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Journal of Biomechanics 40 (2007) 2716–2722

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Numerical simulation of saccular aneurysm hemodynamics:

Influence of morphology on rupture risk
Brent Utter, Jenn Stroud Rossmann
Mechanical Engineering Department, Lafayette College, Easton, PA 18042, USA
Accepted 11 January 2007

Abstract

The governing equations for pulsatile fluid flow were solved in their finite volume formulation in order to simulate blood flow in a
variety of three-dimensional aneurysm geometries. The influence of geometric factors on flow patterns and fluid mechanical forces was
studied with the goal of identifying the risk of aneurysm rupture. Aneurysm morphology was characterized by quantitative shape indices
reflecting the three dimensionality of the vasculature derived from clinical studies. Recirculation zones and secondary flows were
observed in aneurysms and arteries. Regions of extreme and alternating shear stress were observed and identified as sites for potential
aneurysm rupture. The ellipticity of an aneurysm was observed to be strongly correlated with wall shear stress at the aneurysm fundus,
while its non-sphericity, volume, and degree of undulation were more weakly correlated.
r 2007 Elsevier Ltd. All rights reserved.

Keywords: Numerical simulation; Aneurysm; Intracranial; Morphology; Shape index; Rupture

1. Introduction stood to have the greatest influence on aneurysm growth

Aneurysms pose a grave health risk. If left untreated,
aneurysms may continue to expand until rupture, causing
hemorrhage, complications of local organ function, and
possibly death. Aneurysm rupture has high rates of mortality
and morbidity (e.g. Kassell et al., 1990). Of particular interest
due to their location are intracranial aneurysms (ICAs),
commonly found at bifurcations in the circle of Willis. Since
ICAs are asymptomatic prior to rupture (Vega et al., 2002),
intact ICAs are often discovered by neurosurgeons who are
not looking for them. Once an ICA is found, the choice of
treatment is complicated by the limited diagnostic criteria to
predict rupture risk and by the risks of surgical intervention
itself. A detailed understanding of the local hemodynamics,
of the effects of vascular wall remodeling on the flow
patterns, and of long-term adaptation to surgical interven-
tion, is vital to useful clinical treatment of aneurysms.
While wall structure and behavior are relevant to any
investigation of aneurysmal vessels, fluid flow is under-
Corresponding author. Tel.: +1 610 330 5406; fax: +1 610 330 5059.
E-mail address: rossmanj@lafayette.edu (J.S. Rossmann).
and rupture (Liepsch, 2001; Hoi et al., 2004). Experiments
such as those of Gobin et al. (1994) and observations
including those of Strother (1995) have demonstrated the
existence of a recirculation zone inside a saccular aneur-
ysm. This region of slow flow is believed to promote the
formation of thrombi or blood clots (Hademenos and
Massoud, 1998), as recirculating flow also does in
otherwise healthy arteries. Foutrakis et al. (1999) con-
cluded that in the absence of disease, the formation and
growth of saccular aneurysms are due to mechanical forces.
The search for reliable rupture predictors that can be
obtained from available in vivo information has focused
primarily on aneurysm size, aspect ratio, and irregularity.
Hademenos et al. (1994) improved the traditional Laplace’s
law method of determining an aneurysm’s ‘‘critical radius’’
by accounting for the wall’s viscoelasticity, and determined
a radius of 4.8 mm above which rupture was likely.
However, because many large ICAs remain intact, while
some small ICAs rupture (e.g. Beck et al., 2003), size is not
a reliable predictor of rupture risk.
An aneurysm’s aspect ratio (AR) has also been suggested
as a rupture predictor (e.g. Parlea et al., 1999; Ujiie et al.,

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B. Utter, J.S. Rossmann / Journal of Biomechanics 40 (2007) 2716–2722 2717

1999; Nader-Sepahi et al., 2004). AR is the ratio of the

aneurysm’s height to its neck diameter. Nader-Sepahi et al.
(2004) measured the aspect ratio of 75 ruptured and 107
intact aneurysms and found the average AR values of each
group to be 2.70 and 1.80, respectively. However, the AR
of a physiological aneurysm is highly dependent on the
viewing angle or projection plane imaged; for multilobular
and other complex aneurysm geometries, a definitive value
of AR is difficult or impossible to obtain.
Rohde et al. (2005) used Fourier analysis to quantify the
irregularity of aneurysms. Although this method can only
be applied to a two-dimensional projection, the results of
this study suggested that irregular aneurysms were more
likely to rupture.
Ma et al. (2004) developed shape indices based on three-
dimensional morphologies, and calculated these indices for
clinically observed aneurysms. One year later, the authors
evaluated their indices by revisiting the same patient base
(Raghavan et al., 2005). Although the population consisted
of only 27 patients, the results suggested that a more Fig. 1. Base geometry for all simulations.
irregular geometry had a higher chance of rupture.
Fourteen individual aneurysm geometries are examined in this study.
Significantly, the authors found that ‘‘abnormal shape
Of these, 13 are derived from a 7 mm sphere. One 10 mm spherical
characteristics’’ were possible in aneurysms of all sizes. aneurysm is studied; this diameter just exceeds the ‘‘critical’’ value
Their results also indicated that the indices for non- predicted by Hademenos et al. (1994) and would be most likely to receive
sphericity and ellipticity were among the most statistically surgical intervention due to its size. The remaining aneurysms are not
significant indices. smooth spheres, but contain undulations, lobed and elliptical features
modeled on clinical images (e.g. Parlea et al., 1999; Shojima et al., 2004).
Shojima et al. (2004) obtained the geometries of 20
The degree of geometric irregularity can then be quantified using the shape
saccular ICAs using CT angiography, and calculated the indices of Ma et al. (2004), and the blood flow simulated.
local wall shear stress (WSS) acting at the fundi to be
significantly lower than the WSS acting on the surrounding
2.2. Shape indices
vasculature. The authors surmised that low values of WSS
on the aneurysmal wall promote the growth and eventual The indices used to evaluate aneurysms in this study depend on the
rupture, via the degeneration of endothelial cells, of volume and surface area of the aneurysm and of its convex hull (Ma et al.,
saccular ICAs. Also, in a result corroborating the conclu- 2004). The convex hull of an object is the smallest volume that completely
sions of Nader-Sepahi et al. (2004), Shojima et al. (2004) envelops the object and is also completely convex. The volume and surface
found an inverse relationship between an aneurysm’s aspect area of the convex hull for each aneurysm studied are computed using the
Qhull1 algorithm.
ratio and the shear stress acting on the aneurysmal wall. The non-sphericity index (NSI) is defined as
The goal of the current study is to correlate aneurysm
geometry, characterized by the shape indices of Ma et al. V 2=3
NSI ¼ 1  ð18pÞ1=3 ,
(2004), with the intra-aneurysmal fluid dynamics obtained S
using computational fluid dynamics (CFD). Such a where V and S are the volume and surface area of the aneurysm,
respectively. NSI increases as the aneurysm’s geometry deviates from the
correlation could inform the diagnosis and treatment of
shape of a sphere.
an intact aneurysm by elucidating the likelihood of The ellipticity index (EI) is defined as
rupture.
2=3
V CH
EI ¼ 1  ð18pÞ1=3 ,
S CH
2. Methods where VCH and SCH are the volume and surface area of the aneurysm’s
convex hull. EI is closely related to the aspect ratio, because the EI will be
2.1. Geometry of models large when the height of the aneurysm is large compared to the aneurysm’s
width. EI differs from AR in that EI will also be large if the aneurysm’s
This study is focused on aneurysms forming at arterial bifurcations in body is wide compared to its height.
the circle of Willis, and in particular, at the basilar artery bifurcation. The undulation index is defined as
Ingebrigtsen et al. (2004) measured the geometric features of 107  
V
intracranial artery bifurcations. For the basilar artery, they reported an UI ¼ 1  .
V CH
average parent diameter of 3.2 mm, one daughter vessel with diameter
2.0 mm and a 631 branching angle, and a second daughter vessel with
1
diameter 1.8 mm and 651 branch angle. These values are used to create the Qhull was developed by The National Science and Technology
surrounding vasculature of the three-dimensional aneurysms in the current Research Center for Computation and Visualization of Geometric
study, shown in Fig. 1. Structures (The Geometry Center), University of Minnesota.
 ARTICLE IN PRESS
2718 B. Utter, J.S. Rossmann / Journal of Biomechanics 40 (2007) 2716–2722
UI characterizes the ‘‘lumpiness’’ of an aneurysm, and increases as the
aneurysm wall becomes more undulatory.
2.3. Computational method
For the simulations carried out in this study, it is assumed that blood is
an incompressible, Newtonian fluid and that the flow is laminar and
isothermal. The assumption of Newtonian behavior is based on the
findings of Perktold et al. (1989) and others who found minimal changes in
arterial flow patterns when non-Newtonian effects were included. For such
a fluid, the continuity and Navier–Stokes equations are as follows:
r  u ¼ 0,
 
qu
r þ u r u ¼  rp þ mr2 u ,
qt
where u is the velocity, r the fluid density, p the pressure, and m the fluid
viscosity. Solution of these equations in their finite volume form is
accomplished through a commercial software package, CFD–ACE+
(Singhal, 1998). The discretization is temporally implicit and spatially
second order. Velocity–pressure coupling is achieved using the SIMPLEC
algorithm initially suggested by Chorin (1967).
Fig. 2. Mean velocity of blood in the basilar artery (after Marks et al.,
1992).
Fig. 3. Effect of inlet velocity profile on flow in healthy bifurcation: left, inlet profile is uniform; right, parabolic.
A representative volumetric flowrate in the basilar artery was obtained
using phase-contrast cine magnetic resonance by Marks et al. (1992). The
resulting velocity waveform used in the current study is shown in Fig. 2.
Four cycles are simulated to ensure periodic flow conditions, and the
results of the fourth are reported. Flow-through conditions are applied at
the outlets of the daughter vessels. At the walls, which are assumed to be
rigid, no-slip and no-penetration conditions are imposed. At the basilar
artery inlet, the velocity profile is assumed to be uniform with the pulsatile
waveform as shown in Fig. 2.
The effect of the inlet velocity profile on the downstream flow was
examined, and the impact of the uniform flow assumption was found to be
minimal. As shown in Fig. 3, the velocity profile becomes nearly parabolic
upstream of the bifurcation and aneurysm region whether the inlet flow is
uniform or parabolic, as expressed by the Womersley solution (Zamir,
2000). This is physiologically realistic: although the basilar artery receives
blood from two vertebral arteries, it is sufficiently long to allow adequate
mixing of the streams to achieve a nearly parabolic, pulsatile velocity
profile (e.g. Valencia et al., 2006).
As the model was developed, grid refinement studies were performed to
ensure an optimal balance between resolution and computational expense.
These studies demonstrated that unstructured grids consisting of
150,000–250,000 cells, depending on the morphology, adequately captured
the details of the flow without requiring unreasonable processing time.
3. Results
3.1. Flow patterns and forces
Fourteen different aneurysm geometries were created
and analyzed in the current study. Most were derived from
a 7 mm sphere. The calculated systolic WSS distribution,
pressure distribution and streamlines for the 7 mm sphe-
rical aneurysm are shown in Fig. 4.
The WSS and pressure distribution images shown in
Fig. 4 are rotated 401 about the vertical axis to show the
shoulders of the aneurysm more clearly. The peak values
calculated at the shoulders are a WSS of 14 N/m2 (140 dyn/
cm2) and a pressure of 515 N/m2 (3.86 mm Hg); these may
be compared with values in the surrounding vasculature
that vary from 2 to 5 dyn/cm2 and 0.5–2.9 mmHg. The
WSS throughout most of the aneurysm is less than 1 N/m2
(10 dyn/cm2) at systole, with the lowest values observed at
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B. Utter, J.S. Rossmann / Journal of Biomechanics 40 (2007) 2716–2722 2719

Fig. 4. WSS distribution, pressure distribution, and streamlines of intra-aneurysmal flow at systole for 7 mm spherical model. Streamlines are colored by
their distance from the basilar artery midplane.

Fig. 5. Sampling of aneurysm shapes studied: (a) high aspect ratio, (b) distorted 7 mm sphere, and (c) small irregular geometries.

the fundus. These results are in agreement with the findings
of other studies of aneurysmal flow, including those of
Valencia et al. (2006), who also observed low WSS at the
aneurysm fundus.
The instantaneous streamlines in Fig. 4 are colored by
their distance from the midplane. The streamlines, which
begin in the basilar artery’s plane of symmetry, extend out
of plane by as much as 75% of the aneurysm radius. They
demonstrate the three dimensionality of intra-aneurysmal
flow; recirculation zones and out-of-plane motion are
present that would not be captured by a two-dimensional
model.
Similar regions of elevated WSS and pressure exist in
each model. The high aspect ratio model shown in Fig. 5(a)
differs from the spherical models in that a higher average
pressure acts on the high aspect ratio aneurysm both at
systole (7.3% higher than the 7 mm model) and diastole
(6.14% higher). The high aspect ratio model has the highest
values of average pressure on the aneurysmal wall at both
systole (545 N/m2, or 4.09 mmHg) and diastole (242 N/m2,
or 1.82 mmHg).
The aneurysm in Fig. 5(c) has the smallest volume of any
aneurysm in this study. Due to its size, the intra-
aneurysmal flow is not decelerated to the same extent as
it is in larger models. Despite the increased average flow
and small size of this aneurysm, the average systolic WSS
for this model differs from that in the 7 mm spherical
model by only 1 %.
Table 1 shows the spatially averaged systolic wall shear
stress and pressure, as well as the time-averaged WSS near
the fundus, for several of the geometries examined.
3.2. Shape indices
Over the 14 aneurysm models studied, the aneurysm
volume varied from 43 to 517 mm3, the EI from 0.209 to
0.273, UI from 0.002 to 0.1, and NSI from 0.223 to 0.339.
For analysis, all index values are normalized by the largest
value in the set.
Fig. 6 shows that in general, as the EI increases, the
average WSS acting on the aneurysmal wall decreases.
In both the systolic and diastolic series, the lowest EI
represents the 10 mm geometry, whose volume, more
than four times greater than the average volume of the
thirteen other geometries, is its dominant morphological
characteristic.
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Table 1
Spatially averaged aneurysm WSS and pressure at systole, and temporally
averaged WSS at fundus, for several aneurysm models

Aneurysm Systolic Over cycle

Averaged WSS Averaged P Fundus WSS

(N/m2), dyn/cm2 (N/m2), mm Hg (N/m2), dyn/cm2

7 mm sphere 0.7199, 7.2 508, 3.81 0.0523, 0.52

Distorted 1 0.7688, 7.7 540, 4.05 0.0456, 0.46
Distorted 2 0.6722, 6.7 511, 3.83 0.0456, 0.46
Distorted 3 0.7231, 7.2 509, 3.82 0.0345, 0.35
Distorted 4 0.5928, 5.9 510, 3.83 0.0055, 0.05
10 mm sphere 0.2667, 2.7 507, 3.80 0.0172, 0.17
High AR 0.7725, 7.7 545, 4.09 0.0138, 0.14
Small 0.7702, 7.7 524, 3.93 0.0320, 0.32
irregular
Large 0.5022, 5.0 503, 3.77 0.0013, 0.01
irregular

Fig. 7. WSS near fundus versus time over one cardiac cycle. Systole
occurs 0.2 s into cycle (3.2 s in figure); diastolic or minimum inlet flow
conditions are at 0.75 s (here, 3.75 s).

Fig. 6. Average WSS of aneurysm at systole and diastole versus

normalized EI. Fig. 8. Variation in, and average, WSS at fundus over cycle versus EI.

The WSS at the fundus of each aneurysm model over
one cardiac cycle is shown in Fig. 7. The cyclic nature of
the WSS is observable, with stress following the inlet
velocity waveform (systolic 0.2 s into cycle, diastolic at
0.75 s) with varying closeness. The low-flow conditions in
the aneurysm appear to delay both systole and diastole in
the aneurysm dome.
The WSS at the fundus is significantly lower than the
spatially averaged WSS throughout the cycle. As Fig. 7
shows, the fundus WSS values calculated in the larger
(10 mm diameter), more irregular (independent of aneurysm
volume), and higher AR aneurysms are consistently lower
than those in the 7 mm sphere and its undulatory variants.
To illustrate the magnitude of the alternation in WSS at
the fundus of each aneurysm, the maximum ‘‘peak-to-
peak’’ change in WSS at the fundus is normalized by the
average fundus WSS over the cycle. In Figs. 8–10, this
normalized quantity is referred to as the ‘‘normalized
change in WSS.’’ The WSS at the fundus, averaged over
the cycle, is also shown.
The correlation of normalized change in WSS with EI
(shown in Fig. 8) is most strongly linear with an r value of
0.924, while the linear correlations of Figs. 9 (NSI) and 10
(UI) have less compelling r values of 0.704 and 0.474,
respectively. The relative significance of these relationships
is also demonstrated by p values of 2.29  106 (EI), 0.0049
(NSI), and 0.087 (UI), suggesting a strong relationship of
normalized change in WSS with EI, a significant but less
strong one with NSI, and a weak one with UI.
4. Discussion
Of the shape indices investigated, the EI has the strongest
correlation with wall shear stress in the aneurysm. The EI
 ARTICLE IN PRESS
B. Utter, J.S. Rossmann / Journal of Biomechanics 40 (2007) 2716–2722
Fig. 9. Variation in, and average, WSS at fundus over cycle versus NSI.
Fig. 10. Variation in, and average, WSS at fundus over cycle versus UI.
considers three dimensionality and aneurysm orientations
not accounted for by the aneurysm’s aspect ratio. As EI
increases, the wall shear stress at the fundus decreases,
suggesting an increasing risk of rupture with increasing
aneurysm ellipticity.
Fig. 8 shows that as EI increases, the peak-to-peak
change in WSS at the fundus increases, and the time-
averaged wall shear stress at the fundus decreases. The
normalized change in WSS at the fundus is an important
parameter, because significant oscillation of WSS at the
fundus may trigger a biological response from the
endothelial cells lining the wall of the aneurysm.
The seemingly counterintuitive observation that aneur-
ysms commonly rupture at their fundi, in a response to low
WSS, can be understood when biological and mechanical
factors are considered together.
Shojima et al. (2004) suggested that low WSS acting at
the fundus of saccular aneurysms was a direct cause of
aneurysm rupture. These low-flow conditions, and the
2721
compromised supply of nitric oxide usually released in
response to high WSS, result in the aggregation of red
blood cells, and in the buildup and adhesion of platelets
and leukocytes on the intimal surface. Subsequent effects
can include intimal damage, small thrombus formation,
and infiltration of white blood cells and fibrin inside the
aneurysm wall (Ujiie et al, 1999). The biological response
triggered by this low WSS may ultimately cause the
endothelial cells to degenerate via apoptosis. Pentimalli
et al. (2004) found higher levels of apoptosis in ruptured
than intact aneurysms, and also found a strong link
between apoptosis and aneurysm irregularity.
Oscillatory WSS at the neck’s distal end has previously
been suggested to promote aneurysm growth by weakening
the intima (Gonzalez et al., 1992). Fig. 7 illustrates the
cyclic nature of WSS acting on the fundus of the aneurysm.
Figs. 9 and 10 show that aneurysms with increasing levels
of irregularity have increasing normalized differences of
WSS at their fundi. This unstable near-wall environment
may signal an increased risk of rupture.
Tension in the wall of the aneurysm may also lead to
rupture, especially if the wall is thinning via cell degenera-
tion. It is imperative for future work to consider the
interaction between the fluid flow and the arterial wall, as
the effects of vessel remodeling and the material properties
of the arterial wall (e.g. Toth et al., 1998) surely play an
active role in aneurysm growth and rupture. It is
impossible to say anything conclusive about mechanisms
for rupture, including the effects of cyclic loading or
fatigue, without considering the interactions of fluid and
solid mechanics. Humphrey and Canham (2000) provide
an elegant review urging elasticians to consider this
problem.
The current work indicates that aneurysm ellipticity (EI)
and, to a lesser extent, non-sphericity (NSI) are correlated
with fluid mechanical forces and rupture risk. No definitive
correlation was observed between WSS and aneurysm
irregularity as quantified by the undulation index. How-
ever, the full range of values of the shape indices has not
yet been explored. The current study is limited by the small
population of aneurysms, and also by the physiological
accuracy of the aneurysm models, which are based on
geometries obtained in clinical studies (e.g. Parlea et al.,
1999; Shojima et al., 2004). Future studies will simulate
flow through actual vasculature geometries obtained from
CT angiography and MRI; the availability of clinical data
about the progression of these aneurysms will usefully
supplement CFD analyses. Further study will also include
consideration of the fluid particle residence times within the
aneurysm, especially near the fundus, and the implications
for risk of rupture.
Acknowledgments
This work has been supported by the Lafayette
College EXCEL Scholars program and by NSF Grant
 ARTICLE IN PRESS
2722 B. Utter, J.S. Rossmann / Journal of Biomechanics 40 (2007) 2716–2722
DBI-0442269, which provided the Linux cluster used for
computations.
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