Morphological and Hemodynamic Changes during Cerebral Aneurysm Growth

Uthamaraj, Susheil; Dennis, Kendall D.; Sejkorová, Alena; Hejčl, Aleš; Hron, J.; Švihlová, Helena; Carlson, Kent; Suzen, Yildirim; Dragomir-Daescu, Dan

doi:10.3390/brainsci11040520

Cited by 14 publications

(10 citation statements)

References 13 publications

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“…It has been reported that the aneurysm initiation site most consistently coincided with high WSS and WSS gradients 12 , 16 – 19 , and combination of high WSS and positive WSS gradients in the adjacent region of flow acceleration triggers pathological remodeling and subsequent aneurysm formation 4 , 20 . Based on our previous findings that most ACA and BA aneurysms deviated to the smaller lateral angle and smaller daughter branch 6 , 7 , we hypothesized that formation of cerebral aneurysms was associated with both arterial bifurcation geometry and hemodynamic stresses, particularly the arterial branch forming a smaller lateral angle with the parent artery.…”

Section: Discussionmentioning

confidence: 95%

Cerebral aneurysms at major arterial bifurcations are associated with the arterial branch forming a smaller angle with the parent artery

Gao

Hao

et al. 2022

Sci Rep

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Currently, the relationship of bifurcation morphology and aneurysm presence at the major cerebral bifurcations is not clear. This study was to investigate cerebral arterial bifurcation morphology and accompanied hemodynamic stresses associated with cerebral aneurysm presence at major cerebral arterial bifurcations. Cerebral angiographic data of major cerebral artery bifurcations of 554 anterior cerebral arteries, 582 internal carotid arteries, 793 middle cerebral arteries and 195 basilar arteries were used for measurement of arterial diameter, lateral and bifurcation angles and aneurysm deviation. Hemodynamic stresses were analyzed using computational fluid dynamic simulation. Significantly (P < 0.001) more aneurysms deviated toward the smaller branch and the smaller lateral angle than towards the larger branch and larger lateral angle at all four major bifurcations. At the flow direct impinging center, the total pressure was the greatest while the dynamic pressure, wall shear stress (WSS), vorticity and strain rate were the least. Peak 1 and Peak 2 were located on the branch forming a smaller and larger angle with the parent artery, respectively. The dynamic pressure (175.4 ± 18.6 vs. 89.9 ± 7.6 Pa), WSS (28.9 ± 7.4 vs. 15.7 ± 5.3 Pa), vorticity (9874.6 ± 973.4 vs. 7237.8 ± 372.7 1/S), strain rate (9873.1 ± 625.6 vs. 7648.3 ± 472.5 1/S) and distance (1.9 ± 0.8 vs. 1.3 ± 0.3 mm) between the peak site and direct flow impinging center were significantly greater at Peak 1 than at Peak 2 (P < 0.05 or P < 0.01). Moreover, aneurysms deviation and Peak 1 were always on the same side. In conclusion, the branch forming a smaller angle with the parent artery is associated with abnormally enhanced hemodynamic stresses to initiate an aneurysm at the bifurcation apex.

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Section: Discussionmentioning

confidence: 95%

Cerebral aneurysms at major arterial bifurcations are associated with the arterial branch forming a smaller angle with the parent artery

Gao

Hao

et al. 2022

Sci Rep

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“…Macrophage infiltration was also colocalized with the growing regions of the aneurysm ( 4 ). Clinical studies, similarly, found that the aneurysm growth region mainly occurred in aneurysm areas with low WSS and higher OSI ( 5 , 6 ). A meta-analysis also found that low WSS was an important predictor of IA rupture ( 30 ).…”

Section: Discussionmentioning

confidence: 94%

“…There has been an increased focus on developing computational fluid dynamic (CFD) models to investigate the hemodynamics of IAs as growing evidence suggests that hemodynamic factors are an important causative factor for aneurysms, specifically high wall shear stress (WSS) ( 2 , 3 ). Further studies have reported that low WSS and high oscillatory shear index (OSI) may lead to aneurysm growth and rupture, although these results were not always consistent ( 4 – 6 ).…”

Section: Introductionmentioning

confidence: 99%

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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“…In clinical practice, the AR of narrow-necked aneurysms with size <10 mm is rarely >3.42. The growth of aneurysm was accompanied by the change of a series morphology such as AR and hemodynamic ( 38 ). These studies showed that the rupture of aneurysm was the result of multiple factors.…”

Section: Discussionmentioning

confidence: 99%

Different Hemodynamic Characteristics and Resulting in Different Risks of Rupture Between Wide-Neck and Narrow-Neck Aneurysms

et al. 2022

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ObjectiveThis study aimed to determine the ruptured rate and hemodynamic difference between wide-neck aneurysms (WNAs) and narrow-neck aneurysms (NNAs), as well as the hemodynamic parameters of risk factors for aneurysm rupture.MethodsA total of 121 cases of intracranial aneurysms (IAs) were studied retrospectively between January 2019 and April 2021 at Renmin Hospital of Wuhan University. Intracranial aneurysms were classified into four types: ruptured wide-neck aneurysms (RWNAs), unruptured wide-neck aneurysms (UWNAs), ruptured narrow-neck aneurysms (RNNAs), and unruptured narrow-neck aneurysms (UNNAs). The Chi-square test was used to compare differences in rupture ratios. The clinical characteristics and hemodynamics were analyzed statistically to reveal the rupture risk factors. Moreover, significant parameters were subjected to binary logistic regression analysis to identify the independent predictive factors. The receiver operating characteristic (ROC) curve was performed to obtain cutoff values.ResultsWNAs ruptured more frequently than NNAs (P = 0.033). Ruptured intracranial aneurysms (RIAs) were characterized by significantly higher intra-aneurysmal pressure (IAP), wall shear stress (WSS), wall shear stress gradient (WSSG), and lower normalized wall shear stress (NWSS) than unruptured intracranial aneurysms (UIAs). RWNAs had higher IAP, WSS, and lower NWSS than UWNAs (P < 0.05). RNNAs had higher IAP, Streamwise WSSG and lower NWSS compared to UNNAs (P < 0.05). Binary logistic regression revealed that IAP and WSS were independent predictive risk factors for WNAs rupture, with cut-off values of 405.5 and 6.66 Pa, respectively. Also, IAP was an independent predictive risk factor for NNA rupture, with a cut-off value of 255.3 Pa.ConclusionsWide-neck aneurysms and narrow-neck aneurysms have diverse hemodynamics, which prompts a higher rupture ratio for WNAs. IAP could characterize the rupture risk in both WNAs and NNAs independently, but WSS could only predict the rupture risk in WNAs. This research might assist neurosurgeons with fostering a more sensible strategy for the treatment of IAs.

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Morphological and Hemodynamic Changes during Cerebral Aneurysm Growth

Cited by 14 publications

References 13 publications

Cerebral aneurysms at major arterial bifurcations are associated with the arterial branch forming a smaller angle with the parent artery

Cerebral aneurysms at major arterial bifurcations are associated with the arterial branch forming a smaller angle with the parent artery

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

Different Hemodynamic Characteristics and Resulting in Different Risks of Rupture Between Wide-Neck and Narrow-Neck Aneurysms

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