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Suzuki T, Hasegawa H, Shibuya K, Fujiwara H, Oishi M. Clinical and Hemodynamic Features of Aneurysm Rupture in Coil Embolization of Intracranial Aneurysms. Diagnostics (Basel) 2024; 14:1203. [PMID: 38893729 PMCID: PMC11172232 DOI: 10.3390/diagnostics14111203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
Intraprocedural rupture (IPR) during coil embolization (CE) of an intracranial aneurysm is a significant clinical concern that necessitates a comprehensive understanding of its clinical and hemodynamic predictors. Between January 2012 and December 2023, 435 saccular cerebral aneurysms were treated with CE at our institution. The inclusion criterion was extravasation or coil protrusion during CE. Postoperative data were used to confirm rupture points, and computational fluid dynamics (CFD) analysis was performed to assess hemodynamic characteristics, focusing on maximum pressure (Pmax) and wall shear stress (WSS). IPR occurred in six aneurysms (1.3%; three ruptured and three unruptured), with a dome size of 4.7 ± 1.8 mm and a D/N ratio of 1.5 ± 0.5. There were four aneurysms in the internal carotid artery (ICA), one in the anterior cerebral artery, and one in the middle cerebral artery. ICA aneurysms were treated using adjunctive techniques (three balloon-assisted, one stent-assisted). Two aneurysms (M1M2 and A1) were treated simply, yet had relatively small and misaligned domes. CFD analysis identified the rupture point as a flow impingement zone with Pmax in five aneurysms (83.3%). Time-averaged WSS was locally reduced around this area (1.3 ± 0.7 [Pa]), significantly lower than the aneurysmal dome (p < 0.01). Hemodynamically unstable areas have fragile, thin walls with rupture risk. A microcatheter was inserted along the inflow zone, directed towards the caution area. These findings underscore the importance of identifying hemodynamically unstable areas during CE. Adjunctive techniques should be applied with caution, especially in small aneurysms with axial misalignment, to minimize the rupture risk.
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Affiliation(s)
- Tomoaki Suzuki
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi-Dori, Niigata 951-8585, Japan
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Paz C, Suárez E, Cabarcos A, Pinto SIS. Numerical Study of a Thrombus Migration Risk in Aneurysm After Coil Embolization in Patient Cases: FSI Modelling. Cardiovasc Eng Technol 2023; 14:544-559. [PMID: 37468797 PMCID: PMC10465652 DOI: 10.1007/s13239-023-00672-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE There are still many challenges for modelling a thrombus migration process in aneurysms. The main novelty of the present research lies in the modelling of aneurysm clot migration process in a realistic cerebral aneurysm, and the analysis of forces suffered by clots inside an aneurysm, through transient FSI simulations. METHODS The blood flow has been modelled using a Womersley velocity profile, and following the Carreau viscosity model. Hyperelastic Ogden model has been used for clot and isotropic linear elastic model for the artery walls. The FSI coupled model was implemented in ANSYS® software. The hemodynamic forces suffered by the clot have been quantified using eight different clot sizes and positions inside a real aneurysm. RESULTS The obtained results have shown that it is almost impossible for clots adjacent to aneurysm walls, to leave the aneurysm. Nevertheless, in clots positioned in the centre of the aneurysm, there is a real risk of clot migration. The risk of migration of a typical post-coiling intervention clot in an aneurysm, in contact with the wall and occupying a significant percentage of its volume is very low in the case studied, even in the presence of abnormally intense events, associated with sneezes or impacts. CONCLUSIONS The proposed methodology allows evaluating the clot migration risk, vital for evaluating the progress after endovascular interventions, it is a step forward in the personalized medicine, patient follow-up, and helping the medical team deciding the optimal treatment.
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Affiliation(s)
- C. Paz
- CINTECX, Universidade de Vigo, Campus As Lagoas-Marcosende, 36310 Vigo, Spain
| | - E. Suárez
- CINTECX, Universidade de Vigo, Campus As Lagoas-Marcosende, 36310 Vigo, Spain
| | - A. Cabarcos
- CINTECX, Universidade de Vigo, Campus As Lagoas-Marcosende, 36310 Vigo, Spain
| | - S. I. S. Pinto
- Engineering Faculty of University of Porto, Institute of Science and Innovation in Mechanical and Industrial Engineering (LAETA-INEGI), Rua Dr. Roberto Frias, 4200-465 Porto, Portugal
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Cheng L, Huang Y, Yao H, Luo J, Zhang L, Fu R, Lv J, Yang B, Yan L. Wall Shear Stress Reduction Activates Angiotensin II to Facilitate Aneurysmal Subarachnoid Hemorrhage in Intracranial Aneurysms Through MicroRNA-29/The Growth Factor-Beta Receptor Type II/Smad3 Axis. World Neurosurg 2023; 176:e314-e326. [PMID: 37230243 DOI: 10.1016/j.wneu.2023.05.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE We tried to broaden our knowledge of the possible role of wall shear stress (WSS) in the occurrence of intracranial aneurysms (IAs). METHODS Genes implicated in IAs and genes related to WSS were predicted through in silico analysis. Rat models of IAs were established, in which the expression patterns of angiotensin II (Ang II) were characterized, and WSS was assessed. Vascular endothelial cells isolated from rats bearing IAs were treated with microRNA-29 (miR-29) mimic/inhibitor, small interfering RNA-TGF-β receptor type II (TGFBR2)/overexpressed TGFBR2, Ang II, or angiotensin-converting enzyme (ACE) inhibitor. Then, the endothelial-to-mesenchymal transition (EndMT) was evaluated by flow cytometry. Finally, the volume of IAs and risk of subarachnoid hemorrhage were analyzed in vivo in response to miR-29 gain of function. RESULTS WSS was decreased in the IA bearing arteries, which showed a positive correlation with ACE and Ang II in the vascular tissues of IA rats. Reduced miR-29 and increased ACE, Ang II, and TGFBR2 were detected in the vascular tissues of IA rats. Ang II inhibited miR-29, which targeted TGFBR2. Downregulated TGFBR2 was accompanied by suppression of Smad3 phosphorylation. Through impairing miR-29-dependent inhibition of TGFBR2, Ang II enhanced EndMT. In vivo data confirmed that treatment of miR-29 agomir delayed the formation of IA and decreased the risk of subarachnoid hemorrhage. CONCLUSIONS The current study provided evidence that WSS reduction could activate Ang II, reduce miR-29 expression, and activate the TGFBR2/Smad3 axis, thus promoting EndMT and accelerating the progression of IAs.
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Affiliation(s)
- Longhai Cheng
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Yan Huang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Hong Yao
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Jie Luo
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Li Zhang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Rui Fu
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Junti Lv
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China.
| | - Bowen Yang
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
| | - Lidong Yan
- Department of Neurosurgery, Taihe Hospital, Hubei University of Medicine, Shiyan, P.R. China
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Burlakoti A, Kumaratilake J, Taylor J, Henneberg M. Relationship between cerebral aneurysms and variations in cerebral basal arterial network: a morphometric cross-sectional study in Computed Tomography Angiograms from a neurointerventional unit. BMJ Open 2021; 11:e051028. [PMID: 34531215 PMCID: PMC8449962 DOI: 10.1136/bmjopen-2021-051028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Segments of cerebral basal arterial network (CBAN) dampen the peak pressure in blood flowing through these arteries, thus minimising the chances of development of cerebral aneurysms. The objective of this research was to find the relationship of occurrence of intracranial aneurysms to variations of the components of the CBAN. DESIGN AND SETTING This is an observational, quantitative and retrospective research, which used cerebral CT angiography (CCTA) images. PARTICIPANTS Cerebral CTA of 145 adult patients of both sexes were studied. MAIN OUTCOME MEASURES Diameters of segments of CBAN were measured in CCTA images and the relative size of each vessel was calculated to standardise for differences in overall arterial sizes among patients. Relationships among sizes of CBAN components were analysed. Presence of aneurysms in different parts of the CBAN was recorded. RESULTS Forty-six aneurysms in right internal carotid artery (ICA) and middle cerebral artery (MCA) and 32 aneurysms in left ICA and MCA segments were noted in 42 and 30 patients, respectively. Aneurysms in anterior communicating artery complex and vertebral-basilar arterial segments were seen in 27 and 8 patients, respectively, while they were not detected in parts of posterior cerebral artery (PCA). The significant (p<0.001) inverse relationships between sizes of posterior communicating artery and the first segment of PCA on both sides indicated that blood inputs to the second part of PCA were similar. Difference in means of the index of arterial size variation for people with aneurysms (mean 0.96, SD 0.23) and without aneurysms (mean 0.86, SD 0.22) was significant (p=0.015). CONCLUSION Variation in segments of CBAN was quantified. The peak pressure dampening mechanism in such arterial segments reduces the chances of development of aneurysms.
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Affiliation(s)
- Arjun Burlakoti
- School of Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Jaliya Kumaratilake
- Anatomy and Pathology, The University of Adelaide Adelaide Medical School, Adelaide, South Australia, Australia
| | - Jamie Taylor
- South Australia Medical Imaging, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Maciej Henneberg
- Institute of Evolutionary Medicine, University of Zurich, Zurich, Switzerland
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Paz C, Suárez E, Cabarcos A, Pinto SIS. FSI modeling on the effect of artery-aneurysm thickness and coil embolization in patient cases. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 206:106148. [PMID: 33992899 DOI: 10.1016/j.cmpb.2021.106148] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/26/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE The attainment of a methodology to simulate the hemodynamic in patient-specific cerebral vessels with aneurysms is still a challenge. The novelty of this work is focused on the effect of coil embolization in a realistic cerebral aneurysm, according to the vessel wall thickness and aneurysm thickness, through transient FSI simulations. METHODS The quality of the mesh for simulations was checked with a specific mesh convergence study; and the numerical methodology was validated using numerical research data of the literature. The model was implemented in ANSYS® software. The total deformation and equivalent stress evolution in the studied cases, before and after coil embolization, were compared. More than 20 different models were employed due to different arterial wall thickness and aneurysm wall thickness combinations. RESULTS The obtained results have showed that deformation and stress values are highly influenced with the sac thickness. The thinner sac aneurysm thickness is, the greater deformation and stress are. The results after coil embolization process have highlighted that considering typical values of arterial wall thickness and aneurysm thickness 0.3 mm and 0.15 mm respectively, a deformation reduction around 50% and a stress reduction around 70% can be achieved. CONCLUSIONS The proposed methodology is a step forward in the personalized medicine, quantifying the aneurysm rupture risk reduction, and helping the medical team in the preoperative planning, or to deciding the optimal treatment.
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Affiliation(s)
- C Paz
- CINTECX, University of Vigo, Campus Universitario Lagoas-Marcosende, Vigo 36310, España.
| | - E Suárez
- CINTECX, University of Vigo, Campus Universitario Lagoas-Marcosende, Vigo 36310, España.
| | - A Cabarcos
- CINTECX, University of Vigo, Campus Universitario Lagoas-Marcosende, Vigo 36310, España.
| | - S I S Pinto
- Engineering Faculty of University of Porto, Institute of Science and Innovation in Mechanical and Industrial Engineering (LAETA-INEGI), Rua Dr. Roberto Frias, Porto 4200-465, Portugal.
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Suzuki T, Hasegawa H, Ando K, Shibuya K, Takahashi H, Saito S, On J, Oishi M, Fujii Y. Hemodynamic features of an intracranial aneurysm rupture predicted by perianeurysmal edema: A case report. Surg Neurol Int 2021; 12:49. [PMID: 33654552 PMCID: PMC7911146 DOI: 10.25259/sni_780_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Perianeurysmal edema (PAE) has been suggested as an indicator of potential aneurysm rupture; however, the hemodynamic features of these aneurysms are still unknown. A computational fluid dynamic (CFD) analysis was performed to evaluate the hemodynamic features of a very rare case of a ruptured middle cerebral artery (MCA) aneurysm with PAE. Case Description: A 65-year-old woman presented with disturbed consciousness. A subarachnoid hemorrhage due to an azygos anterior cerebral artery (ACA) aneurysm rupture was suspected. An unruptured MCA aneurysm with PAE was identified in the left temporal lobe. Although the ACA aneurysm was clipped to prevent re-bleeding, the MCA aneurysm subsequently ruptured 6 days later. Clipping of the MCA aneurysm was performed, and hemosiderin deposits suggestive of sentinel bleeding were found on the surface of the aneurysm dome. CFD analysis revealed unstable hemodynamic stress at the expanded bleb area after rupture, localized to the rupture site. Moreover, this analysis revealed flow impingement with pressure elevation and low wall shear stress, which indicated increased inflammation and aneurysm wall thinning that likely led to rupture. Conclusion: Hemosiderin deposits at the aneurysm wall and PAE indicates leakage from a cerebral aneurysm. Hemodynamic stress at the aneurysm may promote an inflammatory response and lead to wall weakening accompanied by PAE. Based on our findings, we recommend that surgical intervention should be considered as the first line of treatment for such aneurysms to prevent rupture.
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Affiliation(s)
- Tomoaki Suzuki
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Hitoshi Hasegawa
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Kazuhiro Ando
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Kohei Shibuya
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Haruhiko Takahashi
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Shoji Saito
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Jotaro On
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Makoto Oishi
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
| | - Yukihiko Fujii
- Department of Neurosurgery, Niigata University, Brain Research Institute, Niigata, Japan
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Han P, Jin D, Wei W, Song C, Leng X, Liu L, Yu J, Li X. The prognostic effects of hemodynamic parameters on rupture of intracranial aneurysm: A systematic review and meta-analysis. Int J Surg 2021; 86:15-23. [DOI: 10.1016/j.ijsu.2020.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/13/2020] [Accepted: 12/28/2020] [Indexed: 12/26/2022]
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A review of hemodynamic parameters in cerebral aneurysm. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2020. [DOI: 10.1016/j.inat.2020.100716] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Suzuki T, Stapleton CJ, Koch MJ, Tanaka K, Fujimura S, Suzuki T, Yanagisawa T, Yamamoto M, Fujii Y, Murayama Y, Patel AB. Decreased wall shear stress at high-pressure areas predicts the rupture point in ruptured intracranial aneurysms. J Neurosurg 2020; 132:1116-1122. [DOI: 10.3171/2018.12.jns182897] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEDegenerative cerebral aneurysm walls are associated with aneurysm rupture and subarachnoid hemorrhage. Thin-walled regions (TWRs) represent fragile areas that may eventually lead to aneurysm rupture. Previous computational fluid dynamics (CFD) studies reported the correlation of maximum pressure (Pmax) areas and TWRs; however, the correlation with aneurysm rupture has not been established. This study aims to investigate this hemodynamic correlation.METHODSThe aneurysmal wall surface at the Pmax areas was intraoperatively evaluated using a fluid flow formula under pulsatile blood flow conditions in 23 patients with 23 saccular middle cerebral artery (MCA) bifurcation aneurysms (16 unruptured and 7 ruptured). The pressure difference (Pd) at the Pmax areas was calculated by subtracting the average pressure (Pave) from the Pmax and normalized by dividing this by the dynamic pressure at the aneurysm inlet side. The wall shear stress (WSS) was also calculated at the Pmax areas, aneurysm dome, and parent artery. These hemodynamic parameters were used to validate the correlation with TWRs in unruptured MCA aneurysms. The characteristic hemodynamic parameters at the rupture points in ruptured MCA aneurysms were then determined.RESULTSIn 13 of 16 unruptured aneurysms (81.2%), Pmax areas were identified that corresponded to TWRs. In 5 of the 7 ruptured cerebral aneurysms, the Pmax areas coincided with the rupture point. At these areas, the Pd values were not higher than those of the TWRs in unruptured cerebral aneurysms; however, minimum WSS, time-averaged WSS, and normalized WSS at the rupture point were significantly lower than those of the TWRs in unruptured aneurysms (p < 0.01).CONCLUSIONSAt the Pmax area of TWRs, decreased WSS appears to be the crucial hemodynamic parameter that indicates the risk of aneurysm rupture.
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Affiliation(s)
- Tomoaki Suzuki
- 1Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- 2Department of Neurosurgery, Jikei University School of Medicine, Tokyo
- 3Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata
| | - Christopher J. Stapleton
- 1Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Matthew J. Koch
- 1Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kazutoshi Tanaka
- 4Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo
| | - Soichiro Fujimura
- 4Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo
| | - Takashi Suzuki
- 4Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo
- 5Department of Innovation for Medical Information Technology, Jikei University School of Medicine, Tokyo; and
| | - Takeshi Yanagisawa
- 1Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
- 2Department of Neurosurgery, Jikei University School of Medicine, Tokyo
| | - Makoto Yamamoto
- 6Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
| | - Yukihiko Fujii
- 3Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata
| | - Yuichi Murayama
- 2Department of Neurosurgery, Jikei University School of Medicine, Tokyo
| | - Aman B. Patel
- 1Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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Zhang X, Karuna T, Yao ZQ, Duan CZ, Wang XM, Jiang ST, Li XF, Yin JH, He XY, Guo SQ, Chen YC, Liu WC, Li R, Fan HY. 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. J Neurosurg 2019; 131:868-875. [PMID: 30265195 DOI: 10.3171/2018.4.jns173179] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/26/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Among 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. METHODS One 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. RESULTS Univariate 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). CONCLUSIONS WSS 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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Affiliation(s)
- Xin Zhang
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Tamrakar Karuna
- 2Department of Neurosurgery, CMS-Teaching Hospital, Bharatpur, Chitwan, Nepal
| | - Zhi-Qiang Yao
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.,3Department of Interventional Neuroradiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | - Chuan-Zhi Duan
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xue-Min Wang
- 4Key Laboratory of Psychiatric Disorders of Guangdong Province, Department of Neurobiology, School of Basic Medical Science, Southern Medical University, Guangzhou; and
| | - Shun-Ting Jiang
- 5Department of Neurosurgery, Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xi-Feng Li
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jia-He Yin
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xu-Ying He
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shen-Quan Guo
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yun-Chang Chen
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Wen-Chao Liu
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ran Li
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hai-Yan Fan
- 1National Key Clinical Specialty/Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Wang Y, Leng X, Zhou X, Li W, Siddiqui AH, Xiang J. Hemodynamics in a Middle Cerebral Artery Aneurysm Before Its Growth and Fatal Rupture: Case Study and Review of the Literature. World Neurosurg 2018; 119:e395-e402. [PMID: 30071328 DOI: 10.1016/j.wneu.2018.07.174] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Hemodynamics plays an important role in the natural history of intracranial aneurysms. However, it is difficult to obtain longitudinal aneurysm image data. In this study, we had a rare chance to follow the process of growth and rupture of a middle cerebral artery (MCA) aneurysm. The aim of this study was to investigate the role of hemodynamics for growth and rupture in this particular aneurysm patient. METHODS A 57-year-old woman presented with 2 unruptured MCA aneurysms and 1 ruptured anterior choroidal artery (AchA) aneurysm. The unruptured left MCA aneurysm grew in 7 months and ruptured at 11 months. The rupture region was confirmed during the clipping treatment. Computational fluid dynamic (CFD) simulations were conducted on the AchA and MCA aneurysms in 3 serial imaging procedures, and calculated hemodynamics was correlated with aneurysm growth and rupture. RESULTS The ruptured right AchA aneurysm had much lower wall shear stress (WSS) and higher oscillatory shear index (OSI) than the unruptured left MCA aneurysm. Comparison of the aneurysm growth region with the WSS distribution showed that growth occurred in a high WSS area. During the progression of the MCA aneurysm, we observed that the high aneurysmal WSS region grew first and then the growing region changed into a low WSS level; eventually, rupture occurred in a low WSS area. CONCLUSIONS This case suggests that aneurysm rupture might be associated with low WSS and high OSI, whereas aneurysm growth may be related to high WSS in this particular individual MCA aneurysm patient.
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Affiliation(s)
- Yang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | | | - Xiaobin Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Wenqiang Li
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China
| | - Adnan H Siddiqui
- Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA; Department of Radiology, University at Buffalo, State University of New York, Buffalo, New York, USA
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Longo M, Granata F, Racchiusa S, Mormina E, Grasso G, Longo GM, Garufi G, Salpietro FM, Alafaci C. Role of Hemodynamic Forces in Unruptured Intracranial Aneurysms: An Overview of a Complex Scenario. World Neurosurg 2017; 105:632-642. [DOI: 10.1016/j.wneu.2017.06.035] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 06/04/2017] [Accepted: 06/05/2017] [Indexed: 12/16/2022]
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