Abstract WP83: Wall Shear Stress Strength Over the Cerebral Aneurysm is Drastically Affected by Aneurysm Location While the Magnitude of Disturbed Flow is Closely Related to Aneurysm Size and Surface Area

Abstract

Background and purpose: The rupture rate of cerebral aneurysms varies according to the aneurysm size and location. Although several reports suggest hemodynamic involvement in the mechanisms, there still remains to be clarified. Using computational fluid dynamics, we elucidated here differences in hemodynamics according to size and location of human cerebral aneurysms. Methods: Patient-specific inflow velocities and arterial geometries of 39 MCA aneurysms and anterior communicating artery (Acom) aneurysms were acquired from patients who consented to participate in the multi-institutional prospective clinical study, CFD ABO Study. Pulsatile blood flow was simulated using ANSYS-CFX, based on the Navier-Stokes equations for incompressible fluid. Aneurysms were divided into 3 groups by their size; less than 5mm, less than 7mm and more than 5mm, and more than 7mm. Results: Wall shear stress (WSS) was significantly lower in Acom aneurysms than MCA aneurysms (p=0.00075) while there was no significant difference in WSS according to aneurysm size. In contrast, indicators for disturbed flow, oscillatory shear index (OSI) and normalized transverse WSS (NtransWSS) were significantly higher over the aneurysms of the size less than 7mm and more than 5mm compared to those less than 5mm (p=0.021 and 0.014, respectively). Moreover, there were strong or moderate positive correlations between aneurysm surface area and OSI and NtransWSS, but not WSS. However, there was no significant difference in OSI or NtransWSS between MCA and Acom aneurysms. Conclusions: The data suggest that WSS strength over the cerebral aneurysm is drastically affected by the aneurysm location while the magnitude of disturbed flow is closely related to aneurysm size and surface area. A significant lower WSS in Acom aneurysms compared to MCA aneurysms may be associated with higher rupture rate in Acom aneurysms. In contrast, disturbed flow may be involved in aneurysm enlargement.