Elucidating Sex Differences in Cerebral Aneurysm Biology and Therapy
The Time Is Now
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See related article, pp 411-417
Subarachnoid hemorrhage remains a devastating disease despite improvements in the technology and techniques used in securing and obliterating ruptured aneurysms. As a result, there is evidence to treat unruptured cerebral aneurysms when found incidentally or in the setting of symptoms suggestive of impending rupture. At present, there are no accepted medical therapies that reduce the risk of rupture or lead to aneurysm obliteration. Endovascular and microsurgical treatments continue to be the standards of care but are invasive and not without significant risk. This potential risk is magnified when treating an aneurysm prophylactically, considering it may remain asymptomatic for the entirety of the life of the patient. The widespread availability of highly sensitive noninvasive imaging modalities, such as magnetic resonance angiography and computed tomographic angiography, has greatly increased the number of unruptured aneurysms diagnosed each year. Thus, more now than ever, clinicians are faced with the challenging scenario of managing an unruptured asymptomatic aneurysm. As a result, noninvasive medical therapies that could reduce or eliminate the risk of aneurysm rupture are of great interest.
At the heart of developing effective medical therapies is an improved understanding of the mechanisms underlying cerebral aneurysm formation and rupture. The role of inflammation in the development and rupture of cerebral aneurysms has been clearly established based on burgeoning data derived from human and animal studies.1,2 An enhanced understanding of the inflammatory mediators contributing to the pathogenesis of cerebral aneurysms has facilitated the identification of targeted therapies. Hasan et al3 identified aspirin as a therapeutic agent …