Computational fluid dynamics simulations of intracranial aneurysms at varying heart rates: a "patient-specific" study.
ABSTRACT Rupture of an intracranial aneurysm (IA) is frequently associated with intense physical exertion and/or emotional excitement, events that are typically also accompanied by sudden significant changes in both heart rate and blood pressure. Very few experimental studies of aneurysm hemodynamics have examined the impact on hemodynamic parameters in and around an aneurysm resulting from changes in heart rate. In order to further understanding these changes, as they relate to hemodynamic features that may contribute to rupture of an IA, we examined the characteristics of pulsatile flow in and around two "patient-specific" intracranial aneurysms at three different cardiac frequencies. Three dimensional X-ray angiographic data (3D-DSA) were used to reconstruct accurate and patient-specific aneurysm geometries. Then, computational fluid dynamics techniques were utilized to analyze the characteristics of blood flow in and around the two aneurysms. Physiologically realistic flow conditions, as measured by transcranial Doppler ultrasound, were used in the simulations. Our results showed that there were significant changes in the overall flow patterns (e.g., vortex formation and translation) associated with the changes of heart rates. In both aneurysms, the calculated wall shear stress exhibited substantial increases with an increase in heart rate. Our results suggest that the changes in local hemodynamic forces associated with variations in heart rate are dependent not only on the heart rate but also on the aneurysm geometry. This thus precludes applying our observations about the impact of variations in cardiac rate to aneurysms in general.
Article: High WSS or Low WSS? Complex Interactions of Hemodynamics with Intracranial Aneurysm Initiation, Growth, and Rupture: Toward a Unifying Hypothesis.[show abstract] [hide abstract]
ABSTRACT: Increasing detection of unruptured intracranial aneurysms, catastrophic outcomes from subarachnoid hemorrhage, and risks and cost of treatment necessitate defining objective predictive parameters of aneurysm rupture risk. Image-based computational fluid dynamics models have suggested associations between hemodynamics and intracranial aneurysm rupture, albeit with conflicting findings regarding wall shear stress. We propose that the "high-versus-low wall shear stress" controversy is a manifestation of the complexity of aneurysm pathophysiology, and both high and low wall shear stress can drive intracranial aneurysm growth and rupture. Low wall shear stress and high oscillatory shear index trigger an inflammatory-cell-mediated pathway, which could be associated with the growth and rupture of large, atherosclerotic aneurysm phenotypes, while high wall shear stress combined with a positive wall shear stress gradient trigger a mural-cell-mediated pathway, which could be associated with the growth and rupture of small or secondary bleb aneurysm phenotypes. This hypothesis correlates disparate intracranial aneurysm pathophysiology with the results of computational fluid dynamics in search of more reliable risk predictors.American Journal of Neuroradiology 04/2013; · 2.93 Impact Factor
[show abstract] [hide abstract]
ABSTRACT: Assessing the risk of rupture of intracranial aneurysms is important for clinicians because the natural rupture risk can be exceeded by the small but significant risk carried by current treatments. To this end numerous investigators have used image-based computational fluid dynamics models to extract patient-specific hemodynamics information, but there is no consensus on which variables or hemodynamic characteristics are the most important. This paper describes a computational framework to study and characterize the hemodynamic environment of cerebral aneurysms in order to relate it to clinical events such as growth or rupture. In particular, a number of hemodynamic quantities are proposed to describe the most salient features of these hemodynamic environments. Application to a patient population indicates that ruptured aneurysms tend to have concentrated inflows, concentrated wall shear stress distributions, high maximal wall shear stress and smaller viscous dissipation ratios than unruptured aneurysms. Furthermore, these statistical associations are largely unaffected by the choice of physiologic flow conditions. This confirms the notion that hemodynamic information derived from image-based computational models can be used to assess aneurysm rupture risk, to test hypotheses about the mechanisms responsible for aneurysm formation, progression and rupture, and to answer specific clinical questions.International journal for numerical methods in biomedical engineering. 06/2011; 27(6):822-839.
[show abstract] [hide abstract]
ABSTRACT: Endovascular coiling is a well-established therapy for treating intracranial aneurysms. Nonetheless, postoperative hemodynamic changes induced by this therapy remain not fully understood. The purpose of this work is to assess the influence of coil configuration and packing density on intra-aneurysmal hemodynamics. Three 3D rotational angiography images of 3 intracranial aneurysms before and after endovascular coiling were used. For each aneurysm, a 3D representation of the vasculature was obtained after the segmentation of the images. Afterward, a virtual coiling technique was used to treat the aneurysm geometries with coil models. The aneurysms were coiled with 5 packing densities, and each was generated by using 3 coil configurations. Computational fluid dynamics analyses were carried out in both untreated and treated aneurysm geometries. Statistical tests were performed to evaluate the relative effect of coil configuration on local hemodynamics. The intra-aneurysmal blood flow velocity and wall shear stress were diminished as packing density increased. Aneurysmal flow velocity was reduced >50% due to the first inserted coils (packing density <12%) but with a high dependency on coil configuration. Nonsignificant differences (P > .01) were found in the hemodynamics due to coil configuration for high packing densities (near 30%). A damping effect was observed on the intra-aneurysmal blood flow waveform after coiling. Intra-aneurysmal hemodynamics are altered by coils. Coil configuration might reduce its influence on intra-aneurysmal hemodynamics as the packing density increases until an insignificant influence could be achieved for high packing densities.American Journal of Neuroradiology 09/2011; 32(10):1935-41. · 2.93 Impact Factor