Intracranial aneurysm distribution and characteristics according to gender.

OBJECTIVE: Female sex is associated with a greater prevalence of cerebral aneurysms. However, it also might be linked to the location and size of the aneurysm. The aim of this study was to find the link between female sex and aneurysm characteristics. METHODS: Our study group consisted of 357 patients admitted to the hospital with both unruptured and ruptured aneurysms confirmed by Digital Subtraction Angiography or Computed Tomography Angiography and aneurysmal subarachnoid haemorrhage confirmed by head CT. Patients' medical records were analyzed for necessary information including, but not limited to medical history, blood test results, and aneurysm prevalence, size and location. RESULTS: Women constituted 232 (64.98%) of all patients. In this group, compared to males, we observed a more common occurrence of multiple aneurysms (1.35 ± 0.67 vs. 1.2 ± 0.57; p = .046) and left internal carotid artery aneurysms (25.88% vs. 13.93%; p < .01). Anterior communicating artery aneurysms were less common (17.11% vs. 31.15%; p < .01). Women also had lower dome-to-neck ratios (2.16 ± 0.82 vs. 2.82 ± 1.92; p < .01), were less likely to be smokers (53.6% vs. 33.19%; p < .01) and smoked fewer cigarettes per day (15.09 ± 6.62 vs. 21.09 ± 11.08; p < 0.01). CONCLUSIONS: Female patients have a greater risk of multiple aneurysms and left internal carotid artery aneurysms, but a lower risk of anterior communicating artery aneurysms.

Endovascular treatment of distal anterior cerebral artery aneurysms using flow modulation devices: mid- and long-term results from a two-center study.

Purpose: Flow-diverter (FD) stents have become an established treatment for intracranial aneurysms in recent years, but their use for aneurysms in distal cerebral vessels with small carrier vessel diameters remains controversial. This study describes the method and mid- and long-term outcomes of FD treatment of distal anterior cerebral artery aneurysms (DACAAs) at two neurointerventional centers, to elucidate this topic and provide more in-depth data. Methods: Data for all patients at two neurointerventional centers who were treated with FDs for DACAAs in the pericallosal and supracallosal segment of the anterior cerebral artery were retrospectively analyzed. Data on periprocedural complications, and short-, mid- and long-term follow-up findings were recorded. Results: Forty-one patients were eligible for inclusion in the study. Three FD models were used, one of which had an anti-thrombotic coating. Two periprocedural complications (5%) occurred but did not cause a change in the mRS. In the long-term follow-up, at 29 months and beyond, 83% of assessable patients showed complete occlusion of the aneurysms without new neurological deficits. Conclusion: FDs are a safe and effective treatment approach for DACAAs. This study indicated a low risk of complications, and high closure rates in short-, mid- and long-term follow-up.

The Role of Aspirin in the Management of Intracranial Aneurysms: A Systematic Review and Meta-Analyses.

Objective: To evaluate the association between aspirin use and the risks of unruptured intracranial aneurysm (UIA) growth and aneurysmal subarachnoid hemorrhage (aSAH). Methods: We searched PubMed and Scopus from inception to 1 September 2020. Studies evaluating the associations between aspirin prescription and the risk of UIA growth or the risk of aSAH were included. The study only included patients with intracranial aneurysms. We assessed the quality of included studies using the Newcastle-Ottawa scale. Random-effects meta-analysis was conducted to pool the estimates of effect size quantitatively. Sensitivity analyses using the leave-one-out strategy were performed to identify any potential source of heterogeneity. Results: After a review of 2,226 citations, five cohort studies, two case-control studies, and one nested case-control study involving 8,898 participants were included. Pooled analyses showed that aspirin use, regardless of frequency and duration, was associated with a statistically significantly lower risk of UIA growth (OR 0.25, 95% CI 0.11-0.54; I 2 = 0.0%, p = 0.604) and aSAH (OR, 0.37, 95% CI, 0.23-0.58; I 2 = 79.3%, p = 0.001) in patients presented with intracranial aneurysms. The results did not significantly change in sensitivity analyses. Conclusions: Summarizing available evidence in the literature, our findings indicate that aspirin use, regardless of frequency and duration, was associated with a statistically significantly lower risk of UIA growth and aSAH in patients with UIA. Well-designed and large-scale clinical trials are needed to help define the role of aspirin as a protective pharmaceutical for UIAs.

Symptomatic abdominal aortic aneurysm (AAA) presenting as unilateral lower limb swelling: A case report.

INTRODUCTION: The abdominal aorta is the most common site of true arterial aneurysm, predominantly affecting the segment below the renal arteries [1]. Typically, they are now diagnosed as asymptomatic incidental findings on abdominal imaging for unrelated pathology/symptoms. Symptomatic aneurysms typically present with pain localised to the abdomen, back, or flank [2]. An extremely uncommon scenario is presentation due to the sequelae of compression of the Inferior Vena Cava (IVC). Previously, open surgical repair has been the treatment modality of choice in such cases [3]. PRESENTATION OF CASE: We describe the case of a symptomatic infra-renal AAA presenting with lower limb oedema and shortness of breath due to compression of the IVC which resulted in caval thrombosis and associated embolic disease in the form of a pulmonary embolus (PE). Novel endovascular techniques allowed for management via minimally invasive surgery in the form of endovascular aneurysm repair (EVAR) which avoided the high morbidity and mortality of the previous standard of care, open surgery. DISCUSSION: This resulted in a short duration of admission with resolution of clinical symptoms by follow-up at six-weeks post intervention. CONCLUSION: This case highlights that the endovascular management of symptomatic AAA's resulting in caval thrombosis may offer a viable alternative to open repair with decompression.

Splenic Artery Aneurysms, A Rare Complication of Type 1 Gaucher Disease: Report of Five Cases.

Type 1 Gaucher disease is a rare genetic lysosomal disorder due to acid betaglucosidase deficiency. The main features are thrombocytopenia, anemia, hepatosplenomegaly and complex skeletal disease. Complications include pulmonary hypertension, cirrhosis and splenic infarction; comorbidities, such as autoimmune phenomena, B-cell malignancies and Parkinson disease also occur. Visceral aneurysms have been only rarely noted in Gaucher disease. We report the retrospective data from patients with Gaucher disease type 1 and splenic arterial aneurysm. We describe the different outcomes of a giant splenic arterial aneurysm in five patients with type 1 Gaucher disease and discuss the main possible pathophysiological explanations. Aneurysms of the splenic artery are rare in Gaucher disease but are probably greatly under-reported.

Oncotic (Myxomatous) Aneurysms: A Review of Management / Aneurismas oncóticos (mixomatosos): Revisão das opções de tratamento

Atrial myxomas are the most common primary cardiac tumors and may manifest with neurological symptoms in 30% of cases. Cerebral ischemia, aneurysmal formation, and extravascular metastases are mechanisms that lead to these neurological manifestations. Perilesional changes on computed tomography (CT) and magnetic resonance imaging (MRI) may help in the diagnosis of myxomatous aneurysms, which are usually located in the distal middle cerebral artery (MCA) and in the posterior cerebral artery (PCA) circulation territories. Careful resection of the cardiac lesion is essential for preventing embolism. However, treatment of myxomatous aneurysms is controversial due to the limited understanding of the natural history of this condition. Treatment may include clinical observation in asymptomatic patients, surgical resection, endovascular approaches, adjuvant chemotherapy, and low-dose radiation therapy. We present one case of a female patient with myxomatous aneurysm secondary to an atrial myxoma who presented with neurological symptoms and another case of a female patient who developed neurological symptoms after initial surgical treatment of the primary lesion. Lesion growth rate, topography, morphology, and the patient's clinical condition must be considered when choosing a therapeutical method. Further clinical studies are needed to achieve a better understanding and treatment of this disease.

Mixomas atriais são os tumores primários cardíacos mais comuns. Podem levar a manifestações neurológicas em cerca de 30% dos pacientes devido a: isquemia cerebral, formação de aneurismas e metástases extravasculares. Alterações perilesionais encontradas tanto nas de tomografia (TC) ou ressonância magnética (RM) podem ajudar no diagnóstico de aneurismas mixomatosos, que geralmente envolvem ramos distais das artérias cerebral média e posterior. Ressecção cirôrgica cuidadosa da lesão cardíaca é essencial para prevenção de eventos embólicos. Entretanto, por sua história natural mal conhecida devida à raridade da condição, o tratamento dos aneurismas mixomatosos é controverso, incluindo conduta conservadora em pacientes assintomáticos, abordagem cirôrgica, endovascular, quimioterapia adjuvante e radioterapia em baixas doses. Discutiremos dois casos clínicos de pacientes femininas com aneurismas mixomatosos, tendo o primeiro caso o acometimento neurológico como manifestação inicial e o segundo com sintomas posteriores ao tratamento cirôrgico do tumor primário. Determinação da melhor escolha do tratamento deve levar em consideração taxa de crescimento da lesão, sua topografia, morfologia e clínica do paciente. Mais estudos clínicos são necessários para melhor compreensão e definição de conduta desses pacientes.

Ensayo pictórico: control imagenológico de aneurismas tratados ¿qué examen elegir? / Pictorial essay: imaging control of treated aneurysms. which exam to choose?

Resumen: El tratamiento de aneurismas intracraneanos rotos y no rotos incluye opciones quirúrgicas (clips vasculares) y endovasculares. Existen varios dispositivos y técnicas de manejo endovascular (coils, stents, diversores de flujo), cuyo conocimiento permite elegir e interpretar adecuadamente las técnicas de imágenes para el seguimiento no invasivo. Mediante una revisión pictográfica del control de aneurismas intracraneanos tratados quirúrgicamente y vía endovascular, se muestran las diferencias en la capacidad de caracterización en el seguimiento con angio TC, angio RM sin contraste (con técnica de "tiempo de vuelo" o "TOF" por sus siglas en inglés), angio RM con gadolinio endovenoso (C+) y angiografía por sustracción digital (ASD). Adicionalmente se entregan recomendaciones para el seguimiento de aneurismas según modalidad y dispositivo de tratamiento.

Abstract: Treatment of intracranial ruptured and unruptured aneurysms can be performed with surgical (vascular clips) or endovascular procedures (coils, stents, flw diverters). There are several devices and techniques for endovascular treatment. Knowledge of this techniques allows physicians to choose and interpret accurately imaging modalities for non-invasive follow-up. Through a pictorial essay of imaging follow-up of treated intracranial aneurysms we show the differences in characterization with computed tomography angiography, magnetic resonance angiography without contrast (time of flght or "TOF" technique), contrast enhanced MR angiography (C+) and digital subtraction angiography (DSA). Additionally we recommend imaging modalities for each treatment device.