Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Wall Shear Stress and Flow Patterns in Unruptured and Ruptured Anterior Communicating Artery Aneurysms Using Computational Fluid Dynamics

  • Lee, Ui Yun (Department of Bionanosystem Engineering, Chonbuk National University) ;
  • Jung, Jinmu (Division of Mechanical Design Engineering, Chonbuk National University) ;
  • Kwak, Hyo Sung (Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital) ;
  • Lee, Dong Hwan (Division of Mechanical Design Engineering, Chonbuk National University) ;
  • Chung, Gyung Ho (Department of Radiology, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital) ;
  • Park, Jung Soo (Department of Neurosurgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital) ;
  • Koh, Eun Jeong (Department of Neurosurgery, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital)
  • Received : 2018.07.18
  • Accepted : 2018.08.23
  • Published : 2018.11.01
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Abstract

Objective : The goal of this study was to compare several parameters, including wall shear stress (WSS) and flow pattern, between unruptured and ruptured anterior communicating artery (ACoA) aneurysms using patient-specific aneurysm geometry. Methods : In total, 18 unruptured and 24 ruptured aneurysms were analyzed using computational fluid dynamics (CFD) models. Minimal, average, and maximal wall shear stress were calculated based on CFD simulations. Aneurysm height, ostium diameter, aspect ratio, and area of aneurysm were measured. Aneurysms were classified according to flow complexity (simple or complex) and inflow jet (concentrated or diffused). Statistical analyses were performed to ascertain differences between the aneurysm groups. Results : Average wall shear stress of the ruptured group was greater than that of the unruptured group (9.42% for aneurysm and 10.38% for ostium). The average area of ruptured aneurysms was 31.22% larger than unruptured aneurysms. Simple flow was observed in 14 of 18 (78%) unruptured aneurysms, while all ruptured aneurysms had complex flow (p<0.001). Ruptured aneurysms were more likely to have a concentrated inflow jet (63%), while unruptured aneurysms predominantly had a diffused inflow jet (83%, p=0.004). Conclusion : Ruptured aneurysms tended to have a larger geometric size and greater WSS compared to unruptured aneurysms, but the difference was not statistically significant. Flow complexity and inflow jet were significantly different between unruptured and ruptured ACoA aneurysms.

Keywords

References

  1. Castro MA, Putman CM, Cebral JR : Patient-specific computational fluid dynamics modeling of anterior communicating artery aneurysms: a study of the sensitivity of intra-aneurysmal flow patterns to flow conditions in the carotid arteries. AJNR Am J Neuroradiol 27 : 2061-2068, 2006
  2. Castro MA, Putman CM, Sheridan MJ, Cebral JR : Hemodynamic patterns of anterior communicating artery aneurysms: a possible association with rupture. AJNR Am J Neuroradiol 30 : 297-302, 2009 https://doi.org/10.3174/ajnr.A1323
  3. Cebral JR, Castro MA, Burgess JE, Pergolizzi RS, Sheridan MJ, Putman CM : Characterization of cerebral aneurysms for assessing risk of rupture by using patient-specific computational hemodynamics models. AJNR Am J Neuroradiol 26 : 2550-2559, 2005
  4. Cebral JR, Mut F, Weir J, Putman CM : Association of hemodynamic characteristics and cerebral aneurysm rupture. AJNR Am J Neuroradiol 32 : 264-270, 2011 https://doi.org/10.3174/ajnr.A2274
  5. Chien A, Tateshima S, Castro M, Sayre J, Cebral J, Vinuela F : Patientspecific flow analysis of brain aneurysms at a single location: comparison of hemodynamic characteristics in small aneurysms. Med Biol Eng Comput 46 : 1113-1120, 2008 https://doi.org/10.1007/s11517-008-0400-5
  6. Errill EW : Rheology of blood. Physiol Rev 49 : 863-888, 1969 https://doi.org/10.1152/physrev.1969.49.4.863
  7. Fan J, Wang Y, Liu J, Jing L, Wang C, Li C, et al. : Morphological-hemodynamic characteristics of intracranial bifurcation mirror aneurysms. World Neurosurg 84 : 114-120.e2, 2015 https://doi.org/10.1016/j.wneu.2015.02.038
  8. Fukazawa K, Ishida F, Umeda Y, Miura Y, Shimosaka S, Matsushima S, et al. : Using computational fluid dynamics analysis to characterize local hemodynamic features of middle cerebral artery aneurysm rupture points. World Neurosurg 83 : 80-86, 2015 https://doi.org/10.1016/j.wneu.2013.02.012
  9. Gijsen FJ, van de Vosse FN, Janssen JD : The influence of the non- Newtonian properties of blood on the flow in large arteries: steady flow in a carotid bifurcation model. J Biomech 32 : 601-608, 1999 https://doi.org/10.1016/S0021-9290(99)00015-9
  10. Horiuchi T, Tanaka Y, Hongo K : Surgical treatment for aneurysmal subarachnoid hemorrhage in the 8th and 9th decades of life. Neurosurgery 56 : 469-475; discussion 469-475, 2005 https://doi.org/10.1227/01.NEU.0000153926.67713.B8
  11. Jansen IG, Schneiders JJ, Potters WV, van Ooij P, van den Berg R, van Bavel E, et al. : Generalized versus patient-specific inflow boundary conditions in computational fluid dynamics simulations of cerebral aneurysmal hemodynamics. AJNR Am J Neuroradiol 35 : 1543-1548, 2014 https://doi.org/10.3174/ajnr.A3901
  12. Jou LD, Lee DH, Morsi H, Mawad ME : Wall shear stress on ruptured and unruptured intracranial aneurysms at the internal carotid artery. AJNR Am J Neuroradiol 29 : 1761-1767, 2008 https://doi.org/10.3174/ajnr.A1180
  13. Kojima M, Irie K, Fukuda T, Arai F, Hirose Y, Negoro M : The study of flow diversion effects on aneurysm using multiple enterprise stents and two flow diverters. Asian J Neurosurg 7 : 159-165, 2012 https://doi.org/10.4103/1793-5482.106643
  14. Le WJ, Zhu YQ, Li MH, Yan L, Tan HQ, Xiao SM, et al. : New method for retrospective study of hemodynamic changes before and after aneurysm formation in patients with ruptured or unruptured aneurysms. BMC Neurol 13 : 166, 2013 https://doi.org/10.1186/1471-2377-13-166
  15. Lin N, Ho A, Charoenvimolphan N, Frerichs KU, Day AL, Du R : Analysis of morphological parameters to differentiate rupture status in anterior communicating artery aneurysms. PLoS One 8 : e79635, 2013 https://doi.org/10.1371/journal.pone.0079635
  16. Lin N, Ho A, Gross BA, Pieper S, Frerichs KU, Day AL, et al. : Differences in simple morphological variables in ruptured and unruptured middle cerebral artery aneurysms. J Neurosurg 117 : 913-919, 2012 https://doi.org/10.3171/2012.7.JNS111766
  17. Lu G, Huang L, Zhang XL, Wang SZ, Hong Y, Hu Z, et al. : Influence of hemodynamic factors on rupture of intracranial aneurysms: patientspecific 3D mirror aneurysms model computational fluid dynamics simulation. AJNR Am J Neuroradiol 32 : 1255-1261, 2011 https://doi.org/10.3174/ajnr.A2461
  18. Ma B, Harbaugh RE, Raghavan ML : Three-dimensional geometrical characterization of cerebral aneurysms. Ann Biomed Eng 32 : 264-273, 2004 https://doi.org/10.1023/B:ABME.0000012746.31343.92
  19. Meng H, Tutino VM, Xiang J, Siddiqui A : High WSS or low WSS? Complex interactions of hemodynamics with intracranial aneurysm initiation, growth, and rupture: toward a unifying hypothesis. Am J Neuroradiol 35 : 1254-1262, 2014 https://doi.org/10.3174/ajnr.A3558
  20. Metaxa E, Tremmel M, Natarajan SK, Xiang J, Paluch RA, Mandelbaum M, et al. : Characterization of critical hemodynamics contributing to aneurysmal remodeling at the basilar terminus in a rabbit model. Stroke 41 : 1774-1782, 2010 https://doi.org/10.1161/STROKEAHA.110.585992
  21. Morales HG, Larrabide I, Geers AJ, Aguilar ML, Frangi AF : Newtonian and non-Newtonian blood flow in coiled cerebral aneurysms. J Biomech 46 : 2158-2164, 2013 https://doi.org/10.1016/j.jbiomech.2013.06.034
  22. Papaioannou TG, Karatzis EN, Vavuranakis M, Lekakis JP, Stefanadis C : Assessment of vascular wall shear stress and implications for atherosclerotic disease. Int J Cardiol 113 : 12-18, 2006 https://doi.org/10.1016/j.ijcard.2006.03.035
  23. Raghavan ML, Ma B, Harbaugh RE : Quantified aneurysm shape and rupture risk. J Neurosurg 102 : 355-362, 2005 https://doi.org/10.3171/jns.2005.102.2.0355
  24. Russell JH, Kelson N, Barry M, Pearcy M, Fletcher DF, Winter CD : Computational fluid dynamic analysis of intracranial aneurysmal bleb formation. Neurosurgery 73 : 1061-1068; discussion 1068-1069, 2013 https://doi.org/10.1227/NEU.0000000000000137
  25. Sforza DM, Putman CM, Scrivano E, Lylyk P, Cebral JR : Blood-flow characteristics in a terminal basilar tip aneurysm prior to its fatal rupture. AJNR Am J Neuroradiol 31 : 1127-1131, 2010 https://doi.org/10.3174/ajnr.A2021
  26. Skodvin TO, Johnsen LH, Gjertsen O, Isaksen JG, Sorteberg A : Cerebral aneurysm morphology before and after rupture: nationwide case series of 29 aneurysms. Stroke 48 : 880-886, 2017 https://doi.org/10.1161/STROKEAHA.116.015288
  27. Taylor TN : The medical economics of stroke. Drugs 54 Suppl 3 : 51- 57; discussion 57-58, 1997 https://doi.org/10.2165/00003495-199700543-00008
  28. Xiang J, Natarajan SK, Tremmel M, Ma D, Mocco J, Hopkins LN, et al. : Hemodynamic-morphologic discriminants for intracranial aneurysm rupture. Stroke 42 : 144-152, 2011 https://doi.org/10.1161/STROKEAHA.110.592923
  29. Xiang J, Tutino VM, Snyder KV, Meng H : CFD: computational fluid dynamics or confounding factor dissemination? The role of hemodynamics in intracranial aneurysm rupture risk assessment. AJNR Am J Neuroradiol 35 : 1849-1857, 2014 https://doi.org/10.3174/ajnr.A3710
  30. Xu J, Yu Y, Wu X, Wu Y, Jiang C, Wang S, et al. : Morphological and hemodynamic analysis of mirror posterior communicating artery aneurysms. PLoS One 8 : e55413, 2013 https://doi.org/10.1371/journal.pone.0055413
  31. Zeng Z, Kallmes DF, Durka MJ, Ding Y, Lewis D, Kadirvel R, et al. : Hemodynamics and anatomy of elastase-induced rabbit aneurysm models: similarity to human cerebral aneurysms? AJNR Am J Neuroradiol 32 : 595-601, 2011 https://doi.org/10.3174/ajnr.A2324

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