Search Results (439)

A brain aneurysm is a structural deterioration of the arterial wall in the brain, resulting in the formation of a bulge in or ballooning of a blood vessel. Around 3–5% of the global population is affected by brain aneurysms, wherein only a small fraction results in rupture. Although an unruptured aneurysm is typically asymptomatic and not immediately life threatening, it poses a potential risk of rupture, which can lead to severe health complications or mortality. Therefore, it is crucial to detect and treat aneurysms during the unruptured phase. Moreover, a comprehensive understanding of the flow dynamics within the aneurysm and its parent artery is essential for accurate diagnosis and the prevention of aneurysm recurrence. While prior reviews have focused on computational fluid dynamics (CFD) studies on brain aneurysms, particularly patient-specific models from studies conducted over a decade ago, a more recent review is necessary. Additionally, reviewing various studies on the fluid dynamic behavior of treated aneurysms is crucial. Thus, the advancements in both experimental and computational studies on brain aneurysms must be explored to better understand their underlying fluid flow mechanisms and to develop robust treatment strategies. This review aims to summarize the different types of brain aneurysms, the screening and treatment processes, the key hemodynamic factors, and the fluid dynamic characteristics observed in aneurysms before and after treatment. Full article

Background/Objectives: Ruptured abdominal aortic aneurysm (RAAA) remains a leading cause of vascular death, with mortality rates approaching 90%. Biomarkers capable of identifying the most at-risk population are urgently needed in the clinic. We aimed to identify potential alterations in the urine proteome that can enable non-invasive detection of abdominal aortic aneurysms (AAA) at high risk of rupture. Methods: We used multiplexed kinase inhibitor beads (MIBs) and quantitative mass spectrometry (MIB/MS) to examine potential biomarkers in urine samples. Quantitative proteomic profiling was conducted using iTRAQ labeling and LC-TEMPO MALDI-TOF/TOF analysis, revealing several dysregulated proteins in the urinary proteome between the two groups. MS and MS/MS data were generated using MALDI TOF/TOF instruments (models 5800 or 4800; AB SCIEX). MS/MS spectra were processed with ProteinPilot™ software version 3.0 (AB SCIEX) and matched against the UniProt/Swiss-Prot database for identification of proteins with an Unused ProtScore >1.3. Statistical tests were performed using R/Bioconductor software and bioinformatics analysis using open-source software. Results: We quantitatively measured activity over 130 kinases from various kinase families using MIB/MS with a threshold of 1.5-fold change in expression. Statistical analysis assigned significance to EPHB6, AXL, EPHB4, DDR1, EPHA2 and EPHB3. All were tyrosine kinases, and the Ephrin receptor type was dominant. The reduced expression of specific kinases identified by MIB/MS analysis was validated by Western blot. Conclusions: This pilot study presents a promising breakthrough in the diagnosis and surveillance of AAA. We identified six dysregulated tyrosine kinases in the urine proteome of patients with RAAAs, suggesting their potential as urinary biomarkers for early detection of AAA at high risk of rupture. However, these preliminary findings require confirmation in larger, prospective cohorts to validate their diagnostic utility and generalizability. Full article

Background: Infected aortic aneurysms pose significant therapeutic challenges, given the fragility of infected aneurysmal tissue. Mycotic aneurysms caused by Streptococcus agalactiae are rare and may progress in the absence of classical systemic infection signs. Here, we discuss the surgical management of an unusual presentation of a mycotic aneurysm and its rapid progression with no incremental changes in the patient’s symptoms. Case: A 72-year-old woman presented with subacute general deterioration and back pain. A general workup revealed a mycotic aneurysm of the aortic arch, at the level of the brachiocephalic artery. Initial CT showed a 7 × 5.5 mm pseudoaneurysm that enlarged to 41 × 26 mm within three weeks, despite clinical improvement of her presenting symptoms on antibiotics. Given that the lesion progressed, a staged procedure, consisting of a left carotid–subclavian bypass followed by proximal arch repair, was undertaken with success. Intra-operatively, a completely thrombosed innominate vein was found compressing—and likely tamponading—the pseudoaneurysm, a phenomenon that may have prevented catastrophic rupture. A Dacron graft was sewn end-to-end to the distal ascending aorta; the posterior half of this distal anastomosis incorporated the rim of the innominate artery defect to create a single hemostatic suture line. Conclusions: This case demonstrates a benign initial presentation can degenerate into a catastrophic pseudoaneurysm and how rapidly progressive thoracic infected aneurysms can develop. Heightened clinical acumen is required for accurate diagnosis. Close follow-up is also suggested based on the rapid progression experienced by our patient. Serial imaging, rather than symptomatic or laboratory response alone, should guide the timing of intervention. Full article

Background/Objectives: The fetal-type posterior cerebral artery (fetal PCA) is an anatomical variant that alters hemodynamics and may influence posterior communicating artery (PCoA) aneurysm rupture risk. Aneurysm shape and size irregularity are key rupture predictors. This study investigates the impact of fetal PCA on PCoA aneurysm morphology and rupture risk using a radiomics-based approach. Methods: We retrospectively analyzed 87 patients with PCoA aneurysms (39 ruptured, 48 unruptured) treated at a tertiary center (January 2017–December 2022). Seventeen morphological parameters and 18 radiomic features were extracted per aneurysm. Patients were grouped by fetal PCA presence. Logistic regression and receiver operating characteristic (ROC) analyses identified rupture predictors. Results: Of 87 aneurysms, 38 had fetal PCA (24 ruptured, 14 unruptured), and 49 did not (15 ruptured, 34 unruptured). Fetal PCA was significantly associated with rupture (odds ratio [OR]: 3.28, p = 0.018). A higher non-sphericity index (NSI) correlated with rupture risk (OR: 3.35, p = 0.016). In non-fetal PCA aneurysms, size-related parameters such as height (6.83 ± 3.54 vs. 4.88 ± 2.57 mm, p = 0.034) and area (190.84 ± 167.08 vs. 107.94 ± 103.10 mm², p = 0.046) were key rupture predictors. In fetal PCA aneurysms, flow-related parameters like vessel angle (55.78 ± 31.39 vs. 38.51 ± 24.71, p = 0.035) were more influential. ROC analysis showed good discriminatory power, with an area under the curve: 0.726 for fetal PCA and 0.706 for NSI. Conclusions: Fetal PCA influences PCoA aneurysm rupture risk and morphology. NSI is a reliable rupture marker. Integrating morphological and anatomical data may improve rupture risk assessment and clinical decision-making. Full article

Introduction: The transforming growth factor beta (TGF-β) signaling pathway plays a critical role in cellular processes, including maintaining vascular integrity and regulating vascular remodeling. Aneurysm rupture is associated with pathological changes in the arterial wall. Aims: We aimed to investigate the gene expression of transforming growth factors (TGFB1, TGFB2, TGFB3) in peripheral blood mononuclear cells (PBMCs) isolated from the blood of patients with unruptured intracranial aneurysms (UIAs) and ruptured intracranial aneurysms (RIAs), and from a control group. Additionally, we evaluated serum levels of TGF-β1, TGF-β2, and TGF-β3 and analyzed their associations with various risk factors, including sex, age, aneurysm size, number, shape, smoking, and hypertension. Materials and Methods: The study group consisted of patients diagnosed with intracranial aneurysms (IAs) who were eligible for embolization at the Department of Neurosurgery, Clinical Hospital of the Medical University of Bialystok. The control group consisted of healthy volunteers, recruited from the employees of the Clinical Hospital of the Medical University of Bialystok. Expression levels were assessed using quantitative real-time polymerase chain reaction techniques in PBMCs. Serum concentrations of TGF-β isoforms were evaluated using a multiplexed bead-based immunoassay. Results: Among 32 patients, 24 had unruptured intracranial aneurysms (UIAs), including 18 women and 6 men, while 8 presented with ruptured intracranial aneurysms (RIAs), evenly distributed between women and men (4 each). The mean age of the patients was 53 years (range: 24–71 years). The control group consisted of 20 healthy volunteers, 14 females and 6 males, with a mean age of 51 years (range: 24–71 years). The expression of TGFB1 was significantly higher in the IA versus C group, but TGFB3 expression was significantly higher in the RIA versus C group. The serum level of TGF-β1 and TGF-β3 was significantly higher in the RIA versus UIA group. Serum TGF-β1 levels were higher in men and individuals < 60 years of age. Positive correlations were observed between serum TGF-β1, TGF-β3 and aneurysm size, with significantly higher TGF-β3 levels in patients with giant aneurysms. Conclusions: Our study highlights the distinct roles of TGFB1 and TGFB3 in aneurysm pathophysiology, identifying TGFB1 as a molecular contributor to aneurysm formation and TGFB3 with rupture. Increased serum TGF-β1 and TGF-β3 concentrations could serve as promising noninvasive parameters for assessing the risk of aneurysm rupture. Further research with larger cohorts is needed to define cut-off values and validate the method, enabling the use of blood TGF-β levels as a tool for clinical decision-making. Full article

Background: Gut microbiome composition may influence the risk of intracranial aneurysm rupture. Methods: This study analyzed the gut microbiota of 48 patients—24 with ruptured aneurysms (RA) and 24 with unruptured intracranial aneurysms (UIA)—using next-generation sequencing. Results: While alpha diversity was similar between groups, beta diversity revealed significant taxonomic differences (Bray–Curtis: p = 0.02; unweighted UniFrac: p = 0.0291). Both groups were dominated by the phyla Bacillota, Bacteroidota, and Proteobacteria, but genus- and family-level differences were observed. RA patients showed higher abundances of Anaerotruncus, Coprobacillus, Sellimonas, Hungatella, and Ruthenibacterium, whereas UIA patients exhibited greater levels of Faecalibacterium, Brotolimicola, Clostridiaceae, Roseburia, and Agathobaculum. Linear discriminant analysis identified one class, 10 genera, and 17 species that differed significantly between groups. Notably, Faecalibacterium prausnitzii and Agathobaculum butyriciproducens—bacteria known for their anti-inflammatory and neuroprotective properties—were enriched in UIA patients. Conclusions: These findings suggest that gut microbiota, particularly short-chain fatty acid–producing bacteria, may contribute to vascular protection and aneurysm pathophysiology. Microbiome-based therapeutic strategies could offer new avenues for the prevention of cerebrovascular disease. Full article

Background/Objectives: Left ventricular (LV) pseudoaneurysm is a rare but life-threatening complication after acute myocardial infarction, often resulting from inadequate excision of damaged myocardium and use of only a xenopericardial patch during primary LV free wall rupture repair. Methods: A 62-year-old female developed a giant LV pseudoaneurysm one year after initial surgical repair of a free wall rupture with a xenopericardial patch. Imaging confirmed a large pseudoaneurysm with a broad neck and mural thrombus. She underwent pseudoaneurysmectomy, LV reconstruction with a Dacron patch overlaid by a xenopericardial patch, and concomitant mitral and tricuspid valve repair. Results: Surgical exploration revealed a broad-necked pseudoaneurysm and dehisced patch material. The aneurysm was resected, and the LV was reconstructed, resulting in the exclusion of the pseudoaneurysm and improvement of the shape and function. The patient recovered uneventfully and was discharged in good clinical condition with restored LV function. Conclusions: Pseudoaneurysm formation after LV free wall rupture repair is often due to insufficient resection and the use of only a xenopericardial patch. Surgical management with complete excision, Dacron patch reconstruction, and xenopericardial reinforcement facilitates the favorable remodeling of LV geometry and function, and reduces the risk of recurrence. Full article

Intracranial aneurysms (IAs) are present in approximately 3–5% of the global population and carry a significant risk of rupture, leading to subarachnoid haemorrhage (SAH), a condition associated with high morbidity and mortality. Even with developments in neuroimaging, fundamental clinical difficulty remains in precisely predicting which aneurysms will rupture. Although aneurysm size, location, and patient history define traditional risk assessment, these elements by themselves have insufficient predictive ability. Key elements in rupture risk are aneurysm wall biology, haemodynamics, and inflammation; recent developments in magnetic resonance imaging (MRI) including high-resolution vascular wall imaging (VWI), 4D flow MRI, and quantitative susceptibility mapping (QSM) provide fresh insights on these aspects. The present evidence on these sophisticated MRI techniques is synthesised in this review of the literature, which also analyses their clinical relevance and addresses newly developed computational methods like machine learning for better risk stratification. I underline important studies showing the diagnostic and prognostic worth of MRI-based biomarkers, discuss present constraints, and suggest future lines of research. Personalised aneurysm care could benefit from the combination of multiparametric MRI data with artificial intelligence (AI), hence improving patient outcomes. Full article

Background/Objectives: Foehn, a warm, dry wind blowing down into the valleys of a mountain, is a typical weather condition in southern Germany. Until now, there have been no data regarding the impact of foehn on aortic aneurysm ruptures in the Alpine regions, analyzed in this study. Methods: In this retrospective German dual-center study (University Augsburg, University Munich) were enrolled 152 patients with a rupture of the thoracic aortic aneurysm (rTAA), abdominal aortic aneurysm (rAAA), and thoracoabdominal aortic aneurysm (rTAAA), living within 20 km of weather measuring stations. We analyzed the risk factors for aortic aneurysm rupture dependent on weather changes in southern Germany using the meteorological data from January 2010 to December 2019. Results: The most common form of ruptured aortic aneurysm (rAA) was abdominal aortic rupture in both sexes (64.5% men, 17.1% women). The incidence rate of rAAA from Augsburg and Munich was 20.4% in spring, 26.3% in autumn, 28.9% in summer, and 24.3% in winter. Indeed, in Augsburg, rAAAs occurred most often during winter months (32%), while in Munich the majority of cases occurred during summer (32%). We observed that aortic ruptures on days with a tendency for southerly wind flow and lower air pressure were correlated with foehn in southern Germany. Conclusion: The occurrence of foehn days could be a relevant risk factor for increased incidence of rAA. Full article

Aortic aneurysms (AAs), the dilation or widening of the aorta, lead to dissection or rupture with high morbidity and mortality if untreated. AA displays gender disparities in its prevalence, progression and outcomes, with women having worse outcomes and faster aneurysm growth. However, current guidelines do not address gender dimorphism, emphasizing the urgent need for personalized treatment strategies and further research. Perivascular adipose tissue (PVAT), a unique type of fat surrounding blood vessels, plays a critical role in maintaining vasomotor tone and vascular homeostasis, with dysfunction associated with chronic inflammation and vessel-wall remodeling. Indeed, PVAT dysfunction promotes the development of aortic aneurysms, with hormonal and biomechanical factors exacerbating the pathological vascular microenvironment. The sexually dimorphic characteristics of PVAT include morphological, immunological, and hormonally mediated differences. Thus, targeting PVAT-mediated mechanisms may be a promising option for the (gender-specific) therapeutic management of cardiovascular pathologies. This review examines the emerging importance of PVAT in vascular health, its potential therapeutic implications for AA, and identifies gaps in the current state of research. Full article

Aneurysmal subarachnoid hemorrhage (aSAH) is a life-threatening condition that results from intracranial aneurysm rupture, leading to the accumulation of blood between the arachnoid and pia mater. The blood breakdown products and damage-associated molecule patterns (DAMPs), which are released as a result of vascular and cellular compromise following aneurysm rupture, elicit local endothelial reactions leading to the narrowing of cerebral arteries and ischemia. In addition, vascular inflammation, characterized by activated endothelial cells, perpetuates disruption of the neurovascular unit and the blood–brain barrier. The uncertain prognosis of aSAH patients contributes to the necessity of a fluid biomarker that can serve as a valuable adjunct to radiological and clinical evaluation. Limited studies have investigated vascular inflammation and angiogenic protein expression following aSAH. Reliable markers of the vascular inflammatory and angiogenic response associated with aSAH may allow for the earlier detection of patients at risk for complications and aid in the identification of novel pharmacologic targets. We investigated whether vascular inflammatory and angiogenesis signaling proteins may serve as potential biomarkers of aSAH. Serum and cerebrospinal fluid (CSF) from fifteen aSAH subjects and healthy age-matched controls as well as hydrocephalus (CSF) no-aneurysm controls were evaluated for levels of vascular inflammatory and angiogenesis proteins. Protein measurement was carried out using electrochemiluminescence. The area under the curve (AUC) was calculated using receiver operating characteristics (ROC) to obtain information on biomarker reliability, specificity, sensitivity, cut-off points, and likelihood ratio. In addition, patients were grouped by Glasgow Outcome Score—Extended at 3 months post-injury to determine the correlation between vascular inflammatory protein levels and clinical outcome measures. aSAH subjects demonstrated elevated vascular inflammatory protein levels in serum and CSF when compared to controls. Certain vascular injury and angiogenic proteins were found to be promising biomarkers of inflammatory response in aSAH in the CSF and serum. In particular, elevated levels of serum amyloid-alpha (SAA) were found to be correlated with unfavorable outcomes following aSAH. Determination of these protein levels in CSF and serum in aSAH may be utilized as reliable biomarkers of inflammation in aSAH and used clinically to monitor patient outcomes. Full article

Thoracic aortic aneurysms (TAAs) pose a significant health burden due to their asymptomatic progression, often culminating in life-threatening aortic rupture, and due to the lack of effective pharmacological treatments. Risk factors include elevated hemodynamic stress on the ascending aorta, frequently associated with hypertension and hereditary genetic mutations. Among the hereditary causes, Marfan syndrome is the most prevalent, characterized as a connective tissue disorder driven by FBN1 mutations that lead to life-threatening thoracic aortic ruptures. Similarly, mutations affecting the TGF-β pathway underlie Loeys–Dietz syndrome, while mutations in genes encoding extracellular or contractile apparatus proteins, such as ACTA2, are linked to non-syndromic familial TAA. Despite differences in genetic origin, these hereditary conditions share central pathophysiological features, including aortic medial degeneration, smooth muscle cell dysfunction, and extracellular remodeling, which collectively weaken the aortic wall. Recent evidence highlights mitochondrial dysfunction as a crucial contributor to aneurysm formation in Marfan syndrome. Disruption of the extracellular matrix–mitochondrial homeostasis axis exacerbates aortic wall remodeling, further promoting aneurysm development. Beyond its structural role in maintaining vascular integrity, the ECM plays a pivotal role in supporting mitochondrial function. This intricate relationship between extracellular matrix integrity and mitochondrial homeostasis reveals a novel dimension of TAA pathophysiology, extending beyond established paradigms of extracellular matrix remodeling and smooth muscle cell dysfunction. This review summarizes mitochondrial dysfunction as a potential unifying mechanism in hereditary TAA and explores how understanding mitochondrial dysfunction, in conjunction with established mechanisms of TAA pathogenesis, opens new avenues for developing targeted treatments to address these life-threatening conditions. Mitochondrial boosters could represent a new clinical opportunity for patients with hereditary TAA. Full article

(1) Background: Thoracic aortic aneurysms (TAAs) pose critical health risks and are often asymptomatic until a rupture or dissection occurs. Guidelines recommend surgical repair based on specific aortic diameters and risk factors, emphasizing the importance of early detection and intervention. Despite established clinical risk factors for the early detection of TAAs, the influence of racial disparities on TAAs remains underexplored. This study aims to provide a comprehensive summary of existing research on racial disparities in the presentation and outcomes of TAAs. (2) Methods: This literature review was conducted using a systematic search strategy to explore racial differences in the presentation and surgical outcomes of patients with TAAs. (3) Results: The findings demonstrated that black patients were younger at presentation and had a higher incidence of ruptured TAAs than non-black patients. Furthermore, compared to non-black patients, black patients had higher rates of cardiac arrhythmia and COPD, as well as comorbidities such as diabetes, hypertension, and renal insufficiency. For black patients undergoing open surgery, the surgical results showed improved 5-year survival rates after repair but higher perioperative mortality rates. All-cause or in-hospital mortality did not significantly differ between the racial groups, according to four studies. (4) Discussion: This review highlights significant racial disparities in TAA presentation and outcomes, underscoring the need for personalized risk stratification models. Standardized racial and ethnic definitions are essential for consistent and reliable research. Future studies should focus on identifying the underlying mechanisms driving racial disparities and on refining risk assessment models to enhance diagnostic and therapeutic strategies, ultimately improving patient outcomes across diverse populations. Full article

Intracranial aneurysm (IA) is a common cerebrovascular disease in which sacral aneurysms occurring in the Wills ring region can lead to devastating subarachnoid hemorrhage. Despite advances in research, the underlying mechanisms of IA formation and rupture remain incompletely understood, hindering early diagnosis and effective treatment. This review comprehensively summarizes the current landscape of IA biomarkers, encompassing genetic markers, DNA, RNA, inflammatory molecules, oxidative stress proteins, and extracellular matrix (ECM) components. Accumulating evidence suggests that various biomarkers are associated with different stages of IA pathogenesis, including initiation, progression, and rupture. Aberrant ECM composition and remodeling have been observed in IA patients, and extracellular matrix-degrading enzymes are implicated in IA growth and rupture. Biomarker research in IA holds great potential for improving clinical outcomes. Future studies should focus on validating the existing biomarkers, identifying novel ones, and investigating their underlying mechanisms to facilitate the development of personalized preventive and therapeutic strategies for IA. Full article

Background: Spinal subarachnoid hemorrhage (sSAH) is a very rare disease. Detailed information about the natural course, pathogenesis, radiological manifestation, and therapeutic management is lacking. This study aimed to analyze patients diagnosed with sSAH, focusing on the origin, management strategies, and therapeutic approaches to sSAH. Methods: The study included a cohort of patients admitted to the Department of Neurosurgery, LMU University Hospital, LMU Munich, between January 2021 and December 2024 with a confirmed diagnosis of spinal subarachnoid hemorrhage and, among other things, spinal aneurysms. Data on the included patients were recorded with emphasis on demographics, radiological examination (CT, MRI, and DSA), aneurysm-specific characteristics, and clinical outcome. Results: The study included six patients diagnosed with spinal subarachnoid hemorrhage via multimodal imaging. The etiology of sSAH was identified in all cases, encompassing spinal aneurysms in three patients, anticoagulation therapy in two cases, and bony microspurs in one case, with management strategies tailored as either conservative (monitoring and imaging) or surgical (aneurysm resection, arterial feeder coagulation, or evacuation of intraspinal bleeding). No major adverse events were observed, and all the patients demonstrated neurological improvement or exhibited only mild-to-moderate disability during follow-up. Conclusions: Spinal subarachnoid hemorrhage can be due to a ruptured spinal aneurysm, but in some cases, other underlying causes should be considered as the source of the hemorrhage. Given the scarcity of literature on this condition, it is crucial to identify the correct diagnosis and implement a patient-tailored therapeutic approach. Full article