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        A Comparative Review of the Hemodynamics and Pathogenesis of Cerebral and Abdominal Aortic Aneurysms: Lessons to Learn From Each Other

        Omar Tanweer,Taylor A. Wilson,Eleni Metaxa,Howard A. Riina,Hui Meng 대한뇌혈관외과학회 2014 Journal of Cerebrovascular and Endovascular Neuros Vol.16 No.4

        Objective : Cerebral aneurysms (CAs) and abdominal aortic aneurysms (AAAs)are degenerative vascular pathologies that manifest as abnormal dilationsof the arterial wall. They arise with different morphologies in differenttypes of blood vessels under different hemodynamic conditions. Althoughtreated as different pathologies, we examine common pathways in theirhemodynamic pathogenesis in order to elucidate mechanisms of formation. Materials and Methods : A systematic review of the literature was performed. Current concepts on pathogenesis and hemodynamics were collected andcompared. Results : CAs arise as saccular dilations on the cerebral arteries of the circleof Willis under high blood flow, high wall shear stress (WSS), andhigh wall shear stress gradient (WSSG) conditions. AAAs arise as fusiformdilations on the infrarenal aorta under low blood flow, low, oscillatingWSS, and high WSSG conditions. While at opposite ends of the WSSspectrum, they share high WSSG, a critical factor in arterial remodeling. This alone may not be enough to initiate aneurysm formation, but mayignite a cascade of downstream events that leads to aneurysm development. Despite differences in morphology and the structure, CAs and AAAs sharemany histopathological and biomechanical characteristics. Endothelial celldamage, loss of elastin, and smooth muscle cell loss are universal findingsin CAs and AAAs. Increased matrix metalloproteinases and otherproteinases, reactive oxygen species, and inflammation also contribute tothe pathogenesis of both aneurysms. Conclusion : Our review revealed similar pathways in seemingly differentpathologies. We also highlight the need for cross-disciplinary studies toaid in finding similarities between pathologies.

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