Modeling intracranial aneurysm stability and growth: an integrative mechanobiological framework for clinical cases
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ORIGINAL PAPER
Modeling intracranial aneurysm stability and growth: an integrative mechanobiological framework for clinical cases Frederico S. Teixeira1 · Esra Neufeld1 · Niels Kuster1 · Paul N. Watton2,3 Received: 13 August 2019 / Accepted: 12 May 2020 © The Author(s) 2020
Abstract We present a novel patient-specific fluid-solid-growth framework to model the mechanobiological state of clinically detected intracranial aneurysms (IAs) and their evolution. The artery and IA sac are modeled as thick-walled, non-linear elastic fiberreinforced composites. We represent the undulation distribution of collagen fibers: the adventitia of the healthy artery is modeled as a protective sheath whereas the aneurysm sac is modeled to bear load within physiological range of pressures. Initially, we assume the detected IA is stable and then consider two flow-related mechanisms to drive enlargement: (1) low wall shear stress; (2) dysfunctional endothelium which is associated with regions of high oscillatory flow. Localized collagen degradation and remodelling gives rise to formation of secondary blebs on the aneurysm dome. Restabilization of blebs is achieved by remodelling of the homeostatic collagen fiber stretch distribution. This integrative mechanobiological modelling workflow provides a step towards a personalized risk-assessment and treatment of clinically detected IAs. Keywords Fluid–solid-growth · Growth · Remodelling · Intracranial aneurysm
1 Introduction Intracranial aneurysm (IA), a localized focal out-pouching of the cerebral vasculature, occurs in 3–5% of the adult population. The risk of rupture is very low; however, if rupture does occur, mortality rates are very high. Physicians select The authors gratefully acknowledge the support from the AneuX Project, funded by SystemX.ch and evaluated by the Swiss National Research Fund (2014/261). Paul Watton acknowledges partial support towards this work from the UK EPSRC (EP/ N014642/1) * Paul N. Watton [email protected] Frederico S. Teixeira [email protected] Esra Neufeld [email protected] Niels Kuster [email protected] 1
IT’IS Foundation & ETH Zürich, Zürich, Switzerland
2
Department of Computer Science, Insigneo Institute for in silico Medicine, University of Sheffield, Sheffield, UK
3
Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, USA
IAs for intervention by weighing up rupture likelihood with risks associated with treatments. Unfortunately, personalized rupture risk assessment remains elusive and, consequently, intervention may be recommended for IAs that are stable. Despite continuous efforts on identifying the etiology of the disease, the exact causes of aneurysm formation, growth, stabilization and/or rupture are still not fully understood. Correlations with genetic factors [such as tissue disorders, polycistic kidney disease, first-degree family history etc. (Samuel and Radovanovic 2019)], gender (Desai et al. 2019), ethnicity (Detmer et al. 2019) and external factors (such as high bloo
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