The Role of Computational Fluid Dynamics in the Management of Unruptured Intracranial Aneurysms: A Clinicians' View
Table 10
Literature-based evidence on the importance of hemodynamics in the etiopathogenesis of ICAs. NB: WSS; wall shear stress, MMP-13; matrixmetalloproteneases-13, iNOS; inducible-nitric oxide synthase, NO; nitric oxide, OSI; oscillatory shear index.
Hemodynamic factors
Intracranial aneurysm
Proposed mechanism(s)
References
Initiation
Growth
Rupture
Dynamic
Wall shear stress (WSS)
High
Low
Low
Increased WSS increases the production of MMP-13 which in turn leads to vessel wall damage.Decreased WSS increases iNOS synthesis—NO induced damage to vessel wall.Low WSS increases endothelial proliferation and apoptosis
Boussel et al. [11], Fukuda et al. [30], Gao et al. [7], Jou et al. [31], Malek et al. [21], Meng et al. [32], Shojima et al. [9], Ujiie et al. [33]
Oscillatory shear index (OSI)
High/Low
High
High
Degenerative changes in endothelium
Glor et al. [35], Goubergrits et al. [34], Mantha et al. [15]
Jet of blood stream
Impingement
Impingement
Impingement
Localized endothelial cell injury
Foutrakis et al. [36], Cebral et al. [14], Cebral et al. [37]