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Additionally, the significance of anatomical features like blebs in ruptures is debated. This highlights the necessity for comprehensive research that combines patient\u2010specific risk factors with a detailed analysis of local hemodynamic characteristics at bleb and rupture sites. Our study analyzed 359 intracranial aneurysms from 268 patients, reconstructing patient\u2010specific models for hemodynamic simulations based on 3D rotational angiographic images and intraoperative videos. We identified aneurysm subregions and delineated rupture sites, characterizing blebs and their regional overlap, employing statistical comparisons across demographics, and other risk factors. This work identifies patterns in aneurysm rupture sites, predominantly at the dome, with variations across patient demographics. Hypertensive and anterior communicating artery (ACom) aneurysms showed specific rupture patterns and bleb associations, indicating two pathways: high\u2010flow in ACom with thin blebs at impingement sites and low\u2010flow, oscillatory conditions in middle cerebral artery (MCA) aneurysms fostering thick blebs. Bleb characteristics varied with gender, age, and smoking, linking rupture risks to hemodynamic factors and patient profiles. These insights enhance understanding of the hemodynamic mechanisms leading to rupture events. This analysis elucidates the role of localized hemodynamics in intracranial aneurysm rupture, challenging the emphasis on location by revealing how flow variations influence stability and risk. We identify two pathways to wall failure\u2014high\u2010flow and low\u2010flow conditions\u2014highlighting the complexity of aneurysm behavior. Additionally, this research advances our knowledge of how inherent patient\u2010specific characteristics impact these processes, which need further investigation.<\/jats:p>","DOI":"10.1002\/cnm.3837","type":"journal-article","created":{"date-parts":[[2024,6,5]],"date-time":"2024-06-05T23:27:10Z","timestamp":1717630030000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Distribution of rupture sites and blebs on intracranial aneurysm walls suggests distinct rupture patterns in <scp>ACom<\/scp> and <scp>MCA<\/scp> aneurysms"],"prefix":"10.1002","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4015-4341","authenticated-orcid":false,"given":"Yogesh","family":"Karnam","sequence":"first","affiliation":[{"name":"Department of Bioengineering George Mason University  Fairfax Virginia 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