Additional Value of Intra-Aneurysmal Hemodynamics in Discriminating Ruptured versus Unruptured Intracranial Aneurysms

Schneiders, J.J.; Marquering, Henk A.; Ooij, Pim van; Berg, René van den; Nederveen, Aart J.; Verbaan, Dagmar; Vandertop, W. Peter; Pourquié, Mathieu; Rinkel, Gabriël J.E.; vanBavel, Ed; Majoie, Charles B. L. M.

doi:10.3174/ajnr.a4397

Cited by 31 publications

(20 citation statements)

References 30 publications

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“…After abstract screening, a total 175 full-text manuscripts were retrieved, of which 22 met the inclusion criteria 6–27 . In total, 1257 aneurysms from these 22 studies that performed CFD in search of correlations between aneurysmal hemodynamics and rupture were included in the analysis (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Association of wall shear stress with intracranial aneurysm rupture: systematic review and meta-analysis

Zhou

Zhang

Yin

et al. 2017

Sci Rep

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To evaluate the relationship between wall shear stress (WSS) magnitude and cerebral aneurysm rupture and provide new insight into the disparate computational fluid dynamics (CFD) findings concerning the role of WSS in intracranial aneurysm (IA) rupture. A systematic electronic database (PubMed, Medline, Springer, and EBSCO) search was conducted for all accessible published articles up to July 1, 2016, with no restriction on the publication year. Abstracts, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Random effects meta-analysis was used to pool the complication rates across studies. Twenty-two studies containing CFD data on 1257 patients with aneurysms were included in the analysis. A significantly higher rate of low WSS (0–1.5 Pa) was found in ruptured aneurysms (odds ratio [OR] 2.17; 95% confidence interval [CI], 1.73–2.62). The pooled analyses across 14 studies with low WSS showed significantly lower mean WSS (0.64 vs. 1.4 Pa) (p = 0.037) in the ruptured group. This meta-analysis provides evidence that decreased local WSS may be an important predictive parameter of IA rupture.

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Section: Resultsmentioning

confidence: 99%

Association of wall shear stress with intracranial aneurysm rupture: systematic review and meta-analysis

Zhou

Zhang

Yin

et al. 2017

Sci Rep

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“…Time-resolved MRA, or 4D MRA, directly measures flow velocities and shear stresses within an aneurysm [42]. This may allow for the identification of the inflow zone of aneurysms and may guide endovascular treatment [43,44].…”

Section: Future Developmentsmentioning

confidence: 99%

Imaging of cerebral aneurysms: a clinical perspective

et al. 2016

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Neuroimaging is a critical element in evaluating and treating patients with cerebral aneurysms. Each neuroimaging technique has unique strengths, weaknesses, and current developments. In this review, we discuss the utility of two primary noninvasive radiological techniques-computed tomography angiography (CTA) and magnetic resonance angiography (MRA)-as well as of digital subtraction angiography (DSA) for evaluation of cerebral aneurysms. These techniques allow comprehensive evaluation of aneurysm size, location, rupture status, and other imaging characteristics that guide clinicians to make appropriate and timely treatment recommendations.

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“…Earlier studies of ruptured and unruptured IAs that included IA location, type, and morphologic and hemodynamic parameters showed that hemodynamics did not contribute significantly to rupture discrimination. 33 As suggested by the PHASES score, increased rupture propensity may be related to hypertension, patient age and history of subarachnoid hemorrhage (SAH). However, from additional analysis in our cohort, there was no difference statistical difference between patients with IAs at different locations when considering age over 70 years old (p = 0.5584), hypertension (p = 0.0227), or previous SAH (p = 0.1939), where a p-value of less than 0.017 was considered statistically significant (alpha = 0.05, number of tests = 3).…”

Section: Discussionmentioning

confidence: 99%

Differences in Morphologic and Hemodynamic Characteristics for “PHASES-Based” Intracranial Aneurysm Locations

Varble

Rajabzadeh-Oghaz

Wang³

et al. 2017

AJNR Am J Neuroradiol

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Background and Purpose Several recent prospective studies have found that unruptured intracranial aneurysms (IAs) at various anatomical locations have different propensities for future rupture. However, there remains a lack of understanding regarding the rupture-prone characteristics, such as morphologic and hemodynamic factors, associated with different IA locations. Materials and Methods We investigated the characteristics of 311 unruptured aneurysms at our center. Based on the PHASES study, we separated and compared morphologic and hemodynamic characteristics among three aneurysm location groups: 1. internal carotid artery (ICA), 2. middle cerebral artery (MCA), and 3. anterior communicating (ACOM), posterior communicating (PCOM) and posterior circulation arteries. Results A mixed model statistical analysis showed that size ratio, low wall shear stress area and pressure loss coefficient were different between the IA location groups. Additionally, a pairwise comparison showed that ICA aneurysms had lower size ratios, lower wall shear stress areas and lower pressure loss coefficients compared to MCA aneurysms, and compared to the group of ACOM, PCOM and posterior circulation aneurysms. There was no statistical differences between MCA aneurysms and the group of ACOM, PCOM and posterior circulation aneurysms for morphologic or hemodynamic characteristics. Conclusions ICA aneurysms may be subjected to less rupture-prone morphologic and hemodynamic characteristics compared to other locations, which could explain the decreased rupture propensity of IAs at this location.

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Additional Value of Intra-Aneurysmal Hemodynamics in Discriminating Ruptured versus Unruptured Intracranial Aneurysms

Cited by 31 publications

References 30 publications

Association of wall shear stress with intracranial aneurysm rupture: systematic review and meta-analysis

Association of wall shear stress with intracranial aneurysm rupture: systematic review and meta-analysis

Imaging of cerebral aneurysms: a clinical perspective

Differences in Morphologic and Hemodynamic Characteristics for “PHASES-Based” Intracranial Aneurysm Locations

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