多发脑动脉瘤危险因素的临床研究

目的：探讨多发脑动脉瘤发生的主要危险因素，为脑动脉瘤的防治提供理论依据。方法：应用病例对照研究对42例多发脑动脉瘤病例和164例单发脑动脉瘤对照主要危险因素进行单因素和多因素分析。结果：单因素分析有5个变量达到了统计学意义，分别为性别(女性)、高血压、吸烟、月经状况、脑血管病家族史，其OR(95％CI)分别为3．7(1．5～9．7)、2．7(1．2～6．0)、0．3(0．08～0．96)、2．4(1．1～6．0)、3．5(1．2～9．7)。多因素分析性别、高血压、脑血管病家族史进入最后的模型，其OR(95％CI)分别为3．5(1．7～8．9)、3．0(1．1～5．2)、3．2(1．4～8．6)。结论：女性、高血压、脑血管病家族史为发生多发脑动脉瘤的高危因素。     

Dorsal internal carotid artery aneurysm: classification,pathogenesis, and surgical considerations

Despite the rarity of dorsal internal carotid artery (ICA) aneurysms they still offer surgical challenge to achieve a safe successful clipping due to their peculiar projection.In the past 13 years, 24 cases of dorsal ICA aneurysm were operated upon in our hospitals. Three separate groups of such aneurysms could be identified: group 1; where the aneurysms were located most proximally at the carotid-ophthalmic region, group 3; in which the aneurysms were present most distally just proximal to the ICA bifurcation, and group 2; where the aneurysms were located inbetween. All cases in this surgical series will be reviewed stressing upon the classification, pathogenesis, and surgical tactics of such a rare type of aneurysm.     

Matrix metalloproteinases in ascending aortic aneurysms: bicuspid versus trileaflet aortic valves

BACKGROUND: Abnormal matrix metalloproteinase (MMP) and tissue inhibitor of metalloproteinase (TIMP) expression contributes to the development of abdominal aortic aneurysms. Recent data suggest that MMP-2 and MMP-9 may also play a role in thoracic aortic disease. We sought to determine (1) whether ascending aortic aneurysms are associated with increased MMP expression and (2) whether aortic inflammation and MMP expression differ between patients with congenital bicuspid aortic valves (BAVs) and those with trileaflet aortic valves (TAVs). MATERIALS AND METHODS: Samples of ascending aortic aneurysms were obtained from 29 patients; 14 patients had BAVs and 15 had TAVs. Control ascending aorta was obtained from 14 organ donors or heart transplant recipients. Aortic histology and immunohistochemistry were performed to evaluate elastin degradation, inflammatory changes, and MMP-2 and MMP-9 expression. Aortic levels of MMP-2, MMP-9, TIMP-1, and TIMP-2 were measured using ELISA. RESULTS: Aneurysms in the TAV patients exhibited marked inflammation, high CD68 expression, diminished elastin content, increased MMP-9 expression, and normal MMP-2 levels. In contrast, BAV aneurysms were characterized by a relative lack of inflammation, preservation of elastin content, normal MMP-9 levels, and elevated MMP-2 expression. TIMP-1 and TIMP-2 levels were not significantly different among the three groups. CONCLUSIONS: Ascending aortic aneurysms exhibited increased MMP expression. The pattern of MMP expression and the degree of inflammation, however, differed between aneurysms associated with BAVs and those with TAVs. Variations in the molecular mechanisms underlying different types of thoracic aortic aneurysms warrant further investigation.     

Balloon embolization in the treatment of basilar aneurysms

Summary Some vertebro-basilar aneurysm may not be treatable at a reasonable risk by direct clipping. A possible alternative is transvascular obliteration, using the means of modern interventional neuroradiology in combination with neurophysiological monitoring.These possibilites and related difficulties are outlined and discussed and the example of two cases with different types of vertebrobasilar aneurysms (top of the basilar artery and basilar trunk aneurysm) which have been treated by balloon embolization.Prof. Poeck to his 60th birthday.     

Multiple cerebral aneurysms as delayed complication of left cardiac myxoma: a case report and review

Left cardiac myxoma and also consecutive embolization into the brain is well documented, whereas the association of myxomas with multiple fusiform cerebral aneurysms is rare. We analyze 33 previously reported patients and present a case of a 43-year-old woman with multiple cerebral infarctions 2 years after resection of a recurrent myxoma in the left atrium. Cerebral angiography displayed multiple fusiform aneurysms of several cerebral arteries, including a giant aneurysm of the basilar artery. Serum level of interleukin-6 (IL-6) was highly elevated. The clinical, radiological and pathological features of these aneurysms are summarized. The pathogenesis, including the role of IL-6 in the formation of myxomatous aneurysms, is discussed.     

Multiple basilar artery trunk aneurysms associated with fibromuscular dysplasia

Summary An association between fibromuscular dysplasia (FMD) and intracranial aneurysms has been proposed but the occurrence of multiple aneurysms on the trunk of basilar artery (BA) associated with FMD has not been previously reported.     

前、后交通动脉瘤DSA与CTA诊断的对比研究

目的:评价DSA与CTA诊断前、后交通动脉瘤的优缺点。方法:30例脑出血或单侧动眼神经麻痹而疑有前、后交通动脉瘤的患者进行DSA和CTA检查,比较两种检查方法对前、后交通动脉瘤的检出率及显示动脉瘤瘤颈、瘤体、钙化、血栓的优劣。结果:12例前交通动脉瘤DSA与CTA检查阳性率均为100%。18例后交通动脉瘤,DSA检查阴性1例,可疑2例,阳性15例,阳性率为83.33%;CTA检查阴性1例,可疑6例,阳性11例,阳性率为61.11%。CTA对前交通动脉瘤瘤颈、瘤体、钙化、血栓的显示优于DSA,对后交通动脉瘤与DSA差别不大。结论:CTA对前交通动脉瘤的敏感性达100%,对后交通动脉瘤诊断尚不能代替DSA,DSA与CTA两种检查方法互补可提高动脉瘤,尤其是后交通动脉瘤的检出率。