Fig 1.

Examples of aneurysm growth (A and B) and rupture (C and D) correlated with high wall shear stress and low WSS. A, In a serial study consisting of a baseline and 4 follow-ups, Acevedo-Bolton et al¹⁰ found that the maximal growth region (1) of a giant basilar fusiform intracranial aneurysm consistently had the lowest WSS. B, Sugiyama et al¹³ reported 2 adjacent growing aneurysms, with different hemodynamic characteristics and growing patterns in 1 patient. The proximal growing aneurysm (2) was subjected to local high flow in the growing lobe, while the distal aneurysm (3) was associated with low and oscillatory WSS in the entire aneurysm sac. C, From multivariate statistical analysis of 119 aneurysms, Xiang et al⁵ found that intracranial aneurysm rupture could be predicted by low WSS and high oscillatory shear index. D, Castro et al¹¹ found, from analysis of 26 aneurysms, that intracranial aneurysm rupture was correlated with high maximum WSS. Images were adapted with permission from the cited references.