Chapter 2 - Biology of Cerebral Aneurysm Formation, Growth, and Rupture

Abstract

Cerebral aneurysm rupture leads to significant morbidity and mortality. The biological understanding of aneurysmal growth and rupture may lead to opportunities of preventing subarachnoid hemorrhage. This chapter is dedicated to presenting the current understanding of the biochemical and hemodynamic changes that allow aneurysmal growth and rupture. The role of turbulent flow leading to endothelial cellular damage and subsequent changes to the internal elastic lamina leading to myoproliferation is presented. Atherosclerosis has been integral to the development of ischemic stroke and we present its association to aneurysmal growth and rupture. The roles of proinflammatory markers, including matrix metalloproteinases and interleukin-1, are discussed as such markers are more common in patients with ruptured aneurysm as compared to asymptomatic aneurysms. Finally, we present risk factors of aneurysm rupture, including patient- and aneurysm-related factors as well as triggers for aneurysmal rupture.