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

Dang Luu Vu1,2, Van Hoang Nguyen1, Huu An Nguyen3,4

  • 1From the Radiology Center (D.L.V., V.H.N., H.A.N., Q.A.N, A.T.T., H.K.L., Tat T.N., Thu T.N., C.T., X.B.T., C.C.L.), Bach Mai Hospital, Hanoi, Vietnam.

AJNR. American Journal of Neuroradiology
|August 12, 2024
PubMed

Insights

Complex blood flow patterns in intracranial aneurysms (IAs) are linked to rupture risk. Lower mean aneurysm flow amplitude (MAFA) in the dome and daughter sacs suggests wall changes contributing to rupture. Hypertension, bifurcation location, and irregular shape also increase IA rupture risk.

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.
Abstract

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