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Veeturi SS, Hall S, Fujimura S, Mossa-Basha M, Sagues E, Samaniego EA, Tutino VM. Imaging of Intracranial Aneurysms: A Review of Standard and Advanced Imaging Techniques. Transl Stroke Res 2024:10.1007/s12975-024-01261-w. [PMID: 38856829 DOI: 10.1007/s12975-024-01261-w] [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: 04/16/2024] [Revised: 04/16/2024] [Accepted: 05/13/2024] [Indexed: 06/11/2024]
Abstract
The treatment of intracranial aneurysms is dictated by its risk of rupture in the future. Several clinical and radiological risk factors for aneurysm rupture have been described and incorporated into prediction models. Despite the recent technological advancements in aneurysm imaging, linear length and visible irregularity with a bleb are the only radiological measure used in clinical prediction models. The purpose of this article is to summarize both the standard imaging techniques, including their limitations, and the advanced techniques being used experimentally to image aneurysms. It is expected that as our understanding of advanced techniques improves, and their ability to predict clinical events is demonstrated, they become an increasingly routine part of aneurysm assessment. It is important that neurovascular specialists understand the spectrum of imaging techniques available.
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Affiliation(s)
- Sricharan S Veeturi
- Canon Stroke and Vascular Research Center, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14214, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY, USA
| | - Samuel Hall
- Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Soichiro Fujimura
- Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan
- Division of Innovation for Medical Information Technology, The Jikei University School of Medicine, Tokyo, Japan
| | | | - Elena Sagues
- Department of Neurology, University of Iowa, Iowa City, IA, USA
| | | | - Vincent M Tutino
- Canon Stroke and Vascular Research Center, Clinical and Translational Research Center, University at Buffalo, 875 Ellicott Street, Buffalo, NY, 14214, USA.
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY, USA.
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Qiu Y, Jiang L, Peng S, Zhu J, Zhang X, Xu R. Combining Machine-Measured Morphometric, Geometric, and Hemodynamic Factors to Predict the Risk of Aneurysm Rupture at the Middle Cerebral Artery Bifurcation. World Neurosurg 2024; 185:e484-e490. [PMID: 38395352 DOI: 10.1016/j.wneu.2024.02.059] [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: 12/08/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Middle Cerebral Artery Bifurcation Aneurysm (MbifA) is associated with a high risk of rupture and poor overall prognosis in patients once it ruptures. Morphological, geometric, and hemodynamic parameters have been identified as factors contributing to the rupture of intracranial aneurysms. However, there are no studies that combine these 3 types of parameters to specifically target MbifA rupture. METHODS This study enrolled all patients with MbifAs diagnosed at our treatment center from 1 April 2021 to 31 July 2023 who met the study criteria. All patients underwent digital subtraction angiography examination to obtain 3D rotational angiography data. We imported the complete image data into the Aneurysm/Artery Reconstruction and Analysis machine to obtain 13 morphological parameters (Dneck, Ddome, Height, Dmax, Dartery, aspect ratio [AR], size ratio, dome-neck-ratio [DNR], height-artery-ratio, bottleneck factor, Inflow Angle, Incline Angle, Arterial Angle), 5 geometric parameters (V,S,undulation index [UI], ellipticity index [EI],nonsphericity index [NSI]), and 5 hemodynamic parameters (wall shear stress [WSS], the maximum WSS, the parent artery WSS, the normalized WSS [NWSS], oscillatory shear index [OSI]). All the above significant parameters were tested by univariate and multivariate analyses to find out the independent discriminatory factors. RESULTS A total of 49 MbifAs (16 ruptured and 33 unruptured) from 44 patients were included in the study. Height (P = 0.033), AR (P = 0.007), DNR (P = 0.011), EI (P = 0.042), NSI(P = 0.030), UI(P = 0.027), WSS(P = 0.033), and NWSS(P = 0.002) were all associated with MbifA rupture in univariate analyses, but only NWSS was an independent risk factor (P = 0.036, OR = 0.046, 95% CI: 0.003-0.815) in multivariate logistic regression analysis. CONCLUSIONS Height, AR, DNR, EI, UI, NSI, WSS, and NWSS may be correlated with MbifA rupture, but only NWSS was an independent risk factor. A lower NWSS was associated with a higher risk of MbifA rupture. No significant differences were observed in the angle parameters, including the Inflow Angle, between ruptured and unruptured MbifAs. OSI was significantly increased at the dome of the aneurysm but the mean OSI was not found to be associated with MbifA rupture.
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Affiliation(s)
- Yulong Qiu
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shixin Peng
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ji Zhu
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaodong Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Xu
- Department of Neurosurgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Pettersson SD, Khorasanizadeh M, Maglinger B, Garcia A, Wang SJ, Taussky P, Ogilvy CS. Trends in the Age of Patients Treated for Unruptured Intracranial Aneurysms from 1990 to 2020. World Neurosurg 2023; 178:233-240.e13. [PMID: 37562685 DOI: 10.1016/j.wneu.2023.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The decision for treatment for unruptured intracranial aneurysms (UIAs) is often difficult. Innovation in endovascular devices have improved the benefit-to-risk profile especially for elderly patients; however, the treatment guidelines from the past decade often recommend conservative management. It is unknown how these changes have affected the overall age of the patients selected for treatment. Herein, we aimed to study potential changes in the average age of the patients that are being treated over time. METHODS A systematic search of the literature was performed to identify all studies describing the age of the UIAs that were treated by any modality. Scatter diagrams with trend lines were used to plot the age of the patients treated over time and assess the presence of a potential significant trend via statistical correlation tests. RESULTS A total of 280 studies including 83,437 UIAs treated between 1987 and 2021 met all eligibility criteria and were entered in the analysis. Mean age of the patients was 55.5 years, and 70.7% were female. There was a significant increasing trend in the age of the treated patients over time (Spearman r: 0.250; P < 0.001), with a 1-year increase in the average age of the treated patients every 5 years since 1987. CONCLUSIONS The present study indicates that based on the treated UIA patient data published in the literature, older UIAs are being treated over time. This trend is likely driven by safer treatments while suggesting that re-evaluation of certain UIA treatment decision scores may be of great interest.
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Affiliation(s)
- Samuel D Pettersson
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - MirHojjat Khorasanizadeh
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Benton Maglinger
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alfonso Garcia
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - S Jennifer Wang
- Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Philipp Taussky
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Christopher S Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
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Tikhvinskii D, Kuianova J, Kislitsin D, Orlov K, Gorbatykh A, Parshin D. Numerical Assessment of the Risk of Abnormal Endothelialization for Diverter Devices: Clinical Data Driven Numerical Study. J Pers Med 2022; 12:652. [PMID: 35455768 PMCID: PMC9025183 DOI: 10.3390/jpm12040652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/07/2022] Open
Abstract
Numerical modeling is an effective tool for preoperative planning. The present work is devoted to a retrospective analysis of neurosurgical treatments for the occlusion of cerebral aneurysms using flow-diverters and hemodynamic factors affecting stent endothelization. Several different geometric approaches have been considered for virtual flow-diverters deployment. A comparative analysis of hemodynamic parameters as a result of computational modeling has been carried out basing on the four clinical cases: one successful treatment, one with no occlusion and two with in stent stenosis. For the first time, a quantitative assessment of both: the limiting magnitude of shear stresses that are necessary for the occurrence of in stent stenosis (MaxWSS > 1.23) and for conditions in which endothelialization is insufficiently active and occlusion of the cervical part of the aneurysm does not occur (MaxWSS < 1.68)—has been statistacally proven (p < 0.01).
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Affiliation(s)
- Denis Tikhvinskii
- Lavrentyev Institute of Hydrodynamics SB RAS, Lavrentiev Avenue 15, 630090 Novosibirsk, Russia; (D.T.); (J.K.)
| | - Julia Kuianova
- Lavrentyev Institute of Hydrodynamics SB RAS, Lavrentiev Avenue 15, 630090 Novosibirsk, Russia; (D.T.); (J.K.)
| | - Dmitrii Kislitsin
- Neurosurgery Department, Meshalkin National Medical Research Center, 630055 Novosibirsk, Russia; (D.K.); (K.O.); (A.G.)
| | - Kirill Orlov
- Neurosurgery Department, Meshalkin National Medical Research Center, 630055 Novosibirsk, Russia; (D.K.); (K.O.); (A.G.)
| | - Anton Gorbatykh
- Neurosurgery Department, Meshalkin National Medical Research Center, 630055 Novosibirsk, Russia; (D.K.); (K.O.); (A.G.)
| | - Daniil Parshin
- Lavrentyev Institute of Hydrodynamics SB RAS, Lavrentiev Avenue 15, 630090 Novosibirsk, Russia; (D.T.); (J.K.)
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Xin S, Chen Y, Zhao B, Liang F. Combination of Morphological and Hemodynamic Parameters for Assessing the Rupture Risk of Intracranial Aneurysms: a Retrospective Study On Mirror Middle Cerebral Artery Aneurysms. J Biomech Eng 2022; 144:1135619. [PMID: 35147191 DOI: 10.1115/1.4053793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Indexed: 11/08/2022]
Abstract
Discordant findings were frequently reported by studies dedicated to exploring the association of morphological/hemodynamic factors with the rupture of intracranial aneurysms (IAs), probably owing to insufficient control of confounding factors. In this study, we aimed to minimize the influences of confounding factors by focusing IAs of interest on mirror aneurysms and, meanwhile, modeling IAs together with the cerebral arterial network to improve the physiological fidelity of hemodynamic simulation. 52 mirror aneurysms located at the middle cerebral artery (MCA) in 26 patients were retrospectively investigated. Numerical tests performed on two randomly selected patients demonstrated that over truncation of cerebral arteries proximal to the MCA during image-based model reconstruction led to uncertain changes in computed values of intra-aneurysmal hemodynamic parameters, which justified the minimal truncation strategy adopted in our study. Five morphological parameters (i.e., volume (V), height (H), dome area (DA), non-sphericity index (NSI), and size ratio (SR)) and two hemodynamic parameters (i.e., peak WSS (peakWSS), and pressure loss coefficient (PLc)) were found to differ significantly between the ruptured and unruptured aneurysms and proved by receiver operating characteristic (ROC) analysis to have potential value for differentiating the rupture status of aneurysm with the areas under curve (AUCs) ranging from 0.681 to 0.763. Integrating V, SR, peakWSS and PLc or some of them into regression models considerably improved the classification of aneurysms, elevating AUC up to 0.864, which indicates that morphological and hemodynamic parameters have complementary roles in assessing the risk of aneurysm rupture.
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Affiliation(s)
- Shangzhe Xin
- State Key Laboratory of Ocean Engineering, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
| | - Yongchun Chen
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang
| | - Bing Zhao
- Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, China
| | - Fuyou Liang
- State Key Laboratory of Ocean Engineering, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, 200240, China
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Kim JH, Choi JI, Lim DJ. Radiologic assessment of rupture risk in small (<5 mm) posterior communicating artery aneurysms. Medicine (Baltimore) 2022; 101:e28696. [PMID: 35089225 PMCID: PMC8797568 DOI: 10.1097/md.0000000000028696] [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] [Received: 07/13/2021] [Accepted: 01/05/2022] [Indexed: 01/05/2023] Open
Abstract
Although previous studies have investigated the predictors of posterior communicating artery (PCoA) aneurysm rupture with clinical and radiologic parameters, the accessibility of "small PCoA aneurysms (<5 mm)" has rarely been reported. Here, we designed a study to identify the factors which are thought to be risky and prone to rupture in small PCoA aneurysms (<5 mm).A total of 114 patients diagnosed with PCoA aneurysm under 5 mm in size on digital subtraction angiography were retrospectively enrolled and divided into ruptured (n = 51) and unruptured (n = 63) groups. Clinical variables were reviewed, and 10 radiologic parameters were obtained, including maximum diameter, height, width, neck width, aspect ratio, dome-to-neck ratio, bleb formation, size ratio, presence of fetal-type PCoA, and inflow angle. Statistical analyses were conducted to compare the groups (ruptured vs unruptured) and identify the risk factors for rupture.High rupture rate of small PCoA aneurysm is noted (51/114, 44.7%). In the comparison analysis, parameters of size ratio (P = .045), aspect ratio (P = .001), and bleb formation (P = .015) were significantly different between the 2 groups. In the regression model, the aspect ratio (P = .045) and bleb formation (P = .004) were significantly associated with the rupture of aneurysm.In respect of small (<5 mm) PCoA aneurysms of our cohort, morphologic parameters of "bleb formation" and "a high aspect ratio" are present more often in ruptured aneurysms as compared to unruptured aneurysms.
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Affiliation(s)
- Jang Hun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Jong-Il Choi
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Korea
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Hemodynamic factor evaluation using computational fluid dynamics analysis for de novo bleb formation in unruptured intracranial aneurysms. Neurol Sci 2021; 43:1849-1857. [PMID: 34331615 PMCID: PMC8860802 DOI: 10.1007/s10072-021-05482-x] [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: 03/31/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
Background Although bleb formation increases the risk of rupture of intracranial aneurysms, previous computational fluid dynamic (CFD) studies have been unable to identify robust causative hemodynamic factors, due to the morphological differences of prebleb aneurysm models and a small number of aneurysms with de novo bleb formation. This study investigated the influences of differences in the aneurysm-models and identify causative hemodynamic factors for de novo bleb formation. Materials and methods CFD analysis was conducted on three aneurysm models, actual prebleb, postbleb, and virtual prebleb models of two unruptured aneurysms with de novo bleb formation. A new multipoint method was introduced in this study. We evenly distributed points with a 0.5-mm distance on the aneurysm surface of the actual prebleb models (146 and 152 points in the individual aneurysm, respectively), and we statistically compared hemodynamics at the points in the areas with and without bleb formation (19 and 279 points, respectively). Results Visually, blebs formed on an aneurysm surface area with similar hemodynamic characteristics in the actual and virtual prebleb models. Statistical analysis using the multipoint method revealed that the de novo bleb formation area was significantly correlated with high pressure (p < 0.001), low wall shear stress (WSS) (p < 0.001), and the center of divergent WSS vectors (p = 0.025). Conclusions De novo bleb formation in intracranial aneurysms may occur in areas associated with the combination of high pressure, low WSS, and the center of divergent WSS vectors. The multipoint method is useful for statistical analysis of hemodynamics in a limited number of aneurysms.
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Kimura H, Osaki S, Hayashi K, Taniguchi M, Fujita Y, Seta T, Tomiyama A, Sasayama T, Kohmura E. Newly Identified Hemodynamic Parameter to Predict Thin-Walled Regions of Unruptured Cerebral Aneurysms Using Computational Fluid Dynamics Analysis. World Neurosurg 2021; 152:e377-e386. [PMID: 34087458 DOI: 10.1016/j.wneu.2021.05.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The thin-walled regions (TIWRs) of intracranial aneurysms have a high risk of rupture during surgical manipulation. They have been reported to be predicted by wall shear stress and pressure (PS) based on computational fluid dynamics analysis, although this remains controversial. In this study, we investigated whether the oscillatory shear index (OSI) can predict TIWRs. METHODS Twenty-five unruptured aneurysms were retrospectively analyzed; the position and orientation of the computational fluid dynamics color maps were adjusted to match the intraoperative micrographs. The red area on the aneurysm wall was defined as TIWR, and if most of the regions on the color map corresponding to TIWR were OSI low (lower quartile range), time-averaged wall shear stress (TAWSS) high, or PS high (upper quartile range), each region was defined as a matched region and divided by the total number of TIWRs to calculate the match rate. In addition, the mean values of OSI, TAWSS, and PS corresponding to TIWRs were quantitatively compared with those in adjacent thick-walled regions. RESULTS Among 27 TIWRs of 25 aneurysms, 23, 10, and 14 regions had low OSI, high TAWSS, and high PS regions (match rate: 85.2%, 37.0%, and 51.9%), respectively. Receiver operating characteristic curve analysis demonstrated that OSI was the most effective hemodynamic parameter (area under the curve, 0.881), followed by TAWSS (0.798). Multivariate analysis showed that OSI was a significant independent predictor of TIWRs (odds ratio, 18.30 [95% CI, 3.2800-102.00], P < 0.001). CONCLUSIONS OSI may be a unique predictor for TIWRs. Low OSI strongly corresponds with TIWRs of intracranial aneurysms.
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Affiliation(s)
- Hidehito Kimura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Susumu Osaki
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Kosuke Hayashi
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Masaaki Taniguchi
- Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Japan
| | - Yuichi Fujita
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Seta
- Graduate School of Science and Engineering for Research, University of Toyama, Toyama, Japan
| | - Akio Tomiyama
- Graduate School of Engineering, Kobe University, Kobe, Japan
| | - Takashi Sasayama
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eiji Kohmura
- Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Neurosurgery, Kinki Central Hospital, Itami, Japan
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The association between hemodynamics and wall characteristics in human intracranial aneurysms: a review. Neurosurg Rev 2021; 45:49-61. [PMID: 33913050 DOI: 10.1007/s10143-021-01554-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/02/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022]
Abstract
Hemodynamics plays a key role in the natural history of intracranial aneurysms (IAs). However, studies exploring the association between aneurysmal hemodynamics and the biological and mechanical characteristics of the IA wall in humans are sparse. In this review, we survey the current body of literature, summarize the studies' methodologies and findings, and assess the degree of consensus among them. We used PubMed to perform a systematic review of studies that explored the association between hemodynamics and human IA wall features using different sources. We identified 28 publications characterizing aneurysmal flow and the IA wall: 4 using resected tissues, 17 using intraoperative images, and 7 using vessel wall magnetic resonance imaging (MRI). Based on correlation to IA tissue, higher flow conditions, such as high wall shear stress (WSS) with complex pattern and elevated pressure, were associated with degenerated walls and collagens with unphysiological orientation and faster synthesis. MRI studies strongly supported that low flow, characterized by low WSS and high blood residence time, was associated with thicker walls and post-contrast enhancement. While significant discrepancies were found among those utilized intraoperative images, they generally supported that thicker walls coexist at regions with prolonged residence time and that thinner regions are mainly exposed to higher pressure with complex WSS patterns. The current body of literature supports a theory of two general hemodynamic-biologic mechanisms for IA development. One, where low flow conditions are associated with thickening and atherosclerotic-like remodeling, and the other where high and impinging flow conditions are related to wall degeneration, thinning, and collagen remodeling.
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