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

Abstract

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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“…Foci with elevated WSS within the aneurysm sac was also found in ruptured aneurysms. 107 Inflow jet continues to induce high focal WSS at the impact zone, and flow impingement persists within the enlarging aneurysm sac.…”

“…101 WSS serves as a hemodynamic force acting on the vascular wall to dysregulate endothelial function and to develop and rupture cerebral aneurysms. [102][103][104][105][106][107][108][109][110][111] Image-based computational fluid dynamics (CFD) is a reference standard for obtaining WSS in vivo. The finite element method imports vascular geometry of the aneurysm on CTA or MRA, visualizes velocity fields, and determines complex hemodynamic properties.…”

“…The distribution of WSS on the aneurysm wall has been suggested as an important factor for determining the natural course, but controversy has continued regarding the exact role of WSS in the aneurysm formation, growth, and rupture. [102][103][104][105][106][107][108][109][110][111] Both high or low WSS may drive aneurysm evolution, indicating a complex manifestation of heterogenous phenotype in aneurysm pathophysiology. 111 In the initiating stage, an inflow jet with high WSS and positive WSS gradients induce aneurysmal remodeling by triggering mural cell-mediated destructive remodeling in the small aneurysm or bleb.…”

“…In the clinical series of CFD analysis, the risk of anterior communicating artery aneurysm formation and rupture increases as the WSS increases. [107][108][109] After aneurysm developed initially at the area with an aberrantly high WSS region, then the growing region changed into a low WSS level. Low WSS may adapt and facilitate the growing stage, triggering degenerative changes in the aneurysm wall via an inflammatory-cell-mediated pathway in large atherosclerotic aneurysm phenotypes.…”

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