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

Autor: Karnam Y; Department of Bioengineering, George Mason University, Fairfax, Virginia, USA., Mut F; Department of Bioengineering, George Mason University, Fairfax, Virginia, USA., Yu AK; Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA., Cheng B; Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA., Amin-Hanjani S; Department of Neurological Surgery, UH Cleveland Medical Center, Cleveland, Ohio, USA., Charbel FT; Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA., Woo HH; Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA., Niemelä M; Neurosurgery Research Group, Helsinki University Hospital, Helsinki, Finland., Tulamo R; Neurosurgery Research Group, Helsinki University Hospital, Helsinki, Finland., Jahromi BR; Neurosurgery Research Group, Helsinki University Hospital, Helsinki, Finland., Frösen J; Department of Neurosurgery, University of Tampere, Tampere, Finland.; Hemorrhagic Brain Pathology Research Group, Kuopio University Hospital, Kuopio, Finland., Tobe Y; Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Robertson AM; Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Cebral JR; Department of Bioengineering, George Mason University, Fairfax, Virginia, USA.
Jazyk: angličtina
Zdroj: International journal for numerical methods in biomedical engineering [Int J Numer Method Biomed Eng] 2024 Aug; Vol. 40 (8), pp. e3837. Date of Electronic Publication: 2024 Jun 05.
DOI: 10.1002/cnm.3837
Abstrakt: 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.
(© 2024 The Author(s). International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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