Association Between Aneurysmal Hemodynamics and Rupture Risk of Unruptured Intracranial Aneurysms

Zhongbin Tian; Xifeng Li; Chao Wang; Xin Feng; Kaijian Sun; Yi Tu; Hengxian Su; Xinjian Yang; Chuanzhi Duan

doi:10.3389/fneur.2022.818335

Association Between Aneurysmal Hemodynamics and Rupture Risk of Unruptured Intracranial Aneurysms

Front Neurol. 2022 Apr 21:13:818335. doi: 10.3389/fneur.2022.818335. eCollection 2022.

Authors

Zhongbin Tian¹, Xifeng Li¹, Chao Wang², Xin Feng¹, Kaijian Sun¹, Yi Tu¹, Hengxian Su¹, Xinjian Yang³, Chuanzhi Duan¹

Affiliations

¹ National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
² Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China.
³ Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.

Abstract

Background: Assessing rupture risk in patients with unruptured intracranial aneurysms (UIAs) remains challenging. Hemodynamics plays an important role in the natural history of intracranial aneurysms. This study aimed to compare aneurysmal hemodynamic features between patients with different rupture risk as determined by PHASES score.

Methods: We retrospectively examined 238 patients who harbored a solitary saccular UIA. Patients were stratified by rupture risk into low-, intermediate-, and high-risk groups according to PHASES score. Flow simulations were performed to compare differences in hemodynamics among the groups.

Results: Aneurysmal time-averaged wall shear stress (WSSa) and normalized WSS (WSSn) decreased progressively as PHASES score increased. WSSa and WSSn significantly differed among the low-, intermediate-, and high-risk groups (p < 0.001). WSSa was significantly lower in the high-risk group than the low-risk group (p < 0.001) and the intermediate-risk group (p = 0.004). WSSn was also significantly lower in the high-risk group than the low-risk group (p < 0.001) and the intermediate-risk group (p = 0.001).

Conclusions: Low WSS was significantly associated with higher risk of intracranial aneurysm rupture as determined by PHASES score, indicating that hemodynamics may play an important role in aneurysmal rupture. In the future, a multidimensional rupture risk prediction model that includes hemodynamic parameters should be investigated.

Keywords: PHASES score; hemodynamics; rupture risk; unruptured intracranial aneurysm; wall shear stress.