• H Meng, V M Tutino, J Xiang, and A Siddiqui.
• From the Toshiba Stroke and Vascular Research Center (H.M., V.M.T., J.X., A.S.)Departments of Mechanical and Aerospace Engineering (H.M.)Neurosurgery (H.M., J.X., A.S.)Biomedical Engineering (H.M., V.M.T.), University at Buffalo, State University of New York, Buffalo, New York. huimeng@buffalo.edu.
• AJNR Am J Neuroradiol. 2014 Jul 1; 35 (7): 1254-62.

SummaryIncreasing detection of unruptured intracranial aneurysms, catastrophic outcomes from subarachnoid hemorrhage, and risks and cost of treatment necessitate defining objective predictive parameters of aneurysm rupture risk. Image-based computational fluid dynamics models have suggested associations between hemodynamics and intracranial aneurysm rupture, albeit with conflicting findings regarding wall shear stress. We propose that the "high-versus-low wall shear stress" controversy is a manifestation of the complexity of aneurysm pathophysiology, and both high and low wall shear stress can drive intracranial aneurysm growth and rupture. Low wall shear stress and high oscillatory shear index trigger an inflammatory-cell-mediated pathway, which could be associated with the growth and rupture of large, atherosclerotic aneurysm phenotypes, while high wall shear stress combined with a positive wall shear stress gradient trigger a mural-cell-mediated pathway, which could be associated with the growth and rupture of small or secondary bleb aneurysm phenotypes. This hypothesis correlates disparate intracranial aneurysm pathophysiology with the results of computational fluid dynamics in search of more reliable risk predictors.© 2014 by American Journal of Neuroradiology.

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