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Open Access

High WSS or Low WSS? Complex Interactions of Hemodynamics with Intracranial Aneurysm Initiation, Growth, and Rupture: Toward a Unifying Hypothesis

H. Meng, V.M. Tutino, J. Xiang and A. Siddiqui
American Journal of Neuroradiology July 2014, 35 (7) 1254-1262; DOI: https://doi.org/10.3174/ajnr.A3558
H. Meng
aFrom the Toshiba Stroke and Vascular Research Center (H.M., V.M.T., J.X., A.S.)
bDepartments of Mechanical and Aerospace Engineering (H.M.)
cNeurosurgery (H.M., J.X., A.S.)
dBiomedical Engineering (H.M., V.M.T.), University at Buffalo, State University of New York, Buffalo, New York.
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V.M. Tutino
aFrom the Toshiba Stroke and Vascular Research Center (H.M., V.M.T., J.X., A.S.)
dBiomedical Engineering (H.M., V.M.T.), University at Buffalo, State University of New York, Buffalo, New York.
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J. Xiang
aFrom the Toshiba Stroke and Vascular Research Center (H.M., V.M.T., J.X., A.S.)
cNeurosurgery (H.M., J.X., A.S.)
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A. Siddiqui
aFrom the Toshiba Stroke and Vascular Research Center (H.M., V.M.T., J.X., A.S.)
cNeurosurgery (H.M., J.X., A.S.)
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Abstract

Summary: Increasing detection of unruptured intracranial aneurysms, catastrophic outcomes from subarachnoid hemorrhage, and risks and cost of treatment necessitate defining objective predictive parameters of aneurysm rupture risk. Image-based computational fluid dynamics models have suggested associations between hemodynamics and intracranial aneurysm rupture, albeit with conflicting findings regarding wall shear stress. We propose that the “high-versus-low wall shear stress” controversy is a manifestation of the complexity of aneurysm pathophysiology, and both high and low wall shear stress can drive intracranial aneurysm growth and rupture. Low wall shear stress and high oscillatory shear index trigger an inflammatory-cell-mediated pathway, which could be associated with the growth and rupture of large, atherosclerotic aneurysm phenotypes, while high wall shear stress combined with a positive wall shear stress gradient trigger a mural-cell-mediated pathway, which could be associated with the growth and rupture of small or secondary bleb aneurysm phenotypes. This hypothesis correlates disparate intracranial aneurysm pathophysiology with the results of computational fluid dynamics in search of more reliable risk predictors.

ABBREVIATIONS:

CFD
computational fluid dynamics
ECM
extracellular matrix
WSS
wall shear stress
  • © 2014 by American Journal of Neuroradiology

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American Journal of Neuroradiology: 35 (7)
American Journal of Neuroradiology
Vol. 35, Issue 7
1 Jul 2014
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High WSS or Low WSS? Complex Interactions of Hemodynamics with Intracranial Aneurysm Initiation, Growth, and Rupture: Toward a Unifying Hypothesis
H. Meng, V.M. Tutino, J. Xiang, A. Siddiqui
American Journal of Neuroradiology Jul 2014, 35 (7) 1254-1262; DOI: 10.3174/ajnr.A3558

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High WSS or Low WSS? Complex Interactions of Hemodynamics with Intracranial Aneurysm Initiation, Growth, and Rupture: Toward a Unifying Hypothesis
H. Meng, V.M. Tutino, J. Xiang, A. Siddiqui
American Journal of Neuroradiology Jul 2014, 35 (7) 1254-1262; DOI: 10.3174/ajnr.A3558
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