High Wall Shear Incites Cerebral Aneurysm Formation and Low Wall Shear Stress Propagates Cerebral Aneurysm Growth

Vivig Shantha Kumar, Vignarth Shantha Kumar
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Abstract

This review discusses mechanisms for the development of cerebral aneurysms. Endothelial cells exhibit a variety of structural and functional changes when they come into contact with normal laminar flow. In response to laminar shear stress, endothelial cells modify their potassium ion channels, go through cytoskeletal rearrangements and shape modifications and create prostacyclin. In cerebral arteries, aneurysmal dilatation most frequently starts at locations with substantial wall shear stress, which include arterial bifurcations and vascular branch sites, where blood flow abruptly switches to turbulent flow. At this point, high shear stress frequently arises, placing increased strain on the vasculature. As the vascular branch points and arterial bifurcations are the initial sites of cerebral aneurysm genesis, this helps confirm the role of high wall shear stress in the development of cerebral aneurysms. Low wall shear stress increases the initial proinflammatory effect already present in the vasculature, which furthers the formation of cerebral aneurysms. In fact, regions of aneurysmal regions with low wall shear stress grow more quickly and are more prone to rupture compared to regions with high wall shear stress. Therefore, it seems plausible to assume that turbulent blood flow inside a dilated cerebral aneurysm causes low wall shear stress, thereby encouraging aneurysmal growth. J Neurol Res. 2023;13(1):1-11 doi: https://doi.org/10.14740/jnr749
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高壁剪切刺激脑动脉瘤形成,低壁剪切应力促进脑动脉瘤生长
本文就脑动脉瘤的发生机制作一综述。内皮细胞与正常层流接触时,表现出多种结构和功能变化。在层流剪切应力的作用下,内皮细胞改变其钾离子通道,经历细胞骨架重排和形状改变,并产生前列环素。在脑动脉中,动脉瘤扩张最常开始于具有大量壁剪切应力的部位,包括动脉分叉和血管分支部位,在那里血流突然转变为湍流。在这一点上,经常出现高剪切应力,对血管系统施加更大的压力。由于血管分支点和动脉分叉是脑动脉瘤发生的起始部位,这有助于证实高壁剪切应力在脑动脉瘤发生中的作用。低壁剪切应力增加了血管系统中已经存在的初始促炎作用,这进一步促进了脑动脉瘤的形成。事实上,与高壁剪应力区域相比,低壁剪应力的动脉瘤区域生长更快,更容易破裂。因此,我们似乎可以假设,扩张的脑动脉瘤内的湍流血流导致低壁剪切应力,从而促进动脉瘤生长。中华神经科学杂志,2013;13(1):1-11 doi: https://doi.org/10.14740/jnr749
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