Distribution of rupture sites and blebs on intracranial aneurysm walls suggests distinct rupture patterns in ACom and MCA aneurysms

Yogesh Karnam, Fernando Mut, Alexander K. Yu, Boyle Cheng, Sepideh Amin-Hanjani, Fady T. Charbel, Henry H. Woo, Mika Niemelä, Riikka Tulamo, Behnam Rezai Jahromi, Juhana Frösen, Yasutaka Tobe, Anne M. Robertson, Juan R. Cebral

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Abstract

The mechanisms behind intracranial aneurysm formation and rupture are not fully understood, with factors such as location, patient demographics, and hemodynamics playing a role. Additionally, the significance of anatomical features like blebs in ruptures is debated. This highlights the necessity for comprehensive research that combines patient-specific risk factors with a detailed analysis of local hemodynamic characteristics at bleb and rupture sites. Our study analyzed 359 intracranial aneurysms from 268 patients, reconstructing patient-specific models for hemodynamic simulations based on 3D rotational angiographic images and intraoperative videos. We identified aneurysm subregions and delineated rupture sites, characterizing blebs and their regional overlap, employing statistical comparisons across demographics, and other risk factors. This work identifies patterns in aneurysm rupture sites, predominantly at the dome, with variations across patient demographics. Hypertensive and anterior communicating artery (ACom) aneurysms showed specific rupture patterns and bleb associations, indicating two pathways: high-flow in ACom with thin blebs at impingement sites and low-flow, oscillatory conditions in middle cerebral artery (MCA) aneurysms fostering thick blebs. Bleb characteristics varied with gender, age, and smoking, linking rupture risks to hemodynamic factors and patient profiles. These insights enhance understanding of the hemodynamic mechanisms leading to rupture events. This analysis elucidates the role of localized hemodynamics in intracranial aneurysm rupture, challenging the emphasis on location by revealing how flow variations influence stability and risk. We identify two pathways to wall failure—high-flow and low-flow conditions—highlighting the complexity of aneurysm behavior. Additionally, this research advances our knowledge of how inherent patient-specific characteristics impact these processes, which need further investigation.

Original languageEnglish
Article numbere3837
Number of pages16
JournalINTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING
Volume40
Issue number8
Early online date5 Jun 2024
DOIs
Publication statusPublished - Aug 2024
Publication typeA1 Journal article-refereed

Keywords

  • Acom
  • bleb
  • hemodynamics
  • intracranial aneurysm
  • MCA
  • rupture

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Software
  • Biomedical Engineering
  • Modelling and Simulation
  • Molecular Biology
  • Computational Theory and Mathematics
  • Applied Mathematics

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