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Hemodynamics of Focal Versus Global Growth of Small Cerebral Aneurysms

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Abstract

Background and Purpose

Hemodynamics play a driving role in the life cycle of brain aneurysms from initiation through growth until eventual rupture. The specific factors behind aneurysm growth, especially in small aneurysms, are not well elucidated. The goal of this study was to differentiate focal versus general growth and to analyze the hemodynamic microenvironment at the sites of enlargement in small cerebral aneurysms.

Materials and Methods

Small aneurysms showing growth during follow-up were identified from our prospective aneurysm database. Three dimensional rotational angiography (3DRA) studies before and after morphology changes were available for all aneurysms included in the study, allowing for detailed shape and computational fluid dynamic (CFD) based hemodynamic analysis. Six patients fulfilled the inclusion criteria.

Results

Two different types of change were observed: focal growth, with bleb or blister formation in three, and global aneurysm enlargement accompanied by neck broadening in other three patients. Areas of focal growth showed low shear conditions with increased oscillations at the site of growth (a low wall shear stress [WSS] and high oscillatory shear index [OSI]). Global aneurysm enlargement was associated with increased WSS coupled with a high spatial wall shear stress gradient (WSSG).

Conclusion

For different aneurysm growth types, distinctive hemodynamic microenvironment may be responsible and temporal–spatial changes of the pathologic WSS would have the inciting effect. We suggest the distinction of focal and global growth types in future hemodynamic and histological studies.

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Abbreviations

3D:

Three-dimensional

ICA:

Internal carotid artery

MRA:

Magnetic resonance angiography

CTA:

Computed tomographic angiography

3DRA:

Three-dimensional rotational angiography

WSS:

Wall shear stress

WSSG:

Wall shear stress gradient

OSI:

Oscillatory shear index

GA:

Growth area (of the aneurysm wall)

LVF:

Low value fraction

HVF:

High value fraction

DSA:

Digital subtraction angiography

STL:

STereoLithography

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Funding

This study was supported by Swiss National Science Foundation grants (SNF 32003B_160222 and SNF 320030_156813).

Author information

Authors and Affiliations

  1. Neuroradiology Division, Department of Radiology and Medical Informatics, Geneva University Hospitals, Geneva, Switzerland

    Paolo Machi, Rafik Ouared, Olivier Brina, Pierre Bouillot, Hasan Yilmaz, Maria I Vargas, Karl O Lovblad & Zsolt Kulcsár

  2. Laboratory for Hydraulic Machines, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland

    Pierre Bouillot

  3. Neurosurgery Division, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland

    Renato Gondar & Philippe Bijlenga

  4. Department of Neuroradiology, University Hospital of Zurich, Frauenklinikstraße 10, 8091, Zürich, Switzerland

    Zsolt Kulcsár

Authors
  1. Paolo Machi
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  2. Rafik Ouared
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  3. Olivier Brina
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  4. Pierre Bouillot
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  10. Zsolt Kulcsár
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Corresponding author

Correspondence to Zsolt Kulcsár.

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Conflict of interest

P. Machi, R. Ouared, O. Brina, P. Bouillot, H. Yilmaz, M.I. Vargas, R. Gondar, P. Bijlenga, K.O. Lovblad and Z. Kulcsár declare that they have no competing interests.

Caption Electronic Supplementary Material

Materials and methods

62_2017_640_MOESM2_ESM.jpg

OSI, peak systolic WSSG (Pa/µm) and WSS (Pa) in aneurysms and growth areas for patients p2, p5, p6. Patient representation is row-like. Columns from left to right represent for each patient, the growth area, and the spatial frequency distribution of OSI, peak systolic WSSG and WSS, over the aneurysm (blue) and growth area (yellow), respectively. Medallions, cast the zoom on distributions in growth areas

62_2017_640_MOESM3_ESM.jpg

Columns B, D and F, show the histograms (spatial density distribution functions) of OSI, peak systolic WSSG (Pa/µm) and WSS (Pa) in aneurysms (blue) and growth areas (yellow) for patients p1, p3, p4. Medallions, cast the zoom on distributions in growth areas. Columns A, C and E represent the clusterization (in red) of OSI, peak systolic WSSG and WSS patterns in overall growth areas (green), respectively. Patient representation is row-like

Streamlines (colored by velocity) at peak systolic for all cases. The white arrows show the regions of growth

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Machi, P., Ouared, R., Brina, O. et al. Hemodynamics of Focal Versus Global Growth of Small Cerebral Aneurysms. Clin Neuroradiol 29, 285–293 (2019). https://doi.org/10.1007/s00062-017-0640-6

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  • DOI: https://doi.org/10.1007/s00062-017-0640-6

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