scholarly journals Predisposing factors for recanalization of cerebral aneurysms after endovascular embolization: a multivariate study

2017 ◽  
Vol 10 (3) ◽  
pp. 252-257 ◽  
Author(s):  
Qianqian Zhang ◽  
Linkai Jing ◽  
Jian Liu ◽  
Kun Wang ◽  
Ying Zhang ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Endovascular Treatment ◽  
Cerebral Aneurysms ◽  
Endovascular Embolization ◽  
Predisposing Factors ◽  
Multidimensional Analysis ◽  
Hemodynamic Changes ◽  
Wall Shear

BackgroundThe recanalization of cerebral aneurysms after endovascular embolization (coiling or stent-assisted coiling) has been a matter of concern.ObjectiveTo systematically evaluate the predisposing factors for cerebral aneurysm recanalization using multidimensional analysis in a large patient cohort.MethodsIn 238 patients with 283 aneurysms, patient baseline characteristics, aneurysm morphological characteristics, treatment-related factors, and changes in flow hemodynamics after endovascular treatment (coiling or stent-assisted coiling) were compared between the recanalization and non-recanalization groups. Multivariate logistic regression analysis was performed to determine independent risk factors correlated with recanalization.Results16 aneurysms treated by coiling recanalized, with a recurrence rate of 18.6%, and 24 recanalized in the lesions treated by stent-assisted coiling, with a recanalization rate of 12.2%. Large aneurysms (>10 mm, p=0.002) and a follow-up interval >1 year (p=0.027) were shown to be statistically significant between the recanalization and non-recanalization groups. For flow hemodynamic changes, three parameters (velocity on the neck plane, wall shear stress on the neck wall, and wall shear stress on the whole aneurysm) showed a relatively lower amplitude of decrease after endovascular treatment in the recanalization group. Interestingly, the velocity on the neck plane and wall shear stress on the neck wall may be elevated after treatment. Specifically, the reduction ratio (RR) of velocity on the neck plane showed significant difference between the groups in the multivariate analysis (p=0.013), and was considered an independent risk factor for recanalization.ConclusionsThe aneurysm size, follow-up interval, and flow hemodynamic changes, especially the RR of velocity on the neck plane, have important roles in aneurysm recanalization.

Hemodynamic changes after intracranial aneurysm growth

2021 ◽  
pp. 1-7
Author(s):  
Bart M. W. Cornelissen ◽  
Eva L. Leemans ◽  
Cornelis H. Slump ◽  
René van den Berg ◽  
Henk A. Marquering ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Patient Specific ◽  
Hemodynamic Changes ◽  
Large Variability ◽  
Unruptured Intracranial Aneurysms ◽  
Hemodynamic Characteristics ◽  
Aneurysm Growth ◽  
Wall Shear

OBJECTIVE For accurate risk assessment of unruptured intracranial aneurysms, it is important to understand the underlying mechanisms that lead to rupture. It is known that hemodynamic anomalies contribute to aneurysm growth and rupture, and that growing aneurysms carry higher rupture risks. However, it is unknown how growth affects hemodynamic characteristics. In this study, the authors assessed how hemodynamic characteristics change over the course of aneurysm growth. METHODS The authors included patients with observed aneurysm growth on longitudinal MRA in the period between 2012 and 2016. Patient-specific vascular models were created from baseline and follow-up images. Subsequently, intraaneurysmal hemodynamic characteristics were computed using computational fluid dynamics. The authors computed the normalized wall shear stress, oscillatory shear index, and low shear area to quantify hemodynamic characteristics. Differences between baseline and follow-up measurements were analyzed using paired t-tests. RESULTS Twenty-five patients with a total of 31 aneurysms were included. The aneurysm volume increased by a median (IQR) of 26 (9–39) mm3 after a mean follow-up period of 4 (range 0.4–10.9) years. The median wall shear stress decreased significantly after growth. Other hemodynamic parameters did not change significantly, although large individual changes with large variability were observed. CONCLUSIONS Hemodynamic characteristics change considerably after aneurysm growth. On average, wall shear stress values decrease after growth, but there is a large variability in hemodynamic changes between aneurysms.

Exploring High Frequency Temporal Fluctuations in the Terminal Aneurysm of the Basilar Bifurcation

2012 ◽  
Vol 134 (9) ◽  
Author(s):  
Matthew D. Ford ◽  
Ugo Piomelli
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
High Frequency ◽  
Cerebral Aneurysms ◽  
Patient Specific ◽  
Disturbed Flow ◽  
Frequency Fluctuations ◽  
Wall Shear ◽  
Inflow Jet

Cerebral aneurysms are a common cause of death and disability. Of all the cardiovascular diseases, aneurysms are perhaps the most strongly linked with the local fluid mechanic environment. Aside from early in vivo clinical work that hinted at the possibility of high-frequency intra-aneurysmal velocity oscillations, flow in cerebral aneurysms is most often assumed to be laminar. This work investigates, through the use of numerical simulations, the potential for disturbed flow to exist in the terminal aneurysm of the basilar bifurcation. The nature of the disturbed flow is explored using a series of four idealized basilar tip models, and the results supported by four patient specific terminal basilar tip aneurysms. All four idealized models demonstrated instability in the inflow jet through high frequency fluctuations in the velocity and the pressure at approximately 120 Hz. The instability arises through a breakdown of the inflow jet, which begins to oscillate upon entering the aneurysm. The wall shear stress undergoes similar high-frequency oscillations in both magnitude and direction. The neck and dome regions of the aneurysm present 180 deg changes in the direction of the wall shear stress, due to the formation of small recirculation zones near the shear layer of the jet (at the frequency of the inflow jet oscillation) and the oscillation of the impingement zone on the dome of the aneurysm, respectively. Similar results were observed in the patient-specific models, which showed high frequency fluctuations at approximately 112 Hz in two of the four models and oscillations in the magnitude and direction of the wall shear stress. These results demonstrate that there is potential for disturbed laminar unsteady flow in the terminal aneurysm of the basilar bifurcation. The instabilities appear similar to the first instability mode of a free round jet.

scholarly journals Wall shear stress at the initiation site of cerebral aneurysms

2016 ◽  
Vol 16 (1) ◽  
pp. 97-115 ◽  
Author(s):  
A. J. Geers ◽  
H. G. Morales ◽  
I. Larrabide ◽  
C. Butakoff ◽  
P. Bijlenga ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Cerebral Aneurysms ◽  
Initiation Site ◽  
Wall Shear

scholarly journals 4-D flow MRI aortic 3-D hemodynamics and wall shear stress remain stable over short-term follow-up in pediatric and young adult patients with bicuspid aortic valve

2018 ◽  
Vol 49 (1) ◽  
pp. 57-67 ◽  
Author(s):  
Michael J. Rose ◽  
Cynthia K. Rigsby ◽  
Haben Berhane ◽  
Emilie Bollache ◽  
Kelly Jarvis ◽  
...  
Keyword(s):  
Shear Stress ◽  
Young Adult ◽  
Aortic Valve ◽  
Wall Shear Stress ◽  
Bicuspid Aortic Valve ◽  
Adult Patients ◽  
Short Term ◽  
Flow Mri ◽  
Wall Shear

Analysis of Flow and Wall Shear Stress in Curvature Induced Dorsal Aneurysms: Effect of Arterial Curvature

2009 ◽  
Author(s):  
Arun Ramu ◽  
Guo-Xiang Wang
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Fluid Dynamic ◽  
Cerebral Arteries ◽  
Cerebral Aneurysms ◽  
Morbidity Rate ◽  
Mortality And Morbidity ◽  
Wall Shear ◽  
Primary Velocity ◽  
The Impact

Intracranial aneurysms are abnormal enlargement in the walls of cerebral arteries. The rupture of aneurysms is the leading cause of subarachnoid hemorrhage (SAH), with a high mortality and morbidity rate. A majority of saccular cerebral aneurysms occur at sites of arterial bifurcations. However, a good percentage of aneurysms are curvature induced and are found along the cavernous arterial segment. The occurrence of such non branching aneurysms, clinically called dorsal aneurysms, can be related to the increased wall shear stress at the curved arteries. The rupture of aneurysms usually occurs at the dome region, which is subjected to reduced wall shear stress (wss) owing to low re-circulating flow. Hence it is important to understand the impact of arterial curvature on the WSS distribution along the dome of aneurysms. Previously, studies have not taken into account the aspect of low WSS along the dome region. In the present 3-d computational fluid dynamic approach, we investigate the impact of varying arterial curvature on spherical dorsal aneurysms. The primary velocity patterns, the WSS distribution along the dome of the aneurysm and the area of increased WSS have been quantified for steady flow conditions.

Differential Gene Expression of Endothelial Cells Under High Wall Shear Stress and Spatial Gradients

2010 ◽  
Author(s):  
Jennifer Dolan ◽  
Song Liu ◽  
Hui Meng ◽  
John Kolega
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Vessel Wall ◽  
Cerebral Aneurysms ◽  
In Vivo Studies ◽  
Spatial Gradient ◽  
Flow Acceleration ◽  
Spatial Gradients ◽  
Wall Shear

In both human and animal models, cerebral aneurysms tend to develop at the apices of bifurcations in the cerebral vasculature. Due to the focal nature of aneurysm development it has long been speculated that hemodynamics are an important factor in aneurysm susceptibility. The local hemodynamics of bifurcations are complex, being characterized by flow impingement causing a high frictional force on the vessel wall known as wall shear stress (WSS) and significant flow acceleration or deceleration, manifested as the positive or negative spatial gradient of WSS (WSSG). In vivo studies have recently identified that aneurysm initiation occurs at areas of the vessel wall that experience a combination of both high WSS and positive WSSG [1,2]

Positive and Negative Wall Shear Stress Gradients Have Different Effects on Endothelial Phenotype Under High Wall Shear Stress

2011 ◽  
Author(s):  
Jennifer Dolan ◽  
Frasier Sim ◽  
Hui Meng ◽  
John Kolega
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Vessel Wall ◽  
Cerebral Aneurysms ◽  
In Vivo Studies ◽  
Spatial Gradient ◽  
Cerebral Vasculature ◽  
High Wall Shear Stress ◽  
Wall Shear

In both human and animal models, cerebral aneurysms tend to develop at the apices of bifurcations in the cerebral vasculature where the blood vessel wall experiences complex hemodynamics. In vivo studies have recently revealed that the initiation of cerebral aneurysms is confined to a well-defined hemodynamic microenvironment [1,2]. Metaxa et al. [2] found that early aneurysm remodeling initiates where the vessel wall experiences high wall shear stress (WSS) and flow is accelerating, thus creating a positive spatial gradient in WSS (WSSG). Closer examination of such in vivo studies reveals that exposure of the vessel wall to equally high WSS in the presence of decelerating flow, that is, negative WSSG, does not result in aneurysm-like destruction.

Differential Responses of Endothelial Cells to Positive and Negative Wall Shear Stress Gradients

2010 ◽  
Author(s):  
Jennifer Dolan ◽  
Sukhjinder Singh ◽  
Hui Meng ◽  
John Kolega
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Vessel Wall ◽  
Fluid Shear Stress ◽  
Cerebral Aneurysms ◽  
In Vivo Studies ◽  
Outer Side ◽  
Fluid Shear ◽  
Wall Shear

Cerebral aneurysms tend to develop at bifurcation apices or the outer side of curved vessels where the blood vessel wall experiences complex hemodynamics. In vivo studies have recently revealed that the initiation of cerebral aneurysms is confined to a well-defined hemodynamic microenvironment. Specifically aneurysms form where the vessel wall experiences high fluid shear stress (wall shear stress, WSS) and flow is accelerating, so that the wall is exposed to a positive spatial gradient in the fluid shear stress (wall shear stress gradient, WSSG)[1,2]. Closer examination of such in vivo studies reveals that exposure of the vessel wall to equally high WSS in the presence of decelerating flow, that is, negative WSSG, does not result in aneurysm-like remodeling.

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