Hemodynamic differences between ruptured and unruptured cerebral aneurysms simultaneously existing in the same location: two case reports and proposal of a novel parameter oscillatory velocity index.

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Hemodynamic differences between ruptured and unruptured cerebral aneurysms simultaneously existing in the same location: two case reports and proposal of a novel parameter oscillatory velocity index.

World Neurosurg. 2016 Dec 22;:

Authors: Sano T, Ishida F, Tsuji M, Furukawa K, Shimosaka S, Suzuki H

Abstract
BACKGROUND: Recent studies have demonstrated certain hemodynamic characteristics featuring the rupture status of cerebral aneurysms using computational fluid dynamics. These studies were conducted based on the comparison of a large number of ruptured and unruptured aneurysms. However, not only aneurysm size and location but also perianeurysm environment such as hemorrhage and intracranial pressure would affect the hemodynamic changes. Therefore, we hypothesize that a case in which ruptured and unruptured cerebral aneurysms simultaneously exist in the same location would be an ideal model to reveal hemodynamic characteristics of the rupture status.
CASE DESCRIPTION: We report two rare cases with subarachnoid hemorrhage (SAH), each of which had two aneurysms at the common parent artery. One patient had two aneurysms at the anterior communicating artery and the other at the middle cerebral artery. Preoperative morphological and hemodynamic examinations were performed to diagnose the rupture status of the two aneurysms, and each ruptured aneurysm was then confirmed during surgical clipping. Morphological evaluation revealed higher shape indexes in both ruptured aneurysms. In addition, lower wall shear stress (WSS), WSS gradient, and aneurysm formation indicator were observed in both ruptured aneurysms. In contrast, the ruptured aneurysms had a higher oscillatory shear index and oscillatory velocity index, which was the novel hemodynamic parameter to quantify the fluctuation of flow velocity vector.
CONCLUSIONS: We demonstrated that quantitative characterization of the hemodynamic environment could distinguish the rupture status by using the appropriate models minimizing the certain bias caused by SAH and the aneurysm location.

PMID: 28017758 [PubMed - as supplied by publisher]

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