Browsing by Subject "Intracranial aneurysm"

Now showing 1 - 5 of 5
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    Comparative Assessment of Biomechanical Parameters in Subjects With Multiple Cerebral Aneurysms Using Fluid-Structure Interaction Simulations
    (ASME, 2022) Shidhore, Tanmay C.; Cohen-Gadol, Aaron A.; Rayz, Vitaliy L.; Christov, Ivan C.; Neurological Surgery, School of Medicine
    Cerebral aneurysm progression is a result of a complex interplay of the biomechanical and clinical risk factors that drive aneurysmal growth and rupture. Subjects with multiple aneurysms are unique cases wherein clinical risk factors are expected to affect each aneurysm equally, thus allowing for disentangling the effect of biomechanical factors on aneurysmal growth. Toward this end, we performed a comparative computational fluid-structure interaction analysis of aneurysmal biomechanics in image-based models of stable and growing aneurysms in the same subjects, using the cardiovascular simulation platform simvascular. We observed that areas exposed to low shear and the median peak systolic arterial wall displacement were higher by factors of 2 or more and 1.5, respectively, in growing aneurysms as compared to stable aneurysms. Furthermore, we defined a novel metric, the oscillatory stress index (OStI), which indicates locations of oscillating arterial wall stresses. We observed that growing aneurysms were characterized by regions of combined low wall shear and high OStI, which we hypothesize to be associated with regions of collagen degradation and remodeling. Such regions were either absent or below 5% of the surface area in stable aneurysms. Our results lay the groundwork for future studies in larger cohorts of subjects, to evaluate the statistical significance of these biomechanical parameters in cerebral aneurysm growth.
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    Intracranial Aneurysm Classifier Using Phenotypic Factors: An International Pooled Analysis
    (MDPI, 2022-08-30) Morel, Sandrine; Hostettler, Isabel C.; Spinner, Georg R.; Bourcier, Romain; Pera, Joanna; Meling, Torstein R.; Alg, Varinder S.; Houlden, Henry; Bakker, Mark K.; van’t Hof, Femke; Rinkel, Gabriel J.E.; Foroud, Tatiana; Lai, Dongbing; Moomaw, Charles J.; Worrall, Bradford B.; Caroff, Jildaz; Constant-dits-Beaufils, Pacôme; Karakachoff, Matilde; Rimbert, Antoine; Rouchaud, Aymeric; Gaal-Paavola, Emilia I.; Kaukovalta, Hanna; Kivisaari, Riku; Laakso, Aki; Jahromi, Behnam Rezai; Tulamo, Riikka; Friedrich, Christoph M.; Dauvillier, Jerome; Hirsch, Sven; Isidor, Nathalie; Kulcsàr, Zolt; Lövblad, Karl O.; Martin, Olivier; Machi, Paolo; Pereira, Vitor Mendes; Rüfenacht, Daniel; Schaller, Karl; Schilling, Sabine; Slowik, Agnieszka; Jaaskelainen, Juha E.; von und zu Fraunberg, Mikael; Jiménez-Conde, Jordi; Cuadrado-Godia, Elisa; Soriano-Tárraga, Carolina; Millwood, Iona Y.; Walters, Robin G.; The @neurIST project; The ICAN Study Group; Genetics and Observational Subarachnoid Haemorrhage (GOSH) Study Investigators; International Stroke Genetics Consortium (ISGC); Kim, Helen; Redon, Richard; Ko, Nerissa U.; Rouleau, Guy A.; Lindgren, Antti; Niemelä, Mika; Desal, Hubert; Woo, Daniel; Broderick, Joseph P.; Werring, David J.; Ruigrok, Ynte M.; Bijlenga, Philippe; Medical and Molecular Genetics, School of Medicine
    Intracranial aneurysms (IAs) are usually asymptomatic with a low risk of rupture, but consequences of aneurysmal subarachnoid hemorrhage (aSAH) are severe. Identifying IAs at risk of rupture has important clinical and socio-economic consequences. The goal of this study was to assess the effect of patient and IA characteristics on the likelihood of IA being diagnosed incidentally versus ruptured. Patients were recruited at 21 international centers. Seven phenotypic patient characteristics and three IA characteristics were recorded. The analyzed cohort included 7992 patients. Multivariate analysis demonstrated that: (1) IA location is the strongest factor associated with IA rupture status at diagnosis; (2) Risk factor awareness (hypertension, smoking) increases the likelihood of being diagnosed with unruptured IA; (3) Patients with ruptured IAs in high-risk locations tend to be older, and their IAs are smaller; (4) Smokers with ruptured IAs tend to be younger, and their IAs are larger; (5) Female patients with ruptured IAs tend to be older, and their IAs are smaller; (6) IA size and age at rupture correlate. The assessment of associations regarding patient and IA characteristics with IA rupture allows us to refine IA disease models and provide data to develop risk instruments for clinicians to support personalized decision-making.
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    Lessons learned from whole exome sequencing in multiplex families affected by a complex genetic disorder, intracranial aneurysm
    (PLoS, 2015-03-24) Farlow, Janice L.; Lin, Hai; Sauerbeck, Laura; Lai, Dongbing; Koller, Daniel L.; Pugh, Elizabeth; Hetrick, Kurt; Ling, Hua; Kleinloog, Rachel; van der Vlies, Peter; Deelen, Patrick; Swertz, Morris A.; Verweij, Bon H.; Regli, Luca; Rinkel, Gabriel J.E.; Ruigrok, Ynte M.; Doheny, Kimberly; Liu, Yunlong; Broderick, Joseph; Foroud, Tatiana; Department of Medical and Molecular Genetics, IU School of Medicine
    Genetic risk factors for intracranial aneurysm (IA) are not yet fully understood. Genomewide association studies have been successful at identifying common variants; however, the role of rare variation in IA susceptibility has not been fully explored. In this study, we report the use of whole exome sequencing (WES) in seven densely-affected families (45 individuals) recruited as part of the Familial Intracranial Aneurysm study. WES variants were prioritized by functional prediction, frequency, predicted pathogenicity, and segregation within families. Using these criteria, 68 variants in 68 genes were prioritized across the seven families. Of the genes that were expressed in IA tissue, one gene (TMEM132B) was differentially expressed in aneurysmal samples (n=44) as compared to control samples (n=16) (false discovery rate adjusted p-value=0.023). We demonstrate that sequencing of densely affected families permits exploration of the role of rare variants in a relatively common disease such as IA, although there are important study design considerations for applying sequencing to complex disorders. In this study, we explore methods of WES variant prioritization, including the incorporation of unaffected individuals, multipoint linkage analysis, biological pathway information, and transcriptome profiling. Further studies are needed to validate and characterize the set of variants and genes identified in this study.
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    The SMART Registry: Long-Term Results on the Utility of the Penumbra SMART COIL System for Treatment of Intracranial Aneurysms and Other Malformations
    (Frontiers Media, 2021-04-13) Spiotta, Alejandro M.; Park, Min S.; Bellon, Richard J.; Bohnstedt, Bradley N.; Yoo, Albert J.; Schirmer, Clemens M.; DeLeacy, Reade A.; Fiorella, David J.; Woodward, B. Keith; Hawk, Harris E.; Nanda, Ashish; Zaidat, Osama O.; Sunenshine, Peter J.; Liu, Kenneth C.; Kabbani, Mouhammed R.; Snyder, Kenneth V.; Sivapatham, Thinesh; Dumont, Travis M.; Reeves, Alan R.; Starke, Robert M.; SMART Registry Investigators; Neurological Surgery, School of Medicine
    Introduction: Penumbra SMART COIL® (SMART) System is a novel generation embolic coil with varying stiffness. The study purpose was to report real-world usage of the SMART System in patients with intracranial aneurysms (ICA) and non-aneurysm vascular lesions. Materials and Methods: The SMART Registry is a post-market, prospective, multicenter registry requiring ≥75% Penumbra Coils, including SMART, PC400, and/or POD coils. The primary efficacy endpoint was retreatment rate at 1-year and the primary safety endpoint was the procedural device-related serious adverse event rate. Results: Between June 2016 and August 2018, 995 patients (mean age 59.6 years, 72.1% female) were enrolled at 68 sites in the U.S. and Canada. Target lesions were intracranial aneurysms in 91.0% of patients; 63.5% were wide-neck and 31.8% were ruptured. Adjunctive devices were used in 55.2% of patients. Mean packing density was 32.3%. Procedural device-related serious adverse events occurred in 2.6% of patients. The rate of immediate post-procedure adequate occlusion was 97.1% in aneurysms and the rate of complete occlusion was 85.2% in non-aneurysms. At 1-year, the retreatment rate was 6.8%, Raymond Roy Occlusion Classification (RROC) I or II was 90.0% for aneurysms, and Modified Rankin Scale (mRS) 0-2 was achieved in 83.1% of all patients. Predictors of 1-year for RROC III or retreatment (incomplete occlusion) were rupture status (P < 0.0001), balloon-assisted coiling (P = 0.0354), aneurysm size (P = 0.0071), and RROC III immediate post-procedure (P = 0.0086) in a model that also included bifurcation aneurysm (P = 0.7788). Predictors of aneurysm retreatment at 1-year was rupture status (P < 0.0001). Conclusions: Lesions treated with SMART System coils achieved low long-term retreatment rates.
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    Treatment of Acute Intracranial Vertebrobasilar Dissection with Angioplasty and Stent Placement: Report of Two Cases
    (American Society of Neuroradiology, 2003-05) Willing, Steven J.; Skidmore, Frank; Donaldson, Jill; Nobo, Ulises Lisandro; Chernukha, Konstantin; Radiology and Imaging Sciences, School of Medicine
    Acute vertebrobasilar dissection may cause subarachnoid hemorrhage by rupturing through the adventia or cerebral infarct by progressive occlusion of the true lumen. Recent reports on the endovascular management of this condition have focused on treatment of pseudoaneurysms. We report two cases where angioplasty or stent placement was successfully used to improve compromised blood flow secondary to vertebrobasilar dissection.