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<meta name="DC.Title" content="Differences in Hemodynamics and Rupture Rate of Aneurysms at the Bifurcation of the Basilar and Internal Carotid Arteries" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5088" />
<meta name="DC.Date" content="2017-03-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2017 by American Journal of Neuroradiology" />
<meta name="DC.AccessRights" content="restricted" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Cerebral aneurysms in the posterior circulation are known to have a higher rupture risk than those in the anterior circulation. We sought to test the hypothesis that differences in hemodynamics can explain the difference in rupture rates.

MATERIALS AND METHODS: A total of 117 aneurysms, 63 at the tip of the basilar artery (27 ruptured, 36 unruptured, rupture rate = 43%) and 54 at the bifurcation of the internal carotid artery (11 ruptured, 43 unruptured, rupture rate = 20%) were analyzed with image-based computational fluid dynamics. Several hemodynamic variables were compared among aneurysms at each location and between ruptured and unruptured aneurysms at each location.

RESULTS: On average, aneurysms at the basilar tip had more concentrated inflow ( P &lt; .001), a larger inflow rate ( P &lt; .001), a larger maximum oscillatory shear index ( P = .003), more complex flows ( P = .033), and smaller areas under low wall shear stress ( P &lt; .001) than aneurysms at the bifurcation of the internal carotid artery. In general, ruptured aneurysms had larger inflow concentration ( P = .02), larger shear concentration ( P = .02), more complex flows ( P &lt; .001), and smaller minimum wall shear stress ( P = .003) than unruptured aneurysms.

CONCLUSIONS: High flow conditions, characterized by large and concentrated inflow jets, complex and oscillatory flow patterns, and wall shear stress distributions with focalized regions of high shear and large regions of low shear, are associated with aneurysm rupture, especially for basilar tip aneurysms. The higher flow conditions in basilar tip aneurysms could explain their increased rupture risk compared with internal carotid bifurcation aneurysms.

BAtip
:   basilar artery tip
corelen
:   core-line length
ICAbif
:   internal carotid artery bifurcation
ICI
:   inflow concentration index
LSA
:   areas under low wall shear stress
max
:   maximum
min
:   minimum
OSI
:   oscillatory shear index
Q
:   flow rate
SCI
:   shear concentration index
VE
:   mean velocity
WSS
:   wall shear stress" />
<meta name="DC.Contributor" content="R. Doddasomayajula" />
<meta name="DC.Contributor" content="B. Chung" />
<meta name="DC.Contributor" content="F. Hamzei-Sichani" />
<meta name="DC.Contributor" content="C.M. Putman" />
<meta name="DC.Contributor" content="J.R. Cebral" />
<meta name="article:published_time" content="2017-03-01" />
<meta name="article:section" content="INTERVENTIONAL" />
<meta name="citation_title" content="Differences in Hemodynamics and Rupture Rate of Aneurysms at the Bifurcation of the Basilar and Internal Carotid Arteries" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Cerebral aneurysms in the posterior circulation are known to have a higher rupture risk than those in the anterior circulation. We sought to test the hypothesis that differences in hemodynamics can explain the difference in rupture rates.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;A total of 117 aneurysms, 63 at the tip of the basilar artery (27 ruptured, 36 unruptured, rupture rate = 43%) and 54 at the bifurcation of the internal carotid artery (11 ruptured, 43 unruptured, rupture rate = 20%) were analyzed with image-based computational fluid dynamics. Several hemodynamic variables were compared among aneurysms at each location and between ruptured and unruptured aneurysms at each location.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;On average, aneurysms at the basilar tip had more concentrated inflow (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001), a larger inflow rate (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001), a larger maximum oscillatory shear index (&lt;i&gt;P&lt;/i&gt; = .003), more complex flows (&lt;i&gt;P&lt;/i&gt; = .033), and smaller areas under low wall shear stress (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001) than aneurysms at the bifurcation of the internal carotid artery. In general, ruptured aneurysms had larger inflow concentration (&lt;i&gt;P&lt;/i&gt; = .02), larger shear concentration (&lt;i&gt;P&lt;/i&gt; = .02), more complex flows (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001), and smaller minimum wall shear stress (&lt;i&gt;P&lt;/i&gt; = .003) than unruptured aneurysms.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;High flow conditions, characterized by large and concentrated inflow jets, complex and oscillatory flow patterns, and wall shear stress distributions with focalized regions of high shear and large regions of low shear, are associated with aneurysm rupture, especially for basilar tip aneurysms. The higher flow conditions in basilar tip aneurysms could explain their increased rupture risk compared with internal carotid bifurcation aneurysms.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2017/03/01" />
<meta name="citation_mjid" content="ajnr;38/3/570" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A5088" />
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<meta name="citation_volume" content="38" />
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<meta name="citation_article_type" content="Research Article" />
<meta name="citation_section" content="INTERVENTIONAL" />
<meta name="citation_firstpage" content="570" />
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<meta name="citation_author" content="R. Doddasomayajula" />
<meta name="citation_author_institution" content="aFrom the Bioengineering Department (R.D., B.C., J.R.C.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia" />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0003-1935-6915" />
<meta name="citation_author" content="B. Chung" />
<meta name="citation_author_institution" content="aFrom the Bioengineering Department (R.D., B.C., J.R.C.), Volgenau School of Engineering, George Mason University, Fairfax, Virginia" />
<meta name="citation_author_orcid" content="http://orcid.org/0000-0002-5846-7944" />
<meta name="citation_author" content="F. Hamzei-Sichani" />
<meta name="citation_author_institution" content="bDepartment of Neurosurgery (F.H.-S.), Icahn School of Medicine at Mount Sinai, New York, New York" />
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<meta name="twitter:title" content="Differences in Hemodynamics and Rupture Rate of Aneurysms at the Bifurcation of the Basilar and Internal Carotid Arteries" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Cerebral aneurysms in the posterior circulation are known to have a higher rupture risk than those in the anterior circulation. We sought to test the hypothesis that differences in hemodynamics can explain the difference in rupture rates.

MATERIALS AND METHODS: A total of 117 aneurysms, 63 at the tip of the basilar artery (27 ruptured, 36 unruptured, rupture rate = 43%) and 54 at the bifurcation of the internal carotid artery (11 ruptured, 43 unruptured, rupture rate = 20%) were analyzed with image-based computational fluid dynamics. Several hemodynamic variables were compared among aneurysms at each location and between ruptured and unruptured aneurysms at each location.

RESULTS: On average, aneurysms at the basilar tip had more concentrated inflow ( P &lt; .001), a larger inflow rate ( P &lt; .001), a larger maximum oscillatory shear index ( P = .003), more complex flows ( P = .033), and smaller areas under low wall shear stress ( P &lt; .001) than aneurysms at the bifurcation of the internal carotid artery. In general, ruptured aneurysms had larger inflow concentration ( P = .02), larger shear concentration ( P = .02), more complex flows ( P &lt; .001), and smaller minimum wall shear stress ( P = .003) than unruptured aneurysms.

CONCLUSIONS: High flow conditions, characterized by large and concentrated inflow jets, complex and oscillatory flow patterns, and wall shear stress distributions with focalized regions of high shear and large regions of low shear, are associated with aneurysm rupture, especially for basilar tip aneurysms. The higher flow conditions in basilar tip aneurysms could explain their increased rupture risk compared with internal carotid bifurcation aneurysms.

BAtip
:   basilar artery tip
corelen
:   core-line length
ICAbif
:   internal carotid artery bifurcation
ICI
:   inflow concentration index
LSA
:   areas under low wall shear stress
max
:   maximum
min
:   minimum
OSI
:   oscillatory shear index
Q
:   flow rate
SCI
:   shear concentration index
VE
:   mean velocity
WSS
:   wall shear stress" />
<meta name="og-title" property="og:title" content="Differences in Hemodynamics and Rupture Rate of Aneurysms at the Bifurcation of the Basilar and Internal Carotid Arteries" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/38/3/570" />
<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: Cerebral aneurysms in the posterior circulation are known to have a higher rupture risk than those in the anterior circulation. We sought to test the hypothesis that differences in hemodynamics can explain the difference in rupture rates.

MATERIALS AND METHODS: A total of 117 aneurysms, 63 at the tip of the basilar artery (27 ruptured, 36 unruptured, rupture rate = 43%) and 54 at the bifurcation of the internal carotid artery (11 ruptured, 43 unruptured, rupture rate = 20%) were analyzed with image-based computational fluid dynamics. Several hemodynamic variables were compared among aneurysms at each location and between ruptured and unruptured aneurysms at each location.

RESULTS: On average, aneurysms at the basilar tip had more concentrated inflow ( P &lt; .001), a larger inflow rate ( P &lt; .001), a larger maximum oscillatory shear index ( P = .003), more complex flows ( P = .033), and smaller areas under low wall shear stress ( P &lt; .001) than aneurysms at the bifurcation of the internal carotid artery. In general, ruptured aneurysms had larger inflow concentration ( P = .02), larger shear concentration ( P = .02), more complex flows ( P &lt; .001), and smaller minimum wall shear stress ( P = .003) than unruptured aneurysms.

CONCLUSIONS: High flow conditions, characterized by large and concentrated inflow jets, complex and oscillatory flow patterns, and wall shear stress distributions with focalized regions of high shear and large regions of low shear, are associated with aneurysm rupture, especially for basilar tip aneurysms. The higher flow conditions in basilar tip aneurysms could explain their increased rupture risk compared with internal carotid bifurcation aneurysms.

BAtip
:   basilar artery tip
corelen
:   core-line length
ICAbif
:   internal carotid artery bifurcation
ICI
:   inflow concentration index
LSA
:   areas under low wall shear stress
max
:   maximum
min
:   minimum
OSI
:   oscillatory shear index
Q
:   flow rate
SCI
:   shear concentration index
VE
:   mean velocity
WSS
:   wall shear stress" />
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      <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>
  
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      <h1 class="highwire-cite-title" id="page-title">Differences in Hemodynamics and Rupture Rate of Aneurysms at the Bifurcation of the Basilar and Internal Carotid Arteries</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">R. Doddasomayajula</span>, <span class="highwire-citation-author" data-delta="1">B. Chung</span>, <span class="highwire-citation-author" data-delta="2">F. Hamzei-Sichani</span>, <span class="highwire-citation-author" data-delta="3">C.M. Putman</span> and <span class="highwire-citation-author" data-delta="4">J.R. Cebral</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">March 2017,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">38 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">570-576; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5088 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-14672--6977289834" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">R. Doddasomayajula </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 (R.D., B.C., J.R.C.), 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=R.%2BDoddasomayajula%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=Doddasomayajula%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.%2BDoddasomayajula%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/0000-0003-1935-6915" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. Doddasomayajula</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">B. 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 (R.D., B.C., J.R.C.), 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.%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.%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. Chung</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">F. Hamzei-Sichani </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Department of Neurosurgery (F.H.-S.), Icahn School of Medicine at Mount Sinai, New York, New York</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.%2BHamzei-Sichani%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=Hamzei-Sichani%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.%2BHamzei-Sichani%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/0000-0002-7688-9489" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F. Hamzei-Sichani</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">C.M. Putman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Interventional Neuroradiology (C.M.P.), Inova Fairfax Hospital, Falls Church, 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=C.M.%2BPutman%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=Putman%20C&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%3AC.M.%2BPutman%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/0000-0001-5800-4686" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C.M. Putman</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">J.R. 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 (R.D., B.C., J.R.C.), 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.R.%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.R.%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.R. Cebral</a></li></ul></div></div></div>  </div>

  
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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 38</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 3 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Mar 2017 </div></div>
      
      
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      <div class="highwire-cite-title">Differences in Hemodynamics and Rupture Rate of Aneurysms at the Bifurcation of the Basilar and Internal Carotid Arteries</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">R.</span> <span class="nlm-surname">Doddasomayajula</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">B.</span> <span class="nlm-surname">Chung</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Hamzei-Sichani</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">C.M.</span> <span class="nlm-surname">Putman</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">J.R.</span> <span class="nlm-surname">Cebral</span></span></span></div>
  
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      <div class="highwire-cite-title">Differences in Hemodynamics and Rupture Rate of Aneurysms at the Bifurcation of the Basilar and Internal Carotid Arteries</div>  
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