Document Detail

Influence of intracranial aneurysm-to-parent vessel size ratio on hemodynamics and implication for rupture: results from a virtual experimental study.
MedLine Citation:
PMID:  19349824     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The effectiveness of intracranial aneurysm (IA) size as a predictor for rupture has been debated. We recently performed a retrospective analysis of IA morphology and found that a new index, namely, aneurysm-to-parent vessel size ratio (SR), was strongly correlated with IA rupture, with 77% of ruptured IAs showing an SR of more than 2, and 83% of unruptured IAs showing an SR of 2 or less. As hemodynamics have been implicated in both IA development and rupture, we examine how varying SR influences intra-aneurysmal hemodynamics.
METHODS: One sidewall and 1 terminal IA were virtually reconstructed from patient 3-dimensional angiographic images. In 2 independent in silico experiments, the SR was varied from 1.0 to 3.5 by virtually changing either aneurysm size or vessel diameter while keeping the other parameter constant. Pulsatile computational fluid dynamics simulations were performed on each model for hemodynamics analysis.
RESULTS: Low SR (</=2) aneurysm morphology consistently demonstrated simple flow patterns with a single intra-aneurysmal vortex, whereas higher SR (>2) aneurysm morphology presented multiple vortices and complex flow patterns. The aneurysm luminal area that was exposed to low wall shear stress increased with increasing SR. Complex flow, multiple vortices, and low aneurysmal wall shear stress have been associated with ruptured IAs in previous studies.
CONCLUSION: Higher SR, irrespective of aneurysm type and absolute aneurysm or vessel size, gives rise to flow patterns typically observed in ruptured IAs. These results provide hemodynamic support for the existing correlation of SR with rupture risk.
Markus Tremmel; Sujan Dhar; Elad I Levy; J Mocco; Hui Meng
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurosurgery     Volume:  64     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-07     Completed Date:  2009-07-23     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  622-30; discussion 630-1     Citation Subset:  IM    
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MeSH Terms
Angiography / methods
Blood Vessel Prosthesis
Blood Vessels / pathology*
Cerebrovascular Circulation
Computer Simulation
Hemodynamics / physiology*
Imaging, Three-Dimensional / methods
Intracranial Aneurysm / pathology*,  physiopathology*
Models, Cardiovascular
Pulsatile Flow
Retrospective Studies
Rupture / pathology
Stress, Mechanical
User-Computer Interface*
Grant Support

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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