Intra-aneurysmal flow patterns and wall shear stresses calculated with computational flow dynamics in an anterior communicating artery aneurysm depend on knowledge of patient-specific inflow rates

Karmonik, Christof; Yen, Christopher; Grossman, Robert G.; Klucznik, Richard P.; Benndorf, Goetz

doi:10.1007/s00701-009-0247-z

Cited by 59 publications

(33 citation statements)

References 13 publications

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“…As in previous studies, 8,13,24,36 bleb formation was significantly related to PCoA aneurysm rupture in the present study. In a recent study focusing on bleb formation in an effort to gain insight into the mechanisms underlying aneurysm rupture, the highest shear stress values were at or adjacent to the bleb formation.…”

Section: Projection Of Aneurysm and Bleb Formationsupporting

confidence: 89%

Morphological and clinical risk factors for posterior communicating artery aneurysm rupture

Matsukawa¹,

Fujii²,

Akaike

et al. 2014

JNS

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Object Recent studies have shown that posterior circulation aneurysms, specifically posterior communicating artery (PCoA) aneurysms, are more likely to rupture than other aneurysms. To date, few studies have investigated the factors contributing to PCoA aneurysm rupture. The authors aimed to identify morphological and clinical characteristics predisposing to PCoA aneurysm rupture. Methods The authors retrospectively reviewed 134 consecutive patients with PCoA aneurysms managed at their facility between July 2003 and December 2012. The authors divided patients into groups of those with aneurysmal rupture (n = 39) and without aneurysmal rupture (n = 95) and compared morphological and clinical characteristics. Morphological characteristics were mainly evaluated by 3D CT angiography and included diameter of arteries (anterior cerebral artery, middle cerebral artery, and internal carotid artery), size of the aneurysm, dome-to-neck ratio, neck direction of the aneurysmal dome around the PCoA (medial, lateral, superior, inferior, and posterior), aneurysm bleb formation, whether the PCoA was fetal type, and the existence of other intracranial unruptured aneurysm(s). Results Patients with ruptured PCoA aneurysms were significantly younger (a higher proportion were < 60 years of age) and a significantly higher proportion of patients with ruptured PCoA aneurysms showed a lateral direction of the aneurysmal dome around the PCoA, had bleb formation, and the aneurysm was > 7 mm in diameter and/or the dome-to-neck ratio was > 2.0. Multivariate logistic regression analysis showed age < 60 years (OR 4.3, p = 0.011), history of hypertension (OR 5.1, p = 0.008), lateral direction of the aneurysmal dome around the PCoA (OR 6.7, p = 0.0001), and bleb formation (OR 11, p < 0.0001) to be significantly associated with PCoA aneurysm rupture. Conclusions The present results demonstrated that lateral projection of a PCoA aneurysm may be related to rupture.

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Section: Projection Of Aneurysm and Bleb Formationsupporting

confidence: 89%

Morphological and clinical risk factors for posterior communicating artery aneurysm rupture

Matsukawa¹,

Fujii²,

Akaike

et al. 2014

JNS

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“…These efforts resulted in the discovery that alternative morphometrics and IA hemodynamics correlate strongly with IA rupture. [7][8][9][10] We previously reported that size ratio (SR), IA size divided by parent vessel diameter, correlated strongly with IA rupture status (ruptured versus unruptured) in a retrospective review of patients presenting with IAs. 8 We also demonstrated that IA hemodynamics changed significantly with changes in SR, even when holding other IA morphometrics constant.…”

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confidence: 99%

Size Ratio Correlates With Intracranial Aneurysm Rupture Status

Rahman

Smietana²,

Hauck³

et al. 2010

Stroke

193

126

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Background and Purpose-The prediction of intracranial aneurysm (IA) rupture risk has generated significant controversy. The findings of the International Study of Unruptured Intracranial Aneurysms (ISUIA) that small anterior circulation aneurysms (Ͻ7 mm) have a 0% risk of subarachnoid hemorrhage in 5 years is difficult to reconcile with other studies that reported a significant portion of ruptured IAs are small. These discrepancies have led to the search for better aneurysm parameters to predict rupture. We previously reported that size ratio (SR), IA size divided by parent vessel diameter, correlated strongly with IA rupture status (ruptured versus unruptured). These data were all collected retrospectively off 3-dimensional angiographic images. Therefore, we performed a blinded prospective collection and evaluation of SR data from 2-dimensional angiographic images for a consecutive series of patients with ruptured and unruptured IAs. Methods-We prospectively enrolled 40 consecutive patients presenting to a single institution with either ruptured IA or for first-time evaluation of an incidental IA. Blinded technologists acquired all measurements from 2-dimensional angiographic images. Aneurysm rupture status, location, IA maximum size, and parent vessel diameter were documented. The SR was calculated by dividing the aneurysm size (mm) by the average parent vessel size (mm). A 2-tailed Mann-Whitney test was performed to assess statistical significance between ruptured and unruptured groups. Fisher exact test was used to compare medical comorbidities between the ruptured and unruptured groups. Significant differences between the 2 groups were subsequently tested with logistic regression. SE and probability values are reported. Results-Forty consecutive patients with 24 unruptured and 16 ruptured aneurysms met the inclusion criteria. No significant differences were found in age, gender, smoking status, or medical comorbidities between ruptured and unruptured groups. The average maximum size of the unruptured IAs (6.18Ϯ0.60 mm) was significantly smaller compared with the ruptured IAs (7.91Ϯ0.47 mm; Pϭ0.03), and the unruptured group had significantly smaller SRs (2.57Ϯ0.24 mm) compared with the ruptured group (4.08Ϯ0.54 mm; PϽ0.01). Logistic regression was used to evaluate the independent predictive value of those variables that achieved significance in univariate analysis (IA maximum size and SR). Using stepwise selection, only SR remained in the final predictive model (OR, 2.12; 95% CI, 1.09 to 4.13). Conclusion-SR, the ratio between aneurysm size and parent artery diameter, can be easily calculated from 2-dimensional angiograms and correlates with IA rupture status on presentation in a blinded analysis. SR should be further studied in a large prospective observational cohort to predict true IA risk of rupture. (Stroke. 2010;41:916-920.)

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“…Reliable patient-specific boundary conditions for CFD in patients with both ruptured and unruptured aneurysms are needed to predict local hemodynamics more accurately in intracranial aneurysms. 6,7 Accurate BFV measurements in the perianeurysmal arteries in the circle of Willis are difficult to obtain, because the skull and the tortuosity of the arteries impede conventional methodologies, such as TCD. Making use of phase-contrast MR imaging enables BFV measurement at targeted arterial locations, provided that the resolution is sufficiently high.…”

mentioning

confidence: 99%

Comparison of Phase-Contrast MR Imaging and Endovascular Sonography for Intracranial Blood Flow Velocity Measurements

Schneiders¹,

Ferns²,

Ooij³

et al. 2012

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Local hemodynamic information may help to stratify rupture risk of cerebral aneurysms. Patient-specific modeling of cerebral hemodynamics requires accurate data on BFV in perianeurysmal arteries as boundary conditions for CFD. The aim was to compare the BFV measured with PC-MR imaging with that obtained by using intra-arterial Doppler sonography and to determine interpatient variation in intracranial BFV.

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Intra-aneurysmal flow patterns and wall shear stresses calculated with computational flow dynamics in an anterior communicating artery aneurysm depend on knowledge of patient-specific inflow rates

Cited by 59 publications

References 13 publications

Morphological and clinical risk factors for posterior communicating artery aneurysm rupture

Morphological and clinical risk factors for posterior communicating artery aneurysm rupture

Size Ratio Correlates With Intracranial Aneurysm Rupture Status

Comparison of Phase-Contrast MR Imaging and Endovascular Sonography for Intracranial Blood Flow Velocity Measurements

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