High wall shear stress beyond a certain range in the parent artery could predict the risk of anterior communicating artery aneurysm rupture at follow-up

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OBJECTIVE

Among clinical and morphological criteria, hemodynamics is the main predictor of aneurysm growth and rupture. This study aimed to identify which hemodynamic parameter in the parent artery could independently predict the rupture of anterior communicating artery (ACoA) aneurysms by using multivariate logistic regression and two-piecewise linear regression models. An additional objective was to look for a more simplified and convenient alternative to the widely used computational fluid dynamics (CFD) techniques to detect wall shear stress (WSS) as a screening tool for predicting the risk of aneurysm rupture during the follow-up of patients who did not undergo embolization or surgery.

METHODS

One hundred sixty-two patients harboring ACoA aneurysms (130 ruptured and 32 unruptured) confirmed by 3D digital subtraction angiography at three centers were selected for this study. Morphological and hemodynamic parameters were evaluated for significance with respect to aneurysm rupture. Local hemodynamic parameters were obtained by MR angiography and transcranial color-coded duplex sonography to calculate WSS magnitude. Multivariate logistic regression and a two-piecewise linear regression analysis were performed to identify which hemodynamic parameter independently characterizes the rupture status of ACoA aneurysms.

RESULTS

Univariate analysis showed that WSS (p < 0.001), circumferential wall tension (p = 0.005), age (p < 0.001), the angle between the A1 and A2 segments of the anterior cerebral artery (p < 0.001), size ratio (p = 0.023), aneurysm angle (p < 0.001), irregular shape (p = 0.005), and hypertension (grade II) (p = 0.006) were significant parameters. Multivariate analyses showed significant association between WSS in the parent artery and ACoA aneurysm rupture (p = 0.0001). WSS magnitude, evaluated by a two-piecewise linear regression model, was significantly correlated with the rupture of the ACoA aneurysm when the magnitude was higher than 12.3 dyne/cm2 (HR 7.2, 95% CI 1.5–33.6, p = 0.013).

CONCLUSIONS

WSS in the parent artery may be one of the reliable hemodynamic parameters characterizing the rupture status of ACoA aneurysms when the WSS magnitude is higher than 12.3 dyne/cm2. Analysis showed that with each additional unit of WSS (even with a 1-unit increase of WSS), there was a 6.2-fold increase in the risk of rupture for ACoA aneurysms.

ABBREVIATIONS ACA = anterior cerebral artery; ACoA = anterior communicating artery; CFD = computational fluid dynamics; CWT = circumferential wall tension; DSA = digital subtraction angiography; MRA = MR angiography; SAH = subarachnoid hemorrhage; TCCD = transcranial color-coded duplex; WSS = wall shear stress.

Article Information

Correspondence Chuan-Zhi Duan: Southern Medical University, Zhujiang Hospital, Guangdong, China. doctor_duanzj@163.com.

INCLUDE WHEN CITING Published online September 28, 2018; DOI: 10.3171/2018.4.JNS173179.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Relation between WSS in the parent artery and ACoA aneurysm rupture. The area between two blue dotted lines represents the 95% CI, and each red point shows the WSS magnitude in the parent artery, and the dots are connected to form a dotted line. The WSS magnitude is not correlated with ACoA aneurysm rupture when it is ≤ 12.3 dyne/cm2. Conversely, the WSS magnitude > 12.3 dyne/cm2 showed a significant correlation with ACoA aneurysm rupture. The risk of ACoA aneurysm rupture increases as the WSS increases. Figure is available in color online only.

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