Journal of Surgery Current Trends & Innovations Category: Clinical Type: Review Article

The Effects of Essential Hypertension in Endovascular Treatment of Unruptured Aneurysm

MBA1*
1 Department Of Neurological Surgery, California Institute Of Behavioral Neurosciences & Psychology, Fairfield, United States

*Corresponding Author(s):
Dennis Adjepong, MD, MBA
Department Of Neurological Surgery, California Institute Of Behavioral Neurosciences & Psychology, Fairfield, United States
Tel:+1 5712771998,
Email:adjepongdennis1@gmail.com

Received Date: Apr 02, 2020
Accepted Date: Apr 06, 2020
Published Date: Apr 13, 2020

Abstract

The term aneurysm refers to the weakening or the enlargement of the walls of the artery that creates a bulging or the enlargement of the arterial wall. Most of the aneurysm does not show dangerous symptoms, but the severe stage can rupture that leads to life-threatening internal bleeding. Sudden severe headaches characterize an unruptured aneurysm. It is the key symptom, often described as the worst headache. Other common signs and symptoms include difficulty in speaking, loss of balance, and visual disturbances. It is vital to note that most aneurysms do not show symptoms and are not dangerous. Still, at the severe stage, some can rupture and lead to life-threatening internal bleeding.

Keywords

Aneurysm; Arterial; Unruptured

INTRODUCTION

An unruptured aneurysm is the ballooning in a blood artery in the brain that creates a bulge or the enlargement of the arterial walls [1-4]. The key symptom of the unruptured aneurysm is a sudden severe headache. In some cases, it is coupled with the loss of balance, difficulty speaking, and visual disturbances [5]. The unruptured aneurysm is also likely to cause internal bleeding [6]. The risk of this disease developing and rupturing varies from individuals [7]. However, high blood pressure and smoking are the major risk factors for the development of this disease [8]. Some types of the aneurysm may require surgical treatment to prevent rupture [9]. Unruptured aneurysm patients recuperate after surgical procedures. The surgical procedure will only be done to the patient if it is life-threatening. There has been a significant increase in unruptured aneurysm detection due to the use of CT in clinical practice [10].  Deposits do trigger the action of the heart to pump even faster and harder than usual to pump the blood past the greasy buildup [11]. Approximately many patients live for many years with an aneurysm in the brain without knowing it [12].

Method

The study examines the health journals that look into the key elements or aspects of the aneurysm [13]. The various investigations that relate to the facts about the unruptured aneurysm to examine the prevalence and other issues of the condition such as vital signs and symptoms, the prognosis, and the elements of the patient education [14].

Results

According to the review of the various health journals on the disease that were taken into consideration for the study, the unruptured aneurysm can be life-threatening and often dangerous if not detected during tests in good time [15]. According to research, the occurrence in the full-grown population is amid 1% and 5%; though, 50-80% of all aneurysm do not rupture in the patient’s lifetime [16]. An unruptured aneurysm is shared in females than males with a proportion of 3:1 [17]. Although the actual cause of this condition is yet to be established, particular factors and conditions are essential in the disease's higher prevalence [18]. For instance, tissue damages in significant arteries do play a crucial role in the disease [19]. The arteries can, in this way, be harmed by the blockage of deposits of the fatty acids [20]. This stress can, in some cases, damage the arteries as a result of the higher pressure that is created [21].

Pathophysiology

Their location in the body classifies an aneurysm, the brain, and heart arteries are the common sites of a severe aneurysm [22]. The bulge is likely to take two main shapes, the swelling on both sides of the blood vessels commonly referred to as fusiform aneurysm and the saccular aneurysm that bulges only on one side [23]. The characteristic finding is the decrease in the tunica media, the artery's middle muscular layer that causes structural defects. These defects, together with the hemodynamic factors, can lead to an aneurysm [24]. The condition is often accompanied by sudden and severe headaches and or other symptoms that are possibly related to a ruptured kind of aneurysms. The impact of intracranial bleeding puts the patients at risk of stroke [25]. 

Genetics

The genetic influence for this disease among patients with at least a single pretentious family member has around 4% threat of having the unruptured aneurysm. In contrast, patients with two or more pretentious first-degree household associates have 8%-10% risk of having the disease [26]. However, it does not occur among patients below 50 years [27]. It was also noted that roughly 5% to 15% of cases of trauma is linked to the un-ruptured aneurysm [28]. 

Radiology 

A Computerized Tomography (CT) scan is typically the primary examination to detect the bleeding in the brain, and a cerebrospinal fluid test can also detect bleeding [29]. The present strategies endorse showing with the intracranial attractive timbre imaging for persons having direct families suffering from the disease [30].

Clinical implication 

Unanswered questions may have incidental findings due to complaints that are not related to the disease or detection as they grow and compress the adjacent structures in the brain. These compressions may cause visual field defects, hemiparesis, or seizure [31]. However, other cranial nerves may be involved; this includes the trochlear and the abducent nerves. The real cause of the aneurysm is not known, but a range of factors may increase one's risk of getting affected.

Scientific analysis 

The two articles which were considered for the study were Scientific World Journal and Medical News Today. The first article was the most appropriate since it was more detailed and properly organized. The essential elements of the unruptured aneurysm in the report were well stipulated, and this made it simple to comprehend. The second article was equally important. However, it did not dig deeply into the critical elements of the disease as the first article [32].

Unanswered questions 

The unanswered question is about the prevalence rate of the disease among women and men and the genetic inheritance of the disease among the family members. However, most scientific studies are still aiming at how the rupture risk is affected by location, size, and age younger than 50 years.  The other unanswered question is the prevalence rate based on gender. Most scientific studies on the same subject have not been able to explain why the disease has a considerably higher prevalence in women compared to men.

CONCLUSION

An unruptured aneurysm is a condition that is common among people above the ages of 50years, mostly adults. An unruptured aneurysm is being detected at a higher rate because of the increased use of the imaging services [33]. The unruptured aneurysm is asymptomatic, mainly if it is small. There is limited historical data that is available for patients with an unruptured aneurysm; however, understanding the natural history of the aneurysm is considered necessary in making decisions in the treatment of the disease.

REFERENCES

  1. Briganti F, Napoli M, Tortora F, Solari D, Bergui M, et al. (2020) Italian multicenter experience with flow-diverter devices for intracranial unruptured aneurysm treatment with periprocedural complications—a retrospective data analysis. Interventional Neuroradiology 54: 1145-1152.
  2. Brown RD Jr, Broderick JP (2014) Unruptured intracranial aneurysms: epidemiology, natural history, management options, and familial screening. Lancet Neurology 13: 393-404.
  3. Heiskanen O (1981) Risk of bleeding from unruptured aneurysm in cases with multiple intracranial aneurysms. J Neurosurg 55: 524-526.
  4. Inagawa T, Hirano A (1990) Autopsy study of unruptured incidental intracranial aneurysms. Surgical neurology 34: 361-365.
  5. International Study of Unruptured Intracranial Aneurysms Investigators (1998) Unruptured intracranial aneurysms--risk of rupture and risks of surgical intervention. N Engl J Med 339: 1725-1733.
  6. Cho KC, Kim JJ, Hong CK, Joo JY, Kim YB (2017) Perimesencephalic Nonaneurysmal Subarachnoid Hemorrhage After Clipping of an Unruptured Aneurysm. World neurosurg 102: 694-715.
  7. Jou LD, Lee DH, Morsi H, Mawad ME (2008) Wall shear stress on ruptured and unruptured intracranial aneurysms at the internal carotid artery. AJNR Am J Neuroradiol 29: 1761-1767.
  8. Kosty JA, Andaluz NO, Gozal YM, Krueger BM, Scoville J, et al. (2019) Microsurgical treatment for unruptured intracranial aneurysms: a modern single surgeon series. Br J Neurosurg 33: 322-327.
  9. Juvela S, Porras M, Poussa K (2000) Natural history of unruptured intracranial aneurysms: Probability of and risk factors for aneurysm rupture. J Neurosurg 93: 379-387.
  10. Leech PJ, Stokes BA, Apsimon T, Harper C (1976) Unruptured aneurysm of the anterior spinal artery presenting as paraparesis. Case J Neurosurg 45: 331-333.
  11. Brinjikji W, Chung BJ, Jimenez C, Putman C, Kallmes DF, et al. (2017) Hemodynamic differences between unstable and stable unruptured aneurysms independent of size and location: a pilot study. J Neurointerv Surg 9: 376-380.
  12. Bekelis K, Kerley-Hamilton JS, Teegarden A, Tomlinson CR, Kuintzle R, et al. (2016) MicroRNA and gene expression changes in unruptured human cerebral aneurysms. J Neurosurg 125: 1390-1399.
  13. Lin N, Cahill KS, Frerichs KU, Friedlander RM, Claus EB (2012) Treatment of ruptured and unruptured cerebral aneurysms in the USA: A paradigm shift. J Neurointerv Surg 4: 182-189.
  14.  
  15. Mackey J, Brown RD Jr, Moomaw CJ, Sauerbeck L, Hornung R, et al. (2012) Unruptured intracranial aneurysms in the Familial Intracranial Aneurysm and International Study of Unruptured Intracranial Aneurysms cohorts: differences in multiplicity and location. J Neurosurg 117: 60-64.
  16. McDougall CG, Spetzler RF, Zabramski JM, Partovi S, Hills NK, et al. (2012) The barrow ruptured aneurysm trial. J Neurosurg 116: 135-144.
  17. Xiang J, Yu J, Choi H, Dolan Fox JM, Snyder KV, et al. (2015) Rupture Resemblance Score (RRS): toward risk stratification of unruptured intracranial aneurysms using hemodynamic–morphological discriminants. J Neurointerv Surg 7: 490-495.
  18. Miura Y, Ishida F, Umeda Y, Tanemura H, Suzuki H, et al. (2013) Low wall shear stress is independently associated with the rupture status of middle cerebral artery aneurysms. Stroke 44: 519-521.
  19. Van Rooij WJ, Sluzewski M, van der Laak C (2013) Flow diverters for unruptured internal carotid artery aneurysms: dangerous and not yet an alternative for conventional endovascular techniques. AJNR Am J Neuroradiol 34: 3-4.
  20. Murthy SB, Shah S, Venkatasubba Rao CP, Bershad EM, Suarez JI (2014) Treatment of unruptured intracranial aneurysms with the pipeline embolization device. J Clin Neurosci 21: 6-11.
  21. Inamasu J, Watabe T, Ganaha T, Yamada Y, Nakae S, et al. (2013) Clinical characteristics and risk factors of chronic subdural haematoma associated with clipping of unruptured cerebral aneurysms. J Clin Neurosci 20: 1095-1098.
  22. Huang ZQ, Meng ZH, Hou ZJ, Huang SQ, Chen JN, et al. (2016) Geometric parameter analysis of ruptured and unruptured aneurysms in patients with symmetric bilateral intracranial aneurysms: a multicenter CT angiography study. AJNR Am J Neuroradiol 37: 1413-1417.
  23. Zhang Y, Yang X, Wang Y, Liu J, Li C, et al. (2014) Influence of morphology and hemodynamic factors on rupture of multiple intracranial aneurysms: matched-pairs of ruptured-unruptured aneurysms located unilaterally on the anterior circulation. BMC neurol 14: 253.
  24. Murayama Y, Takao H, Ishibashi T, Saguchi T, Ebara M, et al. (2016). Risk analysis of unruptured intracranial aneurysms: prospective 10-year cohort study. Stroke 47: 365-371.
  25. Moyes PD (1971) Surgical treatment of multiple aneurysms and of incidentally-discovered unruptured aneurysms. J Neurosurg 35: 291-295.
  26. Naggara ON, Lecler A, Oppenheim C, Meder JF, Raymond J (2012) Endovascular treatment of intracranial unruptured aneurysms: A systematic review of the literature on safety with emphasis on subgroup analyses. Radiology 263: 828-835.
  27. Nakagawa T, Hashi K (1994) The incidence and treatment of asymptomatic, unruptured cerebral aneurysms. Journal of neurosurg 80: 217-223.
  28. UCAS Japan Investigators, Morita A, Kirino T, Hashi K, Aoki N, et al. (2012) The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med 366: 2474-2482.
  29. Ujiie H, Sato K, Onda H, Oikawa A, Kagawa M, et al. (1993) Clinical analysis of incidentally discovered unruptured aneurysms. Stroke 24: 1850-1856.
  30. Wardlaw JM, White PM (2000) The detection and management of unruptured intracranial aneurysms. Brain 123: 205-221.
  31. Wiebers DO, Whisnant JP, Huston J 3rd, Meissner I, Brown RD Jr, et al. (2003) International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 362: 103-110.
  32. Mehan WA Jr, Romero JM, Hirsch JA, Sabbag DJ, Gonzalez RG, et al. (2014) Unruptured intracranial aneurysms conservatively followed with serial CT angiography: could morphology and growth predict rupture? J Neurointerv Surg 6: 761-766.
  33. Etminan N, Beseoglu K, Barrow DL, Bederson J, Brown Jr RD, et al. (2014) Multidisciplinary consensus on assessment of unruptured intracranial aneurysms: proposal of an international research group. Stroke 45: 1523-1530.
  34. Figueiredo EG, Welling LC, Preul MC, Sakaya GR, Neville I, et al. (2016) Surgical experience of minipterional craniotomy with 102 ruptured and unruptured anterior circulation aneurysms. J Clin Neurosci 27: 34-39.

Citation: Adjepong D (2020) The Effects of Essential Hypertension in Endovascular Treatment of Unruptured Aneurysm. J Surg Curr Trend Innov 4: 028.

Copyright: © 2020  Dennis Adjepong, MD, MBA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

© 2021, Copyrights Herald Scholarly Open Access. All Rights Reserved!