Proximal stenosis may induce initiation of cerebral aneurysms by increasing wall shear stress and wall shear stress gradient.

Hemodynamic parameters, such as wall shear stress (WSS), WSS gradient (WSSG), aneurysm formation indicator (AFI), or gradient oscillatory number (GON), have been proposed to be linked to initiation of cerebral aneurysms. However, how such conditions occur in humans is unclear. We encountered a rare and interesting case to address this issue. A patient had a newly formed aneurysm with proximal stenosis, which was confirmed by serial imagings. We made two pre-aneurysm models: one with stenosis and the other without stenosis. We performed computational fluid dynamics simulations for these models. Owing to jet flow caused by the stenosis, the maximum WSS and WSSG on the aneurysm initiation site were approximately doubled and tripled, respectively. However, the oscillatory shear index (OSI), AFI, and GON did not change substantially by the stenosis. Computer simulations using artificial vascular models with different degrees of proximal stenosis at different distances demonstrated that oscillatory shear index, AFI, and GON did not change substantially by the stenosis. These results showed that proximal stenosis caused high WSS and high WSSG at the aneurysm initiation site, possibly leading to aneurysm initiation. Proximal stenosis may be a potential factor to induce initiation of one class of cerebral aneurysms by increasing WSS and WSSG.