Search Results (487)

Background: Intracranial aneurysm (IA) rupture is a life-threatening cerebrovascular event with a mortality rate of up to 40%, affecting approximately 500,000 people globally each year. Although environmental pollutants such as 2,2′,4,4′-tetrabromodiphenyl ether (PBDE-47) have been implicated in the pathogenesis of IA, the causal relationship and underlying mechanisms remain unclear. This study aims to systematically explore the potential causal role of PBDE-47 in the development of IA by integrating multi-omics approaches. Methods: We utilized the UK Biobank Drug Proteomics Project (UKB-PPP) genome-wide association study (GWAS) data, including 2940 plasma proteins and 1400 metabolites, along with IA genetic data from 456,348 individuals, to perform a two-sample Mendelian randomization (MR) analysis. Instrumental variables were selected based on genome-wide significance (p < 5 × 10⁻⁸) or suggestive thresholds (p < 5 × 10⁻⁵). Analytical methods included inverse variance weighting (IVW), MR-Egger, weighted median, MR-PRESSO, and Steiger filtering for sensitivity analysis. Molecular docking and 100-nanosecond molecular dynamics simulations were used to evaluate interactions between PBDE-47 and proteins. Mediation analysis assessed the roles of plasma metabolites and miRNAs, and SMR-HEIDI tests were used to verify causal relationships. Results: MR analysis identified 93 plasma proteins potentially causally associated with IA, including 53 protective factors and 40 risk factors. By integrating PBDE-47 targets, IA-related genes, and metabolite-related genes, we identified 15 hub genes. Molecular docking revealed potential binding between PBDE-47 and F2R (binding energy: −5.516 kcal/mol), and SMR-HEIDI testing supported F2R as a potential causal risk factor for IA. Molecular dynamics simulations indicated the stability of the complex structure. Mediation analysis suggested that F2R may influence IA risk through eight plasma metabolites, and miR-130b-3p may indirectly promote IA development by upregulating F2R. Conclusions: Our findings suggest that exposure to PBDE-47 may have a potential causal relationship with IA risk, potentially mediated through the “PBDE–47–F2R–metabolite–miRNA” regulatory axis. These results provide preliminary evidence for early diagnostic biomarkers and targeted interventions for IA. The multi-omics analytical framework established in this study offers new insights into environmental determinants of neurovascular diseases, although further validation is needed to address potential limitations. Full article

An ascending aortic aneurysm is a localized dilation of the ascending aorta, which poses a high risk of aortic dissection or rupture, with surgery recommended at diameters > 5.5 cm. However, events also occur at smaller sizes, suggesting additional factors—such as stenosis—may significantly influence aneurysm severity. To investigate this, a computational fluid dynamics (CFD) analysis was conducted using a patient-specific ascending aortic model (aneurysm diameter: 5.28 cm) under three aortic stenosis severities: mild, moderate, and severe. Results showed that the severe stenosis condition led to the formation of prominent recirculation zones and increased peak velocities, 2.36 m·s⁻¹ compared to 1.53 m·s⁻¹ for moderate stenosis and 1.37 m·s⁻¹ for mild stenosis. A significantly increased pressure loss coefficient was observed for the severe case. Additionally, the wall shear stress (WSS) distribution exhibited higher values along the anterior region and lower values along the posterior region. Peak WSS values were recorded at 43.46 Pa in the severe stenosis model, compared to 21.98 Pa and 13.87 Pa for the moderate and mild cases, respectively. Velocity distribution and helicity analyses demonstrate that increasing stenosis severity amplifies jet-induced flow disturbances, contributing to larger recirculation zones and greater helicity heterogeneity in the ascending aorta. Meanwhile, WSS results indicate that greater stenosis severity is also associated with elevated WSS magnitude and heterogeneity in the ascending aorta, with severe cases exhibiting the highest value. These findings highlight the need to incorporate hemodynamic metrics, alongside traditional diameter-based criteria, into rupture risk assessment frameworks. Full article

The aorta, once viewed as a passive conduit, is now recognized as an active organ crucial for hemodynamic regulation and vascular homeostasis. Thoracic aortic aneurysms (TAAs), particularly those involving the ascending aorta, often remain silent until life-threatening complications such as dissection or rupture occur. Current management primarily relies on aortic diameter criteria, yet up to 60% of type A dissections occur at sizes below the 5.5 cm surgical threshold, revealing the limitations of this approach. This narrative review summarizes recent advances in understanding ascending aortic aneurysms, including insights into their genetic and degenerative mechanisms, the role of novel morphological and hemodynamic markers, and the potential of advanced imaging techniques. It also explores evolving surgical strategies, from conventional open repair, still the gold standard, to minimally invasive and investigational endovascular approaches. By integrating biological, morphological, and clinical factors, emerging strategies aim to move beyond diameter alone toward more personalized risk assessment. This paradigm shift may improve early detection, optimize surgical timing, and ultimately enhance outcomes for patients with ascending aortic aneurysms. Full article

Intracranial aneurysms (IAs) are potentially devastating cerebrovascular lesions, and predicting rupture risk remains a major clinical challenge. Conventional radiological and clinical scores offer only partial risk stratification, highlighting the need for complementary approaches. Liquid biopsy represents a promising non-invasive strategy to identify circulating biomarkers that reflect aneurysm biology and instability. We conducted a systematic review according to PRISMA 2020 guidelines, screening PubMed, Scopus, and Web of Science up to August 2025. Forty-eight eligible studies, encompassing 3515 IA patients, evaluated circulating RNA species, including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs) in serum, plasma, blood, or cerebrospinal fluid. Multiple candidates emerged as consistently dysregulated: upregulation of miR-21, miR-126, and miR-200a-3p, and downregulation of miR-143 and let-7b-5p were recurrently observed across independent cohorts. LncRNAs, such as MALAT1 and MIAT, and circRNAs, including circ_0000690 and circ_0021001, demonstrated diagnostic and prognostic potential, with some correlating with rupture status and clinical severity indices. Despite encouraging findings, heterogeneity in study design, sample handling, and analytic methods limits reproducibility. Large-scale, multicenter validation studies are essential to translate these biomarkers into clinical practice. Full article

Background and Clinical Significance: Mycotic aortic aneurysm is a rare but life-threatening vascular condition characterized by infection-induced dilation or pseudoaneurysm formation in the aorta. The condition carries a high risk of rupture and mortality, especially in individuals with underlying cardiovascular disease, who have undergone recent vascular procedures, or with immunocompromising comorbidities such as diabetes. Its diagnosis is challenging due to its non-specific symptoms and often requires a high index of suspicion, especially in patients presenting with persistent fever and negative initial imaging. Early recognition and intervention are critical, as delayed treatment significantly worsens outcomes. Case Presentation: A 68-year-old male with a history of coronary artery disease, recent stent placement, and hypertension presented with two days of fever, chills, rigors, and a mild nonproductive cough. The laboratory findings were only significant for leukocytosis. The initial chest X-ray and non-contrast CT scans were unremarkable. He was admitted for presumed pneumonia and started on intravenous antibiotics. Persistent fever prompted further investigation with contrast-enhanced CT, which revealed a distal-aortic-arch pseudoaneurysm and mild mediastinal stranding. Blood cultures grew methicillin-sensitive Staphylococcus aureus (MSSA). Transthoracic echocardiogram was negative for endocarditis. The patient was transferred to a tertiary center, where repeat imaging confirmed a 1.5 cm pseudoaneurysm and a 4 mm penetrating atherosclerotic ulcer. After multidisciplinary assessment, he underwent thoracic endovascular aortic repair (TEVAR) and completed four weeks of intravenous cefazolin. Follow-up imaging showed successful aneurysm repair with no complications. Conclusions: Thoracic mycotic aneurysm is a rapidly fatal entity despite intervention. High clinical suspicion is necessary given its non-specific presentation. It is diagnosed most practically using CTA. In addition to antibiotics, TEVAR is gaining traction as a feasible and a safe alternative to open surgical repair (OSR). Full article

Background: Intracranial aneurysms of the posterior circulation are of particular clinical significance due to their higher risk of rupture-associated morbidity and mortality compared to anterior circulation aneurysms. Moreover, they exhibit an increased tendency for recurrence, posing challenges for long-term management. The purpose of this study is to identify key risk factors and define criteria for the early detection of high-risk aneurysms with a machine learning-based analysis. Methods: This study employs machine learning (ML), which, unlike traditional statistical methods, can detect complex, previously unrecognized patterns without predefined hypotheses to predict recurrence and rupture in patients with intracranial aneurysms of the posterior circulation. A total of 229 patients were retrospectively screened (2008–2020), and the data set was analyzed using ML algorithms. To avoid bias, a 10-fold cross-validation was employed, and the model performing best in terms of the Area Under the Curve (AUC) was selected. In addition, the sensitivity, specificity, and accuracy of the model were computed as secondary metrics. Results: A total of 229 patients were included, with over 70% being female, older than 50 years, and diagnosed with arterial hypertension. The most significant predictors of aneurysm recurrence identified by the ML model (AUC of 0.74 with a sensitivity of 0.76, a specificity of 0.70, and an accuracy of 0.76) were age, aneurysm size, arterial hypertension, and a history of nicotine consumption. The DeLong test confirmed that the ML model performed significantly better than random classification with an AUC of 0.5 (p < 0.001). Further analysis revealed that the presence of multiple aneurysms and localization at the basilar artery were independent risk factors for early recurrence within six months. For aneurysm rupture, key predictive features included advanced age, basilar artery localization, atherosclerosis, irregular aneurysm morphology, and familial predisposition. Conclusions: ML algorithms identified several risk factors for recurrence and rupture of intracranial aneurysms of the posterior circulation, aligning with previously established risk factors. These findings are intended to serve as a basis for further research in clinical use and prospective studies. Full article

Coronary artery aneurysms (CAAs) are an uncommon finding, and their rupture is an exceedingly rare and life-threatening complication. Giant aneurysms of the left main coronary artery (LMCA) pose a significant diagnostic and therapeutic challenge. We describe the case of a 62-year-old male who presented with acute coronary syndrome and was subsequently diagnosed with a ruptured giant LMCA aneurysm causing cardiac tamponade and multi-organ dysfunction. The initial diagnosis was suggested by coronary angiography and confirmed with contrast-enhanced multidetector computed tomography (MDCT) and echocardiography. The patient underwent emergency surgery consisting of aneurysm excision, thrombectomy, ligation of the LMCA ostium and its distal branches (LAD and circumflex), and coronary artery bypass grafting (CABG) using the left internal thoracic artery to the left anterior descending artery and a saphenous vein graft to a marginal branch. The patient’s postoperative course was complicated by transient multi-organ dysfunction, which resolved. He was discharged in a stable condition. This case highlights the critical importance of rapid multimodal imaging for diagnosis and the feasibility of emergency surgical intervention to achieve a favorable outcome in patients with a ruptured giant LMCA aneurysm. Full article

Background: Unruptured cerebral aneurysms pose a significant neurosurgical challenge due to their potential for rupture, which can lead to devastating subarachnoid hemorrhage. Advances in imaging have increased incidental detection of multiple unruptured aneurysms, necessitating tailored management strategies to balance rupture risk against treatment complications. Methods: We retrospectively analyzed 41 patients with 101 unruptured cerebral aneurysms, assessing demographics, aneurysm size and location, treatment modalities, and clinical outcomes. Descriptive statistics and correlation analyses examined associations between aneurysm characteristics, comorbidities, and post-treatment complications. Results: Most aneurysms were small (<10 mm, 48.5%), primarily located at the Middle Cerebral Artery Bifurcation (27.7%). Hypertension (56.1%) and smoking (53.7%) were prevalent risk factors. Clipping was the most common intervention (81.2%), with 41.4% of patients experiencing post-operative complications and 36.6% developing neurological deficits. Conclusions: This study underscores the difficulties in managing multiple unruptured cerebral aneurysms owing to diverse aneurysm characteristics and patient risk factors such as hypertension, hyperlipidaemia, and smoking. Clipping was the predominant intervention, with time customized for each individual case. Despite the occurrence of problems such as vasospasm and neurological difficulties, the majority of patients maintained functional independence. The results provide significant insights into the clinical attributes, therapeutic strategies, and outcomes for this patient cohort. Full article

An abdominal aortic aneurysm (AAA) poses a significant risk of arterial wall rupture, which critically endangers the patient’s life. To address this condition, an endovascular aneurysm repair (EVAR) is required, involving the insertion and expansion of a stent-graft within the aorta, to support and isolate the weakened vessel wall. In this context, this article aims to approach the problem from a mechanical perspective and to simulate the expansion and deployment procedure realistically, utilizing the Finite Element Analysis (FEA). The process initiates with the computation evaluation of the aortic structure in order to identify critical regions of stress and strain in an aneurysmatic aortic region. Then, a customized 3D-designed stent graft model was developed for the aorta and positioned properly. Applying all the necessary boundary conditions, a complex nonlinear FEA was conducted until the stent-graft expanded radially, reaching a final diameter 25% larger than the aorta’s vessel wall while withstanding mean stress and strain values close to 400 MPa and 1.5%, respectively. Finally, the mechanical behavior of the stent-graft and its interaction with the internal aortic wall, during the expansion process, was evaluated, and the extracted results were analyzed. Full article

Background/Objectives: Endovascular treatment has become the primary treatment for intracranial aneurysms, yet direct bypass surgery remains an option in selected cases where standard approaches fail. This study aims to evaluate the role, indications, and outcomes of bypass surgery for intracranial aneurysm management in the current endovascular era. Methods: A single-center retrospective analysis was conducted on consecutive cases who underwent direct intracranial bypass surgery for intracranial aneurysms between 2015 and 2024. Data on demographics, aneurysm characteristics, indications, bypass type, patency, and clinical outcomes (using the modified Rankin Scale) were collected. Results: Of the 101 bypasses performed between 2015 and 2025, 25 were used for complex aneurysm cases. Intracranial bypass was necessary in as many as 5% of all microsurgical aneurysm repairs in 2023 and 10% in 2024. Bypass surgery was indicated in young patients with complex aneurysms not amenable to endovascular therapy (45%) and in 20% of the cases for recanalized aneurysms after previous endovascular repair. Intraoperative and postoperative bypass patency was confirmed for all patients except one case due to ongoing malignant brain swelling after an ongoing infarction. At follow-up, 87% of patients, with both ruptured and unruptured aneurysms, had a good outcome (mRS ≤ 2), and all patients had a patent bypass. Permanent morbidity was observed in 5% and procedure-related mortality in 0%. Conclusions: While bypass surgery constitutes a minority of intracranial aneurysm treatment by volume, its role in intracranial aneurysm repair is crucial and relevant in response to the evolving complexity of aneurysms. Further refinement of techniques is necessary. Full article

We studied the hemodynamics of abdominal aortic aneurysms (AAAs) by combining laboratory experiments and numerical simulations, with a focus on potential rupture mechanisms. In particular, we investigated the influence of geometrical features—beyond the commonly used maximum diameter—on flow patterns and the wall shear stress (WSS) distribution. Following our previous in vitro study performed utilizing a symmetrical bulge, we extended the analysis to an asymmetrical aneurysm geometry. Experiments and simulations were conducted under steady flow conditions while varying the Reynolds number over a wide range (490 < Re < 3930), to replicate the flow regimes occurring throughout the cardiac cycle. High-resolution, two-dimensional velocity fields were measured in the lab via image analysis and numerically computed using ANSYS Fluent^®. These data enabled a detailed characterization of both flow patterns and WSS distributions in healthy aorta and within the aneurysmal region. The good agreement between numerical and experimental results, as well as consistency with the literature, validates the adopted approach and supports its use for future investigations into AAA hemodynamics and rupture risk assessment. Full article

Background: Long-term follow-up after endovascular aortic repair (TEVAR) is crucial to detect adverse aortic remodeling, even with modern stent grafts offering enhanced flexibility and durability. Conventional imaging, based on diameter measurements, may fail to identify complications such as endograft migration. Methods: We conducted a longitudinal 3D geometric analysis of thoracic aortic and stent-graft evolution over 10 years in a patient treated for descending thoracic aortic aneurysm (DTAA) by endovascular treatment. A three-dimensional morphological analysis (length, tortuosity, angulation, and diameter) was carried out using advanced imaging software (EndoSize, MATLAB) to track aortic geometry and stent-graft behavior over time. A focused review of the literature on stent-graft migration, its risk factors, complications, and surveillance strategies was also performed. Results: This case illustrates how progressive geometric remodeling—including aortic elongation and increased tortuosity—can lead to delayed stent-graft migration and late type III endoleaks, with an elevated risk of rupture. The 3D analysis revealed early morphological changes that were undetectable using standard diameter-based follow-up. These observations are consistent with published data showing higher migration rates over time, particularly in tortuous anatomies. The literature review further emphasizes the clinical relevance of geometric surveillance, given the high rates of reintervention, morbidity, and mortality associated with stent-graft migration. Conclusions: This study underlines the importance of personalized and geometry-based surveillance after TEVAR. Advanced morphological assessment tools provide valuable insights for the early detection of complications and tailored patient management. Their integration into routine follow-up could help optimize long-term outcomes and prevent life-threatening events such as rupture. Full article

Intracranial aneurysms are a serious cerebrovascular condition with a risk of subarachnoid hemorrhage due to rupture, leading to high mortality and morbidity. Flow Diverter Stents (FDSs) have become an important endovascular treatment option for unruptured large or wide-neck aneurysms. Hemodynamic factors significantly influence treatment outcomes in aneurysms treated with FDSs, and Computational Fluid Dynamics (CFD) has been widely used to evaluate post-deployment flow characteristics. However, conventional wire-resolved CFD methods require extremely fine meshes to reconstruct individual FDS wires, resulting in prohibitively high computational costs. This severely limits their feasibility for use in clinical treatment planning, where fast and robust simulations are essential. To address this limitation, we developed a computationally efficient CFD method that incorporates a porous media model accounting for local variations in wire density after FDS deployment. Based on Virtual Stent Simulation, the FDS region was defined as a hollow cylindrical domain with spatially varying resistance derived from cell-specific wire density. We validated the proposed method using 15 clinical cases, demonstrating close agreement with conventional wire-resolved CFD results. Relative errors in key hemodynamic parameters, including velocity, shear rate, inflow rate, and turnover time, were within 5%, with correlation coefficients exceeding 0.98. The number of grid elements, the data size, and total analysis time were reduced by over 90%. The method also allowed comparison between Total-Filling (OKM Grade A) and Occlusion (Grade D) cases, and evaluation of different FDS sizing, positioning, and coil-assisted strategies. The proposed method enables practical and efficient CFD analysis following FDS treatment and supports hemodynamics-based treatment planning of aneurysms. Full article

Background: The term ‘left atrial appendage aneurysm’ (LAAA) has been recognized since 1962, when it was first described. It is an exceedingly rare pathology that can affect both adults and children. Often asymptomatic, it may be discovered incidentally. The anomaly consists of an exaggerated dilation of the primitive portion of the left atrium, resulting from pectinate muscle dysplasia or as a consequence of an obstructive lesion between the left atrium and the mitral valve. Surgical intervention represents a reliable strategy for preventing catastrophic complications such as stroke, thromboembolism, and rupture. This is a very rare condition, which is why we aimed to present a case report along with a review of the literature. Case presentation: We report the case of a 6-year-old asymptomatic girl in whom a giant left atrial appendage aneurysm was incidentally detected during a routine transthoracic echocardiogram, associated with a small atrial septal defect and a prothrombotic genetic profile. The aneurysm was successfully excised, and the atrial septal defect was closed. The postoperative course was uneventful, and the patient was discharged home on the 8th postoperative day. Conclusions: Left atrial appendage aneurysm is rare in children and often asymptomatic, yet it may be life-threatening due to stroke or thromboembolism. Fetal echocardiography may be considered in selected high-risk pregnancies, and routine postnatal assessment is advised, with surgical intervention recommended particularly for patients with risk factors for thrombus formation in the left atrium or its appendage. Full article

Background: The literature shows that anterior communicating artery (AcoA) aneurysms are the most common intracranial aneurysms. To date, there has only been one postmortem study focused on the correlations between autopsy findings and imaging results in cases of intracranial aneurysms associated with anatomical variants of the circle of Willis (CW). Methods: We investigated the anatomical variants of the CW associated with the occurrence and rupture of AcoA aneurysms by performing comparative analyses, in the same patients, of postmortem autopsy data with antemortem computed tomography–angiography (CTA) results obtained in the first 48 h after the onset of subarachnoid hemorrhage. Our retrospective observational study identified the anatomical variants of the CW at autopsy in 16 deceased adult Romanian patients with AcoA aneurysms over a 12-year period (2010–2022). Results: The autopsy findings revealed that the AcoA ruptured aneurysms had a mean external diameter of 9.50 mm, and 71.4% of them presented three or four anatomical variants inside the same CW. The initial antemortem CTA examination correctly located the AcoA aneurysms in all cases (100%), and an anatomical variant of the CW was only noted in 18.75% of patients. The final postmortem re-analyzed the same CTA images identified in all cases (100%), focusing on both the AcoA aneurysm and all anatomical variants of the CW found during the autopsies. Conclusions: Although it was previously thought that the occurrence of AcoA aneurysms is related only to the hemodynamic changes induced by the nearby arterial anatomical variants, we identified the simultaneous involvement of at least one hypoplastic artery and one or two PCA fetal-type anatomical variants that were located in both the anterior and posterior parts of the CW. Furthermore, if sufficient time is devoted to the CT–angiography analysis and interpretation of the images, anatomical variants of the circle of Willis associated with AcoA aneurysms can be identified as accurately as they are in invasive postmortem autopsy examinations. Full article