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.
Stroke. 2014 Jan;45(1):261-4. doi: 10.1161/STROKEAHA.113.003247. Epub 2013 Nov 19.
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.
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.
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.
The wall shear stress cumulative probability function may be a potential predictor of small-sized aneurysm rupture.
颅内动脉瘤破裂后引发的蛛网膜下腔出血仍然是一种严重的状况。我们进行了一项病例对照研究，旨在评估计算血流动力学在检测易破裂脑动脉瘤中的应用。
最初纳入前瞻性数据库的 4 例偶然发现的、最终破裂的动脉瘤患者（病例）参与了此项研究，这些患者在破裂前进行了三维成像。破裂发生在不同的动脉节段：大脑中动脉 M1 段；基底动脉尖；小脑后下动脉；前交通动脉。每个病例均随机选择 5 个位置和大小相匹配的对照。评估了每个病例的动脉瘤壁切应力百分位数的经验累积分布函数，并用于定义一个易破裂的临界范围。然后使用单变量逻辑回归分析评估破裂的个体风险。
确定并拟合了一种适用于小尺寸动脉瘤的血流动力学易破裂范围的累积壁切应力分布，且该分布与位置无关。初步测试的敏感性和特异性分别为 90%和 93%。
壁切应力累积概率函数可能是小尺寸动脉瘤破裂的一个潜在预测因子。
