Hemodynamic Features of Rupture-Prone Blebs in Ruptured Intracranial Aneurysms: A Computational Fluid Dynamics Study.

Area of Science:

• Neurosurgery
• Biomedical Engineering
• Radiology

Background:

• Blebs on ruptured intracranial aneurysms are suspected rupture sites.
• The precise hemodynamic factors driving bleb rupture are not fully understood.
• Investigating these features is crucial for predicting aneurysm rupture risk.

Purpose of the Study:

• To define the hemodynamic signature of blebs in ruptured intracranial aneurysms.
• To correlate these hemodynamic features with rupture potential.
• To inform targeted treatment strategies for preventing rebleeding.

Main Methods:

• Retrospective analysis of 106 intracranial aneurysm rupture patients treated with coil embolization.
• Focus on patients who underwent intentional bleb coil embolization without rebleeding.
• Computational fluid dynamics (CFD) used to analyze pressure and time-averaged wall shear stress (WSS).

Main Results:

• Six aneurysms were analyzed, with no reported rebleeding.
• Maximum pressure with flow impingement occurred at the bleb neck, increasing intra-bleb pressure.
• Minimum time-averaged WSS was consistently found at the bleb in the aneurysm dome (0.68 ± 0.45 Pa).

Conclusions:

• Aneurysmal blebs exhibiting high pressure and low WSS are likely rupture sites.
• These hemodynamic characteristics can identify high-risk rupture points.
• Targeting these specific areas with coil embolization can effectively block blood flow and prevent rebleeding.