Hemodynamic characteristics of large unruptured internal carotid artery aneurysms prior to rupture: a case control study

Liu, Jian; Fan, Jixing; Xiang, Jianping; Zhang, Ying; Yang, Xiaoling

doi:10.1136/neurintsurg-2014-011577

Cited by 20 publications

(22 citation statements)

References 31 publications

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“…In our present study, a markedly low WSS and high OSI was associated with rupture point without high flow impingement. Our previous study evaluated the hemodynamic characteristics of aneurysms just before rupture and low WSS was also revealed to be associated with rupture of the unruptured aneurysms [6]. Low WSS and high OSI are known to cause dysfunction of endothelial surface inducing nitrous oxide, increase endothelial permeability and consequently promote inflammatory cell infiltration [7, 8].…”

Section: Discussionmentioning

confidence: 99%

Low wall shear stress is associated with the rupture of intracranial aneurysm with known rupture point: case report and literature review

et al. 2016

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BackgroundFew previous hemodynamic studies demonstrated the detailed features of rupture point of intracranial aneurysms. The hemodynamic simulation for the case that ruptured during angiography was even rare. In the present study, we studied the hemodynamic characteristics of a posterior communicating artery segment aneurysm that ruptured during angiography and detailed the hemodynamic features at the rupture point.Case presentationOne 64-years-patient was 60–69 years old and suffered a subarachnoid hemorrhage within 24 h. Standard digital subtraction angiography and three-dimensional (3D) rotational angiography were performed and an 8 mm left posterior communicating artery segment aneurysm was found. The patient had a seizure immediately following 3D angiography for about 40 s and the immediate follow-up angiography showed contrast extravasation from the tip of identified aneurysms. The consequent vital sign of the patient became unstable. Urgent embolization under general anesthesia was planned, but the relatives refused interventional operation considering the high risk of procedure and poor condition of the patient. The computational fluid dynamic (CFD) method was used to evaluate the hemodynamic characteristics at rupture point, and the results showed that the rupture point was associated with markedly low wall shear stress and high oscillatory shear index without flow impingement.ConclusionsWe present a rare case of which the rupture site was identified during angiography. The hemodynamic simulations revealed that the rupture point was associated with markedly low WSS and high OSI without flow impingement. The result may be unique to this particular aneurysm; however, our findings provide insight into the hemodynamics of rupture point.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-016-0759-0) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Low wall shear stress is associated with the rupture of intracranial aneurysm with known rupture point: case report and literature review

et al. 2016

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“…The modeling workflow of the novel FVS deployment incorporated several simplifications [9]. First, the aneurysm geometry was isolated from the 3D patient-specific aneurism model using Geomagic Studio (Raindrop Geomagic, Research Triangle Park, NC, USA), and the centerline of the parent vessel was extracted using Mimics 10.01 (Materialise, Leuven, Belgium).…”

Section: Methodsmentioning

confidence: 99%

Phantom-based experimental validation of fast virtual deployment of self-expandable stents for cerebral aneurysms

et al. 2016

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BackgroundEndovascular intervention using a stent is a mainstream treatment for cerebral aneurysms. To assess the effect of intervention strategies on aneurysm hemodynamics, we have developed a fast virtual stenting (FVS) technique to simulate stent deployment in patient-specific aneurysms. However, quantitative validation of the FVS against experimental data has not been fully addressed. In this study, we performed in vitro analysis of a patient-specific model to illustrate the realism and usability of this novel FVS technique.MethodsWe selected a patient-specific aneurysm and reproduced it in a manufactured realistic aneurismal phantom. Three numerical simulation models of the aneurysm with an Enterprise stent were constructed. Three models were constructed to obtain the stented aneurysms: a physical phantom scanned by micro-CT, fast virtual stenting technique and finite element method. The flow in the three models was simulated using a computational fluid dynamics software package, and the hemodynamics parameters for the three models were calculated and analyzed.ResultsThe computational hemodynamics in the patient-specific aneurysm of the three models resembled the very well. A qualitative comparison revealed high similarity in the wall shear stress, streamline, and velocity plane among the three different methods. Quantitative comparisons revealed that the difference ratios of the hemodynamic parameters were less than 10%, with the difference ratios for area average of wall shear stress in the aneurysm being very low.ConclusionsIn conclusion, the results of the computational hemodynamics indicate that FVS is suitable for evaluation of the hemodynamic factors that affect treatment outcomes.

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“…KEYWORDS cerebral aneurysm; growing aneurysm; stable aneurysm; intrasaccular hemodynamics; near aneurysmal wall hemodynamics; morphology; flow instabilities; vortex structures as an important contributor to aneurysm growth due to its direct effects on the physiology of endothelial cells (ECs). 3,17,36,37 The dysfunction of ECs has been linked to vessel wall remodeling. 3,17,36 Boussel et al 3 and Tanoue et al 36 observed extremely low WSS in the growing regions of the CA in their studies on 7 and 2 patient cases, respectively.…”

Section: Focus19195mentioning

confidence: 99%

Hemodynamic and morphological characteristics of a growing cerebral aneurysm

Dabagh¹,

Nair²,

Gounley³

et al. 2019

Neurosurgical Focus

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The growth of cerebral aneurysms is linked to local hemodynamic conditions, but the driving mechanisms of the growth are poorly understood. The goal of this study was to examine the association between intraaneurysmal hemodynamic features and areas of aneurysm growth, to present the key hemodynamic parameters essential for an accurate prediction of the growth, and to gain a deeper understanding of the underlying mechanisms. Patient-specific images of a growing cerebral aneurysm in 3 different growth stages acquired over a period of 40 months were segmented and reconstructed. A unique aspect of this patient-specific case study was that while one side of the aneurysm stayed stable, the other side continued to grow. This unique case enabled the authors to examine their aims in the same patient with parent and daughter arteries under the same inlet flow conditions. Pulsatile flow in the aneurysm models was simulated using computational fluid dynamics and was validated with in vitro experiments using particle image velocimetry measurements. The authors’ detailed analysis of intrasaccular hemodynamics linked the growing regions of aneurysms to flow instabilities and complex vortex structures. Extremely low velocities were observed at or around the center of the unstable vortex structure, which matched well with the growing regions of the studied cerebral aneurysm. Furthermore, the authors observed that the aneurysm wall regions with a growth greater than 0.5 mm coincided with wall regions of lower (< 0.5 Pa) time-averaged wall shear stress (TAWSS), lower instantaneous (< 0.5 Pa) wall shear stress (WSS), and high (> 0.1) oscillatory shear index (OSI). To determine which set of parameters can best identify growing and nongrowing aneurysms, the authors performed statistical analysis for consecutive stages of the growing CA. The results demonstrated that the combination of TAWSS and the distance from the center of the vortical structure has the highest sensitivity and positive predictive value, and relatively high specificity and negative predictive value. These findings suggest that an unstable, recirculating flow structure within the aneurysm sac created in the region adjacent to the aneurysm wall with low TAWSS may be introduced as an accurate criterion to explain the hemodynamic conditions predisposing the aneurysm to growth. The authors’ findings are based on one patient’s data set, but the study lays out the justification for future large-scale verification. The authors’ findings can assist clinicians in differentiating stable and growing aneurysms during preinterventional planning.

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Hemodynamic characteristics of large unruptured internal carotid artery aneurysms prior to rupture: a case control study

Abstract: For large unruptured ICA aneurysms, low WSS, higher aspect ratio, and irregular shape were indicators of fatal rupture. Early treatment for such lesions with flow diverter and coils may be the best therapeutic option.

Cited by 20 publications

References 31 publications

Low wall shear stress is associated with the rupture of intracranial aneurysm with known rupture point: case report and literature review

Low wall shear stress is associated with the rupture of intracranial aneurysm with known rupture point: case report and literature review

Phantom-based experimental validation of fast virtual deployment of self-expandable stents for cerebral aneurysms

Hemodynamic and morphological characteristics of a growing cerebral aneurysm

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