Identification of Quantifiable Hemodynamic Factors in the Assessment of Cerebral Aneurysm Behavior On behalf of the Subcommittee on Biorheology of the Scientific and Standardization Committee of the ISTH

Arrmelle C Burleson; Vincent T Turitto

doi:10.1055/s-0038-1650533

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 1996; 76(01): 118-123
DOI: 10.1055/s-0038-1650533

Scientific and Standardization Committee Communication

Schattauer GmbH Stuttgart

Identification of Quantifiable Hemodynamic Factors in the Assessment of Cerebral Aneurysm Behavior On behalf of the Subcommittee on Biorheology of the Scientific and Standardization Committee of the ISTH

Authors

Arrmelle C Burleson

The Department of Biomedical Engineering, The University of Memphis, Memphis, TN, USA
Vincent T Turitto

The Department of Biomedical Engineering, The University of Memphis, Memphis, TN, USA

Abstract

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Summary

Previous experimental and theoretical studies on the hemodynamics of saccular intracranial aneurysms have provided evidence that aneurysms tend to grow, thrombose and rupture when (1) wall shear stress and mural tension are increased compared to normal values, and (2) flow deviates from a laminar unidirectional pattern (for example flow recirculation). Aneurysm wall shear stress, however, is the only hemodynamic factor which has received special attention in terms of estimation. Additional flow-related parameters exist which could potentially bring increased insight into mechanisms for cerebral aneurysm behavior; they could also help categorize the severity of such malformations and design effective intravascular treatment techniques. The purpose of this paper is thus to present an overview of such hemodynamic factors that could assist in determining the geometries which present the greatest risks to patients. These parameters include (1) hemodynamic shear stress, (2) pressure and related stresses, (3) impingement force on the aneurysm wall, (4) inflow rate into the aneurysm, and (5) residence time of blood within the aneurysmal sac. In addition, these factors can also be currently estimated in an in vitro setting.

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References

References
1 Ferguson GG. Physical factors in the initiation, growth, and rupture of human intracranial saccular aneurysms. J Neurosurg 1972; 37: 666-677
2 Forbus WD. On the origin of miliary aneurysms of the superficial cerebral arteries. Bull Johns Hopkins Hosp 1930; 47: 239-284
3 Hassler O. Morphological studies on the large cerebral arteries with reference to the aetiology of subarachnoid haemorrhage. Acta Psychiat Neurol Scand 1961; 36: 154
4 Stehbens WE. Histopathology of cerebral aneurysms. Arch Neurol (Chicago) 1963; 8: 272-285
5 Crompton MR. The pathogenesis of cerebral aneurysms. Brain 1966; 89: 797-814
6 Sahs AL. Observations on the pathology of saccular aneurysms. J Neurosurg 1966; 24: 792-806
7 Hung EJ, Botwin MR. Mechanics of rupture of cerebral saccular aneurysms. J Biomechanics 1975; 8: 385-392
8 Crawford T. Some observations on the pathogenesis and natural history of intracranial aneurysms. J Neurol Neurosurg Psychiat 1959; 22: 259-266
9 Bjorkesten G, Troupp H. Changes in the size of intracranial arterial aneurysms. J Neurosurg 1962; 19: 583-588
10 Young B, Meacham WF, Allan JH. Documented enlargement and rupture of a small arterial sacculation. Case report. J Neurosurg 1971; 34: 814-817
11 Zacks DJ, Russel DB, Miller JDR. Fortuitously discovered intracranial aneurysms. Arch Neurol 1980; 37: 39-41
12 Heiskanen O. Risk of bleeding from unruptured aneurysms in cases with multiple intracranial aneurysms. J Neurosurg 1981; 55: 524-526
13 Wiebers DO, Whishant JP, Sundt TM, O’Fallon WM. The significance of unruptured intracranial saccular aneurysms. J Neurosurg 1987; 66: 23-29
14 Solomon RA, Correll JW. Rupture of a previously documented asymptomatic aneurysm enhances the argument for prophylactic surgical intervention. Surg Neurol 1988; 30: 321-323
15 Schievink WI, Piepgras DG, Wirth FP. Rupture of previously documented small asymptomatic saccular intracranial aneurysms. J Neurosurg 1992; 76: 1019-1024
16 Fox JL. Intracranial Aneurysms, Vol I. Springer Verlag, New York 1983
17 Black SP, German WL. Observation on the relationship between the volume and the size of the orifice of experimental aneurysms. J Neurosurg 1960; 17: 984-990
18 Crompton MR. Mechanism of growth and rupture in cerebral berry aneurysms. BritMecJ 1966; b 1: 1138-1142
19 Ferguson GG. Turbulence in human intracranial saccular aneurysms. J Neurosurg 1970; 33: 485-497
20 Hassler O. Scanning electron microscopy of saccular intracranial aneurysms. Am J Pathol 1972; 68: 511-519
21 Roach MR, Scott S, Ferguson GG. The hemodynamic importance of the geometry of bifurcations in the circle of Willis (glass model studies). Stroke 1972; 3: 255-267
22 Stehbens WE. Flow in glass models of arterial bifurcations and berry aneurysms at low Reynolds numbers. Quart J Experim Physiol 1975; 60: 181-192
23 Fredberg JJ. Origin and character of vascular murmurs: Model studies. J Acoust Soc Am 1977; 61: 1077-1085
24 Suzuki J, Ohara H. Clinicopathological study of cerebral aneuysms. J Neurosurg 1978; 48: 505-514
25 Hashimoto N, Handa H, Nagata I, Hazama F. Experimentally induced cerebral aneurysms in rats: part V; Relation of hemodynamics in the circle of Willis to formation of aneurysms. Surg Neurol 1980; 13: 41-45
26 Kerber W, Heilman CB. Flow in experimental berry aneurysms: method and model. AJNR 1983; 4: 374-377
27 Tognetti F, Limoni P, Testa C. Aneurysm growth and hemodynamic stress. Surg Neurol 1983; 20: 74-78
28 Hashimoto T. Dynamic measurement of pressure and flow velocities in glass and silastic model berry aneurysms. Neurol Res 1984; 6: 22-28
29 Kayembe KNT, Sasahara M, Hazama F. Cerebral aneurysms and variations in the circle of Willis. Stroke 1984; 15: 846-850
30 Niimi H, Kawano Y, Sugiyama I. Structure of blood flow through a curved vessel with an aneurysm. Biorheology 1984; 21: 603-615
31 Strother CM, Graves VB, Rappe A. Aneurysm hemodynamics: An experimental study. AJNR 1992; 13: 1089-1095
32 Sehkar LH, Heros RC. Origin, growth, and rupture of saccular aneurysms: A review. Neurosurgery 1981; 18: 248-260
33 Perktold K, Gruber K, Kenner T, Florian H. Calculation of pulsatile flow and particle paths in an aneurysm model. Basic Res Cardiol 1984; 79: 253-261
34 Perktold K. On the paths of fluid particles in an axisymmetrical aneurysm. JBiomech 1987; 20: 311-317
35 Perktold K, Kenner T, Hilbert D, Spork B, Florian H. Numerical blood flow analysis: Arterial bifurcation with a saccular aneurysm. Basic Res Cardiol 1988; 83: 24-31
36 Perktold K, Peter R, Resch M. Pulsatile non-newtonian blood flow simulation through a bifurcation with an aneurysm. Biorheology 1989; 26: 1011-1030
37 Liepsch DW, Steiger HJ, Poll A, Reulen HJ. Hemodynamic stress in lateral saccular aneurysms. Biorheology 1987; 24: 689-710
38 Steiger HJ, Liepsch DW, Poll A, Reulen HJ. Hemodynamic stress in terminal saccular aneurysms: A laser-Doppler study. Heart Vessels 1988; 4: 162-169
39 Steiger HJ, Poll A, Liepsch DW, Reulen HJ. Hemodynamic stress in terminal aneurysms. Acta Neurochir (Wien) 1988; 93: 18-23
40 Liou TM, Chang TW. Flow fields in a simulated axisymmetric terminal aneurysm with symmetric and asymmetric outflows. Exp Therm Fluid Sci 1993; 7: 362-369
41 Liou TM, Chang TW, Chang WC. Pulsatile flow through a bifurcation with a cerebrovascular aneurysm. J Biomech Eng 1994; 116: 112-118
42 Rodbard S. Vascular modifications induced by flow. Am Heart J 1956; 51: 926-942
43 Rodbard S. An analysis of mechanisms of post-stenotic dilatation. Angiol-ogy 1967; 18: 349-369
44 Fry DL. Acute vascular endothelial changes associated with increased blood velocity gradients. Cir Res 1968; 22: 165-197
45 Fry DL. Certain histological and chemical responses of the vascular interface to acutely induced mechanical stress in the aorta of the dog. Cir Res 1969; 14: 93-108
46 Nollert MU, Diamond SL, Mclntire LV. Hydrodynamic shear stress and mass transport modulation of endothelial cell metabolism. Biotechnol Bioeng 1991; 38: 588-602
47 Strony J, Beaudoin A, Brands D, Adelman B. Analysis of shear stress and hemodynamic factors in a model of coronary artery stenosis and thrombosis. Am J Physiol 1993; 265 (05) H1787-H1796
48 O’Brien JR. Shear-induced platelet aggregation. Lancet 1990; 335: 711-713
49 Slack SM, Jennings LK, Turitto VT. Platelet size distribution measurements as indicators of shear stress-induced platelet aggregation. Ann Biomed Eng 1994; 22: 653-659
50 Slack SM, Cui Y, Turitto VT. The effects of flow on blood coagulation and thrombosis. Thromb Haemost 1993; 70: 129-134
51 Heliums JD. 1993 Whitaker Lecture: Biorheology in thrombosis research. Ann Biomed Eng 1994; 22: 445-455
52 Baumgartner HR. The role of blood flow in platelet adhesion, fibrin deposition and formation of mural thrombi. Microvasc Res 1973; 5: 167-179
53 Goldsmith HL, Yu SS, Marlow J. Fluid mechanical stress and the platelet. Thromb Diath Haemorrh 1975; 34: 32-41
54 Goldsmith HL, Turitto VT. Rheological aspects of thrombosis and haemostasis: Basic principles and applications. Thromb Haemost 1986; 55: 415-435
55 Badimon L, Badimon JJ. Mechanisms of arterial thrombosis in non-parallel streamlines: Platelet thrombi grow on the apex of stenotic severely injured vessel wall. J Clin Invest 1989; 84: 1134-1144
56 Early CB, Fink LH. Some fundamental applications of the Law of Laplace in neurosurgery. Surg Neurol 1976; 6: 185-189
57 Lever MJ. Mass transport processes in atherosclerosis. In: Vascular Dynamics - Physiological Perspectives Westerhof N, Gross DR. eds. Plenum Press; New York: 1989
58 Graves VB, Partington CR, Rufenacht DA, Rappe AH, Strother CM. Treatment of carotid artery aneurysms with platinum coils: An experimental study in dogs. AJNR 1990; 11: 249-252
59 Graves VB, Strother CM, Partington CR, Rappe AH. Flow dynamics of lateral carotid artery aneurysms and their effects on coils and balloons: An experimental study in dogs. AJNR 1992; 13: 189-196
60 Graves VB, Strother CM, Rappe AH. Treatment of experimental canine carotid aneurysms with platinum coils. AJNR 1993; 14: 787-793
61 Canham PB, Ferguson GC. A mathematical model for the mechanics of saccular aneurysms. Neurosurgery 1985; 17: 291-295
62 Stehbens WE. Flow disturbances in glass models of aneurysms at low Reynolds numbers. Quart J Experim Physiology 1974; 59: 167-174
63 Steiger HJ, Reulen HJ. Low frequency flow fluctuations in human saccular aneurysms. Acta Neurochir (Wien) 1986; 83: 131-137
64 Steiger HJ, Poll A, Liepsch D, Reulen HJ. Basic flow structure in saccular aneurysms: A flow visualization study. Heart Vessels 1987; 3: 55-65
65 Whitaker S. Introduction to Fluid Mechanics. Krieger Publishing Co, Malabar, FL 1968
66 Weir B. Aneurysms Affecting the Nervous System. Williams & Wilkins, Baltimore, MD 1987
67 Nakatani H, Hashimoto N, Kang Y, Yamazoe N, Kikuchi H, Yamaguchi S, Niimi H. Cerebral blood flow patterns at major vessel bifurcations and aneurysms in rats. J Neurosurg 1991; 74: 258-262