Department of Neurosurgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Graduate School of Engineering, Kobe University, Kobe, Japan.
World Neurosurg. 2021 Aug;152:e377-e386. doi: 10.1016/j.wneu.2021.05.107. Epub 2021 Jun 1.
The thin-walled regions (TIWRs) of intracranial aneurysms have a high risk of rupture during surgical manipulation. They have been reported to be predicted by wall shear stress and pressure (PS) based on computational fluid dynamics analysis, although this remains controversial. In this study, we investigated whether the oscillatory shear index (OSI) can predict TIWRs.
Twenty-five unruptured aneurysms were retrospectively analyzed; the position and orientation of the computational fluid dynamics color maps were adjusted to match the intraoperative micrographs. The red area on the aneurysm wall was defined as TIWR, and if most of the regions on the color map corresponding to TIWR were OSI low (lower quartile range), time-averaged wall shear stress (TAWSS) high, or PS high (upper quartile range), each region was defined as a matched region and divided by the total number of TIWRs to calculate the match rate. In addition, the mean values of OSI, TAWSS, and PS corresponding to TIWRs were quantitatively compared with those in adjacent thick-walled regions.
Among 27 TIWRs of 25 aneurysms, 23, 10, and 14 regions had low OSI, high TAWSS, and high PS regions (match rate: 85.2%, 37.0%, and 51.9%), respectively. Receiver operating characteristic curve analysis demonstrated that OSI was the most effective hemodynamic parameter (area under the curve, 0.881), followed by TAWSS (0.798). Multivariate analysis showed that OSI was a significant independent predictor of TIWRs (odds ratio, 18.30 [95% CI, 3.2800-102.00], P < 0.001).
OSI may be a unique predictor for TIWRs. Low OSI strongly corresponds with TIWRs of intracranial aneurysms.
颅内动脉瘤的薄壁区域（TIWR）在手术操作过程中破裂的风险很高。据报道，基于计算流体动力学分析，壁剪切应力和压力（PS）可以预测 TIWR，尽管这仍然存在争议。在这项研究中，我们研究了振荡剪切指数（OSI）是否可以预测 TIWR。
回顾性分析了 25 个未破裂的动脉瘤；调整计算流体动力学彩色图谱的位置和方向，以匹配术中显微镜照片。动脉瘤壁上的红色区域定义为 TIWR，如果彩色图谱中对应 TIWR 的大部分区域 OSI 低（四分位范围较低）、平均壁剪切应力（TAWSS）高或 PS 高（四分位范围较高），则每个区域被定义为匹配区域，并将其除以 TIWR 的总数来计算匹配率。此外，定量比较了 TIWR 对应的 OSI、TAWSS 和 PS 的平均值与相邻厚壁区域的平均值。
在 25 个动脉瘤的 27 个 TIWR 中，分别有 23、10 和 14 个区域具有低 OSI、高 TAWSS 和高 PS 区域（匹配率：85.2%、37.0%和 51.9%）。接收者操作特征曲线分析表明，OSI 是最有效的血流动力学参数（曲线下面积，0.881），其次是 TAWSS（0.798）。多变量分析表明，OSI 是 TIWR 的显著独立预测因子（优势比，18.30 [95%置信区间，3.2800-102.00]，P<0.001）。
OSI 可能是 TIWR 的独特预测因子。低 OSI 与颅内动脉瘤的 TIWR 强烈相关。
