Further evidence for the dynamic stability of intracranial saccular aneurysms

It has long been thought that intracranial saccular aneurysms enlarge and rupture because of mechanical instabilities. Recent nonlinear analyses suggest, however, that at least certain sub-classes of aneurysms do not exhibit quasi-static limit point instabilities or dynamic instabilities in response to periodic loading, and consequently, that the natural history of these lesions is likely governed by growth and remodeling processes. In this paper, we present additional results that support the finding that one particular sub-class of saccular aneurysms is dynamically stable. Specifically, we extended recent results of Shah and Humphrey, which are based on the assumption that some saccular aneurysms can be modeled as spherical elastic membranes surrounded by a viscous cerebrospinal fluid, to account for a viscohyperelastic behavior of the aneurysm. It is shown that inclusion of a "short-term" viscoelastic contribution to the mechanical behavior of an aneurysm serves to increase its dynamic stability against various disturbances.     

Parameterization of the shape of intracranial saccular aneurysms using Legendre polynomials

Our recent studies of the nonlinear mechanics of saccular aneurysms suggest that it is unlikely that these lesions enlarge or rupture via material (limit point) or dynamic (resonance) instabilities. Rather, there is a growing body of evidence from both vascular biology and biomechanical analyses that implicate mechanosensitive growth and remodeling processes. There is, therefore, a pressing need to quantify regional multiaxial wall stresses which, because of the membrane-like behavior of many aneurysms, necessitates better information on the applied loads and regional surface curvatures. Herein, we present and illustrate a method whereby regional curvatures can be estimated easily for sub-classes of human aneurysms based on clinically available data from magnetic resonance angiography (MRA). Whereas Legendre polynomials are used to illustrate this approach, different functions may prove useful for different sub-classes of lesions.     

On the potentially protective role of contact constraints on saccular aneurysms

Most intracranial saccular aneurysms remain asymptomatic until rupture. Yet, some unruptured lesions present with various symptoms, often related to the compression of a nerve or other intracranial tissue. An obvious question, therefore, is whether or not symptomatic unruptured lesions necessarily have a greater rupture-potential than asymptomatic ones. In this paper, we show numerically that contact constraints can have a protective effect on certain lesions. Specifically, finite element analyses of stress fields in model axisymmetric lesions, with and without the presence of a rigid contacting obstacle at the fundus, reveal that with the exception of near point loads, the constraint decreases the stresses near the fundus. Given that it is well accepted that rupture occurs when wall stress exceeds wall strength, these findings suggest that the rupture-potential will be lower in at least one sub-class of constrained versus comparable unconstrained lesions. Because of the myriad of sizes, shapes, and compositions of saccular aneurysms, however, there is a need to examine this important issue further, hopefully based on an increased awareness for clinical data on lesion-tissue interactions.     

Nonlinear anisotropic stress analysis of anatomically realistic cerebral aneurysms

BACKGROUND: Static deformation analysis and estimation of wall stress distribution of patient-specific cerebral aneurysms can provide useful insights into the disease process and rupture. METHOD OF APPROACH: The three-dimensional geometry of saccular cerebral aneurysms from 27 patients (18 unruptured and nine ruptured) was reconstructed based on computer tomography angiography images. The aneurysm wall tissue was modeled using a nonlinear, anisotropic, hyperelastic material model (Fung-type) which was incorporated in a user subroutine in ABAQUS. Effective material fiber orientations were assumed to align with principal surface curvatures. Static deformation of the aneurysm models were simulated assuming uniform wall thickness and internal pressure load of 100 mm Hg. RESULTS: The numerical analysis technique was validated by quantitative comparisons to results in the literature. For the patient-specific models, in-plane stresses in the aneurysm wall along both the stiff and weak fiber directions showed significant regional variations with the former being higher. The spatial maximum of stress ranged from as low as 0.30 MPa in a small aneurysm to as high as 1.06 MPa in a giant aneurysm. The patterns of distribution of stress, strain, and surface curvature were found to be similar. Sensitivity analyses showed that the computed stress is mesh independent and not very sensitive to reasonable perturbations in model parameters, and the curvature-based criteria for fiber orientations tend to minimize the total elastic strain energy in the aneurysms wall. Within this small study population, there were no statistically significant differences in the spatial means and maximums of stress and strain values between the ruptured and unruptured groups. However, the ratios between the stress components in the stiff and weak fiber directions were significantly higher in the ruptured group than those in the unruptured group. CONCLUSIONS: A methodology for nonlinear, anisotropic static deformation analysis of geometrically realistic aneurysms was developed, which can be used for a more accurate estimation of the stresses and strains than previous methods and to facilitate prospective studies on the role of stress in aneurysm rupture.     

犬囊状动脉瘤模型的制作

本文报道用“静脉囊镶嵌技术·制成犬的囊状动脉瘤模型。18个模型(6个单侧型,6个分叉型,6个末梢型)造型后2周经IA DSA检查。本模型在分型、血流动力学改变方面与人类囊状脑动脉瘤类似。不同类型的动脉瘤模型既有相同的血流动力学特征,又有各自的特点,这与动脉瘤与载瘤动脉的角度有关。我们认为该模型可应用于研究动脉瘤的血流动力学与血管内栓塞治疗。     

Do cardiac aneurysms blow out?

The possibility is suggested that cardiac aneurysms are formed when an infarcted region of the ventricular wall becomes elastically unstable and "blows out". The consequence of such a blowout could be a large saccular aneurysm or even cardiac rupture. We use a nonlinear stress-strain relation capable of describing both the passive and active myocardial wall to examine this possibility in terms of large-deformation membrane theory. Ventricular infarcts made of a material having physical properties like rubber would be expected to blow out, but those made of passive myocardium would not.     

Can aspect ratio be used to categorize intra-aneurysmal hemodynamics?-A study of elastase induced aneurysms in rabbit

Clinical studies suggest that aneurysm aspect ratio (AR) is an important indicator of rupture likelihood. The importance of AR is hypothesized to arise from its influence on intra-aneurysmal hemodynamics. It has been conjectured that slower flow in high AR sacs leads to a cascade of biological activities that weaken the aneurysm wall (Ujiie et al.,1999). However, the connection between AR, hemodynamics and wall weakening has never been proven. Animal models of saccular aneurysms provide a venue for evaluating this conjecture. The focus of this work was to evaluate whether a commonly used elastase induced aneurysm model in rabbits is suitable for a study of this kind from a hemodynamic perspective. In particular, to assess whether hemodynamic factors in low and high AR sacs are statistically different. To achieve this objective, saccular aneurysms were created in 51 rabbits and pulsatile computational fluid dynamics (CFD) studies were performed using rabbit specific inflows. Distinct hemodynamics were found in the low AR (AR<1.8, n=25), and high AR (AR>2.2, n=18) models. A single, stable recirculation zone was present in all low AR aneurysms, whereas a second, transient recirculation zone was also found in the superior aspect of the aneurysm dome for all high AR cases. Aneurysms with AR between 1.8 and 2.2 displayed transitional flow patterns. Differences in values and distributions of hemodynamic parameters were found between low and high AR cases including time averaged wall shear stress, oscillatory shear index, relative residence time and non-dimensional inflow rate. This work lays the foundation for future studies of the dependence of growth and remodeling on AR in the rabbit model and provides a motivation for further studies of the coupling between AR and hemodynamics in human aneurysms.     

A theoretical model for fibroblast-controlled growth of saccular cerebral aneurysms

A new theoretical model for the growth of saccular cerebral aneurysms is proposed by extending the recent constitutive framework of Kroon and Holzapfel [2007a. A model for saccular cerebral aneurysm growth by collagen fibre remodelling. J. Theor. Biol. 247, 775-787]. The continuous turnover of collagen is taken to be the driving mechanism in aneurysmal growth. The collagen production rate depends on the magnitude of the cyclic deformation of fibroblasts, caused by the pulsating blood pressure during the cardiac cycle. The volume density of fibroblasts in the aneurysmal tissue is taken to be constant throughout the growth process. The growth model is assessed by considering the inflation of an axisymmetric membranous piece of aneurysmal tissue, with material characteristics representative of a cerebral aneurysm. The diastolic and systolic states of the aneurysm are computed, together with its load-free state. It turns out that the value of collagen pre-stretch, that determines growth speed and stability of the aneurysm, is of pivotal importance. The model is able to predict aneurysms with typical berry-like shapes observed clinically, and the predicted wall stresses correlate well with the experimentally obtained ultimate stresses of this type of tissue. The model predicts that aneurysms should fail when reaching a size of about 1.2-3.6 mm, which is smaller than what has been clinically observed. With some refinements, the model may, however, be used to predict future growth of diagnosed aneurysms.     

The Helsinki Rat Microsurgical Sidewall Aneurysm Model

Experimental saccular aneurysm models are necessary for testing novel surgical and endovascular treatment options and devices before they are introduced into clinical practice. Furthermore, experimental models are needed to elucidate the complex aneurysm biology leading to rupture of saccular aneurysms.Several different kinds of experimental models for saccular aneurysms have been established in different species. Many of them, however, require special skills, expensive equipment, or special environments, which limits their widespread use. A simple, robust, and inexpensive experimental model is needed as a standardized tool that can be used in a standardized manner in various institutions.The microsurgical rat abdominal aortic sidewall aneurysm model combines the possibility to study both novel endovascular treatment strategies and the molecular basis of aneurysm biology in a standardized and inexpensive manner. Standardized grafts by means of shape, size, and geometry are harvested from a donor rat''s descending thoracic aorta and then transplanted to a syngenic recipient rat. The aneurysms are sutured end-to-side with continuous or interrupted 9-0 nylon sutures to the infrarenal abdominal aorta.We present step-by-step procedural instructions, information on necessary equipment, and discuss important anatomical and surgical details for successful microsurgical creation of an abdominal aortic sidewall aneurysm in the rat.     

A nonlinear dynamical mechanism for bruit generation by an intracranial saccular aneurysm

 Intracranial saccular aneurysms have been clinically observed to emit a transient sound, a bruit, on each heartbeat. The mechanism causing the bruits has been a matter of contention. A qualitative analysis of the nonlinear dynamical properties of the Shah-Humphrey model for periodic pressure forcing of a thin-necked saccular aneurysm, using the Fung nonlinear constitutive model for the aneurysm material, shows that a small blood pressure jump on each beat, whether the pressure is weakly aperiodic or periodic, induces transients in the radial deformation response of the aneurysmal wall on each heartbeat. These transient vibrations, which have a component with frequency near the natural frequency of the system but are not resonant phenomena and which decay rapidly to a limit cycle during each distinct forcing pressure cycle, can generate the bruits. Received: 21 November 2000 / Revised version: 9 August 2001 / Published online: 23 August 2002 Mathematics Subject Classification (2000): 92B99, 70K40, 70K05 Key words or phrases: Intracranial saccular aneurysm – Bruit – Spectrum – Nonlinear dynamics – Transients – Vortex shedding – Fung model     

Magnetic Resonance Imaging of Cerebral Aspergillosis: Imaging and Pathological Correlations

Cerebral aspergillosis is associated with a significant morbidity and mortality rate. The imaging data present different patterns and no full consensus exists on typical imaging characteristics of the cerebral lesions. We reviewed MRI findings in 21 patients with cerebral aspergillosis and correlated them to the immune status of the patients and to neuropathological findings when tissue was available. The lesions were characterized by their number, topography, and MRI signal. Dissemination to the brain resulted from direct spread from paranasal sinuses in 8 patients, 6 of them being immunocompetent. Hematogenous dissemination was observed in 13 patients, all were immunosuppressed. In this later group we identified a total of 329 parenchymal abscesses involving the whole brain with a predilection for the corticomedullary junction. More than half the patients had a corpus callosum lesion. Hemorrhagic lesions accounted for 13% and contrast enhancement was observed in 61% of the lesions. Patients with hematogenous dissemination were younger (p = 0.003), had more intracranial lesions (p = 0.0004) and had a higher 12-week mortality rate (p = 0.046) than patients with direct spread from paranasal sinuses. Analysis of 12 aneurysms allowed us to highlight two distinct situations. In case of direct spread from the paranasal sinuses, aneurysms are saccular and located on the proximal artery portions, while the hematogenous dissemination in immunocompromised patients is more frequently associated with distal and fusiform aneurysms. MRI is the exam of choice for cerebral aspergillosis. Number and type of lesions are different according to the mode of dissemination of the infection.     

An inelastic multi-mechanism constitutive equation for cerebral arterial tissue

Intracranial aneurysms (ICA) are abnormal saccular dilations of cerebral arteries, commonly found at apices of arterial bifurcations and outer walls of curved arterial segments. Histological evidence suggests the stages in ICA development include the deformation of a segment of arterial wall into a “bleb” with no identifiable neck region followed by the development of an aneurysm with a clear neck. Afterwards, the aneurysm may undergo further enlargement, possibly with significant biological response including calcification and thrombosis. Past studies of the biomechanics of cerebral aneurysm tissue have been directed at modeling elastic deformations of pre-existing aneurysms. Taking this approach, the aneurysm wall is treated as a different entity than the arterial tissue from which it developed. In the current work, a nonlinear, inelastic, dual-mechanism constitutive equation for cerebral arterial tissue is developed. It is the first to model the recruitment of collagen fibers and degradation of the internal elastic lamina, two important characteristics of early stage aneurysm formation.     

临床护理路径对囊性动脉瘤介入手术患者的应用研究

目的:应用临床护理路径,提高囊性动脉瘤介入手术患者的护理质量。方法:采用病例对照研究随机选择囊性动脉瘤患者60例。其中病例组30例,对照组30例,在相同治疗条件下病例组使用临床护理路径干预,对照组予以常规护理。结果:病例组使用临床护理路径后,与对照组相比平均住院日缩短P0.05,住院费用减少P0.05,患者满意度提高P0.05。结论:临床护理路径对囊性动脉瘤患者介入手术的干预效果有效,值得临床护理应用。     

Estimation of aneurysm wall stresses created by treatment with a shape memory polymer foam device

In this study, compliant latex thin-walled aneurysm models are fabricated to investigate the effects of expansion of shape memory polymer foam. A simplified cylindrical model is selected for the in-vitro aneurysm, which is a simplification of a real, saccular aneurysm. The studies are performed by crimping shape memory polymer foams, originally 6 and 8 mm in diameter, and monitoring the resulting deformation when deployed into 4-mm-diameter thin-walled latex tubes. The deformations of the latex tubes are used as inputs to physical, analytical, and computational models to estimate the circumferential stresses. Using the results of the stress analysis in the latex aneurysm model, a computational model of the human aneurysm is developed by changing the geometry and material properties. The model is then used to predict the stresses that would develop in a human aneurysm. The experimental, simulation, and analytical results suggest that shape memory polymer foams have potential of being a safe treatment for intracranial saccular aneurysms. In particular, this work suggests oversized shape memory foams may be used to better fill the entire aneurysm cavity while generating stresses below the aneurysm wall breaking stresses.     

Naturally occurring aortic aneurysms in owl monkeys (Aotus spp.).

Spontaneous aortic aneurysms were diagnosed in 22 owl monkeys (Aotus spp.) at necropsy. There were 6 males and 16 females. Clinical findings varied including weight loss, weakness, and lethargy and were not present in all animals. Aortic lesions ranged in size from 2 mm to 3 cm in diameter. Nineteen of the aneurysms were classified histologically as dissecting and three as saccular. Lesions occurred less often in karyotype I monkeys than in karyotype II or III monkeys. The etiopathogenesis of aortic aneurysm in owl monkeys is unknown.     

Aneurysms in a large colony of squirrel monkeys (Saimiri sciureus)

This communication reports the findings of a retrospective study of extracranial aneurysms found at necropsy in a large colony of squirrel monkeys (Saimiri sciureus). Eleven (1.5%) of 730 cases had dissecting, saccular, or fusiform aneurysms of the carotid arteries or aorta. Saccular and fusiform aneurysms were found only in animals that had been fed atherogenic diets, whereas dissecting aneurysms occurred in both normo- and hypercholesterolemic monkeys. Neither the type or location of aneurysms, however, could be predicted by the length of time an animal consumed an atherogenic diet, nor by the total mean serum cholesterol concentration. The anatomical characteristics, location, and incidence of aneurysms found in squirrel monkeys resembled closely those observed in human autopsy cases.     

临床护理路径对囊性动脉瘤介入手术患者的应用研究

目的：应用临床护理路径,提高囊性动脉瘤介入手术患者的护理质量。方法：采用病例对照研究随机选择囊性动脉瘤患者60例。其中病例组30例,对照组30例,在相同治疗条件下病例组使用临床护理路径干预,对照组予以常规护理。结果：病例组使用临床护理路径后,与对照组相比平均住院日缩短P〈0．05,住院费用减少P〈0．05,患者满意度提高P〈0．05。结论：临床护理路径对囊性动脉瘤患者介入手术的干预效果有效,值得临床护理应用。