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

Although wall shear stress (WSS) has long been considered a critical indicator of intracranial aneurysm rupture, there is still no definite conclusion as to whether a high or a low WSS results in aneurysm rupture. The reason may be that the effect of WSS direction has not been fully considered. The objectives of this study are to investigate the magnitude of WSS (WSS) and its divergence on the aneurysm surface and to test the significance of both in relation to the aneurysm rupture. Patient-specific computational fluid dynamics (CFD) was used to compute WSS and wall shear stress divergence (WSSD) on the aneurysm surface for nineteen patients. Our results revealed that if highWSSis stretching aneurysm luminal surface, and the stretching region is concentrated, the aneurysm is under a high risk of rupture. It seems that, by considering both direction and magnitude of WSS, WSSD may be a better indicator for the risk estimation of aneurysm rupture (154).

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Correlation of Wall Shear Stress and Vessel Wall Enhancement for Intracranial Aneurysm Rupture Risk Stratification

10.26226/morressier.5e8335ba7cb08a046ef7c731 ◽

2020 ◽

Author(s):

Michael Maonan Pan

Keyword(s):

Shear Stress ◽

Wall Shear Stress ◽

Intracranial Aneurysm ◽

Risk Stratification ◽

Vessel Wall ◽

Aneurysm Rupture ◽

Rupture Risk ◽

Wall Shear

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

BMC Neurology ◽

10.1186/s12883-016-0759-0 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 18

Author(s):

Yisen Zhang ◽

Linkai Jing ◽

Ying Zhang ◽

Jian Liu ◽

Xinjian Yang

Keyword(s):

Shear Stress ◽

Case Report ◽

Literature Review ◽

Wall Shear Stress ◽

Intracranial Aneurysm ◽

Wall Shear

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Changes in wall shear stress magnitude after aneurysm rupture

Acta Neurochirurgica ◽

10.1007/s00701-013-1773-2 ◽

2013 ◽

Vol 155 (8) ◽

pp. 1559-1563 ◽

Cited By ~ 21

Author(s):

Kenichi Kono ◽

Nagatsuki Tomura ◽

Ryo Yoshimura ◽

Tomoaki Terada

Keyword(s):

Shear Stress ◽

Wall Shear Stress ◽

Aneurysm Rupture ◽

Wall Shear

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Clinical, morphological, and hemodynamic independent characteristic factors for rupture of posterior communicating artery aneurysms

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011865 ◽

2015 ◽

Vol 8 (8) ◽

pp. 808-812 ◽

Cited By ~ 20

Author(s):

Ying Zhang ◽

Linkai Jing ◽

Jian Liu ◽

Chuanhui Li ◽

Jixing Fan ◽

...

Keyword(s):

Shear Stress ◽

Wall Shear Stress ◽

Univariate Analysis ◽

Multivariate Logistic Regression Analysis ◽

Aneurysm Rupture ◽

Irregular Shape ◽

Posterior Communicating Artery ◽

Patient Specific ◽

Younger Age ◽

Wall Shear

ObjectiveTo identify clinical, morphological, and hemodynamic independent characteristic factors that discriminate posterior communicating artery (PCoA) aneurysm rupture status.Methods173 patients with single PCoA aneurysms (108 ruptured, 65 unruptured) between January 2012 and June 2014 were retrospectively collected. Patient-specific models based on their three-dimensional digital subtraction angiography images were constructed and analyzed by a computational fluid dynamic method. All variables were analyzed by univariate analysis and multivariate logistic regression analysis.ResultsTwo clinical factors (younger age and atherosclerosis), three morphological factors (higher aspect ratio, bifurcation type, and irregular shape), and six hemodynamic factors (lower mean and minimum wall shear stress, higher oscillatory shear index, a greater portion of area under low wall shear stress, unstable and complex flow pattern) were significantly associated with PCoA aneurysm rupture. Independent factors characterizing the rupture status were identified as age (OR 0.956, p=0.015), irregular shape (OR 6.709, p<0.001), and minimum wall shear stress (OR 0.001, p=0.038).ConclusionsWe combined clinical, morphological, and hemodynamic characteristics analysis and found the three strongest independent factors for PCoA aneurysm rupture were younger age, irregular shape, and low minimum wall shear stress. This may be useful for guiding risk assessments and subsequent treatment decisions for PCoA aneurysms.

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Role of Hemodynamics in Initiation of Aneurysmal Remodeling

ASME 2010 Summer Bioengineering Conference, Parts A and B ◽

10.1115/sbc2010-19537 ◽

2010 ◽

Author(s):

Hui Meng ◽

Sabareesh K. Natarajan ◽

Eleni Metaxa ◽

Markus Tremmel ◽

Ling Gao ◽

...

Keyword(s):

Risk Factors ◽

Shear Stress ◽

Carotid Artery ◽

Wall Shear Stress ◽

Intracranial Aneurysm ◽

Hemodynamic Stress ◽

Key Factor ◽

Aneurysm Development ◽

Wall Shear

Hemodynamic insult has long been speculated to be a key factor in intracranial aneurysm (IA) formation,1 but the specifics of hemodynamic insult contributing to this process are not understood. Despite other risk factors, IAs are predominantly found at locations associated with unique hemodynamic stress such as at the apices of arterial bifurcations or outer curves, prominent in high wall shear stress (WSS) and wall shear stress gradients (WSSG).2 Furthermore, it appears that increased flow at these locations is required to trigger the initiation of aneurysmal remodeling.3 We have previously shown that increasing flow in the rabbit basilar artery (BA), secondary to common carotid artery (CCA) ligation, resulted in nascent aneurysm development at the basilar terminus (BT).4 However, it is unclear if certain hemodynamic stress thresholds must be exceeded to trigger aneurysmal remodeling, and whether sustained insult is necessary.

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Efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm—A systematic review and meta-analysis

Interventional Neuroradiology ◽

10.1177/1591019920940521 ◽

2020 ◽

pp. 159101992094052 ◽

Cited By ~ 1

Author(s):

Raymond Pranata ◽

Emir Yonas ◽

Rachel Vania ◽

Prijo Sidipratomo ◽

Julius July

Keyword(s):

Systematic Review ◽

Intracranial Aneurysm ◽

Thrombus Formation ◽

Meta Analysis ◽

Class Ii ◽

Aneurysm Rupture ◽

Class I ◽

Efficacy And Safety ◽

Vessel Dissection

Objective PulseRider is a novel self-expanding nickel-titanium (nitinol) stent for treatment of wide-necked aneurysms, which is commonly located at the arterial branches in the brain. This systematic review and meta-analysis aims to assess the efficacy and safety of PulseRider for treatment of wide-necked intracranial aneurysm. Method We performed a systematic literature search on articles that evaluate the efficacy and safety of PulseRider-assisted coiling of the wide-necked aneurysm from several electronic databases. The primary endpoint was adequate occlusion, defined as Raymond-Roy Class I + Raymond-Roy Class II upon immediate angiography and at six-month follow-up. Results There were a total of 157 subjects from six studies. The rate of adequate occlusion on immediate angiography was 90% (95% CI, 85%–94%) and 91% (95% CI, 85%–96%) at six-month follow-up. Of these, Raymond-Roy Class I can be observed in 48% (95% CI, 41%–56%) of aneurysms immediately after coiling, and 64% (95% CI, 55%–72%) of aneurysms on six-month follow-up. Raymond-Roy Class II was found in 30% (95% CI, 23%–37%) of aneurysms immediately after coiling, and 25% (17–33) after six-month follow-up. Complications occur in 5% (95% CI, 1%–8%) of the patients. There were three intraoperative aneurysm rupture, three thrombus formation, three procedure-related posterior cerebral artery strokes, one vessel dissection, and one delayed device thrombosis. There was no procedure/device-related death. Conclusions PulseRider-assisted coiling for treatment of patients with wide-necked aneurysm reached 90% adequate occlusion rate that rises up to 91% at sixth month with 5% complication rate.

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