Integrating Laplace's law with patient-specific hemodynamics to predict rupture risk in unruptured intracranial aneurysms: A systematic review of a biophysical and computational framework.

Introduction: This systematic review aimed to synthesize the literature on integrating biophysical principles such as Laplace's law with patient-specific hemodynamics to create a more precise and mechanistic framework for assessing rupture risk in unruptured intracranial aneurysms. Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between January 2010 and December 2024 were identified from databases including PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar. The Joanna Briggs Institute checklist and Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool were used to assess study quality and bias. Results: These studies showed increasing integration of Laplace's law with patient-specific flow simulations and vessel wall modeling. Hemodynamic models frequently revealed that areas with low wall shear stress or high oscillatory shear index overlapped with regions of high mechanical stress. Thin walled blebs small outpouchings on aneurysms were particularly prone to rupture and were often associated with abnormal flow patterns and higher wall tension. The synthesized evidence supports the conceptual validity of an integrative model that spatially correlates high wall tension with adverse hemodynamic patterns. Conclusion: This review demonstrates that the proposed integration of Laplace's law with advanced hemodynamic modeling, as evidenced by the literature, holds promise for improving rupture risk prediction. Future research should focus on implementing this combined approach in a clinical cohort to compare its predictive ability against existing models like the PHASES score.