Abstract
Background & purposeHyperplastic remodeling (HR) lesions are sometimes found on cerebral aneurysm walls. Atherosclerosis is the results of HR, which may cause an adverse effect on surgical treatment for cerebral aneurysms. Previous studies have demonstrated that atherosclerotic changes had a correlation with certain hemodynamic characteristics. Therefore, we investigated local hemodynamic characteristics of HR lesions of cerebral aneurysms using computational fluid dynamics (CFD).MethodsTwenty-four cerebral aneurysms were investigated using CFD and intraoperative video recordings. HR lesions and red walls were confirmed on the intraoperative images, and the qualification points were determined on the center of the HR lesions and the red walls. The qualification points were set on the virtual operative images for evaluation of wall shear stress (WSS), normalized WSS (NWSS), oscillatory shear index (OSI), relative residence time (RRT), and aneurysm formation indicator (AFI). These hemodynamic parameters at the qualification points were compared between HR lesions and red walls.ResultsHR lesions had lower NWSS, lower AFI, higher OSI and prolonged RRT compared with red walls. From analysis of the receiver-operating characteristic curve for hemodynamic parameters, OSI was the most optimal hemodynamic parameter to predict HR lesions (area under the curve, 0.745; 95% confidence interval, 0.603–0.887; cutoff value, 0.00917; sensitivity, 0.643; specificity, 0.893; P<0.01). With multivariate logistic regression analyses using stepwise method, NWSS was significantly associated with the HR lesions.ConclusionsAlthough low NWSS was independently associated with HR lesions, OSI is the most valuable hemodynamic parameter to distinguish HR lesions from red walls.
Highlights
Recent advancement of computational fluid dynamics (CFD) has brought the novel understanding of hemodynamics such as rupture status,[1] rupture point,[2] and hemostatic pattern of cerebral aneurysms.[3]Atherosclerotic lesions are observed at aneurysmal dome, the parent artery and branches during microsurgery, and these thick and rigid walls may have unfavorable effects on aneurysm clipping or temporary clipping of the parent artery
hyperplastic remodeling (HR) lesions had lower normalized WSS (NWSS), lower Aneurysm formation indicator (AFI), higher oscillatory shear index (OSI) and prolonged relative residence time (RRT) compared with red walls
From analysis of the receiver-operating characteristic curve for hemodynamic parameters, OSI was the most optimal hemodynamic parameter to predict HR lesions
Summary
Recent advancement of computational fluid dynamics (CFD) has brought the novel understanding of hemodynamics such as rupture status,[1] rupture point,[2] and hemostatic pattern of cerebral aneurysms.[3]Atherosclerotic lesions are observed at aneurysmal dome, the parent artery and branches during microsurgery, and these thick and rigid walls may have unfavorable effects on aneurysm clipping or temporary clipping of the parent artery. Recent advancement of computational fluid dynamics (CFD) has brought the novel understanding of hemodynamics such as rupture status,[1] rupture point,[2] and hemostatic pattern of cerebral aneurysms.[3]. Atherosclerosis is thought to be the results of hyperplastic remodeling (HR), which may reflect a compensatory hemodynamic reaction for cerebral aneurysms. Hyperplastic remodeling (HR) lesions are sometimes found on cerebral aneurysm walls. We investigated local hemodynamic characteristics of HR lesions of cerebral aneurysms using computational fluid dynamics (CFD)
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