• Michael Hinrich Schönfeld, Nils Daniel Forkert, Jens Fiehler, Young Dae Cho, Moon Hee Han, Hyun-Seung Kang, Thomas William Peach, and James Vincent Byrne.
• Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
• J Neuroimaging. 2019 Jul 1; 29 (4): 447-453.

Background And PurposeAlthough the role of wall shear stress (WSS) in the initiation, growth, and rupture of intracranial aneurysms has been well studied, its influence on aneurysm recurrence after endovascular treatment requires further investigation. We aimed to compare WSS at necks of recurrent and nonrecurrent aneurysms.MethodsNine recurrent coil-embolized aneurysms were identified and matched with nine nonrecurrent aneurysms. Patient-specific vessel geometries reconstructed from follow-up 3-D time-of-flight magnetic resonance angiography were analyzed using computational fluid dynamics (CFD) simulations. Absolute WSS and the percentage of abnormally low and high WSS at the aneurysm neck compared to the near artery were measured.ResultsThe median percentage of abnormal WSS at the aneurysm neck was 49.3% for recurrent and 34.7% for nonrecurrent aneurysms (P = .011). The area under the receiver-operating-characteristic curve for distinguishing these aneurysms according to the percentage of abnormal WSS was .86 (95% CI .62 to .98). The optimal cut-off value of 45.1% resulted in a sensitivity and a specificity of 88.89% (95% CI 51.8% to 99.7%).ConclusionOur findings indicate that necks of recurrent aneurysms are exposed to abnormal WSS to a larger extent. Abnormal WSS may serve as a metric to distinguish them from nonrecurrent aneurysms with CFD simulations a priori.© 2019 by the American Society of Neuroimaging.

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