Hemodynamic findings associated with intraoperative appearances of intracranial aneurysms

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

doi:10.1007/s10143-018-1027-0

Cited by 13 publications

(9 citation statements)

References 39 publications

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“…The heterogenous pattern of LDL infiltration was, in part, owing to spatially varying permeability of the vessel wall, which was dependent on the local wall shear stress. We compared Figures 1, 2 and found out that high infiltration regions were associated with excessively low wall shear stress regions, which is consistent with literature studies that low shear stress was associated with atherosclerotic change in the aneurysm wall (23)(24)(25)(26). Though aneurysm initiation is generally considered to be linked with high shear stress (27,28), the role of wall shear stress in aneurysm rupture remains controversial.…”

Section: Discussionsupporting

confidence: 84%

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

Qian

Zhang

et al. 2020

Front. Neurol.

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Background: Intracranial aneurysm wall degradation can be associated with lipid infiltration. However, the relationship between lipid infiltration and aneurysm rupture has not been explored quantitatively. To investigate the correlation between lipid infiltration and aneurysm rupture, we utilized patient-specific simulation of low-density lipoprotein (LDL) transport to analyze lipid infiltration in the cerebral aneurysm wall. Methods: Sixty-two aneurysms were analyzed. Patient blood pressure, plasma LDL concentration, and three-dimensional angiographic images were obtained to simulate LDL transport in aneurysms. Morphological, hemodynamic, and lipid accumulation parameters were compared between ruptures and unruptured groups. Multivariate logistic regression was also performed to determine parameters that are independently associated with rupture. Results: Size ratio, wall shear stress, low shear area, relative residence time, area-averaged LDL infiltration rate, and maximum LDL infiltration rate were significant parameters in univariate analysis (P < 0.05). Multivariate analysis revealed that only average LDL infiltration remained as a significant variable (P < 0.05). The prediction model derived showed good performance for rupture prediction (AUC, 0.885; 95% CI, 0.794-0.976). Conclusions: Ruptured aneurysms showed significantly higher LDL infiltration compared to unruptured ones. Our results suggested that lipid infiltration may promote aneurysm rupture. Lipid infiltration characteristics should be considered when assessing aneurysm rupture risk.

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Section: Discussionsupporting

confidence: 84%

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

Qian

Zhang

et al. 2020

Front. Neurol.

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“…Irregular shape generally suggested a more significantly fragile area in IAs, which could present as bled or second aneurysm protruding from the primary IAs, as compared with the surrounding area in the aneurysm dome. As revealed from existing studies, the bled or second aneurysm in an irregular aneurysm was generally thin and blood-blister like, and the rupture areas were commonly associated with these bled or second aneurysms ( Kawaguchi et al, 2012 ; Jiang et al, 2020 ). Notably, the hemodynamic condition of the bled aneurysm is generally low WSS and high OSI ( Kawaguchi et al, 2012 ).…”

Section: Discussionmentioning

confidence: 93%

Rebleeding of Ruptured Intracranial Aneurysm After Admission: A Multidimensional Nomogram Model to Risk Assessment

Yang

et al. 2021

Front. Aging Neurosci.

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ObjectiveRebleeding is recognized as the main cause of mortality after intracranial aneurysm rupture. Though timely intervention can prevent poor prognosis, there is no agreement on the surgical priority and choosing medical treatment for a short period after rupture. The aim of this study was to investigate the risk factors related to the rebleeding after admission and establish predicting models for better clinical decision-making.MethodsThe patients with ruptured intracranial aneurysms (RIAs) between January 2018 and September 2020 were reviewed. All patients fell to the primary and the validation cohort by January 2020. The hemodynamic parameters were determined through the computational fluid dynamics simulation. Cox regression analysis was conducted to identify the risk factors of rebleeding. Based on the independent risk factors, nomogram models were built, and their predicting accuracy was assessed by using the area under the curves (AUCs).ResultA total of 577 patients with RIAs were enrolled in this present study, 86 patients of them were identified as undergoing rebleeding after admission. Thirteen parameters were identified as significantly different between stable and rebleeding aneurysms in the primary cohort. Cox regression analysis demonstrated that six parameters, including hypertension [hazard ratio (HR), 2.54; P = 0.044], bifurcation site (HR, 1.95; P = 0.013), irregular shape (HR, 4.22; P = 0.002), aspect ratio (HR, 12.91; P < 0.001), normalized wall shear stress average (HR, 0.16; P = 0.002), and oscillatory stress index (HR, 1.14; P < 0.001) were independent risk factors related to the rebleeding after admission. Two nomograms were established, the nomogram including clinical, morphological, and hemodynamic features (CMH nomogram) had the highest predicting accuracy (AUC, 0.92), followed by the nomogram including clinical and morphological features (CM nomogram; AUC, 0.83), ELAPSS score (AUC, 0.61), and PHASES score (AUC, 0.54). The calibration curve for the probability of rebleeding showed good agreement between prediction by nomograms and actual observation. In the validation cohort, the discrimination of the CMH nomogram was superior to the other models (AUC, 0.93 vs. 0.86, 0.71 and 0.48).ConclusionWe presented two nomogram models, named CMH nomogram and CM nomogram, which could assist in identifying the RIAs with high risk of rebleeding.

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“…WSS (as the tangential drag force per unit area of the endothelial surface) [ 70 ] was examined in a number of CFD studies. It is the most important CFD parameter [ 71 ]. In most studies, low WSS was associated with unstable aneurysms (high risk of rupture and growth).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Recanalization after Coil Embolization

Wiśniewski

Tyfa

Tomasik

et al. 2021

JPM

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The aim of our study was to identify risk factors for recanalization 6 months after coil embolization using clinical data followed by computational fluid dynamics (CFD) analysis. Methods: Firstly, clinical data of 184 patients treated with coil embolization were analyzed retrospectively. Secondly, aneurysm models for high/low recanalization risk were generated based on ROC curves and their cut-off points. Afterward, CFD was utilized to validate the results. Results: In multivariable analysis, aneurysm filling during the first embolization was an independent risk factor whilst packing density was a protective factor of recanalization after 6 months in patients with aSAH. For patients with unruptured aneurysms, packing density was found to be a protective factor whilst the aneurysm neck size was an independent risk factor. Complex flow pattern and multiple vortices were associated with aneurysm shape and were characteristic of the high recanalization risk group. Conclusions: Statistical analysis suggested that there are various factors influencing recanalization risk. Once certain values of morphometric parameters are exceeded, a complex flow with numerous vortices occurs. This phenomenon was revealed due to CFD investigations that validated our statistical research. Thus, the complex flow pattern itself can be treated as a relevant recanalization predictor.

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Hemodynamic findings associated with intraoperative appearances of intracranial aneurysms

Cited by 13 publications

References 39 publications

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

Rebleeding of Ruptured Intracranial Aneurysm After Admission: A Multidimensional Nomogram Model to Risk Assessment

Risk Factors for Recanalization after Coil Embolization

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