk factors for sIA growth in Eastern Finnish population by studying 205 patients with 350 unruptured sIAs with angiographic follow-up imaging.
METHODS
In this population-based cohort study, we included unruptured sIA patients from the Kuopio University Hospital Intracranial Aneurysm Patient and Family database with at least 6 mo of angiographic follow-up after the diagnosis of sIAs. Angiograms were re-evaluated to detect aneurysms with growth of at least 1.0 mm. Cox regression analysis with patient- and aneurysm-related risk factors was used to calculate hazard ratios with 95% confidence intervals for growth. In addition, we tested the diagnostic value of previously introduced PHASES score for the prediction of sIA growth in Eastern Finnish population.
RESULTS
Of the 350 unruptured aneurysms, 36 (10.3%) showed growth during median follow-up of 1.7 yr and total follow-up of 790 yr. In the multivariate Cox regression analysis, sIA size and location in the middle cerebral artery were significant risk factors for sIA growth. In receiver operator characteristic curves, both PHASES score and sIA size had relatively low areas under the curve.
CONCLUSION
Our study indicates that aneurysm size is the strongest risk factor for aneurysm growth in Eastern Finnish population. Further studies are required to identify new risk factors for aneurysm growth.
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Affiliation(s)
- Joel Björkman
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Juhana Frösen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Olli Tähtinen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Terhi Huttunen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Jukka Huttunen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mitja I Kurki
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Mikael von und zu Fraunberg
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Timo Koivisto
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Hannu Manninen
- Department of Radiology, Kuopio University Hospital, Kuopio, Finland
- Radiology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juha E Jääskeläinen
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti E Lindgren
- Neurosurgery of NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Hemorrhagic Brain Pathology Research Group, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
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Nikolaev SI, Vetiska S, Bonilla X, Boudreau E, Jauhiainen S, Rezai Jahromi B, Khyzha N, DiStefano PV, Suutarinen S, Kiehl TR, Mendes Pereira V, Herman AM, Krings T, Andrade-Barazarte H, Tung T, Valiante T, Zadeh G, Tymianski M, Rauramaa T, Ylä-Herttuala S, Wythe JD, Antonarakis SE, Frösen J, Fish JE, Radovanovic I. Somatic Activating KRAS Mutations in Arteriovenous Malformations of the Brain. N Engl J Med 2018; 378:250-261. [PMID: 29298116 PMCID: PMC8161530 DOI: 10.1056/nejmoa1709449] [Citation(s) in RCA: 277] [Impact Index Per Article: 46.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Sporadic arteriovenous malformations of the brain, which are morphologically abnormal connections between arteries and veins in the brain vasculature, are a leading cause of hemorrhagic stroke in young adults and children. The genetic cause of this rare focal disorder is unknown. METHODS We analyzed tissue and blood samples from patients with arteriovenous malformations of the brain to detect somatic mutations. We performed exome DNA sequencing of tissue samples of arteriovenous malformations of the brain from 26 patients in the main study group and of paired blood samples from 17 of those patients. To confirm our findings, we performed droplet digital polymerase-chain-reaction (PCR) analysis of tissue samples from 39 patients in the main study group (21 with matching blood samples) and from 33 patients in an independent validation group. We interrogated the downstream signaling pathways, changes in gene expression, and cellular phenotype that were induced by activating KRAS mutations, which we had discovered in tissue samples. RESULTS We detected somatic activating KRAS mutations in tissue samples from 45 of the 72 patients and in none of the 21 paired blood samples. In endothelial cell-enriched cultures derived from arteriovenous malformations of the brain, we detected KRAS mutations and observed that expression of mutant KRAS (KRASG12V) in endothelial cells in vitro induced increased ERK (extracellular signal-regulated kinase) activity, increased expression of genes related to angiogenesis and Notch signaling, and enhanced migratory behavior. These processes were reversed by inhibition of MAPK (mitogen-activated protein kinase)-ERK signaling. CONCLUSIONS We identified activating KRAS mutations in the majority of tissue samples of arteriovenous malformations of the brain that we analyzed. We propose that these malformations develop as a result of KRAS-induced activation of the MAPK-ERK signaling pathway in brain endothelial cells. (Funded by the Swiss Cancer League and others.).
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Affiliation(s)
- Sergey I Nikolaev
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Sandra Vetiska
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Ximena Bonilla
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Emilie Boudreau
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Suvi Jauhiainen
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Behnam Rezai Jahromi
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Nadiya Khyzha
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Peter V DiStefano
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Santeri Suutarinen
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Tim-Rasmus Kiehl
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Vitor Mendes Pereira
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Alexander M Herman
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Timo Krings
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Hugo Andrade-Barazarte
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Takyee Tung
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Taufik Valiante
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Gelareh Zadeh
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Mike Tymianski
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Tuomas Rauramaa
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Seppo Ylä-Herttuala
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Joshua D Wythe
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Stylianos E Antonarakis
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Juhana Frösen
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Jason E Fish
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
| | - Ivan Radovanovic
- From the Department of Genetic Medicine and Development, University of Geneva Medical School (S.I.N., X.B., S.E.A.), Service of Genetic Medicine, University Hospitals of Geneva (S.I.N., S.E.A.), and iGE3, Institute of Genetics and Genomics of Geneva (S.E.A.) - all in Geneva; the Department of Fundamental Neurobiology, Krembil Research Institute (S.V., M.T., I.R.), Toronto General Hospital Research Institute (E.B., N.K., P.V.D., J.E.F.), the Department of Pathology (T.-R.K.), the Division of Neurosurgery, Department of Surgery (V.M.P., T.K., H.A.-B., T.T., T.V., G.Z., M.T., I.R.), and the Joint Division of Medical Imaging, Department of Medical Imaging (V.M.P., T.K.), Toronto Western Hospital, University Health Network, the Department of Laboratory Medicine and Pathobiology, University of Toronto (E.B., N.K., P.V.D., T.-R.K., J.E.F.), and the Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research (E.B., N.K., P.V.D., J.E.F.) - all in Toronto; the Department of Molecular Medicine, AIV Institute, University of Eastern Finland (S.J., B.R.J., S.S., S.Y.-H., J.F.), and the Hemorrhagic Brain Pathology Research Group, Department of Neurosurgery and NeuroCenter (S.J., B.R.J., S.S., T.R., J.F.), and the Department of Pathology (T.R.), Kuopio University Hospital - all in Kuopio, Finland; and the Cardiovascular Research Institute and the Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston (A.M.H., J.D.W.)
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Huttunen J, Lindgren A, Kurki MI, Huttunen T, Frösen J, Koivisto T, von Und Zu Fraunberg M, Immonen A, Jääskeläinen JE, Kälviäinen R. Epilepsy-associated long-term mortality after aneurysmal subarachnoid hemorrhage. Neurology 2017; 89:263-268. [PMID: 28615425 PMCID: PMC5513818 DOI: 10.1212/wnl.0000000000004113] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/24/2017] [Indexed: 11/25/2022] Open
Abstract
Objective: To elucidate the epilepsy-associated causes of death and subsequent excess long-term mortality among 12-month survivors of subarachnoid hemorrhage from saccular intracranial aneurysm (SIA-SAH). Methods: The Kuopio SIA Database (kuopioneurosurgery.fi) includes all SIA-SAH patients admitted to the Kuopio University Hospital from its defined catchment population in Eastern Finland. The study cohort consists of 779 patients, admitted from 1995 to 2007, who were alive at 12 months after SIA-SAH. Their use of reimbursable antiepileptic drugs and the causes of death (ICD-10) were fused from the Finnish national registries from 1994 to 2014. Results: The 779 12-month survivors were followed up until death (n = 197) or December 31, 2014, a median of 12.0 years after SIA-SAH. Epilepsy had been diagnosed in 121 (15%) patients after SIA-SAH, and 34/121 (28%) had died at the end of follow-up, with epilepsy as the immediate cause of death in 7/34 (21%). In the 779 patients alive at 12 months after SIA-SAH, epilepsy was an independent risk factor for mortality (hazard ratio 1.8, 95% confidence interval 1.1–3.0). Conclusions: Comorbid epilepsy in 12-month survivors of SIA-SAH is associated with increased risk of death in long-term follow-up. Survivors of SIA-SAH require long-term dedicated follow-up, including identification and effective treatment of comorbid epilepsy to prevent avoidable deaths.
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Affiliation(s)
- Jukka Huttunen
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio.
| | - Antti Lindgren
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Mitja I Kurki
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Terhi Huttunen
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Juhana Frösen
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Timo Koivisto
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Mikael von Und Zu Fraunberg
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Arto Immonen
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Juha E Jääskeläinen
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
| | - Reetta Kälviäinen
- From Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., T.K., M.v.u.z.F., A.I., J.E.J.) and Neurology (R.K.), KUH NeuroCenter, Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio
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Kurtelius A, Kallionpää RA, Huttunen J, Huttunen TJ, Helin K, Koivisto T, Frösen J, von und zu Fraunberg M, Peltonen S, Peltonen J, Jääskeläinen JE, Lindgren AE. Neurofibromatosis type 1 is not associated with subarachnoid haemorrhage. PLoS One 2017; 12:e0178711. [PMID: 28575128 PMCID: PMC5456355 DOI: 10.1371/journal.pone.0178711] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The prevalence of intracranial aneurysms (IAs) has been proposed to be elevated in the patients with neurofibromatosis type 1 (NF1). Our aims were to determine the prevalence of NF1 in a large Finnish population based cohort of IA patients and, on the other hand, the occurrences of subarachnoid haemorrhage and unruptured intracranial aneurysms in a nationwide population-based cohort of NF1 patients and its matched ten-fold control cohort. METHODS The Kuopio IA Database (www.kuopioneurosurgery.fi) includes all ruptured and unruptured IA cases admitted to the Kuopio University Hospital (KUH) from its defined Eastern Finnish catchment population since 1980. In this registry-based study, we cross-linked the Kuopio IA database with the Finnish national registry covering all hospital diagnoses. The NF1 diagnoses of the 4543 patients with either saccular of fusiform IA were identified from 1969 to 2015 and verified from patient records. Our second approach was to analyze the occurrence of aneurysmal subarachnoid haemorrhage (aSAH) and unruptured IAs in a nationwide population-based database of 1410 NF1 patients and its ten-fold matched control cohort (n = 14030) using national registry of hospital diagnoses between 1987 and 2014. RESULTS One NF1 patient was identified among the 4543 IA patients. Three verified IA cases (one unruptured IA and two aSAH cases) were identified in the cohort of 1410 NF1 patients, with similar occurrences in the control cohort. CONCLUSIONS We found no evidence in our population-based cohorts to support the conception that NF1 is associated with IAs. Our results indicate that the incidence of aSAH is not elevated in patients with NF1. Further studies are required to confirm that there is no association between NF1 and unruptured IAs.
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Affiliation(s)
- Arttu Kurtelius
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Roope A. Kallionpää
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Jukka Huttunen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Terhi J. Huttunen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Katariina Helin
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
| | - Timo Koivisto
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Juhana Frösen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Mikael von und zu Fraunberg
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sirkku Peltonen
- Department of Dermatology, University of Turku and Turku University Hospital, Turku, Finland
| | - Juha Peltonen
- Department of Cell Biology and Anatomy, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Juha E. Jääskeläinen
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Antti E. Lindgren
- Neurosurgery, NeuroCenter, Kuopio University Hospital, Kuopio, Finland
- Neurosurgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- * E-mail:
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Björkman J, Frösen J, Tähtinen O, Backes D, Huttunen T, Harju J, Huttunen J, Kurki MI, von Und Zu Fraunberg M, Koivisto T, Manninen H, Jääskeläinen JE, Lindgren AE. Irregular Shape Identifies Ruptured Intracranial Aneurysm in Subarachnoid Hemorrhage Patients With Multiple Aneurysms. Stroke 2017; 48:1986-1989. [PMID: 28468927 DOI: 10.1161/strokeaha.117.017147] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 03/20/2017] [Accepted: 03/29/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We investigated which aneurysm-related risk factors for rupture best discriminate ruptured versus unruptured saccular intracranial aneurysms (sIAs) in subarachnoid hemorrhage patients with multiple sIAs. METHODS We included 264 subarachnoid hemorrhage patients with a ruptured sIA and at least one additional unruptured sIA, from the Kuopio Intracranial Aneurysm database from 2003 to 2015. These patients had 268 ruptured and 445 unruptured sIAs. Angiograms of the 713 sIAs were reevaluated for multiple variables describing aneurysm shape. Multivariate generalized linear mixed models were used to calculate odds ratios with corresponding 95% confidence intervals for the independent risk factors for aneurysm rupture. RESULTS In the multivariate analysis, only sIA size (P<0.004) and irregular shape (P<0.000) independently associated with sIA rupture. As an independent risk factor, irregular shape showed the strongest association with rupture (odds ratio 90.3; 95% confidence interval, 47.0-173.5). The sIA location, flow angles, bottleneck factor, or aspect ratio were not significantly associated with rupture. CONCLUSIONS Irregular shape may identify the ruptured sIA better than size in patients presenting with aSAH and multiple sIAs.
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Affiliation(s)
- Joel Björkman
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Juhana Frösen
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Olli Tähtinen
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Daan Backes
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Terhi Huttunen
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Jaakko Harju
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Jukka Huttunen
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Mitja I Kurki
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Mikael von Und Zu Fraunberg
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Timo Koivisto
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Hannu Manninen
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Juha E Jääskeläinen
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.)
| | - Antti E Lindgren
- From the Department of Neurosurgery, NeuroCenter (J.B., J.F., T.H., J.H., M.I.K., M.v.u.z.F., T.K., J.E.J., A.E.L.), Department of Clinical Radiology (O.T., J.H., H.M.), and Hemorrhagic Brain Pathology Research Group, NeuroCenter (J.F., A.E.L.), Kuopio University Hospital, Finland; Department of Neurosurgery (M.v.u.z.F., T.K., J.E.J.) and Institute of Clinical Medicine (H.M.), University of Eastern Finland, Kuopio; and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, the Netherlands (D.B.).
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Cebral J, Ollikainen E, Chung BJ, Mut F, Sippola V, Jahromi BR, Tulamo R, Hernesniemi J, Niemelä M, Robertson A, Frösen J. Flow Conditions in the Intracranial Aneurysm Lumen Are Associated with Inflammation and Degenerative Changes of the Aneurysm Wall. AJNR Am J Neuroradiol 2016; 38:119-126. [PMID: 27686488 DOI: 10.3174/ajnr.a4951] [Citation(s) in RCA: 113] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/22/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE Saccular intracranial aneurysm is a common disease that may cause devastating intracranial hemorrhage. Hemodynamics, wall remodeling, and wall inflammation have been associated with saccular intracranial aneurysm rupture. We investigated how saccular intracranial aneurysm hemodynamics is associated with wall remodeling and inflammation of the saccular intracranial aneurysm wall. MATERIALS AND METHODS Tissue samples resected during a saccular intracranial aneurysm operation (11 unruptured, 9 ruptured) were studied with histology and immunohistochemistry. Patient-specific computational models of hemodynamics were created from preoperative CT angiographies. RESULTS More stable and less complex flows were associated with thick, hyperplastic saccular intracranial aneurysm walls, while slower flows with more diffuse inflow were associated with degenerated and decellularized saccular intracranial aneurysm walls. Wall degeneration (P = .041) and rupture were associated with increased inflammation (CD45+, P = .031). High wall shear stress (P = .018), higher vorticity (P = .046), higher viscous dissipation (P = .046), and high shear rate (P = .046) were associated with increased inflammation. Inflammation was also associated with lack of an intact endothelium (P = .034) and the presence of organized luminal thrombosis (P = .018), though overall organized thrombosis was associated with low minimum wall shear stress (P = .034) and not with the flow conditions associated with inflammation. CONCLUSIONS Flow conditions in the saccular intracranial aneurysm are associated with wall remodeling. Inflammation, which is associated with degenerative wall remodeling and rupture, is related to high flow activity, including elevated wall shear stress. Endothelial injury may be a mechanism by which flow induces inflammation in the saccular intracranial aneurysm wall. Hemodynamic simulations might prove useful in identifying saccular intracranial aneurysms at risk of developing inflammation, a potential biomarker for rupture.
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Affiliation(s)
- J Cebral
- From the Bioengineering Department (J.C., B.J.C., F.M.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - E Ollikainen
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - B J Chung
- From the Bioengineering Department (J.C., B.J.C., F.M.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - F Mut
- From the Bioengineering Department (J.C., B.J.C., F.M.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia
| | - V Sippola
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - B R Jahromi
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - R Tulamo
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Department of Vascular Surgery (R.T.), Helsinki University Central Hospital, Helsinki, Finland
| | - J Hernesniemi
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - M Niemelä
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - A Robertson
- Mechanical Engineering and Materials Science and Department of Bioengineering (A.R.), Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - J Frösen
- Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland .,Department of Neurosurgery and Hemorrhagic Brain Pathology Research Group (J.F.), Neurocenter, Kuopio University Hospital, Kuopio, Finland
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47
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Huttunen J, Lindgren A, Kurki MI, Huttunen T, Frösen J, von und zu Fraunberg M, Koivisto T, Kälviäinen R, Räikkönen K, Viinamäki H, Jääskeläinen JE, Immonen A. Antidepressant Use After Aneurysmal Subarachnoid Hemorrhage. Stroke 2016; 47:2242-8. [DOI: 10.1161/strokeaha.116.014327] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/13/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
To elucidate the predictors of antidepressant use after subarachnoid hemorrhage from saccular intracranial aneurysm (sIA-SAH) in a population-based cohort with matched controls.
Methods—
The Kuopio sIA database includes all unruptured and ruptured sIA cases admitted to the Kuopio University Hospital from its defined catchment population in Eastern Finland, with 3 matched controls for each patient. The use of all prescribed medicines has been fused from the Finnish national registry of prescribed medicines. In the present study, 2 or more purchases of antidepressant medication indicated antidepressant use. The risk factors of the antidepressant use were analyzed in 940 patients alive 12 months after sIA-SAH, and the classification tree analysis was used to create a predicting model for antidepressant use after sIA-SAH.
Results—
The 940 12-month survivors of sIA-SAH had significantly more antidepressant use (odds ratio, 2.6; 95% confidence interval, 2.2–3.1) than their 2676 matched controls (29% versus 14%). Classification tree analysis, based on independent risk factors, was used for the best prediction model of antidepressant use after sIA-SAH. Modified Rankin Scale until 12 months was the most potent predictor, followed by condition (Hunt and Hess Scale) and age on admission for sIA-SAH.
Conclusions—
The sIA-SAH survivors use significantly more often antidepressants, indicative of depression, than their matched population controls. Even with a seemingly good recovery (modified Rankin Scale score, 0) at 12 months after sIA-SAH, there is a significant risk of depression requiring antidepressant medication.
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Affiliation(s)
- Jukka Huttunen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Antti Lindgren
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Mitja I. Kurki
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Terhi Huttunen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Juhana Frösen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Mikael von und zu Fraunberg
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Timo Koivisto
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Reetta Kälviäinen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Katri Räikkönen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Heimo Viinamäki
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Juha E. Jääskeläinen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
| | - Arto Immonen
- From the Neurosurgery (J.H., A.L., M.I.K., T.H., J.F., M.F., T.K., J.E.J., A.I.) and Neurology (R.K.) of KUH NeuroCenter, and Psychiatry (H.V.), Kuopio University Hospital, and Faculty of Health Sciences, School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland; and Institute of Behavioural Sciences, University of Helsinki, Finland (K.R.)
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48
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Jahromi BR, Frösen J, Hernesniemi J. Commentary: Bypass Surgery for the Treatment of Dolichoectatic Basilar Trunk Aneurysms: A Work in Progress. Neurosurgery 2016; 79:E514-6. [PMID: 27442974 DOI: 10.1227/neu.0000000000001348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Behnam Rezai Jahromi
- *Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Töölö Hospital, Helsinki, Finland; ‡Department of Neurosurgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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49
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Frösen J, Jahromi BR, Hernesniemi J. Intracerebral Hemorrhage as a Surgical Challenge—Where Should We Focus? World Neurosurg 2016; 91:638-9. [DOI: 10.1016/j.wneu.2016.04.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
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50
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Ollikainen E, Tulamo R, Lehti S, Lee-Rueckert M, Hernesniemi J, Niemelä M, Ylä-Herttuala S, Kovanen PT, Frösen J. Smooth Muscle Cell Foam Cell Formation, Apolipoproteins, and ABCA1 in Intracranial Aneurysms: Implications for Lipid Accumulation as a Promoter of Aneurysm Wall Rupture. J Neuropathol Exp Neurol 2016; 75:689-99. [PMID: 27283327 DOI: 10.1093/jnen/nlw041] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Saccular intracranial aneurysm (sIA) aneurysm causes intracranial hemorrhages that are associated with high mortality. Lipid accumulation and chronic inflammation occur in the sIA wall. A major mechanism for lipid clearance from arteries is adenosine triphosphate-binding cassette A1 (ABCA1)-mediated lipid efflux from foam cells to apolipoprotein A-I (apoA-I). We investigated the association of wall degeneration, inflammation, and lipid-related parameters in tissue samples of 16 unruptured and 20 ruptured sIAs using histology and immunohistochemistry. Intracellular lipid accumulation was associated with wall remodeling (p = 0.005) and rupture (p = 0.020). Foam cell formation was observed in smooth muscle cells, in addition to CD68- and CD163-positive macrophages. Macrophage infiltration correlated with intracellular lipid accumulation and apolipoproteins, including apoA-I. ApoA-I correlated with markers of lipid accumulation and wall degeneration (p = 0.01). ApoA-I-positive staining colocalized with ABCA1-positive cells particularly in sIAs with high number of smooth muscle cells (p = 0.003); absence of such colocalization was associated with wall degeneration (p = 0.017). Known clinical risk factors for sIA rupture correlated inversely with apoA-I. We conclude that lipid accumulation associates with sIA wall degeneration and risk of rupture, possibly via formation of foam cells and subsequent loss of mural cells. Reduced removal of lipids from the sIA wall via ABCA1-apoA-I pathway may contribute to this process.
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Affiliation(s)
- Eliisa Ollikainen
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Riikka Tulamo
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Satu Lehti
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Miriam Lee-Rueckert
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Juha Hernesniemi
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Mika Niemelä
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Seppo Ylä-Herttuala
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Petri T Kovanen
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
| | - Juhana Frösen
- From the Biomedicum, Neurosurgery Research Group, Helsinki, Finland (EO, RT, JH, MN, JF); Biomedicum, Wihuri Research Institute, Helsinki, Finland (EO, SL, ML-R, PTK); Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland (RT); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (JH, MN); Department of Molecular Medicine, AIV-Institute, Kuopio, Finland, University of Eastern Finland (SY-H); Department of Neurosurgery, Kuopio University Hospital, Kuopio, Finland (JF); and Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland (JF)
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