Association of wall shear stress with intracranial aneurysm rupture: systematic review and meta-analysis

Geng Zhou,Ming Su,Yanling Yin,Yueqi Zhu,Minghua Li

doi:10.1038/s41598-017-05886-w

Abstract

To evaluate the relationship between wall shear stress (WSS) magnitude and cerebral aneurysm rupture and provide new insight into the disparate computational fluid dynamics (CFD) findings concerning the role of WSS in intracranial aneurysm (IA) rupture. A systematic electronic database (PubMed, Medline, Springer, and EBSCO) search was conducted for all accessible published articles up to July 1, 2016, with no restriction on the publication year. s, full-text manuscripts, and the reference lists of retrieved articles were analyzed. Random effects meta-analysis was used to pool the complication rates across studies. Twenty-two studies containing CFD data on 1257 patients with aneurysms were included in the analysis. A significantly higher rate of low WSS (0–1.5 Pa) was found in ruptured aneurysms (odds ratio [OR] 2.17; 95% confidence interval [CI], 1.73–2.62). The pooled analyses across 14 studies with low WSS showed significantly lower mean WSS (0.64 vs. 1.4 Pa) (p = 0.037) in the ruptured group. This meta-analysis provides evidence that decreased local WSS may be an important predictive parameter of IA rupture.

Highlights

With recent improvements and more diffuse use of cerebrovascular imaging methods, the detection of unruptured cerebral aneurysms has increased, and the incidence is thought to be as high as 7%1,2
To facilitate a more accurate predictive assessment for intracranial aneurysm (IA) rupture risk by computational fluid dynamics (CFD), we explored the relationship between wall shear stress (WSS) magnitude and cerebral aneurysm rupture using data obtained from the current literature, and provide new insight into the disparate CFD findings on the role of WSS in IA rupture
Our analysis showed a significantly higher rate of low WSS for ruptured aneurysms (Fig. 1)

Summary

Introduction

With recent improvements and more diffuse use of cerebrovascular imaging methods, the detection of unruptured cerebral aneurysms has increased, and the incidence is thought to be as high as 7%1,2. Much interest has been centered on the parameter of wall shear stress (WSS) from computational fluid dynamics (CFD) analysis. These extensive studies reported divergent and controversial findings on the correlation of low and high WSS with rupture[4]. To facilitate a more accurate predictive assessment for IA rupture risk by CFD, we explored the relationship between WSS magnitude and cerebral aneurysm rupture using data obtained from the current literature, and provide new insight into the disparate CFD findings on the role of WSS in IA rupture

Methods

Results

Discussion

Conclusion