J Neurosurg 142:1741–1750, 2025
This study analyzes intracranial aneurysm growth, revealing two main mechanisms: high-flow impingement causing wall thinning (mainly in ACom aneurysms) and slow, oscillatory flow leading to wall thickening (mainly in MCA aneurysms). Findings support personalized monitoring and interventions based on regional hemodynamic environments.
• Intracranial aneurysm growth is driven by complex interactions of hemodynamic forces and wall remodeling mechanisms.
• Growth most commonly occurs in the aneurysm body and central flow regions, with patterns varying by location and morphology.
• Two main growth pathways are identified: high-flow impingement (causing wall thinning/degeneration, mainly in ACom aneurysms) and low-flow oscillatory conditions (causing wall thickening/remodeling, mainly in MCA aneurysms).
• High-flow impingement regions (neck, body, inflow) show higher wall shear stress (WSS) and are linked to wall degeneration and rupture risk.
• Low-flow regions (dome, central) have low WSS, high oscillatory shear index, and promote wall remodeling and thickening.
• Distinct growth patterns by aneurysm type suggest targeted monitoring and interventions could reduce rupture risk.
• Findings challenge the simplistic view that only one flow condition drives growth or rupture, emphasizing the need for personalized treatment strategies.
• Study limitations include model assumptions (rigid walls, Newtonian blood), subjective region labeling, and exclusion of nonhemodynamic factors.
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