Predicting Atherosclerosis in Unruptured MCA Aneurysm with Computational Fluid Dynamics Study

Area of Science:

• Medical Imaging
• Computational Fluid Dynamics
• Vascular Surgery

Background:

• Atherosclerotic changes in middle cerebral artery (MCA) aneurysms pose risks of emboli and distal arterial occlusion.
• Computational fluid dynamics (CFD) is being explored as a diagnostic tool for aneurysm hemodynamics.
• Predicting atherosclerotic changes in MCA bifurcation aneurysms is crucial for surgical planning.

Purpose of the Study:

• To evaluate CFD as a tool for predicting atherosclerotic changes in unruptured MCA bifurcation aneurysms.
• To correlate CFD findings with intraoperative microscopic observations of MCA aneurysms.
• To investigate the relationship between CFD-derived hemodynamic parameters and atherosclerosis in MCA aneurysms.

Main Methods:

• Retrospective review of intraoperative video recordings of MCA bifurcation aneurysms (September 2014 - May 2017).
• Analysis of MCA bifurcation aneurysms with atherosclerotic changes using CFD, examining wall pressure, wall shear stress (magnitude and vectors), and flow patterns.
• Correlation of CFD findings with intraoperative observations in patients who underwent open surgery.

Main Results:

• Decreased wall pressure observed in atherosclerotic segments of MCA aneurysms.
• Low shear stress magnitude and divergent shear stress vectors identified in atherosclerotic segments.
• Four cases demonstrated moderately decreased wall pressure and decreased wall shear stress magnitude in atherosclerotic areas.

Conclusions:

• CFD shows potential in identifying hemodynamic changes associated with atherosclerosis in MCA aneurysms.
• Findings suggest a correlation between decreased wall pressure and low shear stress with atherosclerotic changes.
• Larger, multicentric studies are needed to establish statistical significance and validate CFD's predictive capabilities for MCA aneurysm atherosclerosis.