title: Wall shear stress distribution of small aneurysms prone to rupture: a case-control study.
abstract: OBJECTIVE
  Subarachnoid hemorrhage after intracranial aneurysm rupture remains a serious condition. We performed a case-control study to evaluate the use of computed hemodynamics to detect cerebral aneurysms prone to rupture.
  
  
  METHODS
  Four patients with incidental aneurysms that ultimately ruptured (cases) were studied after initially being included in a prospective database including their 3-dimensional imaging before rupture. Ruptures were located in different arterial segments: M1 segment of the middle cerebral artery; basilar tip; posterior inferior cerebellar artery; and anterior communicating artery. For each case, 5 controls matched by location and size were randomly selected. An empirical cumulative distribution function of aneurysm wall shear stress percentiles was evaluated for every case and used to define a critical prone-to-rupture range. Univariate logistic regression analysis was then used to assess the individual risk of rupture.
  
  
  RESULTS
  A cumulative wall shear stress distribution characterizing a hemodynamic prone-to-rupture range for small-sized aneurysms was identified and fitted independent of the location. Sensitivity and specificity of the preliminary tests were 90% and 93%, respectively.
  
  
  CONCLUSIONS
  The wall shear stress cumulative probability function may be a potential predictor of small-sized aneurysm rupture.
authors.affiliation: From the Interventional Neuroradiology Unit, Service of Neuroradiology (V.M.P., O.B., P.B., A.P.N., K.-O.L., R.O.) and Service of Neurosurgery (P.B., K.S.), Faculty of Medicine, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Vitor Mendes
authors.initials: VM
authors.lastname: Pereira
authors.forename: Olivier
authors.initials: O
authors.lastname: Brina
authors.forename: Philippe
authors.initials: P
authors.lastname: Bijlenga
authors.forename: Pierre
authors.initials: P
authors.lastname: Bouillot
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Narata
authors.forename: Karl
authors.initials: K
authors.lastname: Schaller
authors.forename: Karl-Olof
authors.initials: KO
authors.lastname: Lovblad
authors.forename: Rafik
authors.initials: R
authors.lastname: Ouared
mesh_terms: D017542:Aneurysm, Ruptured / Q000473:pathology*; D016022:Case-Control Studies; D002536:Cerebral Arteries / Q000473:pathology; D016208:Databases, Factual; D018450:Disease Progression; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology*; D016015:Logistic Models; D033081:Shear Strength; D013314:Stress, Mechanical
keywords: aneurysm; computer simulation; hemodynamics; rupture