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<meta name="DC.Title" content="Flow Conditions in the Intracranial Aneurysm Lumen Are Associated with Inflammation and Degenerative Changes of the Aneurysm Wall" />
<meta name="DC.Identifier" content="10.3174/ajnr.A4951" />
<meta name="DC.Date" content="2017-01-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2017 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Saccular intracranial aneurysm is a common disease that may cause devastating intracranial hemorrhage. Hemodynamics, wall remodeling, and wall inflammation have been associated with saccular intracranial aneurysm rupture. We investigated how saccular intracranial aneurysm hemodynamics is associated with wall remodeling and inflammation of the saccular intracranial aneurysm wall.

MATERIALS AND METHODS: Tissue samples resected during a saccular intracranial aneurysm operation (11 unruptured, 9 ruptured) were studied with histology and immunohistochemistry. Patient-specific computational models of hemodynamics were created from preoperative CT angiographies.

RESULTS: More stable and less complex flows were associated with thick, hyperplastic saccular intracranial aneurysm walls, while slower flows with more diffuse inflow were associated with degenerated and decellularized saccular intracranial aneurysm walls. Wall degeneration ( P = .041) and rupture were associated with increased inflammation (CD45+, P = .031). High wall shear stress ( P = .018), higher vorticity ( P = .046), higher viscous dissipation ( P = .046), and high shear rate ( P = .046) were associated with increased inflammation. Inflammation was also associated with lack of an intact endothelium ( P = .034) and the presence of organized luminal thrombosis ( P = .018), though overall organized thrombosis was associated with low minimum wall shear stress ( P = .034) and not with the flow conditions associated with inflammation.

CONCLUSIONS: Flow conditions in the saccular intracranial aneurysm are associated with wall remodeling. Inflammation, which is associated with degenerative wall remodeling and rupture, is related to high flow activity, including elevated wall shear stress. Endothelial injury may be a mechanism by which flow induces inflammation in the saccular intracranial aneurysm wall. Hemodynamic simulations might prove useful in identifying saccular intracranial aneurysms at risk of developing inflammation, a potential biomarker for rupture.

max
:   maximum
OSI
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sIA
:   saccular intracranial aneurysm
VO
:   vorticity
WSS
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<meta name="DC.Contributor" content="J. Cebral" />
<meta name="DC.Contributor" content="E. Ollikainen" />
<meta name="DC.Contributor" content="B.J. Chung" />
<meta name="DC.Contributor" content="F. Mut" />
<meta name="DC.Contributor" content="V. Sippola" />
<meta name="DC.Contributor" content="B.R. Jahromi" />
<meta name="DC.Contributor" content="R. Tulamo" />
<meta name="DC.Contributor" content="J. Hernesniemi" />
<meta name="DC.Contributor" content="M. Niemelä" />
<meta name="DC.Contributor" content="A. Robertson" />
<meta name="DC.Contributor" content="J. Frösen" />
<meta name="article:published_time" content="2017-01-01" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="Flow Conditions in the Intracranial Aneurysm Lumen Are Associated with Inflammation and Degenerative Changes of the Aneurysm Wall" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Saccular intracranial aneurysm is a common disease that may cause devastating intracranial hemorrhage. Hemodynamics, wall remodeling, and wall inflammation have been associated with saccular intracranial aneurysm rupture. We investigated how saccular intracranial aneurysm hemodynamics is associated with wall remodeling and inflammation of the saccular intracranial aneurysm wall.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Tissue samples resected during a saccular intracranial aneurysm operation (11 unruptured, 9 ruptured) were studied with histology and immunohistochemistry. Patient-specific computational models of hemodynamics were created from preoperative CT angiographies.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;More stable and less complex flows were associated with thick, hyperplastic saccular intracranial aneurysm walls, while slower flows with more diffuse inflow were associated with degenerated and decellularized saccular intracranial aneurysm walls. Wall degeneration (&lt;i&gt;P&lt;/i&gt; = .041) and rupture were associated with increased inflammation (CD45+, &lt;i&gt;P&lt;/i&gt; = .031). High wall shear stress (&lt;i&gt;P&lt;/i&gt; = .018), higher vorticity (&lt;i&gt;P&lt;/i&gt; = .046), higher viscous dissipation (&lt;i&gt;P&lt;/i&gt; = .046), and high shear rate (&lt;i&gt;P&lt;/i&gt; = .046) were associated with increased inflammation. Inflammation was also associated with lack of an intact endothelium (&lt;i&gt;P&lt;/i&gt; = .034) and the presence of organized luminal thrombosis (&lt;i&gt;P&lt;/i&gt; = .018), though overall organized thrombosis was associated with low minimum wall shear stress (&lt;i&gt;P&lt;/i&gt; = .034) and not with the flow conditions associated with inflammation.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Flow conditions in the saccular intracranial aneurysm are associated with wall remodeling. Inflammation, which is associated with degenerative wall remodeling and rupture, is related to high flow activity, including elevated wall shear stress. Endothelial injury may be a mechanism by which flow induces inflammation in the saccular intracranial aneurysm wall. Hemodynamic simulations might prove useful in identifying saccular intracranial aneurysms at risk of developing inflammation, a potential biomarker for rupture.&lt;/p&gt;" />
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<meta name="twitter:title" content="Flow Conditions in the Intracranial Aneurysm Lumen Are Associated with Inflammation and Degenerative Changes of the Aneurysm Wall" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Saccular intracranial aneurysm is a common disease that may cause devastating intracranial hemorrhage. Hemodynamics, wall remodeling, and wall inflammation have been associated with saccular intracranial aneurysm rupture. We investigated how saccular intracranial aneurysm hemodynamics is associated with wall remodeling and inflammation of the saccular intracranial aneurysm wall.

MATERIALS AND METHODS: Tissue samples resected during a saccular intracranial aneurysm operation (11 unruptured, 9 ruptured) were studied with histology and immunohistochemistry. Patient-specific computational models of hemodynamics were created from preoperative CT angiographies.

RESULTS: More stable and less complex flows were associated with thick, hyperplastic saccular intracranial aneurysm walls, while slower flows with more diffuse inflow were associated with degenerated and decellularized saccular intracranial aneurysm walls. Wall degeneration ( P = .041) and rupture were associated with increased inflammation (CD45+, P = .031). High wall shear stress ( P = .018), higher vorticity ( P = .046), higher viscous dissipation ( P = .046), and high shear rate ( P = .046) were associated with increased inflammation. Inflammation was also associated with lack of an intact endothelium ( P = .034) and the presence of organized luminal thrombosis ( P = .018), though overall organized thrombosis was associated with low minimum wall shear stress ( P = .034) and not with the flow conditions associated with inflammation.

CONCLUSIONS: Flow conditions in the saccular intracranial aneurysm are associated with wall remodeling. Inflammation, which is associated with degenerative wall remodeling and rupture, is related to high flow activity, including elevated wall shear stress. Endothelial injury may be a mechanism by which flow induces inflammation in the saccular intracranial aneurysm wall. Hemodynamic simulations might prove useful in identifying saccular intracranial aneurysms at risk of developing inflammation, a potential biomarker for rupture.

max
:   maximum
OSI
:   oscillatory shear index
sIA
:   saccular intracranial aneurysm
VO
:   vorticity
WSS
:   wall shear stress" />
<meta name="og-title" property="og:title" content="Flow Conditions in the Intracranial Aneurysm Lumen Are Associated with Inflammation and Degenerative Changes of the Aneurysm Wall" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/38/1/119" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Saccular intracranial aneurysm is a common disease that may cause devastating intracranial hemorrhage. Hemodynamics, wall remodeling, and wall inflammation have been associated with saccular intracranial aneurysm rupture. We investigated how saccular intracranial aneurysm hemodynamics is associated with wall remodeling and inflammation of the saccular intracranial aneurysm wall.

MATERIALS AND METHODS: Tissue samples resected during a saccular intracranial aneurysm operation (11 unruptured, 9 ruptured) were studied with histology and immunohistochemistry. Patient-specific computational models of hemodynamics were created from preoperative CT angiographies.

RESULTS: More stable and less complex flows were associated with thick, hyperplastic saccular intracranial aneurysm walls, while slower flows with more diffuse inflow were associated with degenerated and decellularized saccular intracranial aneurysm walls. Wall degeneration ( P = .041) and rupture were associated with increased inflammation (CD45+, P = .031). High wall shear stress ( P = .018), higher vorticity ( P = .046), higher viscous dissipation ( P = .046), and high shear rate ( P = .046) were associated with increased inflammation. Inflammation was also associated with lack of an intact endothelium ( P = .034) and the presence of organized luminal thrombosis ( P = .018), though overall organized thrombosis was associated with low minimum wall shear stress ( P = .034) and not with the flow conditions associated with inflammation.

CONCLUSIONS: Flow conditions in the saccular intracranial aneurysm are associated with wall remodeling. Inflammation, which is associated with degenerative wall remodeling and rupture, is related to high flow activity, including elevated wall shear stress. Endothelial injury may be a mechanism by which flow induces inflammation in the saccular intracranial aneurysm wall. Hemodynamic simulations might prove useful in identifying saccular intracranial aneurysms at risk of developing inflammation, a potential biomarker for rupture.

max
:   maximum
OSI
:   oscillatory shear index
sIA
:   saccular intracranial aneurysm
VO
:   vorticity
WSS
:   wall shear stress" />
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    <div class="highwire-article-citation highwire-citation-type-highwire-article node40--5" data-node-nid="40" id="top-node-40--6861952222" data-pisa="ajnr;38/1/119" data-pisa-master="ajnr;ajnr.A4951" data-apath="/ajnr/38/1/119.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a">
  
  
      <div class="highwire-cite-overline"><span  class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span  class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">INTERVENTIONAL</span></span></div>
  
      <div class="highwire-cite-access"><span class="highwire-citation-access"><i class="highwire-access-icon highwire-access-icon-open-access open-access hw-icon-open-access" title="Open Access" aria-hidden="true"></i><span  class="element-invisible highwire-access-icon highwire-access-icon-open-access" style="">Open Access</span></span></div>
  
      <h1 class="highwire-cite-title" id="page-title">Flow Conditions in the Intracranial Aneurysm Lumen Are Associated with Inflammation and Degenerative Changes of the Aneurysm Wall</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">J. Cebral</span>, <span class="highwire-citation-author" data-delta="1">E. Ollikainen</span>, <span class="highwire-citation-author" data-delta="2">B.J. Chung</span>, <span class="highwire-citation-author" data-delta="3">F. Mut</span>, <span class="highwire-citation-author" data-delta="4">V. Sippola</span>, <span class="highwire-citation-author" data-delta="5">B.R. Jahromi</span>, <span class="highwire-citation-author" data-delta="6">R. Tulamo</span>, <span class="highwire-citation-author" data-delta="7">J. Hernesniemi</span>, <span class="highwire-citation-author" data-delta="8">M. Niemelä</span>, <span class="highwire-citation-author" data-delta="9">A. Robertson</span> and <span class="highwire-citation-author" data-delta="10">J. Frösen</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">January 2017,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">119-126; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A4951 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-40--6861952222" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">J. Cebral </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Bioengineering Department (J.C., B.J.C., F.M.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BCebral%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cebral%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BCebral%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-3216-0856" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Cebral</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">E. Ollikainen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.%2BOllikainen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ollikainen%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AE.%2BOllikainen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-5470-4474" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E. Ollikainen</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">B.J. Chung </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Bioengineering Department (J.C., B.J.C., F.M.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.J.%2BChung%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chung%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.J.%2BChung%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-5846-7944" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B.J. Chung</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">F. Mut </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Bioengineering Department (J.C., B.J.C., F.M.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.%2BMut%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Mut%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AF.%2BMut%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-1907-3739" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F. Mut</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">V. Sippola </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=V.%2BSippola%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Sippola%20V&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AV.%2BSippola%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-8393-6415" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for V. Sippola</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">B.R. Jahromi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=B.R.%2BJahromi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Jahromi%20B&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AB.R.%2BJahromi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-3937-2816" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for B.R. Jahromi</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">R. Tulamo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland</div><div class='author-affiliation'><span class='nlm-sup'>d</span>Department of Vascular Surgery (R.T.), Helsinki University Central Hospital, Helsinki, Finland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BTulamo%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Tulamo%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.%2BTulamo%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-1103-0216" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. Tulamo</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">J. Hernesniemi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BHernesniemi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hernesniemi%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BHernesniemi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-8163-8804" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. Hernesniemi</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">M. Niemelä </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BNiemel%C3%A4%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Niemel%C3%A4%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BNiemel%25C3%25A4%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-1526-0684" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Niemelä</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">A. Robertson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Mechanical Engineering and Materials Science and Department of Bioengineering (A.R.), Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BRobertson%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Robertson%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.%2BRobertson%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-5063-4293" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Robertson</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">J. Frösen </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurosurgery Research Group (E.O., V.S., B.R.J., R.T., J.H., M.N., J.F.), Biomedicum Helsinki and Helsinki University Central Hospital, Helsinki, Finland</div><div class='author-affiliation'><span class='nlm-sup'>e</span>Department of Neurosurgery and Hemorrhagic Brain Pathology Research Group (J.F.), Neurocenter, Kuopio University Hospital, Kuopio, Finland.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=J.%2BFr%C3%B6sen%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Fr%C3%B6sen%20J&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AJ.%2BFr%25C3%25B6sen%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-4677-950X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for J. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" xmlns:xhtml="http://www.w3.org/1999/xhtml" class="section ref-list" id="ref-list-1"><h2 class="">References</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-journal" id="cit-38.1.119.1" data-doi="10.1016/S1474-4422(11)70109-0"><div class="cit-metadata"><ol class="cit-auth-list"><li>
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      <div class="highwire-cite-title">Flow Conditions in the Intracranial Aneurysm Lumen Are Associated with Inflammation and Degenerative Changes of the Aneurysm Wall</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Cebral</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Ollikainen</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">B.J.</span> <span class="nlm-surname">Chung</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Mut</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Sippola</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">B.R.</span> <span class="nlm-surname">Jahromi</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Tulamo</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Hernesniemi</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Niemelä</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Robertson</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Frösen</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jan 2017, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">119-126; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4951 </span></div>
  
  
  
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      <div class="highwire-cite-title">Flow Conditions in the Intracranial Aneurysm Lumen Are Associated with Inflammation and Degenerative Changes of the Aneurysm Wall</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Cebral</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Ollikainen</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">B.J.</span> <span class="nlm-surname">Chung</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Mut</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Sippola</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">B.R.</span> <span class="nlm-surname">Jahromi</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Tulamo</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Hernesniemi</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Niemelä</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Robertson</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Frösen</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Jan 2017, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(1) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">119-126; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A4951 </span></div>
  
  
  
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