title: Physical factors effecting cerebral aneurysm pathophysiology.
abstract: Many factors that are either blood-, wall-, or hemodynamics-borne have been associated with the initiation, growth, and rupture of intracranial aneurysms. The distribution of cerebral aneurysms around the bifurcations of the circle of Willis has provided the impetus for numerous studies trying to link hemodynamic factors (flow impingement, pressure, and/or wall shear stress) to aneurysm pathophysiology. The focus of this review is to provide a broad overview of such hemodynamic associations as well as the subsumed aspects of vascular anatomy and wall structure. Hemodynamic factors seem to be correlated to the distribution of aneurysms on the intracranial arterial tree and complex, slow flow patterns seem to be associated with aneurysm growth and rupture. However, both the prevalence of aneurysms in the general population and the incidence of ruptures in the aneurysm population are extremely low. This suggests that hemodynamic factors and purely mechanical explanations by themselves may serve as necessary, but never as necessary and sufficient conditions of this disease's causation. The ultimate cause is not yet known, but it is likely an additive or multiplicative effect of a handful of biochemical and biomechanical factors.
authors.affiliation: Department of Neurological Surgery, Stony Brook University Medical Center, 100 Nicolls Road, HSC T12, Room 080, Stony Brook, NY 11794-8122, USA.
authors.forename: Chander
authors.initials: C
authors.lastname: Sadasivan
authors.forename: David J
authors.initials: DJ
authors.lastname: Fiorella
authors.forename: Henry H
authors.initials: HH
authors.lastname: Woo
authors.forename: Baruch B
authors.initials: BB
authors.lastname: Lieber
mesh_terms: D001921:Brain / Q000473:pathology / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D006439:Hemodynamics; D006801:Humans; D002532:Intracranial Aneurysm / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*
references.citation: Acta Neurochir (Wien). 1993;120(1-2):1-6
references.pmid: 8434510
references.citation: NMR Biomed. 2012 Jan;25(1):14-26
references.pmid: 21480417
references.citation: J Korean Neurosurg Soc. 2009 Feb;45(2):85-9
references.pmid: 19274117
references.citation: Neurosurgery. 1997 Sep;41(3):642-66; discussion 646-7
references.pmid: 9310982
references.citation: IEEE Trans Med Imaging. 2005 Apr;24(4):457-67
references.pmid: 15822804
references.citation: AJNR Am J Neuroradiol. 2008 Oct;29(9):1761-7
references.pmid: 18599576
references.citation: Stroke. 1997 Apr;28(4):799-804
references.pmid: 9099199
references.citation: J Cereb Blood Flow Metab. 2009 Dec;29(12):1975-82
references.pmid: 19756018
references.citation: Stroke. 2012 May;43(5):1436-9
references.pmid: 22363053
references.citation: J Neurointerv Surg. 2010 Jun;2(2):120-30
references.pmid: 21990591
references.citation: Heart Vessels. 1989;5(1):41-6
references.pmid: 2584177
references.citation: Neurosurgery. 2008 Mar;62(3):602-9; discussion 602-9
references.pmid: 18301349
references.citation: Int J Numer Method Biomed Eng. 2012 Jun-Jul;28(6-7):697-713
references.pmid: 25364846
references.citation: J Biomech Eng. 2008 Apr;130(2):021015
references.pmid: 18412502
references.citation: NMR Biomed. 2009 Oct;22(8):795-808
references.pmid: 19412933
references.citation: Neurosurgery. 1999 Jul;45(1):119-29; discussion 129-30
references.pmid: 10414574
references.citation: J Biomech Eng. 2009 Sep;131(9):091004
references.pmid: 19725693
references.citation: Acta Neurochir (Wien). 2001;143(5):429-48; discussion 448-9
references.pmid: 11482693
references.citation: Neuroradiology. 2005 Dec;47(12):931-7
references.pmid: 16136262
references.citation: J Neurol Neurosurg Psychiatry. 2007 Dec;78(12):1365-72
references.pmid: 17470467
references.citation: Stroke. 1988 Mar;19(3):352-6
references.pmid: 3354022
references.citation: Biomech Model Mechanobiol. 2011 Feb;10(1):109-32
references.pmid: 20496095
references.citation: Neurol Res. 2002;24 Suppl 1:S33-42
references.pmid: 12074435
references.citation: Ann Biomed Eng. 1997 May-Jun;25(3):460-9
references.pmid: 9146801
references.citation: Neuroimaging Clin N Am. 2006 Aug;16(3):383-90, vii
references.pmid: 16935706
references.citation: Biorheology. 1993 May-Aug;30(3-4):287-98
references.pmid: 8286729
references.citation: J Biomech. 2011 Oct 13;44(15):2685-91
references.pmid: 21924427
references.citation: AJNR Am J Neuroradiol. 1999 Aug;20(7):1309-17
references.pmid: 10472991
references.citation: Neurol Res. 1996 Jun;18(3):204-8
references.pmid: 8837052
references.citation: Neuroradiology. 1998 Nov;40(11):755-60
references.pmid: 9860129
references.citation: Neurosurgery. 2011 Feb;68(2):310-7; discussion 317-8
references.pmid: 21135739
references.citation: Stroke. 2008 Nov;39(11):2997-3002
references.pmid: 18688012
references.citation: World Neurosurg. 2012 Nov;78(5):418-21
references.pmid: 22120234
references.citation: Neuroradiology. 1994 Oct;36(7):530-6
references.pmid: 7845578
references.citation: Neurosurgery. 2004 Jun;54(6):1450-60; discussion 1460-2
references.pmid: 15157303
references.citation: Crit Care Med. 2002 Mar;30(3):563-9
references.pmid: 11990915
references.citation: J Neurosurg. 1970 Nov;33(5):485-97
references.pmid: 5479489
references.citation: Neurosurgery. 2006 Feb;58(2):217-23; discussion 217-23
references.pmid: 16462474
references.citation: J Neurosurg. 2004 Jul;101(1):108-13
references.pmid: 15255260
references.citation: J Neurosurg. 2012 Apr;116(4):871-81
references.pmid: 22242668
references.citation: Rofo. 2010 Feb;182(2):140-50
references.pmid: 19859863
references.citation: J Biomech. 2011 Nov 10;44(16):2826-32
references.pmid: 21924724
references.citation: Yale J Biol Med. 2012 Jun;85(2):217-28
references.pmid: 22737050
references.citation: J Neurol Neurosurg Psychiatry. 1959 Nov;22:259-66
references.pmid: 13812726
references.citation: Br Med J. 1966 May 7;1(5496):1138-42
references.pmid: 5932074
references.citation: Neuroradiology. 2008 May;50(5):411-21
references.pmid: 18180916
references.citation: Stroke. 1978 Nov-Dec;9(6):583-7
references.pmid: 741491
references.citation: Acta Neurochir (Wien). 2010 Aug;152(8):1391-8; discussion 1398
references.pmid: 20390310
references.citation: J Neurosurg. 2005 Oct;103(4):662-80
references.pmid: 16266049
references.citation: Technol Health Care. 2005;13(4):281-91
references.pmid: 16055976
references.citation: Neurol Res. 1993 Jun;15(3):185-91
references.pmid: 8103585
references.citation: Stroke. 2005 Sep;36(9):1933-8
references.pmid: 16081858
references.citation: Stroke. 2004 Oct;35(10):2287-93
references.pmid: 15322297
references.citation: Med Phys. 2009 Dec;36(12):5612-21
references.pmid: 20095274
references.citation: Surg Neurol. 2006 Sep;66(3):252-6; discussion 257
references.pmid: 16935627
references.citation: Stroke. 2007 Sep;38(9):2500-5
references.pmid: 17673714
references.citation: Stroke. 1998 Jan;29(1):251-6
references.pmid: 9445359
references.citation: Med Biol Eng Comput. 2008 Nov;46(11):1097-112
references.pmid: 19002516
references.citation: Ann Biomed Eng. 2011 May;39(5):1457-69
references.pmid: 21225345
references.citation: Hum Mol Genet. 2006 Nov 15;15(22):3361-8
references.pmid: 17038484
references.citation: Stroke. 1972 May-Jun;3(3):255-67
references.pmid: 5034974
references.citation: AJNR Am J Neuroradiol. 2004 Sep;25(8):1356-65
references.pmid: 15466332
references.citation: Arch Pathol. 1963 Jan;75:45-64
references.pmid: 14087271
references.citation: AJNR Am J Neuroradiol. 2010 Feb;31(2):304-10
references.pmid: 19797790
references.citation: J Clin Neurosci. 2011 Oct;18(10):1285-8
references.pmid: 21795051
references.citation: J Hum Genet. 2006;51(7):587-94
references.pmid: 16736093
references.citation: J Biomech Eng. 2006 Aug;128(4):516-26
references.pmid: 16813443
references.citation: AJNR Am J Neuroradiol. 2011 Feb;32(2):264-70
references.pmid: 21051508
references.citation: Acta Neurochir (Wien). 2009 May;151(5):479-85; discussion 485
references.pmid: 19343271
references.citation: Surg Neurol. 2006 Jan;65(1):18-25; discussion 25-7
references.pmid: 16378842
references.citation: AJNR Am J Neuroradiol. 2006 Sep;27(8):1703-9
references.pmid: 16971618
references.citation: Neuroradiology. 2010 Dec;52(12):1135-41
references.pmid: 20373097
references.citation: J Magn Reson Imaging. 2011 Jul;34(1):22-30
references.pmid: 21698704
references.citation: Neurosurg Focus. 2009 May;26(5):E2
references.pmid: 19408998
references.citation: J Neurointerv Surg. 2012 Sep;4(5):351-7
references.pmid: 21990529
references.citation: Stroke. 2004 May;35(5):1153-7
references.pmid: 15017007
references.citation: AJNR Am J Neuroradiol. 2006 May;27(5):1113-8
references.pmid: 16687554
references.citation: AJNR Am J Neuroradiol. 1992 Jul-Aug;13(4):1089-95
references.pmid: 1636518
references.citation: J Neurosurg. 2003 Sep;99(3):526-33
references.pmid: 12959441
references.citation: Ann Biomed Eng. 2012 Oct;40(10):2188-211
references.pmid: 22532324
references.citation: J Biomech. 2009 Mar 11;42(4):550-4
references.pmid: 19195658
references.citation: Heart Vessels. 1987;3(2):55-65
references.pmid: 3500943
references.citation: Stroke. 2005 Dec;36(12):2773-80
references.pmid: 16282541
references.citation: J Biomech. 2008;41(2):241-8
references.pmid: 18078944
references.citation: J Neurosurg. 2005 Feb;102(2):355-62
references.pmid: 15739566
references.citation: J Neurosurg. 1987 Jan;66(1):23-9
references.pmid: 3783255
references.citation: J Neurointerv Surg. 2012 Jan 1;4(1):22-6
references.pmid: 21990452
references.citation: Heart Vessels. 2008 Jan;23(1):60-6
references.pmid: 18273548
references.citation: Neurosurgery. 2001 Mar;48(3):495-502; discussion 502-3
references.pmid: 11270538
references.citation: Stroke. 1986 Sep-Oct;17(5):835-41
references.pmid: 3764951
references.citation: AJNR Am J Neuroradiol. 1999 Nov-Dec;20(10):2000-3
references.pmid: 10588134
references.citation: J Biomech. 2003 Aug;36(8):1143-50
references.pmid: 12831740
references.citation: Neurosurgery. 2009 Apr;64(4):622-30; discussion 630-1
references.pmid: 19349824
references.citation: Neurosurgery. 1995 Oct;37(4):774-82; discussion 782-4
references.pmid: 8559308
references.citation: J Neurosurg. 1954 Mar;11(2):128-34
references.pmid: 13152563
references.citation: Annu Rev Fluid Mech. 2009 Jan 1;41:91-107
references.pmid: 19784385
references.citation: Biorheology. 1987;24(6):689-710
references.pmid: 2971404
references.citation: J Clin Pathol. 1995 Dec;48(12):1078-81
references.pmid: 8567990
references.citation: IEEE Trans Med Imaging. 2009 Aug;28(8):1141-55
references.pmid: 19447701
references.citation: Acad Radiol. 2006 Jul;13(7):811-21
references.pmid: 16777554
references.citation: AJNR Am J Neuroradiol. 2003 Apr;24(4):559-66
references.pmid: 12695182
references.citation: Neurosurgery. 2008 Apr;62(4):767-73; discussion 773-5
references.pmid: 18496182
references.citation: Neuroradiology. 2010 Oct;52(10):921-8
references.pmid: 20012431
references.citation: Ann Biomed Eng. 2010 Oct;38(10):3058-69
references.pmid: 20499185
references.citation: J Neurosurg. 1989 Jun;70(6):823-31
references.pmid: 2654334
references.citation: Anat Sci Int. 2008 Jun;83(2):96-106
references.pmid: 18507619
references.citation: J Neurosurg. 1991 Feb;74(2):258-62
references.pmid: 1988596
references.citation: Stroke. 2007 Jun;38(6):1924-31
references.pmid: 17495215
references.citation: J Stroke Cerebrovasc Dis. 2009 Jan;18(1):48-55
references.pmid: 19110145
references.citation: Neurosurgery. 2001 Dec;49(6):1322-5; discussion 1325-6
references.pmid: 11846931
references.citation: Stroke. 1993 May;24(5):639-46
references.pmid: 8488517
references.citation: Acta Neurochir Suppl (Wien). 1990;48:1-57
references.pmid: 2389684
references.citation: Acta Neurochir (Wien). 1978;45(1-2):27-34
references.pmid: 742437
references.citation: Neurosurgery. 2004 Jun;54(6):1343-7; discussion 1347-8
references.pmid: 15157290
references.citation: Physiol Meas. 2005 Aug;26(4):477-88
references.pmid: 15886442
references.citation: AJNR Am J Neuroradiol. 2011 Mar;32(3):587-94
references.pmid: 21310860
references.citation: Basic Res Cardiol. 1988 Jan-Feb;83(1):24-31
references.pmid: 3377740
references.citation: Stroke. 2004 Nov;35(11):2500-5
references.pmid: 15514200
references.citation: AJNR Am J Neuroradiol. 2011 Jan;32(1):145-51
references.pmid: 21127144
references.citation: J Theor Biol. 2007 Aug 21;247(4):775-87
references.pmid: 17482213
references.citation: Comput Math Methods Med. 2012;2012:782801
references.pmid: 22454695
references.citation: AJNR Am J Neuroradiol. 2012 Mar;33(3):396-8
references.pmid: 22282452
references.citation: Lancet Neurol. 2005 Mar;4(3):179-89
references.pmid: 15721828
references.citation: AJNR Am J Neuroradiol. 2005 Nov-Dec;26(10):2550-9
references.pmid: 16286400
references.citation: J Clin Neurosci. 2011 Nov;18(11):1435-8
references.pmid: 21917457
references.citation: Neuroradiology. 1995 Feb;37(2):159-61
references.pmid: 7761006
references.citation: Int J Numer Method Biomed Eng. 2012 Jun-Jul;28(6-7):801-8
references.pmid: 25364852
references.citation: N Engl J Med. 2006 Aug 31;355(9):928-39
references.pmid: 16943405
references.citation: Eur J Vasc Endovasc Surg. 1998 Oct;16(4):301-10
references.pmid: 9818007
references.citation: Ultrasound Med Biol. 2006 Sep;32(9):1307-13
references.pmid: 16965970
references.citation: AJNR Am J Neuroradiol. 1996 Aug;17(7):1333-7
references.pmid: 8871720
references.citation: Radiology. 2009 Sep;252(3):627-8
references.pmid: 19717746
references.citation: Biomech Model Mechanobiol. 2010 Aug;9(4):481-98
references.pmid: 20111978
references.citation: Acta Neuropathol. 2012 Jun;123(6):773-86
references.pmid: 22249619
references.citation: Surg Neurol. 2000 Jun;53(6):530-40; discussion 540-2
references.pmid: 10940419
references.citation: AJNR Am J Neuroradiol. 2009 Feb;30(2):297-302
references.pmid: 19131411
references.citation: N Engl J Med. 1997 Jan 2;336(1):28-40
references.pmid: 8970938
references.citation: AJNR Am J Neuroradiol. 2011 Oct;32(9):1732-7
references.pmid: 21984256
references.citation: J Neurosurg. 2007 Jun;106(6):1051-60
references.pmid: 17564178
references.citation: Ann Biomed Eng. 2004 Feb;32(2):264-73
references.pmid: 15008374
references.citation: J R Soc Interface. 2012 Apr 7;9(69):677-88
references.pmid: 21957117
references.citation: Ann Biomed Eng. 2008 Sep;36(9):1496-514
references.pmid: 18612828
references.citation: Stroke. 2001 Apr;32(4):1036-42
references.pmid: 11283408
references.citation: Surg Neurol. 1992 Nov;38(5):331-7
references.pmid: 1485208
references.citation: AJNR Am J Neuroradiol. 1999 Oct;20(9):1703-5
references.pmid: 10543644
references.citation: Neurosurgery. 2011 Oct;69(4):843-51; discussion 851
references.pmid: 21623246
references.citation: J Neurosurg. 2012 Apr;116(4):866-9; discussion 869-70
references.pmid: 22242673
references.citation: Neurosurg Focus. 2000;8(5):Preview 1
references.pmid: 16865812
references.citation: Basic Res Cardiol. 1984 May-Jun;79(3):253-61
references.pmid: 6477378
references.citation: Stroke. 1984 Sep-Oct;15(5):846-50
references.pmid: 6474536
references.citation: Med Eng Phys. 2008 Jul;30(6):774-82
references.pmid: 18767212
references.citation: AJNR Am J Neuroradiol. 2006 Mar;27(3):504-12
references.pmid: 16551985
references.citation: Ann Biomed Eng. 2011 Feb;39(2):884-96
references.pmid: 20972626
references.citation: Comput Methods Biomech Biomed Engin. 2010 Oct;13(5):625-40
references.pmid: 20140798
references.citation: Ann Biomed Eng. 2000 May;28(5):533-42
references.pmid: 10925951
references.citation: J Korean Neurosurg Soc. 2009 Jan;45(1):11-5
references.pmid: 19242565
references.citation: AJNR Am J Neuroradiol. 2012 Jun;33(6):992-5
references.pmid: 22653325
references.citation: Acta Bioeng Biomech. 2007;9(2):3-7
references.pmid: 18421937
references.citation: Surg Neurol. 2006 Dec;66(6):574-80; discussion 580
references.pmid: 17145314
references.citation: AJNR Am J Neuroradiol. 2010 Feb;31(2):324-6
references.pmid: 19762460
references.citation: AJNR Am J Neuroradiol. 2012 Mar;33(3):395-6
references.pmid: 22268081
references.citation: J Math Biol. 2002 Nov;45(5):441-60
references.pmid: 12424532
references.citation: Neurology. 2008 Feb 26;70(9):700-5
references.pmid: 18299521
references.citation: Acta Neurochir (Wien). 1987;86(3-4):98-105
references.pmid: 3630787
references.citation: Ann Biomed Eng. 2008 Sep;36(9):1489-95
references.pmid: 18563567
references.citation: AJNR Am J Neuroradiol. 2003 Apr;24(4):553-4
references.pmid: 12695178
references.citation: Med Phys. 2010 Apr;37(4):1689-706
references.pmid: 20443490
references.citation: Stroke. 2003 Aug;34(8):1852-7
references.pmid: 12829865
references.citation: J Biomech. 1980;13(2):175-84
references.pmid: 7364778
references.citation: J Biomech Eng. 2011 May;133(5):051008
references.pmid: 21599099
references.citation: Neurosurgery. 1999 Jul;45(1):89-93; discussion 93-4
references.pmid: 10414570
references.citation: J Neurosurg. 2012 Jul;117(1):60-4
references.pmid: 22540404
references.citation: Biorheology. 1989;26(6):1011-30
references.pmid: 2624892
references.citation: Stroke. 2003 Jan;34(1):187-92
references.pmid: 12511772
references.citation: Int J Biochem Cell Biol. 2003 Sep;35(9):1341-60
references.pmid: 12798348
references.citation: J Neurol. 2009 Jan;256(1):45-50
references.pmid: 19221852
references.citation: J Neurosurg. 2002 Jan;96(1):3-42
references.pmid: 11794601
references.citation: Neurosurg Rev. 2011 Jan;34(1):39-47
references.pmid: 20812022
references.citation: Stroke. 2010 May;41(5):916-20
references.pmid: 20378866
references.citation: Stroke. 1996 Nov;27(11):2086-93; discussion 2094
references.pmid: 8898821
references.citation: Stroke. 1985 May-Jun;16(3):377-85
references.pmid: 3890278
references.citation: J Neurosurg. 1978 Apr;48(4):505-14
references.pmid: 632875
references.citation: Magn Reson Med. 2013 Mar 1;69(3):868-76
references.pmid: 22618854
references.citation: AJNR Am J Neuroradiol. 1992 Jan-Feb;13(1):181-8
references.pmid: 1595440
references.citation: Clin Neuropathol. 1991 Jul-Aug;10(4):187-9
references.pmid: 1884526
references.citation: Neurol Med Chir (Tokyo). 1974;14 pt 1:47-53
references.pmid: 4143466
references.citation: Stroke. 1999 Jul;30(7):1396-401
references.pmid: 10390313
references.citation: J Neurosurg. 1972 Dec;37(6):666-77
references.pmid: 4654696
references.citation: Int J Exp Pathol. 1991 Apr;72(2):183-93
references.pmid: 2015201
references.citation: J Neurosurg. 1972 May;36(5):560-3
references.pmid: 5026542
references.citation: Circ Res. 1955 Sep;3(5):463-8
references.pmid: 13250713
references.citation: Neurosurgery. 2007 Feb;60(2):213-25; discussion 225-6
references.pmid: 17290171
references.citation: J Biomech. 1988;21(11):903-14
references.pmid: 3253276
references.citation: AJNR Am J Neuroradiol. 2007 Apr;28(4):622-7
references.pmid: 17416810
references.citation: J Neurosurg. 2001 Nov;95(5):764-70
references.pmid: 11702865