Patient-specific hemodynamic analysis of small internal carotid artery-ophthalmic artery aneurysms

Surg Neurol. 2009 Nov;72(5):444-50; discussion 450. doi: 10.1016/j.surneu.2008.12.013. Epub 2009 Mar 29.


Background: Prophylactic treatment of unruptured small brain aneurysms is still controversial due to the low risk of rupture. Distinguishing which small aneurysms are at risk for rupture has become important for treatment. Previous studies have indicated a variety of hemodynamic properties that may influence aneurysm rupture. This study uses hemodynamic principles to evaluate these in the context of ruptured and unruptured small aneurysms in a single location.

Methods: Eight small internal carotid artery-ophthalmic artery (ICA-Oph) aneurysms (<10 mm) were selected from the University of California, Los Angeles, database. We analyzed rupture-related hemodynamic characteristics including flow patterns, wall shear stress (WSS), and flow impingement using previously developed patient-specific computational fluid dynamics software.

Results: Most ruptured aneurysms had complicated flow patterns in the aneurysm domes, but all of the unruptured cases showed a simple vortex. A reduction in flow velocity between the parent artery and the aneurysm sac was found in all the cases. Inside the aneurysms, the highest flow velocities were found either at the apex or neck. We also observed a trend of higher and more inhomogeneous WSS distribution within ruptured aneurysms (10.66 +/- 5.99 Pa) in comparison with the unruptured ones (6.31 +/- 6.47 Pa) (P < .01).

Conclusion: A comparison of hemodynamic properties between ruptured and unruptured small ICA-Oph aneurysms found that some hemodynamic properties vary between small aneurysms although they are similar in size and share the same anatomical location. In particular, WSS may be a useful hemodynamic factor for studying small aneurysm rupture.

MeSH terms

  • Aneurysm, Ruptured / diagnostic imaging
  • Aneurysm, Ruptured / pathology
  • Aneurysm, Ruptured / physiopathology
  • Blood Flow Velocity / physiology
  • Blood Pressure / physiology
  • Carotid Artery, Internal, Dissection / diagnostic imaging
  • Carotid Artery, Internal, Dissection / pathology
  • Carotid Artery, Internal, Dissection / physiopathology*
  • Cerebral Angiography / methods
  • Cerebrovascular Circulation / physiology*
  • Computer Simulation
  • Hemodynamics / physiology*
  • Hemorheology / physiology
  • Humans
  • Image Processing, Computer-Assisted
  • Intracranial Aneurysm / diagnostic imaging
  • Intracranial Aneurysm / pathology
  • Intracranial Aneurysm / physiopathology*
  • Models, Cardiovascular
  • Ophthalmic Artery / diagnostic imaging
  • Ophthalmic Artery / pathology
  • Ophthalmic Artery / physiopathology*
  • Pulsatile Flow / physiology
  • Shear Strength
  • Stress, Mechanical