Recurrence of Endovascularly and Microsurgically Treated Intracranial Aneurysms-Review of the Putative Role of Aneurysm Wall Biology— Marbacher 2019
The long-term durability of endovascular embolization remains a concern, at least for some aneurysms, despite initial positive results, despite the fact that endovascular therapy has been demonstrated to be safe and has become the primary method of treatment for intracranial aneurysms in many centers. Whereas restoration following endovascular occlusion mostly needs the generation of a biological response, healing after clipping depends on mechanical occlusion. The formation of new tissue over the thrombus the embolization material created during the procedure, or alternatively, the organizing of the thrombus into fibrous tissue, is what promotes healing following embolization. This review emphasizes the critical role that aneurysm wall biology plays in the recovery after intracranial aneurysm (IA) surgery and long-term occlusion. It appears likely that the luminal thrombus' impact on the IA wall and the state of the wall at the time of thrombosis determine whether the thrombus organizes into scar tissue (neointima formation by infiltration of cells from the IA wall) or if the wall undergoes continuous remodeling, which is primarily destructive (loss of mural cells). The latter increases the likelihood of recurrence because intraluminal thrombus organization fails and healing is compromised. In-depth discussions are held regarding the mechanisms underlying IA reopening, the impact of intraluminal thrombosis on the IA wall, and the clinical ramifications of the IA wall condition. It is also discussed how understanding IA wall biology can provide novel IA treatment options and influence patient selection for and follow-up following endovascular treatment.
Marbacher, S., Niemelä, M., Hernesniemi, J., & Frösén, J. (2019). Recurrence of endovascularly and microsurgically treated intracranial aneurysms-review of the putative role of aneurysm wall biology. Neurosurgical review, 42(1), 49–58. https://doi.org/10.1007/s10143-017-0892-2
