Morphological and Hemodynamic Parameters for Middle Cerebral Artery Bifurcation Aneurysm Rupture Risk Assessment

Clinical, 3D Morphological, and Hemodynamic Risk Factors for Instability of Unruptured Intracranial Aneurysms

PURPOSE

Neurosurgeons can manage unruptured intracranial aneurysms (UIAs). However, the stability of UIAs under follow-up remains uncertain. This study aimed to examine the risk factors associated with the instability (rupture or growth) of UIAs during follow-up.

METHODS

We obtained information on patients with UIA who underwent ≥ 6 months of the time of flight-magnetic resonance angiography (TOF-MRA) imaging follow-up in two centers. Computer-assisted semi-automated measurement (CASAM) techniques were used for recording morphological parameters and determining the growth of these aneurysms. We also recorded hemodynamic parameters at the beginning of the follow-up. The univariate and multivariate Cox regression analyses were performed to calculate hazard ratios with corresponding 95% confidence intervals for the clinical, morphological, and hemodynamic risk factors for aneurysm instability.

RESULTS

A total of 304 aneurysms from 263 patients (80.4%) were included for analysis. The annual aneurysm growth rate was 4.7%. Significant predictive factors for aneurysm instability in the multivariate analysis were as follows: poorly controlled hypertension (hazard ratio (HR), 2.97 (95% CI, 1.27-6.98), P = 0.012); aneurysms located on posterior circulation (HR, 7.81 (95% CI, 2.28-26.73), P = 0.001), posterior communication artery (HR, 3.01 (95% CI, 1.07-8.46), P = 0.036), and cavernous carotid artery (HR, 3.78 (95% CI, 1.18-12.17), P = 0.026); and size ratio ≥ 0.87 (HR, 2.54 (95% CI, 1.14-5.68), P = 0.023).

CONCLUSIONS

The management of UIAs should focus on the control of hypertension during the follow-up. Aneurysms on the posterior communicating artery, posterior circulation, and cavernous carotid arteries require intensive surveillance or timely treatment.

Augmenting Prediction of Intracranial Aneurysms' Risk Status Using Velocity-Informatics: Initial Experience

Our primary goal here is to demonstrate that innovative analytics of aneurismal velocities, named velocity-informatics, enhances intracranial aneurysm (IA) rupture status prediction. 3D computer models were generated using imaging data from 112 subjects harboring anterior IAs (4-25 mm; 44 ruptured and 68 unruptured). Computational fluid dynamics simulations and geometrical analyses were performed. Then, computed 3D velocity vector fields within the IA dome were processed for velocity-informatics. Four machine learning methods (support vector machine, random forest, generalized linear model, and GLM with Lasso or elastic net regularization) were employed to assess the merits of the proposed velocity-informatics. All 4 ML methods consistently showed that, with velocity-informatics metrics, the area under the curve and prediction accuracy both improved by approximately 0.03. Overall, with velocity-informatics, the support vector machine's prediction was most promising: an AUC of 0.86 and total accuracy of 77%, with 60% and 88% of ruptured and unruptured IAs being correctly identified, respectively.

Could A1 Aplasia or Hypoplasia Affect the Morphology and Rupture Risk of Anterior Communicating Artery Aneurysm?

Objective

Anterior communicating artery (Acom) aneurysm is one of the most common intracranial aneurysms, constituting approximately 30–35% of all aneurysm formation in the brain. Anatomically, the H-complex (the anatomic morphology of both A1 to A2 segments) is thought to affects the nature of the Acom aneurysm due to its close relationship with the hemodynamics of the vessel. Therefore, we investigated the relative risk factors of aneurysmal rupture, especially focusing on H-complex morphology of the Acom.

Methods

From January 2016 to December 2020, a total of 209 patients who underwent surgery, including clipping and coiling for Acom aneurysm in our institution were reviewed. There were 102 cases of ruptured aneurysm and 107 cases of unruptured aneurysm. The baseline morphology of aneurysms was investigated and the relationship between the H-complex and the clinical characteristics of patients with Acom aneurysms was assessed.

Results

Of the 209 patients, 109 patients (52.1%) had symmetrical A1, 79 patients (37.8%) had unilateral hypoplastic A1, and 21 patients (10.0%) had aplastic A1. The hypoplastic A1 group and the aplastic A1 group were grouped together as unilateral dominancy of A1, and were compared with the symmetrical A1 group. There was no significant difference in demographic characteristics and radiological findings of Acom aneurysms between two groups. However, when dichotomizing the patients into ruptured cases and unruptured cases, unilateral dominance of the A1 segment was associated with aneurysmal rupture with statistical significance (p=0.011).

Conclusion

These results suggest that the unilateral dominance of the A1 segment does not have a significant effect on the morphology of Acom aneurysms, but contributes to aneurysmal rupture. Thus, we can better understand the effects of hemodynamics on Acom aneurysm.

Case Report: Dynamic Changes in Hemodynamics During the Formation and Progression of Intracranial Aneurysms

Despite the devastating consequences of aneurysmal subarachnoid hemorrhage (SAH), the mechanisms underlying the formation, progression, and rupture of intracranial aneurysms (IAs) are complex and not yet fully clear. In a real-world situation, continuously observing the process of aneurysm development in humans appears unrealistic, which also present challenges for the understanding of the underlying mechanism. We reported the relatively complete course of IA development in two real patients. On this basis, computational fluid dynamics simulation (CFD) was performed to evaluate the changes in hemodynamics and analyze the mechanism underlying the formation, progression, and rupture of IAs. Our results suggested that the formation and progression of IAs can be a dynamic process, with constantly changing hemodynamic characteristics. CFD analysis based on medical imaging provides the opportunity to study the hemodynamic conditions over time. From these two rare cases, we found that concentrated high-velocity inflow jets, flows with vortex structures, extremely high WSS, and a very steep WSSG were correlated with the formation of IAs. Complex multi-vortex flows are possibly related to IAs prior to growth, and the rupture of IAs is possibly related to low WSS, extreme instability and complexity of flow patterns. Our findings provide unique insight into the theoretical hemodynamic mechanism underlying the formation and progression of IAs. Given the small sample size the findings of this study have to be considered preliminary and exploratory.

Disturbed flow's impact on cellular changes indicative of vascular aneurysm initiation, expansion, and rupture: A pathological and methodological review

Aneurysms are malformations within the arterial vasculature brought on by the structural breakdown of the microarchitecture of the vessel wall, with aneurysms posing serious health risks in the event of their rupture. Blood flow within vessels is generally laminar with high, unidirectional wall shear stressors that modulate vascular endothelial cell functionality and regulate vascular smooth muscle cells. However, altered vascular geometry induced by bifurcations, significant curvature, stenosis, or clinical interventions can alter the flow, generating low stressor disturbed flow patterns. Disturbed flow is associated with altered cellular morphology, upregulated expression of proteins modulating inflammation, decreased regulation of vascular permeability, degraded extracellular matrix, and heightened cellular apoptosis. The understanding of the effects disturbed flow has on the cellular cascades which initiate aneurysms and promote their subsequent growth can further elucidate the nature of this complex pathology. This review summarizes the current knowledge about the disturbed flow and its relation to aneurysm pathology, the methods used to investigate these relations, as well as how such knowledge has impacted clinical treatment methodologies. This information can contribute to the understanding of the development, growth, and rupture of aneurysms and help develop novel research and aneurysmal treatment techniques.

Risk Factors for Pericallosal Artery Aneurysm Rupture Based on Morphological Computer-Assisted Semiautomated Measurement and Hemodynamic Analysis

Background: Although pericallosal artery aneurysms (PAAs) are relatively uncommon, accounting for only 1-9% of all intracranial aneurysms (IAs), they exhibit a considerably high propensity to rupture. Nevertheless, our current knowledge of the risk factors for PAA rupture is still very limited. To fill this gap, we investigated rupture risk factors for PAAs based on morphological computer-assisted semiautomated measurement (CASAM) and hemodynamic analysis. Methods: Patients with PAAs were selected from the IA database in our institute and their baseline data were collected. Morphological parameters were measured in all enrolled patients by applying CASAM. Computational fluid dynamics simulation (CFD) was performed to evaluate the hemodynamic difference between ruptured and unruptured PAAs. Results: From June 2017 to June 2020, among 2141 patients with IAs in our institute, 47 had PAAs (2.2%). Thirty-one patients (mean age 57.65 ± 9.97 years) with 32 PAAs (20 unruptured and 12 ruptured) were included in the final analysis. Comparing with unruptured PAAs, ruptured PAAs had significantly higher aspect ratio (AR), mean normalized wall shear stress (NWSS), and mean oscillatory shear index (OSI) values than the unruptured PAAs (all P < 0.05) in univariate analyses. Multivariable analysis showed that a high mean OSI was an independent risk factor for PAA rupture (OR = 6.45, 95% CI 1.37-30.32, P = 0.018). Conclusion: This preliminary study indicates that there are morphological and hemodynamic differences between ruptured and unruptured PAAs. In particular, a high mean OSI is an independent risk factor for PAA rupture. Further research with a larger sample size is warranted in the future.

Quantitative analysis of flow vortices: differentiation of unruptured and ruptured medium-sized middle cerebral artery aneurysms

BACKGROUND

Surgical intervention for unruptured intracranial aneurysms (IAs) carries inherent health risks. The analysis of "patient-specific" IA geometric and computational fluid dynamics (CFD) simulated wall shear stress (WSS) data has been investigated to differentiate IAs at high and low risk of rupture to help clinical decision making. Yet, outcomes vary among studies, suggesting that novel analysis could improve rupture characterization. The authors describe a CFD analytic method to assess spatiotemporal characteristics of swirling flow vortices within IAs to improve characterization.

METHODS

CFD simulations were performed for 47 subjects harboring one medium-sized (4-10 mm) middle cerebral artery (MCA) aneurysm with available 3D digital subtraction angiography data. Alongside conventional indices, quantified IA flow vortex spatiotemporal characteristics were applied during statistical characterization. Statistical supervised machine learning using a support vector machine (SVM) method was run with cross-validation (100 iterations) to assess flow vortex-based metrics' strength toward rupture characterization.

RESULTS

Relying solely on vortex indices for statistical characterization underperformed compared with established geometric characteristics (total accuracy of 0.77 vs 0.80) yet showed improvements over wall shear stress models (0.74). However, the application of vortex spatiotemporal characteristics into the combined geometric and wall shear stress parameters augmented model strength for assessing the rupture status of middle cerebral artery aneurysms (0.85).

CONCLUSIONS

This preliminary study suggests that the spatiotemporal characteristics of flow vortices within MCA aneurysms are of value to improve the differentiation of ruptured aneurysms from unruptured ones.

A Dissipation Function-Based Method for Calculating the Energy Loss of Intracranial Aneurysms

At present, the energy loss (EL) mechanism of intracranial aneurysm (IA) rupture is explored based on the global EL calculated by Bernoulli equation, but the details of EL are still unclear. This study aimed to explore the temporal and spatial characteristics of EL of IAs and reveal its mechanism. A novel method for calculating the EL of IAs based on dissipation function (DF) was proposed. DF was derived from the differential form of the energy equation and reflected the irreversible conversion from mechanical energy to internal energy caused by the friction between the fluid micelles. Eight sidewall IAs located at the posterior communicating segment of the internal carotid artery were collected; the three-dimensional (3D) geometric models of IAs were established employing image segmentation and 3D reconstruction. Computational fluid dynamics was applied to obtain hemodynamic parameters of IAs. The temporal and spatial characteristics of EL of IAs were achieved utilizing our proposed method. The simulation results indicated that EL occurred mainly in the boundary layer and the region adjacent to high-velocity inflow jet, EL increased rapidly during cardiac systole and reached its maximum at end-systolic phase and then decreased gradually during diastole until the end of cardiac cycle. The proposed method achieved some improvements over the traditional Bernoulli equation-based method by acquiring the temporal and spatial characteristics of EL, and it could provide insights into the EL of IAs and contribute to further rupture mechanism investigation.

Cerebral aneurysm rupture status classification using statistical and machine learning methods

Morphological characterization and fluid dynamics simulations were carried out to classify the rupture status of 71 (36 unruptured, 35 ruptured) patient specific cerebral aneurysms using a machine learning approach together with statistical techniques. Eleven morphological and six hemodynamic parameters were evaluated individually and collectively for significance as rupture status predictors. The performance of each parameter was inspected using hypothesis testing, accuracy, confusion matrix, and the area under the receiver operating characteristic curve. Overall, the size ratio exhibited the best performance, followed by the diastolic wall shear stress, and systolic wall shear stress. The prediction capability of all 17 parameters together was evaluated using eight different machine learning algorithms. The logistic regression achieved the highest accuracy (0.75), whereas the random forest had the highest area under curve value among all the classifiers (0.82), surpassing the performance exhibited by the size ratio. Hence, we propose the random forest model as a tool that can help improve the rupture status prediction of cerebral aneurysms.

Morphological variables associated with ruptured basilar tip aneurysms

Morphological factors of intracranial aneurysms and the surrounding vasculature could affect aneurysm rupture risk in a location specific manner. Our goal was to identify image-based morphological parameters that correlated with ruptured basilar tip aneurysms. Three-dimensional morphological parameters obtained from CT-angiography (CTA) or digital subtraction angiography (DSA) from 200 patients with basilar tip aneurysms diagnosed at the Brigham and Women's Hospital and Massachusetts General Hospital between 1990 and 2016 were evaluated. We examined aneurysm wall irregularity, the presence of daughter domes, hypoplastic, aplastic or fetal PCoAs, vertebral dominance, maximum height, perpendicular height, width, neck diameter, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine statistical significance. In multivariable analysis, presence of a daughter dome, aspect ratio, and larger flow angle were significantly associated with rupture status. We also introduced two new variables, diameter size ratio and parent-daughter angle ratio, which were both significantly inversely associated with ruptured basilar tip aneurysms. Notably, multivariable analyses also showed that larger diameter size ratio was associated with higher Hunt-Hess score while smaller flow angle was associated with higher Fisher grade. These easily measurable parameters, including a new parameter that is unlikely to be affected by the formation of the aneurysm, could aid in screening strategies in high-risk patients with basilar tip aneurysms. One should note, however, that the changes in parameters related to aneurysm morphology may be secondary to aneurysm rupture rather than causal.

Clinical and radiological outcomes in relation with the anatomical orientation of clipped middle cerebral artery bifurcation aneurysms

BACKGROUND

The middle cerebral artery (MCA) bifurcation represents the most frequent location for intracranial aneurysms. Often, the aneurysmal dome can hide the origin of perforating arteries from the M1 segment during the surgical clipping causing ischemic lesions and worse clinical outcome. The aim of this paper is to analyze the association between the orientation of the aneurysm sac and the clinical and radiological outcomes after surgical clipping.

METHODS

Data from 50 MCA bifurcation clipped aneurysms in 47 patients were collected retrospectively. Three different groups were identified according to the aneurysmal sac orientation: anterior-inferior, posterior and superior. A possible association between the aneurysmal sac projection and the outcome was searched through a univariable logistic regression analysis.

RESULTS

Statistical analysis showed significant correlation between the radiologic evidence of post-operative ischemia in the posterior group (p = 0.046, RR = 1.65) and an increased risk in the superior orientation group (p = 0.145, RR = 1.38). The anterior-inferior group was, instead, significantly associated with no evidence of radiologic ischemia (p = 0.0019, RR = 0.58).

CONCLUSION

The orientation of the aneurysmal dome and sac represents a fundamental feature to be considered during the surgical clipping of the MCA aneurysms. Indeed, its posterior and superior projection is associated with a higher incidence of radiologic ischemic lesions due to the origin of perforating arteries from M1 segment behind the aneurysmal sac. The anterior-inferior orientation, on the contrary, is associated with a lower risk.

Age and morphology of posterior communicating artery aneurysms

Risk of intracranial aneurysm rupture could be affected by geometric features of intracranial aneurysms and the surrounding vasculature in a location specific manner. Our goal is to investigate the morphological characteristics associated with ruptured posterior communicating artery (PCoA) aneurysms, as well as patient factors associated with the morphological parameters. Three-dimensional morphological parameters in 409 patients with 432 PCoA aneurysms diagnosed at the Brigham and Women’s Hospital and Massachusetts General Hospital between 1990 and 2016 who had available CT angiography (CTA) or digital subtraction angiography (DSA) were evaluated. Morphological parameters examined included aneurysm wall irregularity, presence of a daughter dome, presence of hypoplastic or aplastic A1 arteries and hypoplastic or fetal PCoA, perpendicular height, width, neck diameter, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine the association of morphological parameters with rupture of PCoA aneurysms. Additional analyses were performed to determine the association of patient factors with the morphological parameters. Irregular, multilobed PCoA aneurysms with larger height/width ratios and larger flow angles were associated with ruptured PCoA aneurysms, whereas perpendicular height was inversely associated with rupture in a multivariable model. Older age was associated with lower aspect ratio, with a trend towards lower height/width ratio and smaller flow angle, features that are associated with a lower rupture risk. Morphological parameters are easy to assess and could help in risk stratification in patients with unruptured PCoA aneurysms. PCoA aneurysms diagnosed at older age have morphological features associated with lower risk.

Morphological Variables Associated With Ruptured Middle Cerebral Artery Aneurysms

BACKGROUND

Geometric factors of intracranial aneurysms and surrounding vasculature could affect the risk of aneurysm rupture. However, large-scale assessments of morphological parameters correlated with intracranial aneurysm rupture in a location-specific manner are scarce.

OBJECTIVE

To investigate the morphological characteristics associated with ruptured middle cerebral artery (MCA) aneurysms.

METHODS

Five hundred sixty-one patients with 638 MCA aneurysms diagnosed between 1990 and 2016 who had available computed tomography angiography (CTA) were included in this study. CTAs were evaluated using the Vitrea Advanced Visualization software for 3-dimensional (3D) reconstruction. Morphological parameters examined in each model included aneurysm projection, wall irregularity, presence of a daughter dome, presence of hypoplastic or aplastic A1 arteries and hypoplastic or fetal posterior communicating arteries (PCoA), aneurysm height and width, neck diameter, bottleneck factor, aspect and size ratio, height/width ratio, and diameters and angles of surrounding parent and daughter vessels. Univariable and multivariable statistical analyses were performed to determine the association of morphological characteristics with rupture of MCA aneurysms. Logistic regression was used to build a predictive MCA score.

RESULTS

Greater bottleneck and size ratio, and irregular, multilobed, temporally projecting MCA aneurysms are associated with higher rupture risk, whereas higher M1/M2 ratio, larger width, and the presence of an ipsilateral or bilateral hypoplastic PCoA were inversely associated with rupture. The MCA score had good predictive capacity with area under the receiver operating curve = 0.88.

CONCLUSION

These practical morphological parameters specific to MCA aneurysms are easy to assess when examining 3D reconstructions of unruptured aneurysms and could aid in risk evaluation in these patients.

Morphology parameters for rupture in middle cerebral artery mirror aneurysms

Objective

To identify the morphological parameters correlated with the rupture of middle cerebral artery (MCA) aneurysms.

Methods

We retrospectively analyzed the digital subtraction angiography (DSA) data of 48 patients with ruptured mirror MCA aneurysms. Morphological parameters included aneurysm with wall protrusion, maximum diameter (Dmax), height, neck width, aneurysm width, dome projection, parent artery average diameter (Dp), aspect ratio (AR), bottleneck factor (BNF), size ratio (SR), M1/M2 ratio, and height/width (H/W) ratio. These paired parameters were analyzed by conditional univariate and multivariate logistic regressions to screen out the independent risk factors. We established a score based on the independent risk factors. Receiver operating characteristics (ROC) were generated to estimate the prediction performance of the score in our large database of 763 aneurysms.

Results

In the univariate regressions, Dmax, height, aneurysm width, neck width, AR, BNF, H/W ratio, SR, anterior dome projection and aneurysm with wall protrusion were significant risk factors. Aneurysm width (OR 3.296, p=0.015), AR (OR 11.594, p=0.014) and anterior dome projection (OR 9.385, p=0.016) were independent risk factors in multivariate regression. The area under the curve (AUC) value of the score based on the three independent risk factors was 0.829.

Conclusion

Aneurysm width, AR and anterior dome projection were independent risks factors of rupture.

Morphological predictors of middle cerebral artery bifurcation aneurysm rupture

OBJECTIVE

Middle cerebral artery (MCA) bifurcation aneurysms are more likely to be associated with severe hemorrhage or hematoma in a clinical setting. We aimed to investigate the morphological predictors of MCA bifurcation aneurysm rupture.

PATIENTS AND METHODS

We conducted a retrospective analysis of 317 patients with MCA aneurysms between January 2009 and October 2016. Aneurysm status was grouped into ruptured and unruptured groups. The MCA bifurcation was defined as the bifurcation of the main trunk (the origin of the M2 trunks). Aneurysm morphologies were determined using CT angiography. We performed univariate and multivariable regression analyses to investigate the association of morphological characteristics with ruptured MCA bifurcation aneurysms.

RESULTS

A total of 268 (84.5 %) patients with 280 MCA bifurcation aneurysms were included. 207 (73.9 %) aneurysms had ruptured. In the univariate analysis, a larger aneurysm (p = 0.042), a larger size ratio (p = 0.001), a larger aspect ratio (p = 0.017), a greater bottleneck ratio (p = 0.047), an irregular aneurysm (p = 0.004) and the presence of a daughter dome (p = 0.002) were associated with aneurysm rupture. The multivariate analysis showed that a larger size ratio (OR 1.324, 95 % CI, 1.062-1.651; p = 0.013) and the presence of daughter dome (OR 2.462, 95 % CI, 1.123-5.398; p = 0.024) were independently associated with ruptured aneurysms. The threshold of the size ratio for discriminating ruptured and unruptured aneurysms was 2.53 (p < 0.001).

CONCLUSIONS

The size ratio and the presence of a daughter dome were independent predictors of the rupture of MCA bifurcation aneurysms. These parameters may contribute to the evaluation of the risk of rupture of aneurysms.

High wall shear stress beyond a certain range in the parent artery could predict the risk of anterior communicating artery aneurysm rupture at follow-up

OBJECTIVE

Among clinical and morphological criteria, hemodynamics is the main predictor of aneurysm growth and rupture. This study aimed to identify which hemodynamic parameter in the parent artery could independently predict the rupture of anterior communicating artery (ACoA) aneurysms by using multivariate logistic regression and two-piecewise linear regression models. An additional objective was to look for a more simplified and convenient alternative to the widely used computational fluid dynamics (CFD) techniques to detect wall shear stress (WSS) as a screening tool for predicting the risk of aneurysm rupture during the follow-up of patients who did not undergo embolization or surgery.

METHODS

One hundred sixty-two patients harboring ACoA aneurysms (130 ruptured and 32 unruptured) confirmed by 3D digital subtraction angiography at three centers were selected for this study. Morphological and hemodynamic parameters were evaluated for significance with respect to aneurysm rupture. Local hemodynamic parameters were obtained by MR angiography and transcranial color-coded duplex sonography to calculate WSS magnitude. Multivariate logistic regression and a two-piecewise linear regression analysis were performed to identify which hemodynamic parameter independently characterizes the rupture status of ACoA aneurysms.

RESULTS

Univariate analysis showed that WSS (p < 0.001), circumferential wall tension (p = 0.005), age (p < 0.001), the angle between the A1 and A2 segments of the anterior cerebral artery (p < 0.001), size ratio (p = 0.023), aneurysm angle (p < 0.001), irregular shape (p = 0.005), and hypertension (grade II) (p = 0.006) were significant parameters. Multivariate analyses showed significant association between WSS in the parent artery and ACoA aneurysm rupture (p = 0.0001). WSS magnitude, evaluated by a two-piecewise linear regression model, was significantly correlated with the rupture of the ACoA aneurysm when the magnitude was higher than 12.3 dyne/cm2 (HR 7.2, 95% CI 1.5-33.6, p = 0.013).

CONCLUSIONS

WSS in the parent artery may be one of the reliable hemodynamic parameters characterizing the rupture status of ACoA aneurysms when the WSS magnitude is higher than 12.3 dyne/cm2. Analysis showed that with each additional unit of WSS (even with a 1-unit increase of WSS), there was a 6.2-fold increase in the risk of rupture for ACoA aneurysms.

COMPUTATIONAL STUDY ON THE RUPTURE RISK IN REAL CEREBRAL ANEURYSMS WITH GEOMETRICAL AND FLUID-MECHANICAL PARAMETERS USING FSI SIMULATIONS AND MACHINE LEARNING ALGORITHMS

Fluid-mechanical and morphological parameters are recognized as major factors in the rupture risk of human aneurysms. On the other hand, it is well known that a lot of machine learning tools are available to study a variety of problems in many fields. In this work, fluid–structure interaction (FSI) simulations were carried out to examine a database of 60 real saccular cerebral aneurysms (30 ruptured and 30 unruptured) using reconstructions by angiography images. With the results of the simulations and geometric analyses, we studied the analysis of variance (ANOVA) statistic test in many variables and we obtained that aspect ratio (AR), bottleneck factor (BNF), maximum height of the aneurysms (MH), relative residence time (RRT), Womersley number (WN) and Von-Mises strain (VMS) are statically significant and good predictors for the models. In consequence, these ones were used in five machine learning algorithms to determine the rupture risk predictions of the aneurysms, where the adaptative boosting (AdaBoost) was calculated with the highest area under the curve (AUC) in the receiver operating characteristic (ROC) curve (AUC 0.944).