Shedding the Light on the Natural History of Intracranial Aneurysms: An Updated Overview

Medicina

Matías Baldoncini¹  Nunzio Bruno²  Juha Hernesniemi³  Sabino Luzzi⁴  Alice Giotta Lucifero⁴  Renato Galzio⁵ 

[1] Department of Neurological Surgery, Hospital San Fernando, Buenos Aires 1646, Argentina;Division of Neurosurgery, Azienda Ospedaliero Universitaria Consorziale Policlinico di Bari, 70124 Bari, Italy;Juha Hernesniemi International Center for Neurosurgery, Henan Provincial People’s Hospital, Zhengzhou 450000, China;Neurosurgery Unit, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy;Neurosurgery Unit, Maria Cecilia Hospital, 48032 Cotignola, Italy;

关键词: endothelial disfunction;    inflammatory cascade;    intra-aneurysmal flow;    intracranial aneurysm;    subarachnoid hemorrhage;    wall shear stress;   

DOI  :  10.3390/medicina57080742

来源: DOAJ

【 摘 要 】

The exact molecular pathways underlying the multifactorial natural history of intracranial aneurysms (IAs) are still largely unknown, to the point that their understanding represents an imperative challenge in neurovascular research. Wall shear stress (WSS) promotes the genesis of IAs through an endothelial dysfunction causing an inflammatory cascade, vessel remodeling, phenotypic switching of the smooth muscle cells, and myointimal hyperplasia. Aneurysm growth is supported by endothelial oxidative stress and inflammatory mediators, whereas low and high WSS determine the rupture in sidewall and endwall IAs, respectively. Angioarchitecture, age older than 60 years, female gender, hypertension, cigarette smoking, alcohol abuse, and hypercholesterolemia also contribute to growth and rupture. The improvements of aneurysm wall imaging techniques and the implementation of target therapies targeted against inflammatory cascade may contribute to significantly modify the natural history of IAs. This narrative review strives to summarize the recent advances in the comprehension of the mechanisms underlying the genesis, growth, and rupture of IAs.

【 授权许可】

Unknown