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1.
Biomed Res Int ; 2021: 6657595, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34471639

RESUMO

Method: The clinical and imaging data of PEDs in the postmarket multicenter registry study (PLUS) in China were retrospectively analyzed, and patients were divided into two groups on the basis of the follow-up angiographic results: group 1 (no significant change in A1 blood flow) and group 2 (A1 occlusion or decreased blood flow). We collected patients' baseline data and evaluated the following imaging indicators: diameter and ratio of bilateral A1, M1, and internal carotid artery (ICA) vessels before stenting and the ratio of the PED size (sPED) to the ipsilateral ICA (I-ICA) diameter on the implantation side. Results: A total of 1171 patients were included, of whom 48 met the inclusion criteria (17 in group 1 and 31 in group 2). In group 2, three patients experienced neurological deterioration at follow-up. From the univariate analysis of outcomes, single PED without coils, incomplete aneurysm occlusion (IAO), maximum aneurysm diameter, aneurysms involving the ICA bifurcation (ICAb), and large sPED/I-ICA diameter ratio were included in the multivariate analysis (P < 0.20). The multivariate regression analysis results showed that the ratio of sPED/I-ICA diameter was the factor influencing A1 vessel occlusion. The area under the ROC curve was 73.2%. When the sPED/I-ICA diameter ratio was 1.14, sensitivity was 70.6%, and specificity was 77.4%. Conclusion: When an oversized PED is placed from M1 to the ICA, the higher porosity formed at the covered A1 orifice is conducive to maintaining stable A1 blood flow and reducing the risk of A1 vessel occlusion. This trial is registered with ClinicalTrials.gov identifier: NCT03831672.


Assuntos
Artéria Cerebral Anterior/cirurgia , Artéria Carótida Interna/cirurgia , Embolização Terapêutica/métodos , Aneurisma Intracraniano/cirurgia , Adolescente , Adulto , Idoso , Artéria Cerebral Anterior/diagnóstico por imagem , Artéria Cerebral Anterior/patologia , Prótese Vascular , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/patologia , Feminino , Seguimentos , Hemodinâmica , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
J Clin Neurosci ; 90: 8-13, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34275585

RESUMO

OBJECTIVE: To report the stent-assisted coil embolization and flow diversion treatments of blood-blister-like aneurysms based on the theory of acute dissection of the internal carotid artery. PATIENTS AND METHODS: From July 2016 through July 2020, 27 patients presenting with subarachnoid hemorrhage (SAH) due to rupture of internal carotid artery blood blister-like aneurysms were subjected to endovascular treatment with stent-assisted coiling or Pipeline flow diversion. Clinical outcomes were evaluated using modified Rankin Scale score (mRS). RESULTS: A proximal stenosis caused by angiopathology adjacent to aneurysms were found on internal carotid artery angiograms in all 27 cases. The angiopathology combining with the aneurysms implement that acute dissection of the supraclinoid segment of the internal carotid artery indicated the pathogenesis of blood blister-like aneurysm formation. All aneurysms were treated successfully with alleviation of the adjacent angiopathology after stenting on angiograms. During 1-12 months, mean 3.5 months, complete aneurysm obliteration without adjacent stenosis were found in 25(92.6%) patients. Two (7.4%) cases of recanalization were retreated with complete obliteration at 1 week and 3 months after initial treatment. Clinical mRS 0 and 1 outcomes were observed in 23(85.2%) patients, mRS 2 in 3(11.1%) patients and mRS 6 in 1(3.7%) not related to aneurysm treatment during follow-up. CONCLUSIONS: Acute focal dissection of supraclinoid segment of internal carotid artery underlies the development of blood blister-like aneurysm. Stent-assisted coiling and flow diversion treatments constitute appropriate treatment based on the arterial dissection pathology.


Assuntos
Aneurisma Dissecante/terapia , Doenças das Artérias Carótidas/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Aneurisma Intracraniano/terapia , Adulto , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/patologia , Prótese Vascular , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/patologia , Artéria Carótida Interna/patologia , Procedimentos Endovasculares/instrumentação , Humanos , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Retratamento , Estudos Retrospectivos , Stents , Hemorragia Subaracnóidea/etiologia , Resultado do Tratamento
3.
J Clin Neurosci ; 89: 343-348, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34119291

RESUMO

OBJECTIVE: Aneurysmal subarachnoid hemorrhage (aSAH) is associated with high morbidity. The objective was to evaluate, whether specific morphological aneurysm characteristics could serve as predictive values for aSAH severity, disease-related complications and clinical outcome. METHODS: A total of 453 aSAH patients (mean age: 54.9 ±â€¯13.8 years, mean aneurysm size: 7.5 ±â€¯3.6 mm) treated at a single center were retrospectively included. A morphometric analysis was performed based on angiographic image sets, determining aneurysm location, aneurysm size, neck width, aneurysm size ratios, aneurysm morphology and vessel size. The following outcome measures were defined: World Federation of Neurosurgical Societies (WFNS) grade 4 and 5, Fisher grade 4, vasospasm, cerebral infarction and unfavorable functional outcome. RESULTS: Regarding morphology parameters, aneurysm neck width was an independent predictor for Fisher 4 hemorrhage (OR: 1.1, 95%CI: 1.0-1.3, p = 0.048), while dome width (OR: 0.92, 95%CI: 0.86-0.97, p = 0.005) and internal carotid artery location (OR: 2.1, 95%CI: 1.1-4.2, p = 0.028) predicted vasospasm. None of the analyzed morphological characteristics prognosticated functional outcome. Patient age (OR: 0.95, 95%CI: 0.93-0.96, p < 0.001), WFNS score (OR: 4.8, 95%CI: 2.9-8.0, p < 0.001), Fisher score (OR: 2.3, 95%CI: 1.4-3.7, p < 0.001) and cerebral infarction (OR: 4.5, 95%CI: 2.7-7.8, p < 0.001) were independently associated with unfavorable outcome. CONCLUSIONS: The findings indicate a correlation between aneurysm morphology, Fisher grade and vasospasm. Further studies will be required to reveal an independent association of aneurysm morphology with cerebral infarction and functional outcome.


Assuntos
Infarto Cerebral/patologia , Aneurisma Intracraniano/patologia , Hemorragia Subaracnóidea/patologia , Adulto , Idoso , Infarto Cerebral/epidemiologia , Infarto Cerebral/terapia , Humanos , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(22): e26193, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087887

RESUMO

ABSTRACT: Measurement of cortisol in hair is a reliable method for determining long-term cortisol exposure reflecting chronic stress. Research using hair cortisol concentration has been limited to mainly cardiometabolic diseases. The association between hair cortisol concentration and aneurysmal rupture has not yet been studied. We aimed to investigate the relationship between the degree of chronic stress as measured by hair cortisol concentration and aneurysmal rupture.Sixty-eight patients diagnosed with intracranial aneurysms were included in this study (ruptured group, 30; unruptured group, 38). Hair cortisol was measured in 3-cm hair segments, reflecting roughly 3 months of hair growth. For a risk factor analysis, patient-specific factors and aneurysm-specific factors as well as hair cortisol concentration were investigated.Hair cortisol concentrations were significantly higher in the ruptured group than in the unruptured group (55.8 ±â€Š22.0 ng/dL vs. 19.1 ±â€Š6.4 ng/dL; P < .001). High hair cortisol concentration was found to be an independent risk factor for aneurysmal rupture (odds ratio [OR]: 2.245, 95% confidence interval [CI]: 1.825-2.753; P = .013). Additionally, a history of cerebrovascular disease was significantly associated with an increased risk of aneurysmal rupture (OR: 1.577, 95% CI: 1.099-2.262; P = .040).Based on our results, we suggest that chronic stress as measured by hair cortisol concentration could be an independent risk factor for intracranial aneurysmal rupture.


Assuntos
Aneurisma Roto/metabolismo , Cabelo/metabolismo , Hidrocortisona/análise , Aneurisma Intracraniano/patologia , Adulto , Idoso , Aneurisma Roto/etiologia , Transtornos Cerebrovasculares/complicações , Doença Crônica , Feminino , Cabelo/crescimento & desenvolvimento , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/psicologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco , Estresse Psicológico/complicações
5.
Medicine (Baltimore) ; 100(22): e26228, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087904

RESUMO

RATIONALE: Obstructive hydrocephalus (OH) frequently occurs in patients with a ruptured cerebral aneurysm (CA), and it may lead to severe neurological deficits, including life-threatening brain herniation. OH generally occurs in the early stage of CA rupture, rather than in the late stage, and rarely resolves without therapy. PATIENT CONCERNS: A 64-year-old woman with a ruptured anterior communicating artery aneurysm was treated with coil embolization. Nineteen days after her CA rupture, because of the delayed transient OH, she experienced a dramatic cycle in consciousness over 9 hours: wakefulness-drowsiness-coma-drowsiness-wakefulness. DIAGNOSIS: The patient was diagnosed with delayed transient obstructive hydrocephalus, which is a very rare condition. INTERVENTIONS: Mannitol was administered to reduce intracranial pressure. OUTCOMES: The patient was discharged from the hospital 30 days after admission, with a final GCS score of 15 and without weaknesses. At follow-up 2 months after discharge, brain CT revealed non-recurrence of hydrocephalus. LESSONS: A blood clot of any size in the ventricle is likely to lead to obstructive hydrocephalus. Prolonged bed rest for IVH patients may help to reduce the incidence of delayed OH.


Assuntos
Aneurisma Roto/terapia , Hidrocefalia/etiologia , Aneurisma Intracraniano/patologia , Assistência ao Convalescente , Aneurisma Roto/complicações , Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada/métodos , Diuréticos Osmóticos/administração & dosagem , Diuréticos Osmóticos/uso terapêutico , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Feminino , Humanos , Hidrocefalia/diagnóstico , Hidrocefalia/tratamento farmacológico , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/diagnóstico , Manitol/administração & dosagem , Manitol/uso terapêutico , Pessoa de Meia-Idade , Resultado do Tratamento
6.
Sci Rep ; 11(1): 9441, 2021 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-33941796

RESUMO

Aneurysm wall motion has been reported to be associated with rupture. However, its quantification with medical imaging is challenging and should be based on experimental ground-truth to avoid misinterpretation of results. In this work a time-resolved CT angiography (4D-CTA) acquisition protocol is proposed to detect the pulsation of intracranial aneurysms with a low radiation dose. To acquire ground-truth data, the accuracy of volume pulsation detection and quantification in a silicone phantom was assessed by applying pressure sinusoidal waves of increasing amplitudes. These experiments were carried out using a test bench that could reproduce pulsatile waveforms similar to those inside the internal carotid arteries of human subjects. 4D-CTA acquisition parameters (mAs, kVp) were then selected to achieve reliable pulsation detection and quantification with the lowest radiation dose achievable. The resulting acquisition protocol was then used to image an anterior communicating artery aneurysm in a human subject. Data reveals that in a simplified in vitro setting 4D-CTA allows for an effective and reproducible method to detect and quantify aneurysm volume pulsation with an inferior limit as low as 3 mm3 and a background noise of 0.5-1 mm3. Aneurysm pulsation can be detected in vivo with a radiation dose approximating 1 mSv.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Angiografia Cerebral/métodos , Angiografia por Tomografia Computadorizada/métodos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Roto/patologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Aneurisma Intracraniano/patologia , Pessoa de Meia-Idade , Imagens de Fantasmas
7.
Life Sci ; 278: 119617, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34004250

RESUMO

Intracranial aneurysm (IA) is one of the most challenging vascular lesions in the brain for clinicians. It was reported that 1%-6% of the world's population is affected by IAs. Owing to serious complications arising from these lesions, much attention has been paid to better understand their pathophysiology. Non-coding RNAs including short non-coding RNAs and long non-coding RNAs, have critical roles in modulating physiologic and pathological processes. These RNAs are emerging as new fundamental regulators of gene expression, are related with the progression of IA. Non-coding RNAs act via multiple mechanisms and be involved in vascular development, growth and remodeling. Furthermore, these molecules are involved in the regulation of inflammation, a key process in the formation and rupture of IA. Studying non-coding RNAs can yield a hypothetical mechanism for better understanding IA. The present study aims to focus on the role of these non-coding RNAs in the pathogenesis of IA.


Assuntos
Inflamação/fisiopatologia , Aneurisma Intracraniano/patologia , RNA Longo não Codificante/genética , Animais , Humanos , Aneurisma Intracraniano/etiologia , Aneurisma Intracraniano/metabolismo
8.
Aging (Albany NY) ; 13(9): 13195-13210, 2021 05 10.
Artigo em Inglês | MEDLINE | ID: mdl-33971625

RESUMO

We aimed to develop and validate a morphology-based radiomics signature nomogram for assessing the risk of intracranial aneurysm (IA) rupture. A total of 254 aneurysms in 105 patients with subarachnoid hemorrhage and multiple intracranial aneurysms from three centers were retrospectively reviewed and randomly divided into the derivation and validation cohorts. Radiomics morphological features were automatically extracted from digital subtraction angiography and selected by the least absolute shrinkage and selection operator algorithm to develop a radiomics signature. A radiomics signature-based nomogram was developed by incorporating the signature and traditional morphological features. The performance of calibration, discrimination, and clinical usefulness of the nomogram was assessed. Ten radiomics morphological features were selected to build the radiomics signature model, which showed better discrimination with an area under the curve (AUC) equal to 0.814 and 0.835 in the derivation and validation cohorts compared with 0.747 and 0.666 in the traditional model, which only include traditional morphological features. When radiomics signature and traditional morphological features were combined, the AUC increased to 0.842 and 0.849 in the derivation and validation cohorts, thus showing better performance in assessing aneurysm rupture risk. This novel model could be useful for decision-making and risk stratification for patients with IAs.


Assuntos
Algoritmos , Aneurisma Intracraniano/patologia , Nomogramas , Humanos , Curva ROC , Estudos Retrospectivos , Risco , Tomografia Computadorizada por Raios X/métodos
9.
Aging (Albany NY) ; 13(9): 12800-12816, 2021 05 02.
Artigo em Inglês | MEDLINE | ID: mdl-33934089

RESUMO

Intracranial aneurysms (IAs) are common cerebrovascular diseases that carry a high mortality rate, and the mechanisms that contribute to IA formation and rupture have not been elucidated. ADAMTS-5 (ADAM Metallopeptidase with Thrombospondin Type 1 Motif 5) is a secreted proteinase involved in matrix degradation and ECM (extracellular matrix) remodeling processes, and we hypothesized that the dysregulation of ADAMTS-5 could play a role in the pathophysiology of IA. Immunofluorescence revealed that the ADAMTS-5 levels were decreased in human and murine IA samples. The administration of recombinant protein ADAMTS-5 significantly reduced the incidence of aneurysm rupture in the experimental model of IA. IA artery tissue was collected and utilized for histology, immunostaining, and specific gene expression analysis. Additionally, the IA arteries in ADAMTS-5-administered mice showed reduced elastic fiber destruction, proteoglycan accumulation, macrophage infiltration, inflammatory response, and apoptosis. To further verify the role of ADAMTS-5 in cerebral vessels, a specific ADAMTS-5 inhibitor was used on another model animal, zebrafish, and intracranial hemorrhage was observed in zebrafish embryos. In conclusion, our findings indicate that ADAMTS-5 is downregulated in human IA, and compensatory ADAMTS-5 administration inhibits IA development and rupture with potentially important implications for treating this cerebrovascular disease.


Assuntos
Proteína ADAMTS5/metabolismo , Matriz Extracelular/patologia , Aneurisma Intracraniano/complicações , Proteína ADAMTS5/administração & dosagem , Proteína ADAMTS5/genética , Adulto , Idoso , Animais , Modelos Animais de Doenças , Embrião não Mamífero , Feminino , Humanos , Injeções Intraperitoneais , Aneurisma Intracraniano/tratamento farmacológico , Aneurisma Intracraniano/patologia , Aneurisma Intracraniano/cirurgia , Masculino , Camundongos , Proteólise , Proteínas Recombinantes/administração & dosagem , Ruptura Espontânea/etiologia , Ruptura Espontânea/patologia , Ruptura Espontânea/prevenção & controle , Remodelação Vascular , Peixe-Zebra , Proteínas de Peixe-Zebra/antagonistas & inibidores , Proteínas de Peixe-Zebra/metabolismo
10.
Turk Neurosurg ; 31(3): 318-323, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34047353

RESUMO

AIM: To study the clinical profile, imaging features, intra-operative findings, post-operative outcome at discharge and at 6 months in patients with internal carotid artery (ICA) bifurcation aneurysm. MATERIAL AND METHODS: Present study is a retrospective analysis of data of patients who underwent surgery for ICA bifurcation aneurysm between the period of 1st January 2011 to 31st December 2015 at our institute. Demographic variable, clinical grade, radiological finding was assessed. Outcome was measured using modified Rankin score (mRs) at discharge and at 6 months follow up. All ICA bifurcation aneurysms were clipped using a standard pterional craniotomy. RESULTS: A total of 28 patients were included in the study out of which 4 had bilateral ICA bifurcation aneurysms. Mean age was 44.15 (age range 14-65) years, with 43.75% of patient were < 40yrs. Multiple aneurysms were seen in 11 (39.28%) patients, with superior projection being the most common in 53.12%. Vasospasm was seen in 12 (42.85%) with 4 patients undergoing chemical angioplasty. At discharge good outcome (mRs < 3) was seen in 4/5 (80%) patients in the un-bled category, whereas 18/23 (78.2%) in bled category. At 6 months follow up, mRs < 3 was seen 4 (100%) patients in unbled category, and 84.21% (16 of 19) patients in bled group. CONCLUSION: The findings of the present study have shown an increased incidence of bilaterality and multiplicity for ICA bifurcation aneurysms. The direction of the dome of aneurysm and temporary clipping do not affect the treatment outcomes. These aneurysms have excellent outcomes following surgery.


Assuntos
Doenças das Artérias Carótidas/cirurgia , Aneurisma Intracraniano/cirurgia , Resultado do Tratamento , Adolescente , Adulto , Idoso , Doenças das Artérias Carótidas/patologia , Artéria Carótida Interna/cirurgia , Feminino , Humanos , Índia , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Procedimentos Neurocirúrgicos/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Instrumentos Cirúrgicos , Centros de Atenção Terciária , Adulto Jovem
11.
Sci Rep ; 11(1): 7947, 2021 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-33846487

RESUMO

In the hemodynamic study, computational fluid dynamics (CFD) analysis has shown that high wall shear stress (WSS) is an important parameter in cerebral aneurysm formation. However, CFD analysis is not more realistic than fluid-structure interaction (FSI) analysis given its lack of considering the involvement of vascular structures. To investigate the relationship between the hemodynamic parameters and the aneurysm formation, the locations of high WSS and high strain were extracted from the CFD and FSI analyses, respectively. Then the distances between the aneurysm formation site and the locations of high WSS or high strain were calculated. A total of 37 intracranial paraclinoid aneurysms were enrolled for quantitative comparison. Additionally, the dura mater was modeled to facilitate realistic results in FSI analysis. The average distance from the location of the aneurysm formation site to the high strain (1.74 mm [Formula: see text] 1.04 mm) was smaller than the average distance to the high WSS (3.33 mm [Formula: see text] 1.18 mm). The presence of dura mater also influenced the findings in the aneurysm formation site. High strain extracted by FSI analysis is an important hemodynamic factor related to the formation of cerebral aneurysms. Strain parameter could help to predict the formation of aneurysms and elucidate the appropriate treatment.


Assuntos
Aneurisma Intracraniano/patologia , Estresse Mecânico , Adulto , Idoso , Idoso de 80 Anos ou mais , Dura-Máter/patologia , Módulo de Elasticidade , Humanos , Pessoa de Meia-Idade
12.
Int J Med Sci ; 18(9): 2017-2022, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33850472

RESUMO

Blood blister-like aneurysms (BBAs) are rare and usually appear at nonbranching sites in the supraclinoid portion of the internal carotid artery (ICA). Because it is difficult to obtain histological specimens of the aneurysm wall and because experimental models are challenging to establish, the pathogenesis of BBAs remains uncertain. In this paper, we reviewed the diagnostic, radiological, and pathophysiological characteristics of patients with BBAs. We also summarized the existing evidence and potential mechanisms related to the causes of BBAs. Current evidence indicates that atherosclerosis and dissection are the main prerequisites for the formation of BBAs. Hemodynamics may play a role in the process of BBA formation due to the unique vascular anatomy of the supraclinoid ICA. Further research on histopathology and hemodynamics is warranted in this field.


Assuntos
Aneurisma Roto/etiologia , Doenças das Artérias Carótidas/etiologia , Artéria Carótida Interna/patologia , Aneurisma Intracraniano/etiologia , Aneurisma Roto/diagnóstico , Aneurisma Roto/patologia , Aneurisma Roto/terapia , Doenças das Artérias Carótidas/diagnóstico , Doenças das Artérias Carótidas/patologia , Doenças das Artérias Carótidas/terapia , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Angiografia Cerebral , Embolização Terapêutica , Procedimentos Endovasculares/instrumentação , Procedimentos Endovasculares/métodos , Humanos , Aneurisma Intracraniano/diagnóstico , Aneurisma Intracraniano/patologia , Aneurisma Intracraniano/terapia , Microcirurgia/métodos , Stents , Resultado do Tratamento
13.
J Neuroimaging ; 31(3): 532-540, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33848017

RESUMO

BACKGROUND AND PURPOSE: We aimed to assess the accuracy of magnetic resonance angiography (MRA) in the differentiation of small aneurysms versus infundibular dilations (IDs) at the internal carotid artery-posterior communicating artery (ICA-PComA) junction, emphasizing the role of MRA axial source images. METHODS: This retrospective study consisted of 83 focal arterial protrusions at ICA-PComA junction in 76 patients who underwent both MRA and digital subtraction angiography (DSA)/3-dimensional rotational angiography (3DRA). The diagnostic performance of MRA for differential diagnosis of aneurysm from ID was calculated using DSA/3DRA interpretation as the standard of reference. In addition, long-axis diameter, short-axis diameter, long-axis diameter/short-axis diameter (L/S) ratio, and angle of lesion (angle of the long-axis of lesion with respect to the x-axis) measured on MRA source images were compared between aneurysms and IDs. RESULTS: Sensitivity, specificity, and accuracy of MRA for distinguishing aneurysms from IDs were 74.4% (57.9-87.0%) to 76.9% (60.7-88.9%), 93.2% (81.3-98.6%) to 95.5% (84.5-99.4%), and 85.5% (76.1-92.3%), respectively. Significant differences were found for the long-axis diameter (P < .001), short-axis diameter (P < .001), L/S ratio (P < .05), and angle of the lesion (P < .001) on MRA axial source images between aneurysms and IDs. The angle of the lesion had the highest discriminatory ability (area under the curve = .966 [.902-.994]) to differentiate aneurysms from IDs. An angle of lesion >60° was 89.7% (75.8-97.1%) sensitive and 100% (92.0-100.0%) specific for diagnosis of aneurysm. CONCLUSIONS: MRA is a useful imaging modality for distinguishing between aneurysm and ID at the ICA-PComA junction. Furthermore, geometric parameters on MRA axial source images can provide added value in their differentiation.


Assuntos
Angiografia Digital/métodos , Artéria Carótida Interna/diagnóstico por imagem , Dilatação Patológica/diagnóstico , Aneurisma Intracraniano/diagnóstico , Angiografia por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Dilatação , Dilatação Patológica/diagnóstico por imagem , Feminino , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
J Stroke Cerebrovasc Dis ; 30(6): 105763, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33831769

RESUMO

OBJECTIVES: The wall of enlarged unruptured cerebral aneurysm (EUCA) is thought to be reddish, thin, and fragile. This study aimed to evaluate the EUCA wall redness based on quantitative signal intensity method and to compare the clinical and radiological characteristics between EUCA and non-EUCA. MATERIALS & METHODS: In this retrospective analysis, red (R), green (G), blue (B), and RGB signal intensities of aneurysm were quantitatively measured using an intraoperative digital picture in 150 cases. Color intensities were measured by two independent investigators. Aneurysm redness was defined as an R/RGB ratio since the brightness of the operative field differed by each surgery or angle of the microscope. RESULTS: The median aneurysm size was 4.9 mm (IQR 3.9-5.9 mm). Median color intensity of R, G, B, RGB, and R/RGB ratio were 206 (185-215), 129 (107-150), 136 (115-157), 157 (140-174), and 1.26 (1.20-1.38), respectively. The intraclass correlation coefficient for R/RGB ratio was 0.73 (P<0.0001). The proportion of female sex was significantly higher for EUCA (p = 0.019). Median R/RGB ratio in GUCA was significantly larger than that of non-EUCA (OR 1.25, 95% CI 1.19-1.35) (p = 0.035). Even after adjustment of female sex, a R/RGB ratio ≧1.36 was related to EUCA (OR 3.02, 95% CI 1.30-7.02). CONCLUSIONS: The present study showed that a R/RGB ratio could be calculated easily and a larger R/RGB ratio was related to EUCA. When EUCA is managed by surgical treatment, more careful manipulation should be needed compared to non-EUCA due to a "red" wall of EUCA.


Assuntos
Artérias Cerebrais/patologia , Aneurisma Intracraniano/patologia , Microscopia de Vídeo , Idoso , Cor , Feminino , Humanos , Interpretação de Imagem Assistida por Computador , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos
15.
Clin Interv Aging ; 16: 665-674, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33907388

RESUMO

Objective: It remains unclear whether irregular morphological features of intracranial aneurysms (IAs) are associated with atherosclerosis. We investigated the effect of cerebrovascular atherosclerosis stenosis (CAS) on irregular morphology of IAs. Patients and Methods: This single-center case-control study included consecutive patients with IAs at our institution from September 2011 to September 2018. Cases were patients with irregular IAs, and age- and location-matched controls were patients with regular IAs. Conditional logistic regression models were used to assess the relationship between angiographic variables of CAS and aneurysmal irregularity. Results: A total of 140 cases of irregular IAs and 140 controls were included in the analysis. Sixteen patients with irregular IAs (11.4%) and eleven patients with regular IAs (7.9%) had >50% parent artery stenosis; however, the differences were not statistically significant between these two groups. In addition, no significant between-group differences were observed in distributions of the cerebrovascular stenosis, number of arterial stenoses, and location of the stenosis. In the final adjusted conditional logistic regression model, only aneurysm size (≥7 mm) was significantly associated with irregular IA morphology (P = 0.022). Moreover, 89 cases of irregular IAs and 89 controls were included in the analysis of unruptured IAs (UIAs). In the final adjusted conditional logistic regression model, only aneurysm size (≥7 mm) was significantly associated with irregular UIA morphology (P = 0.020). Conclusion: Our findings indicate that the morphological irregularity of unruptured intracranial aneurysms is more related with aneurysm size rather than cerebrovascular atherosclerosis. Further studies are needed to use prospective data to identify causative factors responsible for aneurysmal irregularity.


Assuntos
Aterosclerose/epidemiologia , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/patologia , Fatores Etários , Idoso , Aterosclerose/patologia , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
17.
Mol Med Rep ; 23(4)2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33655339

RESUMO

Toll­like receptor (TLR) 2/4 serves an important regulatory role in nerve tissue injury. However, the downstream and potential mechanisms remain to be elucidated. The present study was designed to investigate the roles of the TLR2/4­major myeloid differentiation response gene 88 (MyD88)­NF­κB signaling pathway in the development of intracranial aneurysm. The expression of TLR2, TLR4 and MyD88 in the blood of normal controls and patients with intracranial aneurysm were detected by quantitative PCR and ELISA. Human brain vascular smooth muscle cells were treated by Angiotensin II (Ang II) to evaluate the involvement of TLR2/4­MyD88­NF­κB signaling pathway in the process. The in vitro experiment was divided into four groups: The control group, an Ang â…¡ group, an Ang â…¡ + small interfering (si)RNA control group and an Ang â…¡ + TLR2­group. Cell viability, migration, apoptosis and expression of TLR2, TLR4, MyD88, NF­κB and phosphorylated (p­)p65 expression were detected. The results demonstrated that the expression of TLR2, TLR4, MyD88 and NF­κB at mRNA and protein levels in patients with intracranial aneurysm was significantly higher compared with corresponding protein in normal controls (P<0.05). In vitro experiments demonstrated that Ang â…¡ treatment increased the cell proliferation and migration rate but reduced the apoptotic rate compared with the control (P<0.05). The expression of TLR2, TLR4, MyD88, NF­κB and p­p65 was significantly increased in the Ang II group (vs. control; P<0.05). By contrast, TLR2­short interfering RNA reduced the cell proliferation and migration rate, and reduced the expression of TLR2, TLR4, MyD88, NF­κB and p­p65 (vs. Ang â…¡ + short interfering RNA control; P<0.05). In conclusion, the data of the present study indicated that the TLR2/4­MyD88­NF­κB signaling pathway is involved in the pathogenesis of intracranial aneurysm.


Assuntos
Aneurisma Intracraniano/genética , Fator 88 de Diferenciação Mieloide/genética , Receptor 2 Toll-Like/genética , Receptor 4 Toll-Like/genética , Angiotensina II/farmacologia , Feminino , Regulação da Expressão Gênica/genética , Humanos , Aneurisma Intracraniano/patologia , Aneurisma Intracraniano/terapia , Masculino , Músculo Liso Vascular/efeitos dos fármacos , Músculo Liso Vascular/patologia , Fator 88 de Diferenciação Mieloide/antagonistas & inibidores , NF-kappa B/genética , RNA Mensageiro/genética , RNA Interferente Pequeno/farmacologia , Transdução de Sinais/efeitos dos fármacos , Receptor 2 Toll-Like/antagonistas & inibidores , Receptor 4 Toll-Like/antagonistas & inibidores , Fator de Transcrição RelA/antagonistas & inibidores , Fator de Transcrição RelA/genética
18.
Int J Comput Assist Radiol Surg ; 16(4): 597-607, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33715047

RESUMO

PURPOSE: For the evaluation and rupture risk assessment of intracranial aneurysms, clinical, morphological and hemodynamic parameters are analyzed. The reliability of intracranial hemodynamic simulations strongly depends on the underlying models. Due to the missing information about the intracranial vessel wall, the patient-specific wall thickness is often neglected as well as the specific physiological and pathological properties of the vessel wall. METHODS: In this work, we present a model for structural simulations with patient-specific wall thickness including different tissue types based on postmortem histologic image data. Images of histologic 2D slices from intracranial aneurysms were manually segmented in nine tissue classes. After virtual inflation, they were combined into 3D models. This approach yields multiple 3D models of the inner and outer wall and different tissue parts as a prerequisite for subsequent simulations. RESULT: We presented a pipeline to generate 3D models of aneurysms with respect to the different tissue textures occurring in the wall. First experiments show that including the variance of the tissue in the structural simulation affect the simulation result. Especially at the interfaces between neighboring tissue classes, the larger influence of stiffer components on the stability equilibrium became obvious. CONCLUSION: The presented approach enables the creation of a geometric model with differentiated wall tissue. This information can be used for different applications, like hemodynamic simulations, to increase the modeling accuracy.


Assuntos
Hemodinâmica/fisiologia , Imageamento Tridimensional/métodos , Aneurisma Intracraniano/cirurgia , Cadáver , Simulação por Computador , Módulo de Elasticidade , Análise de Elementos Finitos , Humanos , Aneurisma Intracraniano/patologia , Reprodutibilidade dos Testes , Medição de Risco
19.
Am J Med Genet A ; 185(5): 1430-1436, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33683022

RESUMO

Activating variants in the platelet-derived growth factor receptor ß gene (PDGFRB) have been associated with Kosaki overgrowth syndrome, infantile myofibromatosis, and Penttinen premature aging syndrome. A recently described phenotype with fusiform aneurysm has been associated with mosaic PDGFRB c.1685A > G p.(Tyr562Cys) variant. Few reports however have examined the vascular phenotypes and mosaic effects of PDGFRB variants. We describe clinical characteristics of two patients with a recurrent mosaic PDGFRB p.(Tyr562Cys) variant identified via next-generation sequencing-based genetic testing. We observed intracranial fusiform aneurysm in one patient and found an additional eight patients with aneurysms and phenotypes associated with PDGFRB-activating variants through literature search. The conditions caused by PDGFRB-activating variants share overlapping features including overgrowth, premature aged skin, and vascular malformations including aneurysms. Aneurysms are progressive and can result in morbidities and mortalities in the absence of successful intervention. Germline and/or somatic testing for PDGFRB gene should be obtained when PDGFRB activating variant-related phenotypes are present. Whole-body imaging of the arterial tree and echocardiography are recommended after diagnosis. Repeating the imaging study within a 6- to 12-month period after detection is reasonable. Finally, further evaluation for the effectiveness and safety profile of kinase inhibitors in this patient population is warranted.


Assuntos
Aneurisma/genética , Transtornos do Crescimento/genética , Aneurisma Intracraniano/genética , Receptor beta de Fator de Crescimento Derivado de Plaquetas/genética , Adulto , Senilidade Prematura/genética , Aneurisma/epidemiologia , Aneurisma/patologia , Criança , Feminino , Predisposição Genética para Doença , Mutação em Linhagem Germinativa/genética , Transtornos do Crescimento/epidemiologia , Transtornos do Crescimento/patologia , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Lactente , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/patologia , Masculino , Pessoa de Meia-Idade , Mosaicismo , Fenótipo , Anormalidades da Pele/epidemiologia , Anormalidades da Pele/genética , Anormalidades da Pele/patologia , Adulto Jovem
20.
Dis Markers ; 2021: 8889569, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33574968

RESUMO

Objective: Intracranial aneurysm (IA) is a fatal disease owing to vascular rupture and subarachnoid hemorrhage. Much attention has been given to circular RNAs (circRNAs) because they may be potential biomarkers for many diseases, but their mechanism in the formation of IA remains unknown. Methods: circRNA expression profile analysis of blood samples was conducted between patients with IA and controls. Overall, 235 differentially expressed circRNAs were confirmed between IA patients and the control group. The reliability of the microarray results was demonstrated by quantitative real-time polymerase chain reaction (qRT-PCR). Results: Of 235 differentially expressed genes, 150 were upregulated, while the other 85 were downregulated. Five miRNAs matched to every differential expression of circRNAs, and related MREs were predicted. We performed gene ontology (GO) analysis to identify the functions of their targeted genes, with the terms "Homophilic cell adhesion via plasma membrane adhesion molecules" and "Positive regulation of cellular process" showing the highest fold enrichment. Conclusions: This study demonstrated the role of circRNA expression profiling in the formation of IA and revealed that the mTOR pathway can be a latent therapeutic strategy for IA.


Assuntos
Moléculas de Adesão Celular/genética , Aneurisma Intracraniano/genética , MicroRNAs/genética , RNA Circular/genética , Adulto , Estudos de Casos e Controles , Moléculas de Adesão Celular/classificação , Moléculas de Adesão Celular/metabolismo , Biologia Computacional/métodos , Angiografia por Tomografia Computadorizada , Feminino , Regulação da Expressão Gênica , Ontologia Genética , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/metabolismo , Aneurisma Intracraniano/patologia , Masculino , MicroRNAs/classificação , MicroRNAs/metabolismo , Pessoa de Meia-Idade , Anotação de Sequência Molecular , Análise de Sequência com Séries de Oligonucleotídeos , RNA Circular/classificação , RNA Circular/metabolismo , Reação em Cadeia da Polimerase em Tempo Real
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