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Associations of hemodynamics, morphology, and patient characteristics with aneurysm rupture stratified by aneurysm location

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Purpose

The mechanisms of cerebral aneurysm rupture are not fully understood. We analyzed the associations of hemodynamics, morphology, and patient age and gender with aneurysm rupture stratifying by location.

Methods

Using image-based models, 20 hemodynamic and 17 morphological parameters were compared in 1931 ruptured and unruptured aneurysms with univariate logistic regression. Rupture rates were compared between males and females as well as younger and older patients and bifurcation versus sidewall aneurysms for different aneurysm locations. Subsequently, associations between hemodynamics and morphology and patient as well as aneurysm characteristics were analyzed for aneurysms at five locations.

Results

Compared to unruptured aneurysms, ruptured aneurysms were characterized by a more irregular shape and were exposed to a more adverse hemodynamic environment described by faster flow, higher wall shear stress, more oscillatory shear, and more unstable and complex flows. These associations with rupture status were consistent for different aneurysm locations. Rupture rates were significantly higher in males at the internal carotid artery (ICA) bifurcation, ophthalmic ICA, and the middle cerebral artery (MCA) bifurcation. At the anterior communicating artery (ACOM) and MCA bifurcation, they were significantly higher for younger patients. Bifurcation aneurysms had significantly larger rupture rates at the MCA and posterior communicating artery (PCOM). In these groups with higher rupture rates, aneurysms were characterized by adverse hemodynamics and more complex shapes.

Conclusion

Hemodynamic and morphological differences between ruptured and unruptured aneurysms are consistent across locations. Adverse morphology and hemodynamics are related to rupture as well as younger age, male gender, and bifurcation aneurysms.

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Abbreviations

CFD:

Computational fluid dynamics

ICA:

Internal carotid artery

VA:

Vertebral artery

ROC:

Receiver operating characteristic

ACOM:

Anterior communicating artery

ICA-OPH:

Ophthalmic segment of the ICA

ICA-BIF:

Internal carotid artery bifurcation

PCOM:

‘Posterior communicating artery

MCA:

Middle cerebral artery

MCA-DIST-PROX:

Without the MCA-bifurcation

WSS:

Wall shear stress

OSI:

Oscillatory shear index

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Author information

Authors and Affiliations

  1. Bioengineering Department, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA

    Felicitas J. Detmer, Bong Jae Chung & Juan R. Cebral

  2. Neurosurgery Department, University of Antioquia, Medellin, Colombia

    Carlos Jimenez

  3. Department of Neurological Surgery, University of Massachusetts, Worcester, MA, USA

    Farid Hamzei-Sichani

  4. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    David Kallmes

  5. Interventional Neuroradiology Unit, Inova Fairfax Hospital, Falls Church, VA, USA

    Christopher Putman

Authors
  1. Felicitas J. Detmer
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  2. Bong Jae Chung
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  3. Carlos Jimenez
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  4. Farid Hamzei-Sichani
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  7. Juan R. Cebral
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Corresponding author

Correspondence to Felicitas J. Detmer.

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Funding

This study was funded by the National Institutes of Health/National Institute of Neurological Disorders and Stroke (NIH-NINDS) [R21NS094780].

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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For this type of study formal consent is not required.

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Detmer, F.J., Chung, B.J., Jimenez, C. et al. Associations of hemodynamics, morphology, and patient characteristics with aneurysm rupture stratified by aneurysm location. Neuroradiology 61, 275–284 (2019). https://doi.org/10.1007/s00234-018-2135-9

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  • DOI: https://doi.org/10.1007/s00234-018-2135-9

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