title: Hemodynamic changes in a middle cerebral artery aneurysm at follow-up times before and after its rupture: a case report and a review of the literature.
abstract: Hemodynamic parameters play a significant role in the development of cerebral aneurysms. Parameters such as wall shear stress (WSS) or velocity could change in time and may contribute to aneurysm growth and rupture. However, the hemodynamic changes at the rupture location remain unclear because it is difficult to obtain data prior to rupture. We analyzed a case of a ruptured middle cerebral artery (MCA) aneurysm for which we acquired imaging data at three time points, including at rupture. A patient with an observed MCA aneurysm was admitted to the emergency department with clinical symptoms of a subarachnoid hemorrhage. During three-dimensional (3D) digital subtraction angiography (DSA), the aneurysm ruptured again. Imaging data from two visits before rupture and this 3D DSA images at the moment of rupture were acquired, and computational fluid dynamic (CFD) simulations were performed. Results were used to describe the time-dependent changes of the hemodynamic variables associated with rupture. Time-dependent hemodynamic changes at the rupture location were characterized by decreased WSS and flow velocity magnitude. The impingement jet in the dome changed its position in time and the impingement area at follow-up moved near the rupture location. The results suggest that the increased WSS on the dome and increased low wall shear stress area (LSA) and decreased WSS on the daughter bleb with slower flow and slow vortex may be associated with rupture. CFD performed during the follow-up period may be part of diagnostic tools used to determine the risk of aneurysm rupture.
authors.affiliation: Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic.|Division of Engineering, Mayo Clinic, Rochester, MN, USA.
authors.forename: A
authors.initials: A
authors.lastname: Sejkorová
authors.affiliation: Division of Engineering, Mayo Clinic, Rochester, MN, USA.
authors.forename: K D
authors.initials: KD
authors.lastname: Dennis
authors.affiliation: Mathematical Institute of Charles University, 8, Praha, Czech Republic.
authors.forename: H
authors.initials: H
authors.lastname: Švihlová
authors.affiliation: Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: O
authors.initials: O
authors.lastname: Petr
authors.affiliation: Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: G
authors.initials: G
authors.lastname: Lanzino
authors.affiliation: Department of Neurosurgery, Masaryk Hospital, J. E. Purkyně University, Ústí nad Labem, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
authors.forename: A
authors.initials: A
authors.lastname: Hejčl
authors.affiliation: Department of Physiology and Biomedical Engineering, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA. DragomirDaescu.Dan@mayo.edu.
authors.forename: D
authors.initials: D
authors.lastname: Dragomir-Daescu
mesh_terms: D017542:Aneurysm, Ruptured / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D015901:Angiography, Digital Subtraction; D005260:Female; D006439:Hemodynamics; D006801:Humans; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008875:Middle Aged; D008955:Models, Cardiovascular; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology
keywords: Computational fluid dynamics; Flow dynamic; Rupture location; Velocity; Wall shear stress