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Arterial Pouch Microsurgical Bifurcation Aneurysm Model in the Rabbit
Published on: May 14, 2020
Rupture point is associated with divergent hemodynamics in intracranial aneurysms
Aleš Hejčl1,2,3, Jana Brunátová4,5, Helena Švihlová4
1Department of Neurosurgery, Masaryk Hospital, J. E. Purkyne University, Ústí nad Labem, Czechia.
Insights
Understanding intracranial aneurysm (IA) rupture requires analyzing hemodynamics. This study found varied hemodynamic conditions at IA rupture sites, suggesting multiple pathological pathways for aneurysm wall damage.
Area of Science:
- Biomedical Engineering
- Medical Imaging
- Fluid Dynamics
Background:
- Intracranial aneurysm (IA) rupture risk factors remain unclear, impacting patient management.
- Hemodynamic analysis at the rupture point could elucidate risk factors.
- Few studies have investigated IA rupture hemodynamics, with conflicting results.
Purpose of the Study:
- To identify hemodynamic parameters at the rupture site of intracranial aneurysms.
- To correlate specific hemodynamic conditions with aneurysm rupture points.
- To investigate potential pathological pathways leading to IA rupture.
Main Methods:
- Utilized preoperative computed tomography (CT) and CT angiography (CTA) to identify IA rupture points in surgically treated patients.
- Calculated hemodynamic parameters for the entire aneurysm sac and the specific rupture site.
- Validated computational fluid dynamics (CFD) simulations with particle image velocimetry (PIV) experiments in two cases.
Main Results:
- Identified distinct rupture points in 6 aneurysms.
- Found rupture points near vortices with low wall shear stress (WSS) and high oscillatory shear index (OSI) in 4 cases.
- Observed rupture in a flow jet with high WSS in 1 case, and in a bleb with no specific hemodynamic parameters in another.
Conclusions:
- Different hemodynamic scenarios are associated with intracranial aneurysm rupture sites.
- Numerical simulations (CFD) were validated by experimental models (PIV).
- Supports the hypothesis that diverse pathological mechanisms contribute to aneurysm wall damage and rupture.
Background:
Understanding the risk factors leading to intracranial aneurysm (IA) rupture have still not been fully clarified. They are vital for proper medical guidance of patients harboring unruptured IAs. Clarifying the hemodynamics associated with the point of rupture could help could provide useful information about some of the risk factors. Thus far, few studies have studied this issue with often diverging conclusions.
Methods:
We identified a point of rupture in patients operated for an IAs during surgery, using a combination of preoperative computed tomography (CT) and computed tomography angiography (CTA). Hemodynamic parameters were calculated both for the aneurysm sac as a whole and the point of rupture. In two cases, the results of CFD were compared with those of the experiment using particle image velocimetry (PIV).
Results:
We were able to identify 6 aneurysms with a well-demarcated point of rupture. In four aneurysms, the rupture point was near the vortex with low wall shear stress (WSS) and high oscillatory shear index (OSI). In one case, the rupture point was in the flow jet with high WSS. In the last case, the rupture point was in the significant bleb and no specific hemodynamic parameters were found. The CFD results were verified in the PIV part of the study.
Conclusion:
Our study shows that different hemodynamic scenarios are associated with the site of IA rupture. The numerical simulations were confirmed by laboratory models. This study further supports the hypothesis that various pathological pathways may lead to aneurysm wall damage resulting in its rupture.
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