Role of Hemodynamic Forces in Unruptured Intracranial Aneurysms: An Overview of a Complex Scenario

Longo, Marcello; Granata, Francesca; Racchiusa, Sergio; Mormina, Enricomaria; Grasso, Giovanni; Longo, Giuseppe; Garufi, Giada; Salpietro, Francesco M.; Alafaci, Concetta

doi:10.1016/j.wneu.2017.06.035

Cited by 41 publications

(32 citation statements)

References 111 publications

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“…Because WSS is the tangential force exerted by the horizontally moving fluid on the surface 7 and OSI denotes WSS fluctuation magnitude and the tangential force oscillation in a cardiac cycle, 8 low WSS with low OSI may reflect a concentrated blood inflow jet at the enhanced area. We assume that a regional concentrated inflow jet is likely to damage the endothelial cell layer and lead to inflammation, thus changing the aneurysm geometry and promoting its tendency to grow or rupture.…”

Section: Discussionmentioning

confidence: 99%

“…Three hemodynamic parameters, which were time-averaged over a cardiac cycle of enhanced area, nonenhanced area, the whole aneurysm, and parent artery, respectively, were calculated, namely mean static pressure (P), mean wall shear stress, and oscillatory shear index (OSI). 8 To compare hemodynamic differences between ruptured and unruptured aneurysms, we calculated the P and WSS of the enhanced area and the whole aneurysm normalized by the parent artery P and WSS.…”

Section: Hemodynamic Analysismentioning

confidence: 99%

“…Computational fluid dynamics has been used to investigate hemodynamic parameters that are linked with cerebral aneurysm formation, progression, and rupture, one of which is wall shear stress (WSS), the most highlighted but controversial parameter. [6][7][8] However, to our knowledge, no published investigations have revealed the association between hemodynamic characteristics and aneurysm wall enhancement on HR-VWI postgadolinium T1WI.…”

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confidence: 95%

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Low Wall Shear Stress Is Associated with Local Aneurysm Wall Enhancement on High-Resolution MR Vessel Wall Imaging

Wang¹,

Qi²,

et al. 2018

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Some retrospective studies have found that the aneurysm wall enhancement on high-resolution MR vessel wall postgadolinium T1WI has the potential to distinguish unstable aneurysms. This study aimed to identify hemodynamic characteristics that differ between the enhanced and nonenhanced areas of the aneurysm wall on high-resolution MR vessel wall postgadolinium T1WI. MATERIALS AND METHODS: TOF-MRA and high-resolution MR vessel wall T1WI of 25 patients were fused to localize the enhanced area of the aneurysm wall. Using computational fluid dynamics, we studied the aneurysm models. Mean static pressure, mean wall shear stress, and oscillatory shear index were compared between the enhanced and nonenhanced areas. RESULTS: The aneurysmal enhanced area had lower wall shear stress (P Ͻ .05) and a lower oscillatory shear index (P ϭ .021) than the nonenhanced area. In addition, the whole aneurysm had lower wall shear stress (P Ͻ .05) and a higher oscillatory shear index (P ϭ .007) than the parent artery. CONCLUSIONS: This study suggests that there are hemodynamic differences between the enhanced and nonenhanced areas of the aneurysm wall on high-resolution MR vessel wall postgadolinium T1WI. ABBREVIATIONS: HR-VWI ϭ high-resolution MR vessel wall imaging; OSI ϭ oscillatory shear index; P ϭ mean static pressure; WSS ϭ wall shear stress

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Section: Discussionmentioning

confidence: 99%

Section: Hemodynamic Analysismentioning

confidence: 99%

mentioning

confidence: 95%

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Low Wall Shear Stress Is Associated with Local Aneurysm Wall Enhancement on High-Resolution MR Vessel Wall Imaging

Wang¹,

Qi²,

et al. 2018

AJNR Am J Neuroradiol

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“…More and more published CFD studies seem to suggest that high WSS results in intracranial aneurysm growth and low WSS in rupture. 7,12,14,15,18,19,22,24,25,27 However, these results were inconsistent with those obtained by Liu et al and Yu et al 13,26,30,34 They found high WSS in the ruptured aneurysm group. Moreover, it is important to note that their average WSS in the aneurysm region (1.64 ± 1.16 N/m 2 ) was significantly lower than that observed in the vessel region (p < 0.05), which highly accords with our findings.…”

Section: Discussionmentioning

confidence: 74%

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

Zhang

Tamrakar

Yao

et al. 2019

Journal of Neurosurgery

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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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“…The hemodynamics of intracranial aneurysms has been studied using computational fluid dynamics (CFD) (reviews available) [26][27][28][29][30][31][32][33][34][35][36][37]. CFD has been used to identify a hemodynamic discriminator to distinguish between ruptured and unruptured aneurysms.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of hemodynamic discriminators for ruptured intracranial aneurysms

et al. 2019

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Researchers have aimed to identify unruptured intracranial aneurysms at a higher risk of rupture during follow-up for a long time. Computational fluid dynamics has been used widely to identify a hemodynamic discriminator between ruptured and unruptured aneurysms. However, this method has yet to reach a consensus between groups, which may be due, in part, to the significant degrees of freedom in hemodynamic indexes and computational workflows. The present review aims to characterize the degree of association between ruptured aneurysms and hemodynamic indexes, as well as the degree of variability between groups. A PubMed search identified 588 relevant studies. Thirteen met our criteria, yielding a total of 3,692 aneurysms. The definition of hemodynamic indexes were first carefully assessed and then classified accordingly. The variability of hemodynamic indexes between groups displayed a significant indexdependent nature. Normalizing hemodynamic indexes was an effective measure of reducing variability. Hemodynamic indexes were evaluated for associability and quantifiability. Overall, in an attempt to advance the diagnostic performance of hemodynamic indexes, these results shed light on the poor ability to interpret hemodynamic states pathologically. Future studies should incorporate the pathological significance of hemodynamic states into the design of hemodynamic indexes.

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Role of Hemodynamic Forces in Unruptured Intracranial Aneurysms: An Overview of a Complex Scenario

Cited by 41 publications

References 111 publications

Low Wall Shear Stress Is Associated with Local Aneurysm Wall Enhancement on High-Resolution MR Vessel Wall Imaging

Low Wall Shear Stress Is Associated with Local Aneurysm Wall Enhancement on High-Resolution MR Vessel Wall Imaging

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

Systematic review of hemodynamic discriminators for ruptured intracranial aneurysms

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