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Hemodynamics in aneurysm blebs with different wall characteristics.

Seyedeh Fatemeh Salimi Ashkezari1, Fernando Mut2, Bong Jae Chung3

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Thin blebs in intracranial aneurysms are linked to higher blood flow and rupture risk. Understanding bleb characteristics is crucial for predicting aneurysm rupture and improving patient outcomes.

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Area of Science:

  • Neurosurgery
  • Biomedical Engineering
  • Cardiovascular Research

Background:

  • Intracranial aneurysms possess secondary structures called blebs, which are associated with increased rupture risk.
  • The precise mechanisms governing bleb development and their influence on aneurysm progression remain incompletely understood.
  • Blebs can significantly alter local hemodynamics and wall stress within an aneurysm.

Purpose of the Study:

  • To investigate the relationship between intracranial aneurysm blebs with varying wall characteristics and their association with local hemodynamics.
  • To explore the correlation between bleb features, hemodynamic forces, and the sites of aneurysm rupture.
  • To differentiate the hemodynamic environment of thin-walled blebs versus thick-walled atherosclerotic blebs.

Main Methods:

  • Image-based computational fluid dynamics (CFD) was employed to analyze blebs observed in intra-operative videos.
  • A comparative analysis was conducted between thin, translucent blebs and thick, atherosclerotic/hyperplastic blebs.
  • Rupture points were meticulously identified in video recordings of aneurysms that had ruptured and contained blebs.

Main Results:

  • Thin blebs were found to be situated closer to the inflow region compared to atherosclerotic blebs within the same aneurysm (P=0.0234).
  • Blebs located near the inflow exhibited significantly higher velocity, vorticity, shear strain rate, wall shear stress (WSS), and WSS gradient.
  • In ruptured aneurysms with blebs, rupture sites were associated with thin blebs (42%), atherosclerotic blebs (25%), or occurred away from blebs (33%).

Conclusions:

  • Intracranial aneurysm blebs exhibit heterogeneity, with distinct thin and thick atherosclerotic wall types.
  • Thin blebs are preferentially located near the inflow, experiencing higher and more variable hemodynamic forces, including WSS.
  • Aneurysm rupture can originate from thin blebs, atherosclerotic blebs, or other regions, underscoring the need for further research into bleb wall failure mechanisms.