Patient-Specific Modelling of Intracranial Aneurysm Evolution

Abstract

Intracranial aneurysms appear as sac-like outpouchings of the cerebral vasculature wall; inflated by the pressure of the blood that fills them. They are relatively common and affect up to 5% of the adult population. Fortunately, most remain asymptomatic. However, there is a small but inherent risk of rupture: 0.1% to 1% of detected aneurysms rupture every year. If rupture does occur there is a 30% to 50% chance of fatality. Consequently, if an aneurysm is detected, clinical intervention may be deemed appropriate. Therapy is currently aimed at pre-rupture detection and preventative treatment. However, interventional procedures are not without risk to the patient. The improvement and optimization of interventional techniques is an important concern for patient welfare and is necessary for rationalisation of healthcare priorities. Hence there is a need to develop methodologies to assist in identifying those ICAs most at risk of rupture. We focus on the mathematical modelling and computational simulation of ICA evolution. Models must take into consideration: (i) the biomechanics of the arterial wall; (ii) the biology of the arterial wall and (iii) the complex interplay between (i) and (ii), i.e. the mechanobiology of the arterial wall. The ultimate ambition of such models is to aid clinical diagnosis on a patient-specific basis. However, due to the significant biological complexity coupled with limited histological information such models are still in their relative infancy. Current research focuses on simulating the evolution of an ICA with an aim to yield insight into the growth and remodelling (G&R) processes that give rise to inception, enlargement, stabilisation and rupture. We present a novel Fluid-Structure-Growth computational framework for modelling aneurysm evolution.