Morphologic and hemodynamic analysis of paraclinoid aneurysms: ruptured versus unruptured.
BACKGROUND
In order to determine the risk factors related to aneurysm rupture, we studied the aneurysms at the paraclinoid segment of the internal carotid artery by applying morphologic and hemodynamic numerical analyzes.


METHODS
107 patients with 110 paraclinoid aneurysms (26 ruptured, 84 unruptured) were analyzed using computational fluid dynamics based on patient-specific three-dimensional geometrical models. A series of morphologic and hemodynamic parameters were evaluated to find the potential indicators of aneurysm rupture.


RESULTS
Aneurysms with an irregular shape accounted for 23.1% of the ruptured group and only 8.3% of the unruptured group. The difference was statistically significant (p=0.042, χ(2) test). Ruptured paraclinoid aneurysms were found to be significantly smaller than unruptured aneurysms (p=0.041), which is different from the results of most previous studies. Energy loss (EL) and inflow concentration showed a level of statistical significance to assess the risk of rupture in paraclinoid aneurysms. By multivariate logistic regression analysis, aneurysm shape (regular or irregular), EL and inflow concentration were retained as independently significant parameters. The odds of rupture were increased by 1.65 times for a 10% increase in EL, by 4.88 times for an aneurysm with an irregular shape and by 2.91 times for an aneurysm with concentrated inflow jet.


CONCLUSIONS
Irregular shape, larger EL and concentrated inflow jet were independently associated with the rupture status of paraclinoid aneurysms. These findings need to be further confirmed based on large multicenter and multipopulation data.
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Jian
J
Liu
The Mechanical and Aerospace Engineering Department and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
Jianping
J
Xiang
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Ying
Y
Zhang
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Yang
Y
Wang
Department of Biomedical Engineering, Capital Medical University, Beijing, China.
Haiyun
H
Li
The Mechanical and Aerospace Engineering Department and Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
Hui
H
Meng
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Xinjian
X
Yang
D000465:Algorithms; D017542:Aneurysm, Ruptured / Q000473:pathology* / Q000503:physiopathology*; D015901:Angiography, Digital Subtraction; D002533:Cerebral Angiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008959:Models, Neurological; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors