Suggested Connections Between Risk Factors of Intracranial Aneurysms: A Review

Cebral, Juan R.; Raschi, Marcelo

doi:10.1007/s10439-012-0723-0

Cited by 97 publications

(78 citation statements)

References 141 publications

(182 reference statements)

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“…42,43 Certainly, variations in hemodynamics and different risk factors among different individuals contribute to the heterogeneity of the disease.…”

Section: Relationship Between Hemodynamics and Aneurysm Developmentmentioning

confidence: 99%

High WSS or Low WSS? Complex Interactions of Hemodynamics with Intracranial Aneurysm Initiation, Growth, and Rupture: Toward a Unifying Hypothesis

Meng

Tutino

Xiang

et al. 2013

AJNR Am J Neuroradiol

752

590

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SUMMARY:Increasing detection of unruptured intracranial aneurysms, catastrophic outcomes from subarachnoid hemorrhage, and risks and cost of treatment necessitate defining objective predictive parameters of aneurysm rupture risk. Image-based computational fluid dynamics models have suggested associations between hemodynamics and intracranial aneurysm rupture, albeit with conflicting findings regarding wall shear stress. We propose that the "high-versus-low wall shear stress" controversy is a manifestation of the complexity of aneurysm pathophysiology, and both high and low wall shear stress can drive intracranial aneurysm growth and rupture. Low wall shear stress and high oscillatory shear index trigger an inflammatory-cell-mediated pathway, which could be associated with the growth and rupture of large, atherosclerotic aneurysm phenotypes, while high wall shear stress combined with a positive wall shear stress gradient trigger a mural-cell-mediated pathway, which could be associated with the growth and rupture of small or secondary bleb aneurysm phenotypes. This hypothesis correlates disparate intracranial aneurysm pathophysiology with the results of computational fluid dynamics in search of more reliable risk predictors. ABBREVIATIONS:CFD ϭ computational fluid dynamics; ECM ϭ extracellular matrix; WSS ϭ wall shear stress

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“…42,43 Certainly, variations in hemodynamics and different risk factors among different individuals contribute to the heterogeneity of the disease.…”

Section: Relationship Between Hemodynamics and Aneurysm Developmentmentioning

confidence: 99%

High WSS or Low WSS? Complex Interactions of Hemodynamics with Intracranial Aneurysm Initiation, Growth, and Rupture: Toward a Unifying Hypothesis

Meng

Tutino

Xiang

et al. 2013

AJNR Am J Neuroradiol

752

590

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“…A variety of genes or chromosomal regions have been identified in both familial and sporadic cases of IAs. [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73] In linkage studies, regions on chromosomes 1p34.3-p36.13, 7q11, 19q13.3, and Xp22 have been associated with IAs. Genome-wide association studies identified replicated associations on chromosome 4q31.23 (EDNRA), 8q12.1 (SOX17), 9p213 (CDKN2A/CDKN2B/CDKN2BAS), 10q24.32 (CNNM2), 12q22, 13q13.1 (KL/STARD13), 18q11.2 (RBBP8), and 20p12.1, with the strongest evidence for the CDKN2BAS and SOX17 genes.…”

Section: Family History and Geneticsmentioning

confidence: 99%

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Thompson¹,

Brown²,

Amin‐Hanjani³

et al. 2015

Stroke

799

352

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Purpose— The aim of this updated statement is to provide comprehensive and evidence-based recommendations for management of patients with unruptured intracranial aneurysms. Methods— Writing group members used systematic literature reviews from January 1977 up to June 2014. They also reviewed contemporary published evidence-based guidelines, personal files, and published expert opinion to summarize existing evidence, indicate gaps in current knowledge, and when appropriate, formulated recommendations using standard American Heart Association criteria. The guideline underwent extensive peer review, including review by the Stroke Council Leadership and Stroke Scientific Statement Oversight Committees, before consideration and approval by the American Heart Association Science Advisory and Coordinating Committee. Results— Evidence-based guidelines are presented for the care of patients presenting with unruptured intracranial aneurysms. The guidelines address presentation, natural history, epidemiology, risk factors, screening, diagnosis, imaging and outcomes from surgical and endovascular treatment.

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“…While aneurysms can remain unsymptomatic for years, they may grow and eventually rupture, which is often lethal [1,2]. The formation and subsequent growth of an aneurysm is not only caused by systemic risk factors, but a significant role is also attributed to the local haemodynamic environment [3]. Blood flow patterns cause a nonuniform mechanical load on the vessel wall which may lead to deleterious remodelling [4 -6].…”

Section: Introductionmentioning

confidence: 99%

Transitional flow in aneurysms and the computation of haemodynamic parameters

Poelma

Watton

Ventikos

2015

J. R. Soc. Interface.

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Haemodynamic forces appear to play an influential role in the evolution of aneurysms. This has led to numerous studies, usually based on computational fluid dynamics. Their focus is predominantly on the wall shear stress (WSS) and associated derived parameters, attempting to find correlations between particular patterns of haemodynamic indices and regions subjected to disease formation and progression. The indices are generally determined by integration of flow properties over a single cardiac cycle. In this study, we illustrate that in some cases the transitional flow in aneurysms can lead to significantly different WSS distributions in consecutive cardiac cycles. Accurate determination of time-averaged haemodynamic indices may thus require simulation of a large number of cycles, which contrasts with the common approach to determine parameters using data from a single cycle. To demonstrate the role of transitional flow, two exemplary cases are considered: flow in an abdominal aortic aneurysm and in an intracranial aneurysm. The key differences that are observed between these cases are explained in terms of the integral timescale of the transitional flows in comparison with the cardiac cycle duration: for relatively small geometries, transients will decay before the next cardiac cycle. In larger geometries, transients are still present when the systolic phase produces new instabilities. These residual fluctuations serve as random initial conditions and thus seed different flow patterns in each cycle. To judge whether statistics are converged, the derived indices from at least two successive cardiac cycles should be compared.

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Suggested Connections Between Risk Factors of Intracranial Aneurysms: A Review

Cited by 97 publications

References 141 publications

High WSS or Low WSS? Complex Interactions of Hemodynamics with Intracranial Aneurysm Initiation, Growth, and Rupture: Toward a Unifying Hypothesis

High WSS or Low WSS? Complex Interactions of Hemodynamics with Intracranial Aneurysm Initiation, Growth, and Rupture: Toward a Unifying Hypothesis

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

Transitional flow in aneurysms and the computation of haemodynamic parameters

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