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

作者：Yogesh Karnam, Fernando Mut, Alexander Kwong-Tak Yu, Boyle C. Cheng, Sepideh Amin‐Hanjani, Fady T. Charbel, Henry H. Woo, Mika R. Niemela, Riikka M. Tulamo, Behnam Rezai Jahromi, Juhana Frösén, Yasutaka Tobe, Anne M. Robertson, Juan Raul Cebral · 发表于：International Journal for Numerical Methods in Biomedical Engineering · 年份：2024 · DOI：10.1002/cnm.3837 · 被引用次数：6 · 研究领域：Intracranial Aneurysms: Treatment and Complications、Traumatic Brain Injury and Neurovascular Disturbances、Cerebrovascular and Carotid Artery Diseases

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...