Hemodynamic Characteristics in Ruptured and Unruptured Intracranial Aneurysms: A Prospective Cohort Study Utilizing...

Area of Science:

• Cerebrovascular disease research
• Medical imaging and computational fluid dynamics
• Neurosurgery and interventional radiology

Background:

• Intracranial aneurysms (IAs) pose significant risks, with rupture leading to severe outcomes.
• Current risk assessment predominantly relies on clinical, anatomical, and morphological factors.
• Hemodynamic forces are critical in IA development, progression, and rupture.

Purpose of the Study:

• To investigate distinct hemodynamic characteristics between ruptured and unruptured IAs.
• To identify specific hemodynamic parameters associated with IA rupture.
• To compare hemodynamic profiles using advanced computational tools.

Main Methods:

• Prospective cohort study of 127 patients with ruptured and unruptured IAs from July 2021 to July 2022.
• Utilized Digital Subtraction Angiography (DSA) and the AneurysmFlow tool for hemodynamic assessment.
• Compared hemodynamic, clinical, anatomical, and morphological parameters between IA groups.

Main Results:

• Complex flow patterns (type 3 and 4) were significantly more frequent in ruptured IAs (OR, 5.57; P < .001).
• Mean Aneurysm Flow Amplitude (MAFA) was lower in ruptured IAs, particularly in the dome/daughter sacs, indicating potential wall pathology.
• Hypertension, bifurcation location, and irregular shape were independently associated with increased rupture risk.

Conclusions:

• Complex flow patterns and reduced MAFA in specific regions of IAs are associated with rupture.
• Hemodynamic assessment using AneurysmFlow provides valuable insights into IA pathophysiology.
• Clinical factors like hypertension and anatomical features like irregular shape remain crucial independent predictors of IA rupture.