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Intracranial aneurysms: from vessel wall pathology to therapeutic approach
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Intracranial aneurysms: from vessel wall pathology to therapeutic approach
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Intracranial aneurysms: from vessel wall pathology to therapeutic approach
Intracranial aneurysms: from vessel wall pathology to therapeutic approach
Journal Article

Intracranial aneurysms: from vessel wall pathology to therapeutic approach

2011
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Overview
Intracranial arterial aneurysms can pose life-threatening risks to patients, so understanding the cause and the progression of these lesions is important for choosing the right treatment. This Review argues that aneurysms are a symptom of an underlying vascular disease rather than constituting a disease on their own. The authors classify intracranial aneurysms by vessel wall pathology and demonstrate that knowledge of the morphology and pathology of this structure is important in determining the therapeutic approach. An aneurysm is a focal dilatation of an arterial blood vessel. Luminal forces, such as high blood flow, shear stress and turbulence, are implicated in the pathogenesis of intracranial aneurysms, and luminal characteristics, such as sac size and morphology, are usually essential to the clinical decision-making process. Despite frequent clinical emphasis on the vessel lumen, however, the pathology underlying the formation, growth and rupture of an aneurysm mainly resides in the vessel wall. Research on the morphology and histopathology of the vessel wall reveals that intracranial aneurysms do not constitute a single disease, but are a shared manifestation of a wide range of diseases, each of which has a unique natural history and optimum therapy. This Review classifies intracranial aneurysms by vessel wall pathology, and demonstrates that understanding the morphology and pathology of this structure is important in determining the therapeutic approach. The article concludes that aneurysms represent a symptom of an underlying vascular disease rather than constituting a disease on their own. Key Points Intracranial aneurysms do not constitute a single disease, but are a manifestation of a wide range of diseases Aneurysmal diseases vary in their natural histories and optimum treatment strategies Despite frequent clinical emphasis on the vessel lumen, the pathology underlying aneurysm formation, growth and rupture mainly resides in the vessel wall A classification of intracranial aneurysms based on vessel wall pathology is important to understand these life-threatening conditions and to determine the best therapeutic approaches