Rupture point hemodynamics of intracranial aneurysms: Case report and literature review

Abstract BACKGROUND Hemodynamics play an important role in the development of intracranial aneurysms. Rupture point confirmation in intracranial aneurysms with multiple blebs is significant to avoid intraoperative re-rupture. However, rupture point hemodynamics are difficult to obtain. This study aims to investigate rupture hemodynamic characteristics fortuitously captured in one specific aneurysm patient. METHODS A female patient in her fifties with a right ruptured middle cerebral artery bifurcation aneurysm was admitted into our hospital. While conducting a three-dimensional (3D) rotation angiography, the aneurysm re-ruptured, permitting us the rare opportunity to acquire 3D geometric imaging before and at the moment of rebleeding. The rupture point was identified by 3D infusion geometry. The hemodynamic characteristics of the rupture point region were analyzed and compared to the hemodynamics affecting the rest of the aneurysm sac. RESULTS Computational flow dynamic (CFD) analysis demonstrated a concentrated flow jet that impinged directly on the site of rupture with high OSI, RRT, GON and time-averaged pressure (TAP). Low TAWSS and TAWSSG were also observed at the rupture point in this particular MCA aneurysm patient. The TAWSS and TAWSSG at rupture point were only 13% and 30% respectively compared to the rest of aneurysm sac. The OSI, RRT, GON and time-averaged pressure (TAP) at rupture site were 4.3, 5.2, 2.0 and 1.2 times greater than the rest of the aneurysm sac respectively. CONCLUSIONS This case demonstrates that aneurysm rupture point hemodynamics appear s to be associated with low TAWSS and TAWSSG, in combination with high OSI, RRT, GON and pressure.