Case Report: Dynamic Changes in Hemodynamics During the Formation and Progression of Intracranial Aneurysms.

Despite the devastating consequences of aneurysmal subarachnoid hemorrhage (SAH), the mechanisms underlying the formation, progression, and rupture of intracranial aneurysms (IAs) are complex and not yet fully clear. In a real-world situation, continuously observing the process of aneurysm development in humans appears unrealistic, which also present challenges for the understanding of the underlying mechanism. We reported the relatively complete course of IA development in two real patients. On this basis, computational fluid dynamics simulation (CFD) was performed to evaluate the changes in hemodynamics and analyze the mechanism underlying the formation, progression, and rupture of IAs. Our results suggested that the formation and progression of IAs can be a dynamic process, with constantly changing hemodynamic characteristics. CFD analysis based on medical imaging provides the opportunity to study the hemodynamic conditions over time. From these two rare cases, we found that concentrated high-velocity inflow jets, flows with vortex structures, extremely high WSS, and a very steep WSSG were correlated with the formation of IAs. Complex multi-vortex flows are possibly related to IAs prior to growth, and the rupture of IAs is possibly related to low WSS, extreme instability and complexity of flow patterns. Our findings provide unique insight into the theoretical hemodynamic mechanism underlying the formation and progression of IAs. Given the small sample size the findings of this study have to be considered preliminary and exploratory.