Hemodynamics and Rupture of Terminal Cerebral Aneurysms
Received 20 January 2009; accepted 31 March 2009. published online 24 June 2009.
Rationale and Objectives
The objective of this study was to investigate the relationship between hemodynamics patterns and aneurysmal rupture in cerebral aneurysms of the same morphology regardless their location. Particularly, terminal aneurysms in both the anterior and posterior circulation were studied.
Materials and Methods
A total of 42 patient-specific vascular models were constructed from three-dimensional rotational angiography images. All patients had terminal aneurysms at different arteries: a) middle cerebral; b) anterior communicating; c) internal carotid (terminus); d) internal carotid–posterior communicating; e) basilar; or f) anterior cerebral. Hemodynamics information (intra-aneurysmal velocity and wall shear stress distributions) was derived from image-based computational fluid dynamics models with realistic patient-specific anatomies.
Results
The group of aneurysms with an inflow jet that splits in two secondary jets, one of which enters the aneurysm before reaching one of the daughter vessels (type B), had the highest peak wall shear stress (WSS) and the highest rupture rate. The peak WSS averaged over each flow type showed a higher value in the ruptured group. The average peak WSS in the ruptured group (all types) was 188 dyn/cm2 (compared to 118 dyn/cm2 for the unruptured).
Conclusions
This finding is in agreement with a previous work in which only anterior communicating artery aneurysms were investigated. The significance of these findings is that, if they are statistically confirmed with larger number of cases, flow types could be directly observed during angiographic examinations and linked to WSS categories that may help evaluate which aneurysms are more likely to rupture.
aCenter for Computational Fluid Dynamics, Department of Computational and Data Sciences, George Mason University, 4400 University Drive, MSN 6A2, Fairfax, VA 22030
bInterventional Neuroradiology, Inova Fairfax Hospital, Falls Church, VA
ABSTRACT