Table 1. A summary of the reviewed studies and basic information regarding the number of patients and aneurysms.

AWE: aneurysm wall enhancement, PCoA: posterior communicating artery, MCA: middle cerebral artery, WSS: wall shear stress, IA: intracranial aneurysm, AR: aspect ratio, OSI: oscillatory shear index, WSSmin: minimum wall shear stress, LSA: low wall shear stress area, SR: size ratio.

Authors/Year of Publication	Type of the Study	Purpose of the Study	No. of the Patients	No. of the Aneurysms	No. of Ruptured Aneurysms	Result/Conclusion
Lv et al., 2020 [16]	Cohort	To investigate the relationship between morphology, hemodynamics, and AWE on MRI of the vessel wall and their significance in the rupture of IAs.	57	65	65	Unruptured IAs with a higher rupture risk showed a significantly larger size, lower wall shear stress, and more intense AWE.
Detmer et al., 2019 [17]	Cross-sectional	To look for associations of hemodynamics, morphology, patient age, and gender with aneurysm rupture.	1265	1931	N/A	Adverse morphology and hemodynamics are related to rupture as well as younger age, male gender, and bifurcation aneurysms.
Detmer et al., 2019 [18]	Cross-sectional	To develop a model for aneurysm rupture based on hemodynamic and geometric parameters, aneurysm location, and patient gender and age.	1472	2129	616	The model of combined variables discriminated between ruptured and unruptured aneurysms. Internal validation indicated the potential for the application of this model in clinical practice after evaluation with longitudinal data.
Ambekar et al., 2016 [15]	Literature review	To explain the physical and biological interactions that govern aneurysm pathophysiology.	N/A	N/A	N/A	The combined effect of the assessed hemodynamic stressors triggers inflammatory and signaling cascades that ultimately result in vessel wall thinning, dilation, and rupture.
Liu et al., 2019 [19]	Cohort	To explore the hemodynamic-morphological risk factors for the intra-operative aneurysm rupture.	2237	2237	96	AR, NWSSm, and OSI are considered as three independent risk factors for intraoperative aneurysm rupture, which could serve as predictors.
Zhang et al., 2018 [20]	Case-control	To evaluate the impact of morphological and hemodynamic factors on the rupture of matched-pairs of ruptured-unruptured IAs.	40	20	0	Irregular shape, larger size, higher AR, lower WSSmin, and more LSA may indicate a higher risk for their rupture.
Soldozy et al., 2019 [13]	Cross-section	To find out a model for predicting aneurysm rupture based on geometric and hemodynamic parameters, location, age, and gender of the patient.	1061	1631	492	The model was able to distinguish between ruptured and unruptured aneurysms. After internal validation, it was applicable to clinical practice.
Huang et al., 2018 [21]	Cohort	To find out morphometric and hemodynamic analyses in ruptured and unruptured PCoA aneurysms to improve predictive assessment for rupture.	79	79	57	There was the highest incidence of types II + III with the largest surface area, but the lowest incidence of types I + IV with the smallest surface area in ruptured PCoA aneurysms.
Qiu et al., 2017 [22]	Cross-section	To explore the relationship of various morphological characteristics and WSS by measuring morphological indices, WSS of aneurysms, and the parent artery surface.	39	47	N/A	There is an uneven distribution of WSS in the various parts of the pre-aneurysm vessel. AR and SR can affect aneurysm WSS.
Longo et al., 2017 [23]	Literature review	To find the role of hemodynamic forces in the evaluation of the natural history of unruptured IAs.	N/A	N/A	N/A	A competent risk rupture stratification and treatment strategy selection based on hemodynamic forces have not yet been created, and further efforts should be made to accomplish this vital goal.
Song et al., 2017 [24]	Cross-section	To find out the hemodynamic and morphological differences between aneurysmal MCA bifurcation and contralateral nonaneurysmal anatomy.	36	36	24	A larger bifurcation angle was more prevalent in aneurysmal than nonaneurysmal MCA bifurcations and the higher flow resistance caused by the larger bifurcation angle might be a potential hemodynamic factor associated with the MCA aneurysm presence.
Doddasomayajula et al., 2017 [25]	Cross-section	To test whether the differences in hemodynamics between anterior and posterior circulations can explain the difference in rupture rates of IAs.	117	117	36	Large and concentrated inflow jets, complex and oscillatory flow patterns, and WSS distributions in the posterior circulation, especially in the tip of the basilar artery, could explain their increased rupture risk compared with internal carotid bifurcation aneurysms.
Kaneko et al., 2017 [26]	Cross-section	To develop an in vitro model to study the biological effect of complex-flow stress on endothelial cells.	N/A	N/A	N/A	A geometrically realistic IA model with live endothelial lining was successfully developed, which enables studying the biological impact of complex flow on endothelial cells.
Mocco et al., 2017 [27]	Cohort	To use the prospective International Study of Unruptured IAs cohort to identify morphological characteristics predictive of unruptured IA rupture.	255	255	57	Morphological factors, like perpendicular height and SR, may influence unruptured IA rupture risk.
Qiu et al., 2017 [28]	Cohort	To investigate the correlations between intracranial aneurysm morphology and WSS to find out reliable predictors of rupture risk.	63	72	41	Aneurysm morphology might affect the distribution and magnitude of WSS based on differences in blood flow.
Skodvin et al., 2019 [29]	Case series	To compare morphologies from different angiograms obtained before and just after rupture. To evaluate if postrupture morphology can be used to assess the rupture risk.	29	29	29	The changes in aneurysm morphology that were observed after rupture reflect the cumulative effect of time with continuous growth, and formation of irregularities. Postrupture morphology should not be considered in the evaluation of rupture risk.
Detmer et al., 2018 [14]	Review	To discuss the important natural history studies of unruptured IAs and review the existing scientific evidence and recent advances that help identify the rupture risk guide management of Unruptured IAs.	N/A	N/A	N/A	AR, SR, and WSS are the three most promising factors that might have a role in predicting the risk of rupture.
Can and Du, 2015 [30]	Meta-analysis	To quantify the effect of hemodynamic factors on aneurysm formation and their association with the risk of rupture.	499	499	168	An increase in WSS and gradient oscillatory numbers may contribute to aneurysm formation, whereas low WSS is associated with ruptured aneurysms. The location of the aneurysm at the bifurcation or sidewall may affect the correlation of these hemodynamic factors.
Zhang et al., 2014 [31]	Cross-section	To investigate the rupture-related characteristics on 20 matched-pairs of ruptured-unruptured saccular aneurysms located unilaterally on the anterior circulation in the same patient.	20	20	20	The ruptured aneurysms manifested irregular shape, larger size, higher AR, lower WSS minimum, and more LSA compared with their unruptured mates.
Total	___	___	7269	9167	1701	___