title: A proposed parent vessel geometry-based categorization of saccular intracranial aneurysms: computational flow dynamics analysis of the risk factors for lesion rupture.
abstract: OBJECTIVE
  The authors created a simple, broadly applicable classification of saccular intracranial aneurysms into three categories: sidewall (SW), sidewall with branching vessel (SWBV), and endwall (EW) according to the angiographically documented patterns of their parent arteries. Using computational flow dynamics analysis (CFDA) of simple models representing the three aneurysm categories, the authors analyzed geometry-related risk factors such as neck width, parent artery curvature, and angulation of the branching vessels.
  
  
  METHODS
  The authors performed CFDAs of 68 aneurysmal geometric formations documented on angiograms that had been obtained in patients with 45 ruptured and 23 unruptured lesions. In successfully studied CFDA cases, the wall shear stress, blood velocity, and pressure maps were examined and correlated with aneurysm rupture points. Statistical analysis of the cases involving aneurysm rupture revealed a statistically significant correlation between aneurysm depth and both neck size (p < 0.0001) and caliber of draining arteries (p < 0.0001). Wider-necked aneurysms or those with wider-caliber draining vessels were found to be high-flow lesions that tended to rupture at larger sizes. Smaller-necked aneurysms or those with smaller-caliber draining vessels were found to be low-flow lesions that tended to rupture at smaller sizes. The incidence of ruptured aneurysms with an aspect ratio (depth/neck) exceeding 1.6 was 100% in the SW and SWBV categories, whereas the incidence was only 28.75% for the EW aneurysms.
  
  
  CONCLUSIONS
  The application of standardized categories enables the comparison of results for various aneurysms' geometric formations, thus assisting in their management. The proposed classification system may provide a promising means of understanding the natural history of saccular intracranial aneurysms.
authors.affiliation: Department of Neuroendovascular Therapy, Graduate School of Medicine, Tohoku University, Sendai, Japan.
authors.forename: Tamer
authors.initials: T
authors.lastname: Hassan
authors.forename: Eugene V
authors.initials: EV
authors.lastname: Timofeev
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Saito
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ezura
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsumoto
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Takayama
authors.forename: Teij
authors.initials: T
authors.lastname: Tominaga
authors.forename: Akira
authors.initials: A
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D017542:Aneurysm, Ruptured / Q000145:classification* / Q000473:pathology*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000145:classification* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012039:Regional Blood Flow; D012307:Risk Factors; D013314:Stress, Mechanical