An assessment of how the anterior cerebral artery anatomy impacts ACoA aneurysm formation based on CFD analysis

Objective The aim of this study was to identify independent anatomic, morphologic and hemodynamic features of the ACoA (anterior communicating artery) complex that serve as risk factors for the occurrence of ACoA aneurysms. Methods Fifteen consecutive patients with 15 ACoA aneurysms were included. Computational fluid dynamics (CFD) simulations based on patient-specific models were carried out using 3D time-of-flight magnetic resonance angiography (3D-TOF-MRA) images. A reverse reconstruction technique was used to generate a pre-aneurysm vessel anatomy. Geometric parameters and hemodynamic changes were compared and evaluated. Results The overall prevalence of symmetric, dysplastic, and absent A1 segments were 53.3%, 26.7%, and 20%. The mean wall shear stress (WSS) of the absent group (AG) was significantly higher than that of the symmetric group (SG) and dysplastic group (DG). The absolute mean A1 artery flow rate (410.2 +/- 88 versus 439.4 +/- 101 mL/min;p = .45) of the aneurysm side was similar between the SG and DG but significantly higher in the AG (528.1 +/- 77 mL/min;p < .05). The A1-A2 angles of the aneurysm side showed no significant differences among the 3 groups (p = .32). However, the mean A1-A2 angle on the aneurysm side was smaller than the contralateral A1-A2 angle (101.9 +/- 9.1 versus 120.3 +/- 7.7p <.05). A regression analysis demonstrated that high WSS was significantly associated with a large A1-A2 ratio (R-2=0.52;p <.05). Conclusions ACoA aneurysms are a high-WSS pathology. Severe flow impingement and the anatomic vasculature structures play a role in triggering the occurrence of ACoA aneurysms.