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Intracranial Aneurysms: Clinical Assessment and Treatment Options

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Biomechanics and Mechanobiology of Aneurysms

Part of the book series: Studies in Mechanobiology, Tissue Engineering and Biomaterials ((SMTEB,volume 7))

Abstract

Intracranial aneurysms (IA) represent a challenging pathological entity ubiquitous in 2–6% percent of the population which may present occasionally with a devastating and often fatal intracranial bleed. While the understanding of the pathophysiological mechanisms governing their genesis and rupture are still being elucidated, advancements in the imaging techniques have enabled radiologists to accurately characterize their morphology and relationship with the neighboring vasculature. The past few decades have seen a refinement in the microneurosurgical techniques and made possible permanent exclusion of the aneurysm from the circulation. The development of detachable platinum microcoils to embolize the aneurysmal sac led to the dawn of an era of minimally invasive endovascular surgery. This branch has seen phenomenal progress with the development of an assortment of medical devices. These include guidewires and catheters for access, improvements in the embolic coil design, endovascular balloons, neurovascular stents and flow diverting devices that facilitate obliteration of the aneurysm. Recently concluded clinical trials attest to the remarkable safety profile of endovascular occlusion. However, there is a concern over the durability of treatment necessitating mandatory follow up imaging and retreatments for aneurysm recanalization. Also, controversy exists over the indications for offering treatment for the incidentally discovered IA. Future research into the identification of factors influencing the aneurysms predisposition to rupture and development of markers to assess that risk, will hopefully address this issue.

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Abbreviations

ADPKD:

Autosomal dominant polycystic kidney disease

AICA:

Anterior inferior cerebellar artery

CAMEO:

Cerebral aneurysm multicenter European Onyx trial

CARAT:

Cerebral aneurysm rerupture after treatment

CCT:

Cerecyte coil trial

CE-MRA:

Contrast-enhanced magnetic resonance angiography

CSF:

Cerebrospinal fluid

CT:

Computed tomography

CTA:

Computed tomography angiography

DMSO:

Dimethyl sulfoxide

DSA:

Digital subtraction angiography

EVOH:

Ethylene vinyl alcohol

EVT:

Endovascular treatment

FDA:

Food and drug administration

FLAIR:

Fluid-attenuated inversion recovery

GDC:

Guglielmi detachable coils

HELPS:

HydroCoil endovascular aneurysm occlusion and packing study

IA:

Intracranial aneurysm

ICA:

Internal cerebral artery

ICP:

Intracranial pressure

ISAT:

International subarachanoid aneurysm trial

ISUIA:

International study of unruptured intracranial aneurysms

MCA:

Middle cerebral artery

MIP:

Maximum intensity projection

MMP:

Matrix metalloproteinase

MR:

Magnetic resonance

MRA:

Magnetic resonance angiography

PICA:

Posterior inferior cerebellar artery

SAH:

Subarachnoid hemorrhage

SNIS:

Society of neurointerventional surgery

TCD:

Transcranial doppler

TOF:

Time of flight

VR:

Volume rendered

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  1. New England Center for Stroke Research, Neuroimaging and Intervention, Departments of Radiology, Neurological Surgery and Neurology, University of Massachusetts, Worcester, USA

    Manik Mehra, Gabriela Spilberg, Matthew J. Gounis & Ajay K. Wakhloo

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  1. Manik Mehra
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  2. Gabriela Spilberg
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  3. Matthew J. Gounis
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  4. Ajay K. Wakhloo
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Correspondence to Matthew J. Gounis .

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  1. Dept. Mechanical and Aerospace, Engineering, University Limerick, Limerick, Ireland

    Tim McGloughlin

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© 2011 Springer-Verlag Berlin Heidelberg

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Mehra, M., Spilberg, G., Gounis, M.J., Wakhloo, A.K. (2011). Intracranial Aneurysms: Clinical Assessment and Treatment Options. In: McGloughlin, T. (eds) Biomechanics and Mechanobiology of Aneurysms. Studies in Mechanobiology, Tissue Engineering and Biomaterials, vol 7. Springer, Berlin, Heidelberg. https://doi.org/10.1007/8415_2011_78

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  • DOI: https://doi.org/10.1007/8415_2011_78

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  • Print ISBN: 978-3-642-18094-1

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