Rupture prediction of intracranial aneurysms: a nationwide matched case-control study of hemodynamics at the time of diagnosis

Torbjørn Øygard Skodvin Faculty of Health, UiT The Arctic University of Norway, Tromsø;
Department of Neurosurgery, University Hospital of Northern Norway, Tromsø;

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Øyvind Evju Simula Research Laboratory, Oslo;

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Christian A. Helland Department of Neurosurgery, Haukeland University Hospital, Bergen; and
Department of Clinical Medicine, University of Bergen, Norway

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Jørgen Gjernes Isaksen Faculty of Health, UiT The Arctic University of Norway, Tromsø;
Department of Neurosurgery, University Hospital of Northern Norway, Tromsø;

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OBJECTIVE

Hemodynamic rupture predictors in intracranial aneurysms (IAs) must be investigated in prerupture aneurysms, because rupture might significantly alter aneurysm hemodynamics. Both clinical and aneurysmal factors influence hemodynamics, possibly confounding results in unmatched patient materials. The authors aimed to identify hemodynamic variables at the time of diagnosis that could be associated with IA rupture.

METHODS

A nationwide matched case-control study of IA hemodynamics at the time of diagnosis was performed. Twelve IAs that later ruptured were matched 1:2 with control aneurysms that remained unruptured during a median follow-up time of 4.5 years (interquartile range 3.7–8.2 years). Cases and controls were matched by aneurysm location and size, and patient sex and age. Hemodynamic parameters were obtained from computational fluid dynamics simulations.

RESULTS

The low shear area (LSA) was significantly higher in cases than in controls in univariate analysis (p = 0.041). Minimum logarithmic wall shear stress, averaged logarithmic wall shear stress, pressure loss coefficient, and inflow concentration index showed a tendency to be associated with later rupture (p = 0.09, 0.14, 0.15, and 0.18, respectively). The LSA remained statistically significant in multivariable analysis (p = 0.030).

CONCLUSIONS

Hemodynamics at the time of diagnosis are different in aneurysms that later rupture than in those that remain unruptured. Increased LSA might be an early predictor of rupture.

ABBREVIATIONS

ACoA = anterior communicating artery; CFD = computational fluid dynamics; IA = intracranial aneurysm; ICA = internal carotid artery; ICI = inflow concentration index; IQR = interquartile range; LSA = low shear area; MCA = middle cerebral artery; OSI = oscillatory shear index; PCoA = posterior communicating artery; PHASES = population, hypertension, age, size of aneurysm, earlier SAH from another aneurysm, site of aneurysm; PLc = pressure loss coefficient; SAH = subarachnoid hemorrhage; VDR = viscous dissipation ratio; WSS = wall shear stress.

Supplementary Materials

    • Supplementary Methods and Table (PDF 910 KB)
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