Bifurcation Type and Larger Low Shear Area Are Associated with Rupture Status of Very Small Intracranial Aneurysms

Zhang, Yisen; Tian, Zhongbin; Jing, Linyuan; Liu, Jian; Yang, Xiaoling

doi:10.3389/fneur.2016.00169

Cited by 20 publications

(14 citation statements)

References 24 publications

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“…7 Specifically, WSS, one of the most frequently explored but still controversial and puzzling hemodynamic parameters, either high or low, has been shown to be correlated with aneurysm progression and rupture. 7,14,15 However, the hemodynamic characteristics correlated with the enhanced area of the aneurysm wall on HR-VWI postgadolinium T1WI have still not been investigated. Therefore, in this study, computational fluid dynamics was performed on aneurysm models generated from 25 patients with local aneurysm enhancement on HR-VWI postgadolinium T1WI, for hemodynamic simulation and parameter calculation.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies also suggested that applying directly to the en- dothelial cells and acting as a mechanobiological trigger, low WSS may predispose the region to the dysfunction of flow-induced nitric oxide, upgrade endothelial surface adhesion molecules, promote the permeability of endothelial cells, and, thus, facilitate atherosclerotic and inflammatory cell infiltration. 10,14,[19][20][21] Edjlali et al 3 proposed the potential of low WSS in monitoring the aneurysm wall inflammatory process. Hu et al 4 collected a specimen of the aneurysm wall from a patient intraoperatively, which had exhibited local wall enhancement on the high-resolution MRI, and the following histologic study revealed phagocyte and lymphocyte invasion.…”

Section: Discussionmentioning

confidence: 99%

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Low Wall Shear Stress Is Associated with Local Aneurysm Wall Enhancement on High-Resolution MR Vessel Wall Imaging

Wang¹,

Qi²,

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Some retrospective studies have found that the aneurysm wall enhancement on high-resolution MR vessel wall postgadolinium T1WI has the potential to distinguish unstable aneurysms. This study aimed to identify hemodynamic characteristics that differ between the enhanced and nonenhanced areas of the aneurysm wall on high-resolution MR vessel wall postgadolinium T1WI. MATERIALS AND METHODS: TOF-MRA and high-resolution MR vessel wall T1WI of 25 patients were fused to localize the enhanced area of the aneurysm wall. Using computational fluid dynamics, we studied the aneurysm models. Mean static pressure, mean wall shear stress, and oscillatory shear index were compared between the enhanced and nonenhanced areas. RESULTS: The aneurysmal enhanced area had lower wall shear stress (P Ͻ .05) and a lower oscillatory shear index (P ϭ .021) than the nonenhanced area. In addition, the whole aneurysm had lower wall shear stress (P Ͻ .05) and a higher oscillatory shear index (P ϭ .007) than the parent artery. CONCLUSIONS: This study suggests that there are hemodynamic differences between the enhanced and nonenhanced areas of the aneurysm wall on high-resolution MR vessel wall postgadolinium T1WI. ABBREVIATIONS: HR-VWI ϭ high-resolution MR vessel wall imaging; OSI ϭ oscillatory shear index; P ϭ mean static pressure; WSS ϭ wall shear stress

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Low Wall Shear Stress Is Associated with Local Aneurysm Wall Enhancement on High-Resolution MR Vessel Wall Imaging

Wang¹,

Qi²,

et al. 2018

AJNR Am J Neuroradiol

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“…That is the reason why RRS can effectively discriminate IAs rupture. Yet recent many studies propose other parameters including LSAR, which RSS was not involved, could also suggest the abnormal characteristics ( Zhang et al, 2016a , b ). In line with recent studies, SR, NWSSa, and OSI, in which RSS is considered, cannot just reflect the possible area of vascular injury and impact effect to vascular wall ( Castro, 2013 ; Chen et al, 2016 ; Paliwal et al, 2017 ).…”

Section: Discussionmentioning

confidence: 99%

“…Yet results from recent studies suggested that WSS might be strongly collinearity with the morphological characteristics (including AR). Besides, some other parameters including LSAR and WSSG were also correlated with IAs rupture closely ( Fan et al, 2015 ; Zhang et al, 2016a , b ; Levitt et al, 2017 ; Sano et al, 2017 ; Skodvin et al, 2017a ; Varble et al, 2017 ). Given these, we assumed that higher discriminating accuracy could be achieved in discriminating ruptured from unruptured IAs.…”

Section: Introductionmentioning

confidence: 87%

A Novel Scoring System for Rupture Risk Stratification of Intracranial Aneurysms: A Hemodynamic and Morphological Study

Jiang

et al. 2018

Front. Neurosci.

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Objective: The aim of the present study is to investigate the potential morphological and hemodynamic risk factors related to intracranial aneurysms (IAs) rupture and establish a system to stratify the risk of IAs rupture to help the clinical decision-making.Methods: Patients admitted to our hospital for single-IAs were selected from January 2012 and January 2018. A propensity score matching was conducted to match patients. The morphological parameters were obtained from high solution CTA images, and the hemodynamic parameters were obtained in accordance with the outcomes of computational fluid dynamics (CFDs) simulation. Differences in the morphologic and hemodynamic parameters were compared. The significant parameters were selected to establish a novel scoring system (Intracranial Aneurysm Rupture Score, IARS). The comparison was drawn between the discriminating accuracy of IARS and the Rupture Resemblance Score (RRS) system to verify the value of IARS. Then, a group of patients with unruptured IAs was stratified into the high risk and low risk groups by IARS and RRS system separately and was followed up for 18–27 months to verify the value of IARS. The outcome of different stratifications was compared.Results: The matching process yielded 167 patients in each group. Differences of statistical significance were found in aneurysm length (p = 0.001), perpendicular height (H) (p < 0.001), aspect ratio (AR) (p < 0.001), size ratio (SR) (p < 0.001), deviated angle (DA) (p < 0.001), normalized average wall shear stress (NWSSa) (p < 0.001), wall shear stress gradient (WSSG) (p < 0.001), low shear area ratio (LSAR) (p = 0.01), and oscillatory shear index (OSI) (p = 0.01). Logistic regression analysis further demonstrated that SR, DA, NWSSa, LSAR, and OSI were the independent risk factors of IAs rupture. SR, DA, LSAR, and OSI were finally selected to establish the IARS. Our present IARS showed a higher discriminating value (AUC 0.81 vs. 0.77) in comparison with the RRS (SR, NWSSa, and OSI). After follow-up, seven patients were subject to IAs rupture. 5/26 in high risk group stratified by IARS, yet 7/57 in high risk group stratified by RRS. The accuracy of IARS was further verified (19.2% vs. 12.3%, AUC for the IARS and the RRS was 0.723 and 0.673, respectively).Conclusion: SR, DA, NWSSa, LSAR, and OSI were considered the independent risk factors of IAs rupture. Our novel IARS showed higher accuracy in discriminating IA rupture in comparison with RRS.

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“…Additionally, it is important to note that in the contro-versial parameters of high versus low WSS, multivariate analysis was usually performed. 6,14,19,36 However, few researchers have further studied the threshold effect of WSS on ACoA aneurysm rupture using the two-piecewise linear regression model. In our cross-sectional study, univariate linear regression models and multivariate analyses were used to predict the risk of ACoA aneurysm rupture based on WSS in the parent artery.…”

Section: Discussionmentioning

confidence: 99%

High wall shear stress beyond a certain range in the parent artery could predict the risk of anterior communicating artery aneurysm rupture at follow-up

Zhang

Tamrakar

Yao

et al. 2019

Journal of Neurosurgery

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OBJECTIVEAmong clinical and morphological criteria, hemodynamics is the main predictor of aneurysm growth and rupture. This study aimed to identify which hemodynamic parameter in the parent artery could independently predict the rupture of anterior communicating artery (ACoA) aneurysms by using multivariate logistic regression and two-piecewise linear regression models. An additional objective was to look for a more simplified and convenient alternative to the widely used computational fluid dynamics (CFD) techniques to detect wall shear stress (WSS) as a screening tool for predicting the risk of aneurysm rupture during the follow-up of patients who did not undergo embolization or surgery.METHODSOne hundred sixty-two patients harboring ACoA aneurysms (130 ruptured and 32 unruptured) confirmed by 3D digital subtraction angiography at three centers were selected for this study. Morphological and hemodynamic parameters were evaluated for significance with respect to aneurysm rupture. Local hemodynamic parameters were obtained by MR angiography and transcranial color-coded duplex sonography to calculate WSS magnitude. Multivariate logistic regression and a two-piecewise linear regression analysis were performed to identify which hemodynamic parameter independently characterizes the rupture status of ACoA aneurysms.RESULTSUnivariate analysis showed that WSS (p < 0.001), circumferential wall tension (p = 0.005), age (p < 0.001), the angle between the A1 and A2 segments of the anterior cerebral artery (p < 0.001), size ratio (p = 0.023), aneurysm angle (p < 0.001), irregular shape (p = 0.005), and hypertension (grade II) (p = 0.006) were significant parameters. Multivariate analyses showed significant association between WSS in the parent artery and ACoA aneurysm rupture (p = 0.0001). WSS magnitude, evaluated by a two-piecewise linear regression model, was significantly correlated with the rupture of the ACoA aneurysm when the magnitude was higher than 12.3 dyne/cm2 (HR 7.2, 95% CI 1.5–33.6, p = 0.013).CONCLUSIONSWSS in the parent artery may be one of the reliable hemodynamic parameters characterizing the rupture status of ACoA aneurysms when the WSS magnitude is higher than 12.3 dyne/cm2. Analysis showed that with each additional unit of WSS (even with a 1-unit increase of WSS), there was a 6.2-fold increase in the risk of rupture for ACoA aneurysms.

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Bifurcation Type and Larger Low Shear Area Are Associated with Rupture Status of Very Small Intracranial Aneurysms

Cited by 20 publications

References 24 publications

Low Wall Shear Stress Is Associated with Local Aneurysm Wall Enhancement on High-Resolution MR Vessel Wall Imaging

Low Wall Shear Stress Is Associated with Local Aneurysm Wall Enhancement on High-Resolution MR Vessel Wall Imaging

A Novel Scoring System for Rupture Risk Stratification of Intracranial Aneurysms: A Hemodynamic and Morphological Study

High wall shear stress beyond a certain range in the parent artery could predict the risk of anterior communicating artery aneurysm rupture at follow-up

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