The association between hemodynamics and wall characteristics in human intracranial aneurysms: a review

Rajabzadeh-Oghaz, Hamidreza; Siddiqui, Adnan H.; Asadollahi, Arash; Kolega, John; Tutino, Vincent M.

doi:10.1007/s10143-021-01554-w

Cited by 8 publications

(10 citation statements)

References 51 publications

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“…Supra-high, low, or oscillatory WSS promote endothelial dysfunction. Several studies have demonstrated the importance of high levels of WSS together with a positive WSS gradient (i.e., accelerating flow) in the formation of IAs (for reviews, see [15,71]). Once the aneurysm is formed, flow within the dome is influenced by the location of the aneurysm, the geometry of the aneurysm and of the parental artery, and by the aneurysm neck characteristics.…”

Section: Biomechanical Forces In Intracranial Aneurysmmentioning

confidence: 99%

“…The different studies performed on animal models and in humans give contradictory results about the implication of low or supra-high WSS in IA growth and rupture. Based on histological investigations, intraoperative image analysis, or vessel wall imaging, authors have linked the different conditions of WSS to endothelial dysfunction, SMC turn-over, inflammatory cell infiltration, presence of atherosclerotic plaques, and wall thinning or thickening with sometimes opposite conclusions [71]. However, two mechanistic pathways, one involving low WSS and high OSI, and one involving high WSS, high WSS gradient, and low OSI, have been proposed to explain IA wall remodeling and rupture (Fig.…”

Section: Wall Shear Stress and Intracranial Aneurysm Risk Of Rupturementioning

confidence: 99%

“…However, two mechanistic pathways, one involving low WSS and high OSI, and one involving high WSS, high WSS gradient, and low OSI, have been proposed to explain IA wall remodeling and rupture (Fig. 3) [71,87]. In all cases, when the wall strength is lower than the hemodynamic forces, the aneurysmal wall ruptures.…”

Section: Wall Shear Stress and Intracranial Aneurysm Risk Of Rupturementioning

confidence: 99%

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Intracranial aneurysm wall (in)stability–current state of knowledge and clinical perspectives

2021

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Intracranial aneurysm (IA), a local outpouching of cerebral arteries, is present in 3 to 5% of the population. Once formed, an IA can remain stable, grow, or rupture. Determining the evolution of IAs is almost impossible. Rupture of an IA leads to subarachnoid hemorrhage and affects mostly young people with heavy consequences in terms of death, disabilities, and socioeconomic burden. Even if the large majority of IAs will never rupture, it is critical to determine which IA might be at risk of rupture. IA (in)stability is dependent on the composition of its wall and on its ability to repair. The biology of the IA wall is complex and not completely understood. Nowadays, the risk of rupture of an IA is estimated in clinics by using scores based on the characteristics of the IA itself and on the anamnesis of the patient. Classification and prediction using these scores are not satisfying and decisions whether a patient should be observed or treated need to be better informed by more reliable biomarkers. In the present review, the effects of known risk factors for rupture, as well as the effects of biomechanical forces on the IA wall composition, will be summarized. Moreover, recent advances in high-resolution vessel wall magnetic resonance imaging, which are promising tools to discriminate between stable and unstable IAs, will be described. Common data elements recently defined to improve IA disease knowledge and disease management will be presented. Finally, recent findings in genetics will be introduced and future directions in the field of IA will be exposed.

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Section: Biomechanical Forces In Intracranial Aneurysmmentioning

confidence: 99%

Section: Wall Shear Stress and Intracranial Aneurysm Risk Of Rupturementioning

confidence: 99%

Section: Wall Shear Stress and Intracranial Aneurysm Risk Of Rupturementioning

confidence: 99%

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Intracranial aneurysm wall (in)stability–current state of knowledge and clinical perspectives

2021

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“…The formation and rupture of IAs is a complex pathological process that despite extensive research (25)(26)(27), is still poorly understood. Considerable scientific evidence supports the notion that hemodynamic forces acting on the vessel wall induce vascular remodeling leading to IA formation, growth and rupture (28)(29)(30)(31). Involved processes include inflammatory cell infiltration, smooth muscle cell (SMC) phenotypic switch, apoptosis, reorganization of extra cellular matrix (ECM), calcification and lipid accumulation (28)(29)(30)(31).…”

Section: Introductionmentioning

confidence: 99%

“…Considerable scientific evidence supports the notion that hemodynamic forces acting on the vessel wall induce vascular remodeling leading to IA formation, growth and rupture (28)(29)(30)(31). Involved processes include inflammatory cell infiltration, smooth muscle cell (SMC) phenotypic switch, apoptosis, reorganization of extra cellular matrix (ECM), calcification and lipid accumulation (28)(29)(30)(31). Numerous studies have tackled the mysteries of IA instability based on morphological dome aspects such as IA size and intraoperative appearance (32)(33)(34).…”

Section: Introductionmentioning

confidence: 99%

Effect of Aneurysm and Patient Characteristics on Intracranial Aneurysm Wall Thickness

Acosta

Cayron

Dupuy

et al. 2021

Front. Cardiovasc. Med.

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Background: The circle of Willis is a network of arteries allowing blood supply to the brain. Bulging of these arteries leads to formation of intracranial aneurysm (IA). Subarachnoid hemorrhage (SAH) due to IA rupture is among the leading causes of disability in the western world. The formation and rupture of IAs is a complex pathological process not completely understood. In the present study, we have precisely measured aneurysmal wall thickness and its uniformity on histological sections and investigated for associations between IA wall thickness/uniformity and commonly admitted risk factors for IA rupture.Methods: Fifty-five aneurysm domes were obtained at the Geneva University Hospitals during microsurgery after clipping of the IA neck. Samples were embedded in paraffin, sectioned and stained with hematoxylin-eosin to measure IA wall thickness. The mean, minimum, and maximum wall thickness as well as thickness uniformity was measured for each IA. Clinical data related to IA characteristics (ruptured or unruptured, vascular location, maximum dome diameter, neck size, bottleneck factor, aspect and morphology), and patient characteristics [age, smoking, hypertension, sex, ethnicity, previous SAH, positive family history for IA/SAH, presence of multiple IAs and diagnosis of polycystic kidney disease (PKD)] were collected.Results: We found positive correlations between maximum dome diameter or neck size and IA wall thickness and thickness uniformity. PKD patients had thinner IA walls. No associations were found between smoking, hypertension, sex, IA multiplicity, rupture status or vascular location, and IA wall thickness. No correlation was found between patient age and IA wall thickness. The group of IAs with non-uniform wall thickness contained more ruptured IAs, women and patients harboring multiple IAs. Finally, PHASES and ELAPSS scores were positively correlated with higher IA wall heterogeneity.Conclusion: Among our patient and aneurysm characteristics of interest, maximum dome diameter, neck size and PKD were the three factors having the most significant impact on IA wall thickness and thickness uniformity. Moreover, wall thickness heterogeneity was more observed in ruptured IAs, in women and in patients with multiple IAs. Advanced medical imaging allowing in vivo measurement of IA wall thickness would certainly improve personalized management of the disease and patient care.

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Multimodal exploration of the intracranial aneurysm wall

et al. 2023

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Purpose Intracranial aneurysms (IAs) are pathological changes of the intracranial vessel wall, although clinical image data can only show the vessel lumen. Histology can provide wall information but is typically restricted to ex vivo 2D slices where the shape of the tissue is altered. Methods We developed a visual exploration pipeline for a comprehensive view of an IA. We extract multimodal information (like stain classification and segmentation of histologic images) and combine them via 2D to 3D mapping and virtual inflation of deformed tissue. Histological data, including four stains, micro-CT data and segmented calcifications as well as hemodynamic information like wall shear stress (WSS), are combined with the 3D model of the resected aneurysm. Results Calcifications were mostly present in the tissue part with increased WSS. In the 3D model, an area of increased wall thickness was identified and correlated to histology, where the Oil red O (ORO) stained images showed a lipid accumulation and the alpha-smooth muscle actin (aSMA) stained images showed a slight loss of muscle cells. Conclusion Our visual exploration pipeline combines multimodal information about the aneurysm wall to improve the understanding of wall changes and IA development. The user can identify regions and correlate how hemodynamic forces, e.g. WSS, are reflected by histological structures of the vessel wall, wall thickness and calcifications.

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The association between hemodynamics and wall characteristics in human intracranial aneurysms: a review

Cited by 8 publications

References 51 publications

Intracranial aneurysm wall (in)stability–current state of knowledge and clinical perspectives

Intracranial aneurysm wall (in)stability–current state of knowledge and clinical perspectives

Effect of Aneurysm and Patient Characteristics on Intracranial Aneurysm Wall Thickness

Multimodal exploration of the intracranial aneurysm wall

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