Cerebral aneurysms affect a substantial fraction of the adult population and are increasingly detected with noninvasive imaging. Only a small fraction of aneurysms rupture, but subarachnoid hemorrhage secondary to aneurysm rupture is a devastating event that carries high rates of morbidity and mortality, and large healthcare costs. Although improving, endovascular and surgical interventions still carry significant risks that may exceed the natural rupture risk. Therefore, it is important to properly evaluate aneurysms to avoid unnecessary interventions of low risk aneurysms, and to identify high-risk aneurysms for immediate treatment. The most important predictors of aneurysm rupture according to past studies are size and location. However, it is well known that many small aneurysms do rupture. On the other hand, the posterior communicating artery (PCOM) is a common site for intracranial aneurysms and aneurysms at this location have larger risks than those at other locations. As such, clinicians often need to decide whether or not to treat PCOM aneurysms, but do not have other reliable parameters to guide and support their decisions. PCOM aneurysms have different angio- architectures (relationship of the aneurysm with respect to the parent artery). However, it is unknown whether aneurysms with different angio-architectures have different rupture rate. Our preliminary data suggests that they do. But, it remains unknown if ruptured or unruptured PCOM aneurysms with different angio-architectures have different hemodynamic and geometric features that explain the different rupture rate and distinguish vulnerable from benign aneurysms. The objectives of this project are to: 1) statistically confirm that PCOM aneurysms with different angio-architectural configurations have different rupture rates, 2) identify hemodynamic and geometric parameters that distinguish between ruptured and unruptured aneurysms of each architecture, and 3) provide clinicians with another tool in the armamentarium to face the neurovascular pathology, by developing a scoring scale for the rupture risk assessment of PCOM aneurysms. Clinical relevance of the proposed project: The results of this exploratory project will be applicable immediately to the clinical practice, and will be generalized and extended in future studies to other locations and aneurysm characteristics. Successful completion of this project will: 1) provide new knowledge to distinguish between vulnerable and benign PCOM aneurysms, 2) improve safety and outcome of aneurysm treatment by better patient selection, 3) advance our understanding of mechanisms responsible for aneurysm rupture, 4) guide future experiments and research, 5) guide development of procedures and devices. Each of these factors will contribute to the improvement of patient care.

Public Health Relevance

Cerebral aneurysms located at the posterior communicating artery (PCOM), are common, have higher relative risk than other locations, and are difficult to evaluate in order to recommend immediate treatment or conservative observation. The objective of this project is to improve risk assessment of PCOM aneurysms by identifying angio-architectural, hemodynamic and geometric features associated with rupture, and use these factors to build a scoring scale to guide and support clinical decisions. The knowledge and tools generated in this project are expected to positively impact the clinical decision making process and to improve the care of patients with intracranial aneurysms.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21NS094780-02
Application #
9144876
Study Section
Neuroscience and Ophthalmic Imaging Technologies Study Section (NOIT)
Program Officer
Koenig, James I
Project Start
2015-09-15
Project End
2017-08-31
Budget Start
2016-09-01
Budget End
2017-08-31
Support Year
2
Fiscal Year
2016
Total Cost
Indirect Cost
Name
George Mason University
Department
Engineering (All Types)
Type
Biomed Engr/Col Engr/Engr Sta
DUNS #
077817450
City
Fairfax
State
VA
Country
United States
Zip Code
22030
Detmer, Felicitas J; Fajardo-Jiménez, Daniel; Mut, Fernando et al. (2018) External validation of cerebral aneurysm rupture probability model with data from two patient cohorts. Acta Neurochir (Wien) 160:2425-2434
Detmer, Felicitas J; Chung, Bong Jae; Jimenez, Carlos et al. (2018) Associations of hemodynamics, morphology, and patient characteristics with aneurysm rupture stratified by aneurysm location. Neuroradiology :
Chung, B J; Mut, F; Putman, C M et al. (2018) Identification of Hostile Hemodynamics and Geometries of Cerebral Aneurysms: A Case-Control Study. AJNR Am J Neuroradiol 39:1860-1866
Detmer, Felicitas J; Chung, Bong Jae; Mut, Fernando et al. (2018) Development and internal validation of an aneurysm rupture probability model based on patient characteristics and aneurysm location, morphology, and hemodynamics. Int J Comput Assist Radiol Surg 13:1767-1779
Detmer, Felicitas J; Chung, Bong Jae; Mut, Fernando et al. (2018) Development of a statistical model for discrimination of rupture status in posterior communicating artery aneurysms. Acta Neurochir (Wien) :
Chung, B J; Doddasomayajula, R; Mut, F et al. (2017) Angioarchitectures and Hemodynamic Characteristics of Posterior Communicating Artery Aneurysms and Their Association with Rupture Status. AJNR Am J Neuroradiol 38:2111-2118
Doddasomayajula, R; Chung, B J; Mut, F et al. (2017) Hemodynamic Characteristics of Ruptured and Unruptured Multiple Aneurysms at Mirror and Ipsilateral Locations. AJNR Am J Neuroradiol 38:2301-2307