Competition between radial expansion and thickening in the enlargement of an intracranial saccular aneurysm

Rupture of intracranial saccular aneurysms is the leading cause of spontaneous subarachnoid hemorrhage, which results in significant morbidity and mortality. Although many have suggested that saccular aneurysms enlarge and rupture due to mechanical instabilities, our recent nonlinear analyses suggest that at least certain classes of aneurysms do not exhibit a quasi-static limit point instability or dynamic instabilities in response to periodic loading. Based on an increased understanding of the ubiquitous role of growth and remodeling within the vasculature and recent histopathological data on saccular aneurysms, it is hypothesized that a stress-mediated regulation of collagen turnover causes their enlargement. There is a need, however, for a theoretical framework to explore this and competing hypotheses. In this paper, we present a 2-D constrained mixture model for growth and remodeling of an ellipsoidally shaped saccular aneurysm and numerically simulate enlargement and changes in material symmetry in the aneurysmal wall. Results suggest that ellipsoidal aneurysms tend toward spherical shapes, and a competition between radial expansion and wall thickening plays a critical role in determining the stability of an enlarging lesion.