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      Computational Fluid Dynamics of Intracranial and Extracranal Arteries using 3-Dimensional Angiography: Technical Considerations with Physician's Point of View

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          Abstract

          We investigate the potentials and limitations of computational fluid dynamics (CFD) analysis of patient specific models from 3D angiographies. There are many technical problems in acquisition of proper vascular models, in pre-processing for making 2D surface and 3D volume meshes and also in post-processing steps for display the CFD analysis. We hope that our study could serves as a technical reference to validating other tools and CFD results.

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          Association of hemodynamic characteristics and cerebral aneurysm rupture.

          J Cebral, F Mut, J. Weir … (2011)
          Hemodynamic factors are thought to play an important role in the initiation, growth, and rupture of cerebral aneurysms. This report describes a study of the associations between qualitative intra-aneurysmal hemodynamics and the rupture of cerebral aneurysms. Two hundred ten consecutive aneurysms were analyzed by using patient-specific CFD simulations under pulsatile flow conditions. The aneurysms were classified into categories by 2 blinded observers, depending on the complexity and stability of the flow pattern, size of the impingement region, and inflow concentration. A statistical analysis was then performed with respect to the history of previous rupture. Interobserver variability analysis was performed. Ruptured aneurysms were more likely to have complex flow patterns (83%, P < .001), stable flow patterns (75%, P = .0018), concentrated inflow (66%, P = <.0001), and small impingement regions (76%, P = .0006) compared with unruptured aneurysms. Interobserver variability analyses indicated that all the classifications performed were in very good agreement-that is, well within the 95% CI. A qualitative hemodynamic analysis of cerebral aneurysms by using image-based patient-specific geometries has shown that concentrated inflow jets, small impingement regions, complex flow patterns, and unstable flow patterns are correlated with a clinical history of prior aneurysm rupture. These qualitative measures provide a starting point for more sophisticated quantitative analysis aimed at assigning aneurysm risk of future rupture. These analyses highlight the potential for CFD to play an important role in the clinical determination of aneurysm risks.
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            Aneurysm rupture following treatment with flow-diverting stents: computational hemodynamics analysis of treatment.

            J.R. Cebral, F Mut, M Raschi … (2011)
            Flow-diverting approaches to intracranial aneurysm treatment had many promising early results, but recent apparently successful treatments have been complicated by later aneurysm hemorrhage. We analyzed 7 cases of aneurysms treated with flow diversion to explore the possible rupture mechanisms. CFD analysis of pre- and posttreatment conditions was performed on 3 giant aneurysms that ruptured after treatment and 4 successfully treated aneurysms. Pre- and posttreatment hemodynamics were compared including WSS, relative blood flows, vascular resistances, and pressures, to identify the effects of flow-diverter placements. Expected reductions in aneurysm velocity and WSS were obtained, indicating effective flow diversion from the sac into the parent artery, consistent with periprocedural observations. In each case with postaneurysm rupture, the result of flow diversion led to an increase in pressure within the aneurysm. This pressure increase is related to larger effective resistance in the parent artery from placement of the devices and, in 2 cases, the reduction of a preaneurysm stenosis. Flow-diversion devices can cause intra-aneurysmal pressure increases, which can potentially lead to rupture, especially for giant aneurysms. This relates both to changes in the parent artery configuration, such as reduction of a proximal stenosis, and to the flow diversion into higher resistance parent artery pathways combined with cerebral autoregulation, leading to higher pressure gradients. These may be important effects that should be considered when planning interventions. Potentially dangerous cases could be identified with angiography and/or patient-specific CFD models.
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              Plaque rupture in the carotid artery is localized at the high shear stress region: a case report.

              Jolanda Wentzel, Frank J. H. Gijsen, Aad van der Lugt … (2007)
              Cerebrovascular events are related to atherosclerotic disease in the carotid arteries and are frequently caused by rupture of a vulnerable plaque. These ruptures are often observed at the upstream region of the plaque, where the wall shear stress (WSS) is considered to be highest. High WSS is known for its influence on many processes affecting tissue regression. Until now, there have been no serial studies showing the relationship between plaque rupture and WSS. Summary of Case- We investigated a serial MRI data set of a 67-year-old woman with a plaque in the carotid artery at baseline and an ulcer at 10-month follow up. The lumen, plaque components (lipid/necrotic core, intraplaque hemorrhage), and ulcer were segmented and the lumen contours at baseline were used for WSS calculation. Correlation of the change in plaque composition with the WSS at baseline showed that the ulcer was generated exclusively at the high WSS location. In this serial MRI study, we found plaque ulceration at the high WSS location of a protruding plaque in the carotid artery. Our data suggest that high WSS influences plaque vulnerability and therefore may become a potential parameter for predicting future events.
              Article 0 comments Cited 60 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Neurointervention
                Journal ID (iso-abbrev): Neurointervention
                Journal ID (publisher-id): NI
                Title: Neurointervention
                Publisher: Korean Society of Interventional Neuroradiology
                ISSN (Print): 2093-9043
                ISSN (Electronic): 2233-6273
                Publication date (Print): September 2013
                Publication date (Electronic): 29 August 2013
                Volume: 8
                Issue: 2
                Pages: 92-100
                Affiliations
                [1 ]Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea.
                [2 ]Department of Mechanical Engineering, Dankook University, Gyeonggido, Korea.
                [3 ]Molds & Dies Technology R&D Group, Korea Institute of Industrial Technology, Incheon, Korea.
                [4 ]Department of Radiology, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea.
                Author notes
                Correspondence to: Sung-Tae Park, MD, Department of Radiology, Soonchunhyang University Hospital, 59 Daesagwan-ro, Youngsan-gu, Seoul 140-743, Korea. Tel. 82.2.709.9396, Fax. 82.2.709.9066, stpark@ 123456schmc.ac.kr
                Article
                DOI: 10.5469/neuroint.2013.8.2.92
                PMC ID: 3766807
                PubMed ID: 24024073
                SO-VID: 88b825d8-f44b-4b60-ab98-3ba5282769da
                Copyright © Copyright © 2013 Korean Society of Interventional Neuroradiology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 16 April 2013
                Date accepted : 23 June 2013
                Categories
                Subject: Technical Note

                ScienceOpen disciplines: Neurosciences
                Keywords: hemodynamics,angiography,carotid arteries
                Data availability:
                ScienceOpen disciplines: Neurosciences
                Keywords: hemodynamics, angiography, carotid arteries

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