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Differences Between Ruptured Aneurysms With and Without Blebs: Mechanistic Implications

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Abstract

Purpose

Blebs are known risk factors for intracranial aneurysm (IA) rupture. We analyzed differences between IAs that ruptured with blebs and those that ruptured without developing blebs to identify distinguishing characteristics among them and suggest possible mechanistic implications.

Methods

Using image-based models, 25 hemodynamic and geometric parameters were compared between ruptured IAs with and without blebs (n = 673), stratified by location. Hemodynamic and geometric differences between bifurcation and sidewall aneurysms and for aneurysms at five locations were also analyzed.

Results

Ruptured aneurysms harboring blebs were exposed to higher flow conditions than aneurysms that ruptured without developing blebs, and this was consistent across locations. Bifurcation aneurysms were exposed to higher flow conditions than sidewall aneurysms. They had larger maximum wall shear stress (WSS), more concentrated WSS distribution, and larger numbers of critical points than sidewall aneurysms. Additionally, bifurcation aneurysms were larger, more elongated, and had more distorted shapes than sidewall aneurysms. Aneurysm morphology was associated with aneurysm location (p < 0.01). Flow conditions were different between aneurysm locations.

Conclusion

Aneurysms at different locations are likely to develop into varying morphologies and thus be exposed to diverse flow conditions that may predispose them to follow distinct pathways towards rupture with or without bleb development. This could explain the diverse rupture rates and bleb presence in aneurysms at different locations.

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Acknowledgments

This work was supported by the National Institutes of Health (NIH) Grant #2R01NS097457.

Funding

This work was supported by the NIH Grant #2R01NS097457.

Conflict of interest

All authors declare that they have no conflict of interest. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Informed Consent

Informed consent was obtained from all patients for being included in the study.

Research Involving Human and Animal Studies

The protocols for patient consent, handling of patient data, and analysis were approved by the institutional review board (IRB) at George Mason University. No animal studies were carried out by the authors for this article.

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Authors and Affiliations

  1. Department of Bioengineering, Volgenau School of Engineering, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA

    Seyedeh Fatemeh Salimi Ashkezari, Fernando Mut & Juan R. Cebral

  2. Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, PA, USA

    Anne M. Robertson

  3. Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA

    Anne M. Robertson

  4. Department of Mechanical Engineering, George Mason University, Fairfax, VA, USA

    Juan R. Cebral

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  1. Seyedeh Fatemeh Salimi Ashkezari
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Correspondence to Seyedeh Fatemeh Salimi Ashkezari.

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Associate Editor Zhenglun Alan Wei oversaw the review of this article.

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Salimi Ashkezari, S.F., Mut, F., Robertson, A.M. et al. Differences Between Ruptured Aneurysms With and Without Blebs: Mechanistic Implications. Cardiovasc Eng Tech 14, 92–103 (2023). https://doi.org/10.1007/s13239-022-00640-4

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  • DOI: https://doi.org/10.1007/s13239-022-00640-4

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