The role of wall shear stress in the parent artery as an independent variable in the formation status of anterior communicating artery aneurysms

Zhang, Xin; Yao, Zhiqiang; Karuna, T.; He, Xiaofu; Wang, Xuemin; Li, Wenchao; Li, Ran; Guo, Shenquan; Chen, Yun-Chang; Li, Gan-Cheng

doi:10.1007/s00330-018-5624-7

Cited by 23 publications

(26 citation statements)

References 37 publications

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“…We compared Figures 1, 2 and found out that high infiltration regions were associated with excessively low wall shear stress regions, which is consistent with literature studies that low shear stress was associated with atherosclerotic change in the aneurysm wall (23)(24)(25)(26). Though aneurysm initiation is generally considered to be linked with high shear stress (27,28), the role of wall shear stress in aneurysm rupture remains controversial. In some studies, the rupture sites of aneurysms were found to be associated with the low shear stress region (29,30).…”

Section: Discussionsupporting

confidence: 84%

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

Qian

Zhang

et al. 2020

Front. Neurol.

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Background: Intracranial aneurysm wall degradation can be associated with lipid infiltration. However, the relationship between lipid infiltration and aneurysm rupture has not been explored quantitatively. To investigate the correlation between lipid infiltration and aneurysm rupture, we utilized patient-specific simulation of low-density lipoprotein (LDL) transport to analyze lipid infiltration in the cerebral aneurysm wall. Methods: Sixty-two aneurysms were analyzed. Patient blood pressure, plasma LDL concentration, and three-dimensional angiographic images were obtained to simulate LDL transport in aneurysms. Morphological, hemodynamic, and lipid accumulation parameters were compared between ruptures and unruptured groups. Multivariate logistic regression was also performed to determine parameters that are independently associated with rupture. Results: Size ratio, wall shear stress, low shear area, relative residence time, area-averaged LDL infiltration rate, and maximum LDL infiltration rate were significant parameters in univariate analysis (P < 0.05). Multivariate analysis revealed that only average LDL infiltration remained as a significant variable (P < 0.05). The prediction model derived showed good performance for rupture prediction (AUC, 0.885; 95% CI, 0.794-0.976). Conclusions: Ruptured aneurysms showed significantly higher LDL infiltration compared to unruptured ones. Our results suggested that lipid infiltration may promote aneurysm rupture. Lipid infiltration characteristics should be considered when assessing aneurysm rupture risk.

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Section: Discussionsupporting

confidence: 84%

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

Qian

Zhang

et al. 2020

Front. Neurol.

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“…Current hypotheses of IA genesis are based on the chronic vascular injury as a result of long-lasting hemodynamic stress with subsequent inflammatory cascades resulting in degeneration and reorganization of the affected arterial wall (8,13,21). In addition, role of parent artery morphology in development of IA was also previously discussed (14,26).…”

Section: Introductionmentioning

confidence: 99%

In the wall lies the truth: a systematic review of diagnostic markers in intracranial aneurysms

et al. 2020

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Objective: Despite recent advances in molecular biology and genetics, the development of intracranial aneurysms (IA) is still poorly understood. Elucidation of the processes occurring in the IA wall is essential for a better understanding of IA pathophysiology. We sought to analyze the current evidence from histological, molecular and genetic studies of IA. Methods: We systematically searched PubMed, Scopus, Web of Science and Cochrane Library for articles published before Mar 1, 2019 reporting on different diagnostic markers in human IA specimens. Expression of the markers in IA wall (vs. healthy arterial wall) and association with the rupture status were analyzed. The quality of the included studies and the level of the evidence for the markers were incorporated into the final data assessment. Results: We included 123 studies reporting on analyses of 3476 IA (median 19 IA/study) published between 1966 and 2018. Based on microscopic, biochemical, genetic and biomechanical analyses, data on 358 diagnostic targets in the IA wall were collected. We developed a scale to distribute the diagnostic markers according to their specificity for IA or healthy arterial wall, as well as for ruptured or unruptured IA. We identified different functional pathways, which might reflect the intrinsic and extrinsic processes underlying IA pathophysiology. Conclusions: Multiple histological and molecular markers and the related functional pathways contributing to the development of IA might present promising targets for future therapeutic interventions. Because of small numbers of IA samples in each study, 89% of the analyzed diagnostic markers presented with the lowest level of evidence. This underlines the need for the initiation of a multi-centric prospective histological IA register for pooled data analysis.

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“…The normal TAWSS magnitudes in arteries range from 1.5 to 7 Pa, whereas it could reach 1 to 22 Pa in IAs [58]. Despite both aberrantly high (>7 Pa) [38][39][40][41] and low TAWSS (<1.5 Pa) [27,[34][35][36][37], they have been reported to contribute to the IA rupture via complex mechanobiological mechanisms [14,17]; associations between low TAWSS and the risk of rupture of large IAs (>5 mm) have been identified by some of the latest investigations [14,15,59]. Additionally, high OSI (>0.2), which reflects the elevated local flow instability, was also considered as an important factor in the rupture of IAs by upregulating inflammatory cell-mediated destructive remodeling [14,56,[60][61][62].…”

Section: Impacts Of Unilateral Ica Revascularization On Acoaa Hemodynmentioning

confidence: 96%

“…The decreasing stenosis degree resulted in a reduction of overall TAWSS level and maximum TAWSS on the dome of the ACoAA. Table 3 listed the low TAWSS (<1.5 Pa) [27,[34][35][36][37] and high TAWSS (>7 Pa) [38][39][40][41] areas on the ACoAA dome. Compared with the sever stenosis case, a larger low TAWSS area and smaller high TAWSS area were observed in the case of reduced stenosis degree.…”

Section: The Impact Of Revascularization On Flow Patternsmentioning

confidence: 99%

Impacts of Internal Carotid Artery Revascularization on Flow in Anterior Communicating Artery Aneurysm: A Preliminary Multiscale Numerical Investigation

Zhu

Wei

et al. 2019

Applied Sciences

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The optimal management strategy of patients with concomitant anterior communicating artery aneurysm (ACoAA) and internal carotid artery (ICA) stenosis is unclear. This study aims to evaluate the impacts of unilateral ICA revascularization on hemodynamics factors associated with rupture in an ACoAA. In the present study, a multiscale computational model of ACoAA was developed by coupling zero-dimensional (0D) models of the cerebral vascular system with a three-dimensional (3D) patient-specific ACoAA model. Distributions of flow patterns, wall shear stress (WSS), relative residence time (RRT) and oscillating shear index (OSI) in the ACoAA under left ICA revascularization procedure were quantitatively assessed by using transient computational fluid dynamics (CFD) simulations. Our results showed that the revascularization procedures significantly changed the hemodynamic environments in the ACoAA. The flow disturbance in the ACoAA was enhanced by the resumed flow from the affected side. In addition, higher OSI (0.057 vs. 0.02), prolonged RRT (1.14 vs. 0.39) and larger low WSS area (66 vs. 50 mm2) in ACoAA were found in the non-stenotic case. These acute changes in hemodynamics after revascularization may elevate the rupture risk of ACoAA. The preliminary results validated the feasibility of predicting aneurismal hemodynamics characteristics in revascularization procedures by using multiscale CFD simulations, which would benefit the management of this group of patients.

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The role of wall shear stress in the parent artery as an independent variable in the formation status of anterior communicating artery aneurysms

Cited by 23 publications

References 37 publications

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

Elevated Lipid Infiltration Is Associated With Cerebral Aneurysm Rupture

In the wall lies the truth: a systematic review of diagnostic markers in intracranial aneurysms

Impacts of Internal Carotid Artery Revascularization on Flow in Anterior Communicating Artery Aneurysm: A Preliminary Multiscale Numerical Investigation

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