Influence of size, shape and properties on the mechanics of axisymmetric saccular aneurysms.

Rupture of intracranial saccular aneurysms is the most common cause of spontaneous subarachnoid hemorrhage which, despite advances in neurosurgery, continues to result in significant morbidity and mortality. Currently, the decision to treat a diagnosed, unruptured aneurysm is based primarily on the maximum dimension of the lesion even though there is controversy over the 'critical size' (e.g. many 'large' lesions do not rupture whereas some 'small' ones do). There is a need, therefore, for improved predictors of the rupture-potential of these lesions. In this paper, we show that it is highly unlikely that saccular aneurysms expand or rupture due to a limit point instability, and suggest that a rupture-criterion should be based on local multiaxial states of stress or strain. Moreover, our results from nonlinear finite element analyses reveal important roles of lesion shape, material properties, and loading conditions, not just size, in governing the distributions of stress and strain within a sub-class of axisymmetric saccular aneurysms. For example, we find that maximum biaxial stresses and strains are most often at the fundus, where rupture tends to occur, and that maximum stresses increase markedly with increases in lesion size, the ratio of neck diameter to lesion height, and the distending transmural pressure.