Characteristics of intracranial aneurysms associated with extracranial carotid artery disease in South Korea

Objective

Although it is hypothesized that inflammatory signals and/or hemodynamic stress resulting from carotid disease increase the risk of aneurysm formation and growth, a relationship between intracranial aneurysms and extracranial carotid artery disease (ECAD) has not been explored. Here, we examined the characteristics of intracranial aneurysms associated with ECAD.

Methods

A total of 606 consecutive patients with stenosis of 50% or more of the proximal internal carotid artery (pICA) were enrolled. Stenosis was identified by conventional angiography between January 2003 and December 2009. We determined the prevalence of intracranial aneurysms in this population. The characteristics of the aneurysms were analyzed according to the degree and laterality of stenosis. The changes in the aneurysms were tracked for the evaluation of stability.

Results

In 86 patients (14.2%), 120 aneurysms were detected in association with pICA stenosis. In this group, 97 were associated with unilateral pICA stenosis. The distribution of aneurysms was independent of the laterality of stenosis, but aneurysms were more prevalent in the contralateral side as the stenosis grade increased (P < 0.001). All aneurysms with an imaging follow-up (28.9 ± 14.3 months) were stable, and the course was not affected by treatment of the carotid stenosis. In 23 aneurysms associated with bilateral pICA stenosis, there was only one case that increased in size during a 41-month period.

Conclusion

Intracranial aneurysms were most likely associated with ECAD, but were evenly distributed irrespective of the laterality of the stenosis. The distribution was related to the severity of the contralateral pICA stenosis. The low incidence of aneurysm growth or rupture in patients with significant ECAD indicates that these aneurysms do not require immediate intervention more than other conditions.     

Cerebrovascular neurosurgery in 2012

Considerable advances in our understanding of the natural history and treatment of cerebrovascular disease were made in 2012. The landmark Unruptured Cerebral Aneurysm Study in Japan was published, illustrating a significantly greater rupture risk than previously reported for small anterior and posterior communicating artery aneurysms, those with daughter domes, and giant aneurysms. Results from the Cerecyte (DePuy Synthes, West Chester, PN, USA) coil trial did not demonstrate a statistically significant positive impact of these bioactive coils on angiographic occlusion rates or outcome. The Clazosentan to Overcome Neurological Ischemia and Infarct Occurring after Subarachnoid Hemorrhage study was also published and unfortunately did not demonstrate an overall favorable long-term functional outcome rate for patients with aneurysmal subarachnoid hemorrhage receiving clazosentan. Studies furthering our understanding of the natural history and treatment of vascular malformations were also published, including large prospective natural history studies of cavernous malformations from the Mayo Clinic and the Scottish Audit of Intracranial Vascular Malformations database. Although pregnancy was found to be a significant risk factor for arteriovenous malformation hemorrhage, several studies did not demonstrate pregnancy as a significant risk factor for cavernous malformation hemorrhage. Finally, prospective randomized control trials illustrated significantly improved angiographic and clinical outcome results for both the Solitaire (ev3 Endovascular, Plymouth, MN, USA; SWIFT trial) and Trevo (Concentric Medical, Mountainview, CA, USA; TREVO 2 trial) stent retrievers as compared to the Merci (Concentric Medical) clot retriever.     

Traumatic Middle Cerebral Artery Aneurysm Secondary to a Gunshot Wound

Traumatic intracranial aneurysms are rare lesions, accounting for less than 1% of all intracranial aneurysms. Formation of these lesions after a penetrating missile wound is very unusual, and diagnosis can be difficult due to the presence of associated lesions. In this article, we report a case of a woman who developed a middle cerebral artery aneurysm after a gunshot wound, and discuss potential pitfalls found during diagnostic work‐up.     

人工合成E-选择素对兔颈总动脉动脉瘤壁平滑肌细胞增殖活性的影响

目的 探讨人工合成E-选择素对兔颈总动脉动脉瘤壁平滑肌细胞增殖活性的影响.方法 新西兰白兔54只,雌雄各半,随机分成9组(每组6只),对照组;实验1、2、3、4周组;治疗l、2、3、4周组.用弹性蛋白酶(EA)滴注法建立兔右颈总动脉瘤模型,并用CTA和HE染色观察模型动脉瘤的形态学改变和病理变化,免疫组化分析基质金属蛋白酶-2(MMP-2)、细胞增殖核抗原(PCNA)和平滑肌α肌动蛋白(α-SMA)表达,Real-time PCR检测骨桥蛋白(OPN)和MMP-2 mRNA表达.结果 大体测量和CTA结果显示:治疗组与实验组相比,其动脉瘤高度和宽度均有不同程度减小;免疫组化结果显示:治疗组动脉瘤壁MMP-2蛋白表达与同期实验组相比均有减少,治疗1、2周组动脉瘤壁PCNA蛋白表达低于同期实验组,而治疗3、4周组动脉瘤壁PCNA蛋白表达与同期实验组比较表达升高;治疗组动脉瘤壁α-SMA蛋白表达低于同期实验组.Real-time PCR结果显示:治疗组动脉瘤壁OPN mRNA表达与同期实验组相比均有增加,而治疗组动脉瘤壁MMP-2 mRNA表达分别低于同期实验组.结论 人工合成E-选择素可以抑制兔颈总动脉瘤壁平滑肌细胞数目和层数的减少,有效促进兔颈总动脉瘤壁平滑肌细胞的增殖,使血管平滑肌细胞由收缩型向合成型转化,进而对动脉瘤壁起到一定的修复作用.     

脾动脉瘤反复出血栓塞治疗1例

患者男,22岁.1年前因腹部刀刺伤后在当地医院行剖腹探查、胰腺修补术,术后4个月时出现腹部不适,经当地超声检查诊断为"胰腺假性囊肿",遂行手术治疗,术后出现胰瘘并行外引流术.     

髂动脉夹层动脉瘤1例

患者男,65岁.因前列腺手术前常规B超检查偶然发现左中下腹一包块而行彩超检查.所用仪器:ALOKA SSD-1700 Ⅱ型,探头频率3.5 MHz.     

1例动脉瘤性蛛网膜下腔出血患者的循证治疗

目的结合1例典型动脉瘤性蛛网膜下腔出血(aSAH)患者的循证治疗经过,总结评价治疗aSAH的最佳证据,为临床实践提供参考。方法根据所提出的如何预防并发症及处理破裂动脉瘤的问题,全面检索Cochrane图书馆(2006年第4期)、OVID ACP Journal Club(1991～2006)、OVID MEDLINE (1966～2006)、美国国家指南交换中心(1998～2006)及中国生物医学文献数据库(1978～2006),获取并评价相关的系统评价、随机对照试验、临床对照试验证据及治疗指南。结果共纳入7篇系统评价、3篇RCT、1篇CCT和5篇临床指南。当前证据表明,口服尼莫地平可有效预防脑血管痉挛相关的不良结局,而替拉扎特对分级较好的女性患者无效,其他预防措施效果尚不明确；是否应用抗纤溶剂预防再出血,各证据间存在异议；破裂动脉瘤若同时适合手术夹闭或介入治疗,选择后者临床结局更佳。参照证据和指南,并结合患者情况和意愿,我们对该例患者实施尼莫地平和抗纤溶剂治疗,并对动脉瘤行早期介入栓塞。住院期间患者未发生脑血管痉挛缺血和早期再出血,短期随访示临床转归良好,介入治疗的远期效益尚待后续随访证实。结论为有效预防并发症发生和改善预后,应基于最佳临床证据和指南对aSAH患者实施治疗。     

胸主动脉腔内修复术后截瘫发生的危险因素及处理

目的:探讨胸主动脉腔内修复术(TEVAR)后截瘫发生的危险因素及处理。方法:回顾性分析2011年5月—2015年5月593例行TEVAR手术的Stanford B型主动脉夹层患者资料,分析术后截瘫发生的危险因素并总结处理方法。结果:593例患者中,9例(1.5%)发生TEVAR术后截瘫。单变量分析结果显示,糖尿病、高血压、吸烟、围术期低血压和左锁骨下动脉封堵可能与TEVAR术后截瘫有关(均P0.05);多变量Logistic回归分析结果显示,围术期低血压是TEVAR术后截瘫的独立危险因素(P0.05)。所有截瘫患者经脑脊液引流、激素冲击、适当升压、抗凝、扩血管、营养神经、降颅压联合治疗后,神经系统功能均完全恢复。结论:围术期低血压是TEVAR后截瘫发生的重要危险因素。截瘫发生后早期采取相应保守治疗手段提高脊髓灌注可以有效改善预后。