Distinctive flow pattern of wall shear stress and oscillatory shear index: similarity and dissimilarity in ruptured and unruptured cerebral aneurysm blebs

Clinical article

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Object

The difference in the hemodynamics of wall shear stress (WSS) and oscillatory shear index (OSI) between ruptured and unruptured aneurysms is not well understood. The authors investigated the hemodynamic similarities and dissimilarities in ruptured and thin-walled unruptured aneurysm blebs.

Methods

Magnetic resonance imaging–based fluid dynamics analysis was used to calculate WSS and OSI, and hemodynamic and intraoperative findings were compared. The authors also compared ruptured and unruptured thin-walled blebs for the magnitude of WSS and OSI.

Results

Intraoperatively, 13 ruptured and 139 thin-walled unruptured aneurysm blebs were identified. Twelve of the ruptured (92.3%) and 124 of the unruptured blebs (89.2%) manifested low WSS and high OSI. The degree of WSS was significantly lower in ruptured (0.49 ± 0.12 Pa) than in unruptured (0.64 ± 0.15 Pa; p < 0.01) blebs.

Conclusions

Ruptured and unruptured blebs shared a distinctive pattern of low WSS and high OSI. The degree of WSS at the rupture site was significantly lower than in the unruptured thin-walled blebs.

Abbreviations used in this paper:ACA = anterior cerebral artery; ACoA = anterior communicating artery; CFD = computational fluid dynamics; ICA = internal carotid artery; MCA = middle cerebral artery; MRA = MR angiography; OSI = oscillatory shear index; SAH = subarachnoid hemorrhage; WSS = wall shear stress.

Article Information

Address correspondence to: Tomohiro Kawaguchi, M.D., Ph.D., Department of Neurosurgery, Aomori Prefectural Central Hospital, 2-1-1 Higashitsukurimichi, Aomori 030-8553, Japan. email: kawaguchi@nsg.med.tohoku.ac.jp.

Please include this information when citing this paper: published online August 24, 2012; DOI: 10.3171/2012.7.JNS111991.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Case 1. Images obtained in a 74-year-old woman with a ruptured ACoA aneurysm. Digital subtraction angiogram (A) revealing an irregular aneurysm measuring 11.2 mm in diameter and a bleb at its apex (arrow). Magnetic resonance imaging–based fluid dynamics analysis (B) showing that at 0.41 Pa, WSS was lower than in the surrounding area (left; arrow). The OSI on the bleb was 0.31, higher than in the surrounding area (right; arrow). The aneurysm neck was clipped on the day of admission. Intraoperative photograph (C) showing that the bleb was covered with a clot and fibrin net (arrow). Histological studies confirmed the bleb as the site of rupture. Photomicrographs (D) revealing an absent intimal layer and internal elastic lamina along with degenerative changes around the rupture point. EVG = elastica van Gieson.

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    Case 2. Images obtained in a 70-year-old woman with an unruptured aneurysm. Digital subtraction angiogram (A) revealing an irregular 10-mm aneurysm harboring multiple blebs on the right MCA bifurcation (arrows and arrowhead each indicate a bleb). Magnetic resonance imaging–based fluid dynamics analysis (B) showing that all 3 blebs (left; solid arrow, arrowhead, and open arrow) were exposed to low WSS (0.72, 0.91, and 0.97 Pa, respectively). The OSI mapping indicated a high OSI (0.37) for 1 of the blebs (right; open arrow); the other 2 blebs (right; solid arrow and arrowhead) had a low OSI (0.02 and 0.08, respectively). Intraoperative photograph (C) showing a totally exposed aneurysm. The bleb with low WSS and high OSI was confirmed to be thin-walled (open arrow; solid arrow and arrowhead each indicate a bleb). The aneurysm neck was clipped, and the patient was discharged 8 days after surgery without neurological deficits. M1 = M1 segment; M2 = M2 segment.

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    Case 3. Images obtained in a 48-year-old woman with an unruptured aneurysm. Digital subtraction angiogram (A) revealing a 6-mm aneurysm on the right MCA bifurcation. Blebs were detected at the aneurysm apex (open arrow) and around the neck (solid arrow). Magnetic resonance imaging–based fluid dynamics analysis (B) showed that WSS was low at both blebs (left; 0.67 Pa [solid arrow] and 0.48 Pa [open arrow]). The OSI was low at the bleb around the aneurysm neck (right; 0.091 [solid arrow]) and high at the bleb at the apex (right; 0.29 [open arrow]). Surgery was scheduled for the following month; however, on the day of hospital discharge, the patient reported a sudden-onset headache. Computed tomography revealed SAH, and she underwent emergency surgery. Intraoperative photographs (C) showing rupture of the bleb at the aneurysm apex (left; open arrow) and an intact bleb around the neck (right; solid arrow). She underwent aneurysm neck clipping and was discharged 18 days after surgery without neurological deficits.

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