# Improving Cerebral Aneurysm Risk Assessment through Understanding Wall Vulnerability and Failure Modes

> **NIH NIH R01** · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · 2024 · $599,744

## Abstract

Project Summary and Relevance
At least 1 in 50 adults in the US harbor an intracranial aneurysm (IA), a pathological outpouching of a brain
artery. Even with improvements in clinical management, IA rupture is fatal for approximately 45% of patients and
50% of survivors suffer from disabilities that prevent them from returning to a normal life. Treatment to prevent
rupture strives to shield the wall from blood pressure induced loads by mechanically clipping the IA neck during
open brain surgery or by inducing thrombosis using endovascular coiling or stent implantation. These treatments
have significant risks of complications that can be higher than the natural rupture risk, including 1-2% risk of
mortality. Since the risk of treatment may exceed the natural risk of rupture, there is an urgent need for a reliable
method to identify fragile aneurysms at risk of rupture that require immediate treatment and avoid unnecessary
treatment in others.
The clinical focus of this project is aneurysms that have focal areas of growth (blebs) as these IA have
high clinical prevalence (approximately 30%) and are a known risk factor for rupture. Despite this clinical
importance, very little is known about why blebs form nor the actual mechanisms by which blebs increase rupture
risk. Our prior work demonstrates that aneurysms with blebs can have different wall structures and failure
mechanisms than other aneurysms. Even within this subgroup, there are a wide range of wall types and risk
factors. Current clinical practice does not distinguish between different types of blebs or their failure modes and
treats all blebs equally.
The proposed research is innovative because it seeks to change this common clinical approach for aneurysm
evaluation where all blebs are treated as a single group. Furthermore, our research is also innovative because
it changes the way aneurysms are studied by focusing directly on the vulnerability of the aneurysm wall and its
failure modes instead of searching for correlations between different factors and aneurysm rupture.
The goal of this project is to improve risk assessment by identifying clinically measurable features that
predispose some IAs to bleb formation and then determine which walls features determine rupture risk in these
IAs. Specifically, the goals of this project are to i) Identify aneurysms that are at risk for developing blebs, ii)
Determine causes for wall vulnerability in aneurysms with blebs, iii) Understand the connection between dental
pathogens and IA wall vulnerability. We will achieve these objectives using a multi-faceted approach that
combines bioimaging and mechanical testing of human aneurysm tissue with in silico patient specific modeling
of the blood flow inside the aneurysms and stresses within the aneurysm wall. We will leverage our multi-
disciplinary team of world leaders in the field of cerebral aneurysms which includes seven neurosurgeons and
experts in patient specific CFD modeling, computational biomec...

## Key facts

- **NIH application ID:** 10862568
- **Project number:** 5R01NS097457-09
- **Recipient organization:** UNIVERSITY OF PITTSBURGH AT PITTSBURGH
- **Principal Investigator:** Juan R Cebral
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $599,744
- **Award type:** 5
- **Project period:** 2016-07-01 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10862568

## Citation

> US National Institutes of Health, RePORTER application 10862568, Improving Cerebral Aneurysm Risk Assessment through Understanding Wall Vulnerability and Failure Modes (5R01NS097457-09). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10862568. Licensed CC0.

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