Real-time quantitative prediction of cerebral-aneurysm growth with thrombosis-stratified vascular remodeling

Intracranial aneurysms consisted of a coexistence of thin and thick walls, suggesting that two distinct vascular remodeling are involved, but their mechanism has yet to be clarified. This research combined human pathology, in vivo, ex vivo, and in silico experiments, and thereby aimed at understanding and modeling the mechanism. As a result, an aneurysmal progression was found to be associated with vascular strain by blood pressure. The increased wall strain due to wall thinning was associated with massive death of smooth muscle cells, resulting in a formation of microscopic tear, through which the aneurysm is enlarged morphologically. The micro tear promoted thrombus formation as a repair of vascular tissues, but the formation of thrombus has a dependence on surrounding environment. Flow impingement and concentrated wall strain were preventive factors of thrombus formation, which has a role of bifurcating the vascular remodeling in either wall-thinning or -thickening direction.