Abstract
An aneurysm is a localized pathological dilatation of a blood vessel (or of the cardiac wall) involving all layers. Various types of aneurysm exist (saccular (berry), fusiform, inflammatory/infective “mycotic” (septic), dissecting, dolichoectasia, and false aneurysms).
DSA is the gold standard in imaging and is superior over computerized tomography angiography (CTA) and magnetic resonance angiography (MRA).
Increased mechanical stress in aneurysm-prone regions triggers events that culminate in vascular dysfunction, leaving the endothelium nude from antithrombotic protection. Aneurysm formation is initiated by hemodynamically triggered endothelial dysfunction. An inflammatory response implicating several cytokines and inflammatory mediators as well as macrophages, T-cells, and mast cells ensues. Inflammatory pathways and mediators implicated in aneurysma formation and rupture are involved in endothelial dysfunction, phenotypic modulation, and loss of smooth muscle cells, macrophages, M1/M2 imbalance, leukocyte infiltration, vascular remodeling, and cell death. Various genes are associated with the formation and rupture of aneurysms.
Treatment consists of clipping (done by neurosurgeon in 30% of cases) or coiling (performed by interventional neuroradiologists in 70% of the cases). Clinical outcome is usually good; complications might include emboli, thrombosis, rupture with resultant subarachnoidal and/or intracerebral hemorrhage, obstruction of branch vessels.
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Weis, S. et al. (2019). Vascular Disorders: Aneurysms. In: Imaging Brain Diseases. Springer, Vienna. https://doi.org/10.1007/978-3-7091-1544-2_21
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DOI: https://doi.org/10.1007/978-3-7091-1544-2_21
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