Greater hemodynamic stresses initiated the anterior communicating artery aneurysm on the vascular bifurcation apex

Objective: To investigate hemodynamic stresses associated with the anterior communicating artery (Acom) aneurysm formation using computational fluid dynamics (CFD) analysis. Methods: Three-dimensional geometries of the anterior cerebral artery (ACA) bifurcations in 20 patients with Acom aneurysms and 20 control subjects were used for CFD analysis to investigate hemodynamic stresses including the total and dynamic pressure, wall shear stress (WSS), vorticity and strain rate. Results: At the direct flow impinging center on the bifurcation apex, the total pressure was the maximal but decreased quickly from the impinging center to both daughter branches. The WSS, dynamic pressure, vorticity and strain rate were the minimal at the direct impinging center but increased rapidly and reached the peaks at both daughter branches. The ACA bifurcation angle was significantly (P < 0.001) greater in patients with than without Acom aneurysms (144.2 degrees +/- 4.1 degrees vs. 105.1 degrees +/- 3.2 degrees). Most aneurysms (70% and 85%, respectively) were deviated to the smaller daughter branch or to the daughter branch forming a smaller angle with the A1 segment of ACA, where the hemodynamic stresses were significantly (P < 0.05) greater than those on the contralateral daughter branch. After aneurysm formation, the hemodynamic stresses on the aneurysm dome were all significantly decreased compared with at the aneurysm initiation site with aneurysm virtual removal (P < 0.001). Conclusion: Formation of the Acom aneurysm is closely associated with and is to decrease the locally abnormally enhanced hemodynamic stresses. (c) 2021 Elsevier Ltd. All rights reserved.