High hemodynamic stresses induce aneurysms at internal carotid artery bends

To investigate the role of hemodynamic stresses in initiating cerebral aneurysms at bends of internal carotid artery (ICA). Sixty-one patients with 68 aneurysms at ICA bends were retrospectively enrolled as the experiment group. Among the 61 patients, 30 normal ICAs without aneurysms were chosen as the control. All patients had 3-dimensional angiography and CFD analysis. The bending angle was significantly (P < .0001) smaller in the experiment than control group (131.2º ± 14.9º vs 150.3º ± 9.5º). The dynamic pressure, shear stress, vorticity magnitude and strain rate were the least at direct flow impinging center where the total pressure was very high. The dynamic stress, shear stress, strain rate and gradients of total pressure except for gradient 1 were significantly (P < .05) greater at the aneurysm site than at all the other sites. The total pressure at the aneurysm site was greater (P < .05) than at 1 lateral location and at the distal area but smaller (P < .05) than at the proximal area. The dynamic pressure, shear stress, strain rate and gradient of total pressure at the aneurysm site were significantly (P < .001) greater than on the aneurysm dome. The hemodynamic stresses were all significantly (P < .01) greater at the aneurysm site in the experiment group than at the site corresponding to the aneurysm in the control group. Aneurysms at the ICA bends are caused by direct flow impingement and increased hemodynamic stresses, and smaller arterial bending angles result in abnormally enhanced hemodynamic stresses to initiate an aneurysm near the flow impingement area.