Tian Zhongbin, Li Xifeng, Wang Chao, Feng Xin, Sun Kaijian, Tu Yi, Su Hengxian, Yang Xinjian, Duan Chuanzhi
National Key Clinical Specialty, Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Neurosurgery Institute, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
Department of Neurosurgery, Binzhou Medical University Hospital, Binzhou, China.
Front Neurol. 2022 Apr 21;13:818335. doi: 10.3389/fneur.2022.818335. eCollection 2022.
Assessing rupture risk in patients with unruptured intracranial aneurysms (UIAs) remains challenging. Hemodynamics plays an important role in the natural history of intracranial aneurysms. This study aimed to compare aneurysmal hemodynamic features between patients with different rupture risk as determined by PHASES score.
We retrospectively examined 238 patients who harbored a solitary saccular UIA. Patients were stratified by rupture risk into low-, intermediate-, and high-risk groups according to PHASES score. Flow simulations were performed to compare differences in hemodynamics among the groups.
Aneurysmal time-averaged wall shear stress (WSSa) and normalized WSS (WSSn) decreased progressively as PHASES score increased. WSSa and WSSn significantly differed among the low-, intermediate-, and high-risk groups ( < 0.001). WSSa was significantly lower in the high-risk group than the low-risk group ( < 0.001) and the intermediate-risk group ( = 0.004). WSSn was also significantly lower in the high-risk group than the low-risk group ( < 0.001) and the intermediate-risk group ( = 0.001).
Low WSS was significantly associated with higher risk of intracranial aneurysm rupture as determined by PHASES score, indicating that hemodynamics may play an important role in aneurysmal rupture. In the future, a multidimensional rupture risk prediction model that includes hemodynamic parameters should be investigated.
评估未破裂颅内动脉瘤（UIAs）患者的破裂风险仍然具有挑战性。血流动力学在颅内动脉瘤的自然病程中起着重要作用。本研究旨在比较根据PHASES评分确定的不同破裂风险患者之间的动脉瘤血流动力学特征。
我们回顾性研究了238例患有孤立性囊状未破裂颅内动脉瘤的患者。根据PHASES评分将患者按破裂风险分层为低、中、高风险组。进行血流模拟以比较各组之间的血流动力学差异。
随着PHASES评分增加，动脉瘤的时间平均壁面切应力（WSSa）和标准化壁面切应力（WSSn）逐渐降低。低、中、高风险组之间的WSSa和WSSn存在显著差异（<0.001）。高风险组的WSSa显著低于低风险组（<0.001）和中风险组（=0.004）。高风险组的WSSn也显著低于低风险组（<0.001）和中风险组（=0.001）。
根据PHASES评分，低壁面切应力与颅内动脉瘤破裂的较高风险显著相关，表明血流动力学可能在动脉瘤破裂中起重要作用。未来，应研究包含血流动力学参数的多维破裂风险预测模型。
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