Journal Article

Hemodynamics in aneurysm blebs with different wall characteristics

Mut, Fernando, Rezai Jahromi, Behnam, Amin-Hanjani, Sepideh, Maiti, Spandan, See, Alfred P, Charbel, Fady T, Frösen, Juhana, Niemelä, Mika, Salimi Ashkezari, Seyedeh Fatemeh, Chung, Bong Jae, Cebral, Juan R, Robertson, Anne M, Yu, Alexander K, Stapleton, Christopher J

2021

Overview

BackgroundBlebs are important secondary structures of intracranial aneurysms associated with increased rupture risk and can affect local wall stress and hemodynamics. Mechanisms of bleb development and evolution are not clearly understood. We investigate the relationship between blebs with different wall characteristics and local hemodynamics and rupture sites.MethodsBlebs with different wall appearances in intra-operative videos were analyzed with image-based computational fluid dynamics. Thin red blebs were compared against thick atherosclerotic/hyperplastic white/yellow blebs. Rupture points were identified in videos of ruptured aneurysms harboring blebs.ResultsThin blebs tended to be closer to the inflow than atherosclerotic blebs of the same aneurysm (P=0.0234). Blebs near the inflow had higher velocity (P=0.0213), vorticity (P=0.0057), shear strain rate (P=0.0084), wall shear stress (WSS) (P=0.0085), and WSS gradient (P=0.0151) than blebs far from the inflow. In a subset of 12 ruptured aneurysms harboring blebs, rupture points were associated with thin blebs in 42% of aneurysms, atherosclerotic blebs in 25%, and were away from blebs in the remaining 33%.ConclusionsNot all blebs are equal; some have thin translucent walls while others have thick atherosclerotic walls. Thin blebs tend to be located closer to the inflow than atherosclerotic blebs. Blebs near the inflow are exposed to stronger flows with higher and spatially variable WSS than blebs far from the inflow which tend to have uniformly lower WSS. Aneurysms can rupture at thin blebs, atherosclerotic blebs, and even away from blebs. Further study of wall failure in aneurysms with different bleb types is needed.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: aneurysm / Aneurysm, Ruptured - diagnostic imaging / Aneurysm, Ruptured - physiopathology / Aneurysm, Ruptured - surgery / Aneurysms / Boundary conditions / Female / Hemodynamics / Hemodynamics - physiology / hemorrhage / Hemorrhagic stroke / Humans / Hydrodynamics / Imaging, Three-Dimensional - methods / Intracranial Aneurysm - diagnostic imaging / Intracranial Aneurysm - physiopathology / Intracranial Aneurysm - surgery / Male / Medical imaging / Microsurgery - methods / Risk Factors / Stress, Mechanical / Variables