Hemodynamic characteristics associated with thinner regions of intracranial aneurysm wall

Jiang, Pengjun; Li, Qingyuan; Wu, Jun; Chen, Xin; Li, Maogui; Li, Zhengsong; Yang, Shuzhe; Guo, Rui; Gao, Bin; Cao, Yong; Wang, Rong; Wang, Shuo

doi:10.1016/j.jocn.2019.06.024

Cited by 20 publications

(6 citation statements)

References 34 publications

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“…The association between AWE and other hemodynamic variables, such as RRT, LSA, OSI, and AP, remains controversial. Previous studies found that hyperplastic aneurysm regions had lower AP while thin aneurysm regions had elevated AP ( 33 , 35 ). Spearman's correlation analysis found that AP was positively associated with WSS in this study, and low AP was associated with AWE.…”

Section: Discussionmentioning

confidence: 85%

“…Takao et al found no association between aneurysm rupture status and low WSS ( 31 ), while Cebral et al reported that ruptured aneurysms were more likely to have high WSS ( 32 ). Low WSS has also been associated with the thin region of the IA wall in some studies ( 33 , 34 ). However, several studies found that thick aneurysm walls with inflammatory cell infiltration and atherosclerosis were negatively correlated with WSS and positively correlated with RRT ( 7 , 27 , 35 ).…”

Section: Discussionmentioning

confidence: 89%

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Hemodynamic Characteristic Analysis of Aneurysm Wall Enhancement in Unruptured Middle Cerebral Artery Aneurysm

Zhong

Kuang

et al. 2022

Front. Neurol.

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Background and PurposeAneurysm wall enhancement (AWE) on vessel wall magnetic resonance imaging has been suggested as a marker of the unstable status of intracranial aneurysm (IA) and may predict IA rupture risk. However, the role of abnormal hemodynamics in unruptured IAs with AWE remains poorly understood. This study aimed to determine the association between abnormal hemodynamics and AWE in unruptured middle cerebral artery (MCA) aneurysms.MethodsA total of 28 patients with 32 bifurcation aneurysms of the middle cerebral artery>3mm in size were retrospectively selected for this study. Vessel wall magnetic resonance images were reviewed, and the AWE pattern of each aneurysm was classified as no AWE, partial AWE, and circumferential AWE. Computational fluid dynamics were used to calculate the hemodynamic variables of each aneurysm. Univariate and multivariate analyses investigated the association between AWE and hemodynamic variables.ResultsAWE was present in 13 aneurysms (40.6%), with 7 (21.9%) showing partial AWE and 6 (18.7%) showing circumferential AWE. Kruskal–Wallis H analysis revealed that hemodynamic variables including wall shear stress (WSS), oscillatory shear index, aneurysm pressure (AP), relative residence time, and low shear area (LSA) were significantly associated with AWE (p < 0.05). Further ordinal logistic regression analysis found that WSS was the only factor with a significant association with AWE (p = 0.048); similar trends were identified for LSA (p = 0.055) and AP (p = 0.058). Spearman's correlation analysis showed that AWE was negatively correlated with WSS (rs = −0.622, p < 0.001) and AP (rs = −0.535, p = 0.002) but positively correlated with LSA (rs = 0.774, p < 0.001).ConclusionLow wall shear stress, low aneurysm pressure, and increased low shear area were associated with aneurysm wall enhancement on vessel wall magnetic resonance imaging in unruptured cerebral aneurysms. These abnormal hemodynamic parameters may induce inflammation and cause aneurysm wall enhancement. However, the association between these parameters and their underlying pathological mechanisms requires further investigation.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 89%

Hemodynamic Characteristic Analysis of Aneurysm Wall Enhancement in Unruptured Middle Cerebral Artery Aneurysm

Zhong

Kuang

et al. 2022

Front. Neurol.

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“…Flow impingement, as described in prior CFD studies, is recognized as a hazardous hemodynamic feature predisposing to aneurysmal rupture [ 22 , 23 ]. Furthermore, excessive hemodynamic stress accompanied by pressure elevation is believed to initiate the thinning and fragility of rupture-prone walls [ 24 , 25 ], potentially resulting in severe bleeding. WSS represents another critical hemodynamic stress factor strongly associated with aneurysm growth and rupture [ 26 , 27 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Hemodynamic Features of Aneurysm Rupture in Coil Embolization of Intracranial Aneurysms

Suzuki,

Hasegawa,

Shibuya

et al. 2024

Diagnostics

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Intraprocedural rupture (IPR) during coil embolization (CE) of an intracranial aneurysm is a significant clinical concern that necessitates a comprehensive understanding of its clinical and hemodynamic predictors. Between January 2012 and December 2023, 435 saccular cerebral aneurysms were treated with CE at our institution. The inclusion criterion was extravasation or coil protrusion during CE. Postoperative data were used to confirm rupture points, and computational fluid dynamics (CFD) analysis was performed to assess hemodynamic characteristics, focusing on maximum pressure (Pmax) and wall shear stress (WSS). IPR occurred in six aneurysms (1.3%; three ruptured and three unruptured), with a dome size of 4.7 ± 1.8 mm and a D/N ratio of 1.5 ± 0.5. There were four aneurysms in the internal carotid artery (ICA), one in the anterior cerebral artery, and one in the middle cerebral artery. ICA aneurysms were treated using adjunctive techniques (three balloon-assisted, one stent-assisted). Two aneurysms (M1M2 and A1) were treated simply, yet had relatively small and misaligned domes. CFD analysis identified the rupture point as a flow impingement zone with Pmax in five aneurysms (83.3%). Time-averaged WSS was locally reduced around this area (1.3 ± 0.7 [Pa]), significantly lower than the aneurysmal dome (p < 0.01). Hemodynamically unstable areas have fragile, thin walls with rupture risk. A microcatheter was inserted along the inflow zone, directed towards the caution area. These findings underscore the importance of identifying hemodynamically unstable areas during CE. Adjunctive techniques should be applied with caution, especially in small aneurysms with axial misalignment, to minimize the rupture risk.

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“…While most studies focus on a single aspect, like morphological or the latter mentioned hemodynamic parameters, the following approaches combine multiple modalities. Jiang et al [13] analyzed 28 middle cerebral artery IAs. They performed hemodynamic simulations using models based on preoperative CT angiography (CTA).…”

Section: Related Workmentioning

confidence: 99%

Multimodal exploration of the intracranial aneurysm wall

et al. 2023

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Purpose Intracranial aneurysms (IAs) are pathological changes of the intracranial vessel wall, although clinical image data can only show the vessel lumen. Histology can provide wall information but is typically restricted to ex vivo 2D slices where the shape of the tissue is altered. Methods We developed a visual exploration pipeline for a comprehensive view of an IA. We extract multimodal information (like stain classification and segmentation of histologic images) and combine them via 2D to 3D mapping and virtual inflation of deformed tissue. Histological data, including four stains, micro-CT data and segmented calcifications as well as hemodynamic information like wall shear stress (WSS), are combined with the 3D model of the resected aneurysm. Results Calcifications were mostly present in the tissue part with increased WSS. In the 3D model, an area of increased wall thickness was identified and correlated to histology, where the Oil red O (ORO) stained images showed a lipid accumulation and the alpha-smooth muscle actin (aSMA) stained images showed a slight loss of muscle cells. Conclusion Our visual exploration pipeline combines multimodal information about the aneurysm wall to improve the understanding of wall changes and IA development. The user can identify regions and correlate how hemodynamic forces, e.g. WSS, are reflected by histological structures of the vessel wall, wall thickness and calcifications.

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Hemodynamic characteristics associated with thinner regions of intracranial aneurysm wall

Cited by 20 publications

References 34 publications

Hemodynamic Characteristic Analysis of Aneurysm Wall Enhancement in Unruptured Middle Cerebral Artery Aneurysm

Hemodynamic Characteristic Analysis of Aneurysm Wall Enhancement in Unruptured Middle Cerebral Artery Aneurysm

Clinical and Hemodynamic Features of Aneurysm Rupture in Coil Embolization of Intracranial Aneurysms

Multimodal exploration of the intracranial aneurysm wall

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