The Big Bang theory of intracranial aneurysm rupture: Gazing through the Computational fluid dynamics telescope

Aneurysms are out-pouchings of blood vessels typically arising at branch points. They pose a significant health risk by a potential to fatal rupture. With advancements in medical imaging, improved access to medical services and pre-emptive medical check-ups, the pick-up rate of un-ruptured intracranial aneurysms (UIAs) has increased tremendously. Stratification of the risk of rupture of un-ruptured intracranial aneurysms has been a challenge for investigators. Computational simulations of blood flow through aneurysms holds promise to equip clinicians make crucial decisions in the management of intracranial aneurysms. The imaging data of seventeen patients with intracranial aneurysms were processed and flow analyzed. Wall shear stress, pressure distribution and velocity streamlines were determined and depicted on the aneurysm. Areas of high wall shear stress correlated with the impingement sites of inlet jet of the blood. Flow velocity streamlines depicted within the three-dimensional structure of the aneurysm help understand the impingement site of the inlet blood stream, the flow pattern within the aneurysm and vortices. Pressure distribution patterns also matched impingement zones in the aneurysm. The methodology used in the study is simple and reproducible yielding results to equip clinicians to make crucial and timely judgments in the management of un-ruptured intracranial aneurysms. Assimilation of a larger database of CFD based simulations on intracranial aneurysms will expand the possibility of identifying statistically significant variables which could help predict the rupture potential of aneurysms.