Morphologic and hemodynamic analysis of intracranial mirror aneurysms

Abstract Intracranial mirror aneurysms are pathologic dilatations of cerebral arteries that occur at identical locations in both hemispheres. They do not always have identical sizes, shapes, or rupture states, despite identical patient-specific risk factors. As a subgroup of multiple aneurysms and thus small amounts of data, clinical research about their causes and development has not been conclusive. Using eight patients with 16 mirror aneurysms with different rupture states, we investigated differences between the hemispheres. We virtually performed stitching: detaching the aneurysm domes to place them on the opposite parent vessel to assess the influence of aneurysm morphology and upstream parent vessel shape on hemodynamics. In the unaltered datasets, we found that blood flow within aneurysms in the left hemisphere has higher wall shear stress and velocity. After stitching, we found that both upstream parent vessel as well as aneurysm morphology influence hemodynamics. Morphologic parameters like size, undulation index, and aneurysm angle had a higher influence. In a short rupture risk analysis we found a correlation between rupture and aspect ratio and non-sphericity index. Overall, we found possible indicators for mirror aneurysm analysis that illustrated the importance of morphological analysis, though more datasets are necessary for conclusive statements about special treatment for mirror aneurysms.