Intracranial aneurysms are a potentially devastating pathological dilation of brain arteries that affect 1–5 % of the population. In this study we investigated the vortex structures of both unruptured and ruptured intracranial aneurysms as a discriminating property. We performed pulsatile computational fluid dynamic simulations on 204 patient-specific aneurysm models (57 ruptured and 147 unruptured) derived from patient angiographic imaging. Using Q-criterion we analyzed the coherent structures both throughout the aneurysm volume and at the wall. The relative surface area with positive Q values (indicating vortices at the wall) was able to differentiate ruptured and unruptured aneurysms. For the first time, in a large patient cohort, mechanistic fluid analysis is leading to insights into rupture pathways.

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