Methodologies to assess blood flow in cerebral aneurysms: Current state of research and perspectives Approches méthodologiques de l'étude des flux dans les anévrismes intracrâniens : état de la recherche et perspectives

Summary With intracranial aneurysms disease bringing a weakened arterial wall segmentto initiate, grow and potentially rupture an aneurysm, current understanding of vessel wallbiology perceives the disease to follow the path of a dynamic evolution and increasingly recog-nizes blood flow as being one of the main stakeholders driving the process. Although currentlymostly morphological information is used to decide on whether or not to treat a yet unrupturedaneurysm, among other factors, knowledge of blood flow parameters may provide an advancedunderstanding of the mechanisms leading to further aneurismal growth and potential rupture.Flow patterns, velocities, pressure and their derived quantifications, such as shear and vortic-ity, are today accessible by direct measurements or can be calculated through computation.This paper reviews and puts into perspective current experimental methodologies and numer-ical approaches available for such purposes. In our view, the combination of current medicalimaging standards, numerical simulation methods and endovascular treatment methods allowfor thinking that flow conditions govern more than any other factor fate and treatment in cere-bral aneurysms. Approaching aneurysms from this perspective improves understanding, andwhile requiring a personalized aneurysm management by flow assessment and flow correction,if indicated.© 2009 Elsevier Masson SAS. All rights reserved.