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]
Flow pattern	—	—	Complex	Statistical association	Cebral et al. [14, 37]
Hydrostatic
Pressure	High	High	High	Passive yield/water hammer effect	Inci and Spetzler [38], Morimoto et al. [8] Steiger et al. [39]