Differences in Cerebral Aneurysm Rupture Rate According to Arterial Anatomies Depend on the Hemodynamic Environment
Differences in Cerebral Aneurysm Rupture Rate According to Arterial Anatomies Depend on the Hemodynamic Environment
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DOI：
10.3174/ajnr.a6030
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发表时间：
2019-05-01
影响因子：
3.5
通讯作者：
Yonemoto, N.
中科院分区：
文献类型：
--
作者：
Fukuda, S.;Shimogonya, Y.;Yonemoto, N.
背景和目的：脑动脉瘤的破裂率因其大小和位置的不同而有显著差异。这些差异背后的机制尚不清楚。材料和方法：84个脑动脉瘤(42个前交通动脉和42个大脑中动脉)的解剖破裂风险取决于动脉瘤表面的血流动力学环境。材料和方法：从我们的临床研究中获得了84个脑动脉瘤(42个前交通动脉和42个大脑中动脉)的特定几何形状和血流速度。模拟脉动血流以计算血流动力学指标，特别关注壁切应力大小和时间扰动。多变量分析确定血流动力学指标与已知破裂预测因素(年龄、性别、高血压、吸烟史、位置和大小)之间的关联。结果：所有基于壁切应力大小的指标与大小和位置呈显著负相关(P<；0.03)，但与其他危险因素无关。所有基于壁面剪应力扰动的指标都与大小显著相关(P<；.001)。只有归一化的横向壁切应力，一个多向壁切应力扰动的指标，与位置有关(P=0.03)。在血流动力学指标中，归一化横壁剪应力对位置和大小的优势比最高(优势比分别为1.275和1.579；95%可信区间分别为1.020-1.693和1.238-2.219)。在动脉几何参数中，长宽比与所有血流动力学指标的相关性第二强，仅次于我们新提出的长宽比-非球度指数。结论：不同大小和位置的动脉瘤破裂率的差异可能以不同的方式反映了血液动力学环境的不同。增强的多向壁切应力干扰可能尤其与动脉瘤破裂有关。
BACKGROUND AND PURPOSE: Cerebral aneurysms have significantly different rupture rates depending on their size and location. The mechanisms underlying these differences are unclear. We examined whether anatomic rupture risks are dependent on the hemodynamic environment on the aneurysmal surface.MATERIALS AND METHODS: Patient-specific geometries and flow rates of 84 cerebral aneurysms (42 anterior communicating artery and 42 MCA aneurysms) were acquired from our clinical study, the Computational Fluid Dynamics Analysis of Blood Flow in Cerebral Aneurysms: Prospective Observational Study. Pulsatile blood flow was simulated to calculate hemodynamic metrics with special attention to wall shear stress magnitude and temporal disturbance. Multivariate analyses were performed to identify associations between hemodynamic metrics and known rupture predictors (age, sex, hypertension, smoking history, location, and size).RESULTS: All the wall shear stress magnitude-based metrics showed a significant negative association with size and location (P < .03), but not other risk factors. All the wall shear stress disturbance-based metrics were significantly related to size (P < .001). Only normalized transverse wall shear stress, a metric for multidirectional wall shear stress disturbance, was related to location (P = .03). The normalized transverse wall shear stress had the highest odds ratio for location and size among hemodynamic metrics (odds ratios, 1.275 and 1.579; 95% confidence intervals, 1.020-1.693 and 1.238-2.219, respectively). Among the arterial geometric parameters, the aspect ratio had the second strongest association with all hemodynamic metrics, after our newly proposed aspect ratio-asphericity index.CONCLUSIONS: The differences in aneurysm rupture rates according to size and location may reflect differences in hemodynamic environments in qualitatively different ways. An enhanced multidirectional wall shear stress disturbance may be especially associated with aneurysm rupture.