The role of wall shear stress in the parent artery as an independent variable in the formation status of anterior communicating artery aneurysms
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The study aimed to determine which hemodynamic parameters independently characterize anterior communicating artery (AcomA) aneurysm formation and explore the threshold of wall shear stress (WSS) of the parent artery to better illustrate the correlation between the magnitude of WSS and AcomA aneurysm formation.
Eighty-one patients with AcomA aneurysms and 118 patients without intracranial aneurysms (control population), as confirmed by digital subtraction angiography (DSA) from January 2014 to May 2017, were included in this cross-sectional study. Three-dimensional-DSA was performed to evaluate the morphologic characteristics of AcomA aneurysms. Local hemodynamic parameters were obtained using transcranial color-coded duplex (TCCD). Multivariate logistic regression and a two-piecewise linear regression model were used to determine which hemodynamic parameters are independent predictors of AcomA aneurysm formation and identify the threshold effect of WSS of the parent artery with respect to AcomA aneurysm formation.
Univariate analyses showed that the WSS (p < 0.0001), angle between the A1 and A2 segments of the anterior cerebral artery (ACA) (p < 0.001), hypertension (grade II) (p = 0.007), fasting blood glucose (FBG; > 6.0 mmol/L) (p = 0.005), and dominant A1 (p < 0.001) were the significant parameters. Multivariate analyses showed a significant association between WSS of the parent artery and AcomA aneurysm formation (p = 0.0001). WSS of the parent artery (7.8-12.3 dyne/cm2) had a significant association between WSS and aneurysm formation (HR 2.0, 95% CI 1.3-2.8, p < 0.001).
WSS ranging between 7.8 and 12.3 dyne/cm2 independently characterizes AcomA aneurysm formation. With each additional unit of WSS, there was a one-fold increase in the risk of AcomA aneurysm formation.
• Multivariate analyses and a two-piecewise linear regression model were used to evaluate the risk factors for AcomA aneurysm formation and the threshold effect of WSS on AcomA aneurysm formation.
• WSS ranging between 7.8 and 12.3 dyne/cm 2 was shown to be a reliable hemodynamic parameter in the formation of AcomA aneurysms. The probability of AcomA aneurysm formation increased one-fold for each additional unit of WSS.
• An ultrasound-based TCCD technique is a simple and accessible noninvasive method for detecting WSS in vivo; thus, it can be applied as a screening tool for evaluating the probability of aneurysm formation in primary care facilities and community hospitals because of the relatively low resource intensity.
KeywordsAnterior communicating artery aneurysm Hemodynamics Risk
Abbreviations and acronyms
Anterior cerebral artery
Anterior communicating artery aneurysm
Coronary artery disease
Computational fluid dynamics
Computed tomography angiography
Circumferential wall tension
Diastolic blood pressure
Digital subtraction angiography
Fasting blood glucose;
Magnetic resonance angiography
Systolic blood pressure
Transcranial color-coded duplex
Wall shear stress
We acknowledge further polishing of the article to improve the language and the rationality of the content provided by Dr. Tamrakar Karuna (CMS-Teaching Hospital, Bharatpur, Chitwan, Nepal) and the helpful comments on this article received from the reviewers. We also appreciate Prof. Chi Chen (Department of Health Statistics of Guizhou University of TCM, Guiyang City, China) for his important contribution to the professional statistical analysis in the study.
This study received funding from the Science and Technology Project Foundation of Guangdong Province (grant no. 2016A020215098), Key Project of Clinical Research of Southern Medical University (grant no. LC2016ZD024), and National Key Research Development Program (grant no. 2016YFC1300804, 2016YFC1300800).
Compliance with ethical standards
The scientific guarantor of this publication is Chuan-Zhi Duan who works in the Department of Neurosurgery, Zhujiang Hospital, Southern Medical University.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
Prof. Chi Chen, who has significant statistical expertise (Department of Health Statistics of Guizhou University of TCM, Guiyang City, China), kindly provided statistical advice for this manuscript.
This is a retrospective and cross-sectional study. The data are anonymous, and the requirement for written informed consent was waived by the Institutional Review Board. However, the informed consent concerning the DSA procedure was signed by each patient before the operation.
Approval for this study was obtained from the local Institutional Review Board of the participating centers. Ethics approval was obtained from the Institutional Review Board of Southern Medical University Zhujiang Hospital and the First Affiliated Hospital of Zhengzhou University.
• cross-sectional study
• multicenter study
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