Computational Fluid Dynamic Analysis of Intracranial Aneurysmal Bleb Formation

Russell, Jeremy; Kelson, Neil A.; Barry, Mark; Pearcy, Mark J.; Fletcher, David F.; Winter, Chris

doi:10.1227/neu.0000000000000137

Cited by 42 publications

(33 citation statements)

References 31 publications

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“…Moreover, the flow characteristics just prior to rupture have been reported 44,45 , where both studies demonstrated low WSS on the aneurysm sacs before their rupture. Although the literature on this is scarce, some studies support the notion that WSS decreases sharply in the bleb region after blister formation 8,46 .…”

Section: Discussionmentioning

confidence: 94%

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Association of wall shear stress with intracranial aneurysm rupture: systematic review and meta-analysis

Zhou

Zhang

Yin

et al. 2017

Sci Rep

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To evaluate the relationship between wall shear stress (WSS) magnitude and cerebral aneurysm rupture and provide new insight into the disparate computational fluid dynamics (CFD) findings concerning the role of WSS in intracranial aneurysm (IA) rupture. A systematic electronic database (PubMed, Medline, Springer, and EBSCO) search was conducted for all accessible published articles up to July 1, 2016, with no restriction on the publication year. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Random effects meta-analysis was used to pool the complication rates across studies. Twenty-two studies containing CFD data on 1257 patients with aneurysms were included in the analysis. A significantly higher rate of low WSS (0–1.5 Pa) was found in ruptured aneurysms (odds ratio [OR] 2.17; 95% confidence interval [CI], 1.73–2.62). The pooled analyses across 14 studies with low WSS showed significantly lower mean WSS (0.64 vs. 1.4 Pa) (p = 0.037) in the ruptured group. This meta-analysis provides evidence that decreased local WSS may be an important predictive parameter of IA rupture.

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Section: Discussionmentioning

confidence: 94%

“…High OSI modulates the gene expression of endothelial cells to upregulate endothelial surface adhesion molecules, cause dysfunction of flow-induced NO, increase endothelial permeability, and thereby promote the rupture process 7,8,47 . In our analysis, six of fifteen reports found a positive correlation between high OSI and IA rupture.…”

Section: Discussionmentioning

confidence: 99%

Association of wall shear stress with intracranial aneurysm rupture: systematic review and meta-analysis

Zhou

Zhang

Yin

et al. 2017

Sci Rep

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“…In our study, as concerns the aneurysm rupture risk, height/width ratio and the difference of the dominant A1 artery were correlated with aneurysm rupture. In terms of height/width ratio, these results could be related to more ruptured aneurysms with small impaction zones, higher inflows, and, consequently, a higher wall shear stress (jet inflow) 5)32)39). Aneurysms in the A com complex are more likely to have asymmetric A1 segments and to have asymmetric inflow angiographically from the hypoplastic A1 segment.…”

Section: Discussionmentioning

confidence: 99%

The Rupture Risk of Aneurysm in the Anterior Communicating Artery: A Single Center Study

Kim

Hwang

2017

J Cerebrovasc Endovasc Neurosurg

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ObjectiveThe aim of this study was to evaluate the characteristics of ruptured aneurysms at anterior communicating artery (A com) with an analysis of clinical and morphological data, which could further our understanding of the risks of ruptured A com aneurysms.Materials and MethodsAn analysis of data with 86 ruptured and 44 unruptured A com aneurysms were analyzed using a digital subtraction angiography or 3-dimensional computed tomography angiography between January 2010 and December 2015 in a single center.ResultsFifty-five percent of ruptured A com aneurysms were smaller than 4 mm in size. They had a smooth wall (44%), with a mean size ratio of 4.22 (range: 0.7-14.3) and mean height/width ratio of 1.48 (range: 0.5-2.9); 23 patients of A1 positive difference. Unruptured aneurysms were mostly 2-10 mm in size (94%) and had an irregular wall (43%), with a mean size ratio of 4.1 (range: 0.8-9.1) and mean height/width ratio of 1.2 (range: 0.1-2.6); 6 patients of A1 positive difference. In terms of the morphology of aneurysms, size of A com, maximum aneurysm size, neck width, aneurysm wall morphology, and size ratio were not different with statistical significance. However, dominance of A1 (p = 0.01) and height/width ratio (p = 0.03) were found to be a significant predictive factor for rupture of A com aneurysms.ConclusionTo better understand the rupture risk of A com aneurysms, a large, multicenter, collaborative, and prospective study should be performed in the future.

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“…There are a number of established risk factors for intracranial aneurysm rupture such as family history, female sex, age (the sixth decade), pregnancy, labor, previous aneurysmal subarachnoid hemorrhage, excessive alcohol intake and cigarette smoking (16,21,42,47,48,51,55,26,67,69,(76)(77)(78)81). The morbidity and mortality associated with the surgical and endovascular treatment of unruptured intracranial aneurysm is considerable.…”

Section: Introductionmentioning

confidence: 99%

Mouse Models of Intracranial Aneurysm

et al. 2014

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Subarachnoid hemorrhage secondary to rupture of an intracranial aneurysm is a highly lethal medical condition. Current management strategies for unruptured intracranial aneurysms involve radiological surveillance and neurosurgical or endovascular interventions. There is no pharmacological treatment available to decrease the risk of aneurysm rupture and subsequent subarachnoid hemorrhage. There is growing interest in the pathogenesis of intracranial aneurysm focused on the development of drug therapies to decrease the incidence of aneurysm rupture. The study of rodent models of intracranial aneurysms has the potential to improve our understanding of intracranial aneurysm development and progression. This review summarizes current mouse models of intact and ruptured intracranial aneurysms and discusses the relevance of these models to human intracranial aneurysms. The article also reviews the importance of these models in investigating the molecular mechanisms involved in the disease. Finally, potential pharmaceutical targets for intracranial aneurysm suggested by previous studies are discussed. Examples of potential drug targets include matrix metalloproteinases, stromal cell-derived factor-1, tumor necrosis factor-α, the renin-angiotensin system and the β-estrogen receptor. An agreed clear, precise and reproducible definition of what constitutes an aneurysm in the models would assist in their use to better understand the pathology of intracranial aneurysm and applying findings to patients.

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Computational Fluid Dynamic Analysis of Intracranial Aneurysmal Bleb Formation

Cited by 42 publications

References 31 publications

Association of wall shear stress with intracranial aneurysm rupture: systematic review and meta-analysis

Association of wall shear stress with intracranial aneurysm rupture: systematic review and meta-analysis

The Rupture Risk of Aneurysm in the Anterior Communicating Artery: A Single Center Study

Mouse Models of Intracranial Aneurysm

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