Hemodynamics in Ruptured Intracranial Aneurysms

Incidental detection of unruptured intracranial aneurysms (UIA) has increased in the recent years. There is a need in the clinical community to identify those that are prone to rupture and would require preventive treatment. Hemodynamics in cerebral blood vessels plays a key role in the lifetime cycle of intracranial aneurysms (IA). Understanding their initiation, growth, and rupture or stabilization may identify those hemodynamic features that lead to aneurysm instability and rupture. Modeling hemodynamics using computational fluid dynamics (CFD) could aid in understanding the processes in the development of IA. The neurosurgical approach during operation of IA allows direct visualization of the aneurysm sac and its sampling in many cases. Detailed analysis of the quality of the aneurysm wall under the microscope, together with histological assessment of the aneurysm wall and CFD modeling, can help in building complex knowledge on the relationship between the biology of the wall and hemodynamics. Detailed CFD analysis of the rupture point can further strengthen the association between hemodynamics and rupture. In this chapter we summarize current knowledge on CFD and intracranial aneurysms

Reproducibility of the computational fluid dynamic analysis of a cerebral aneurysm monitored over a decade

Computational fluid dynamics (CFD) simulations are increasingly utilised to evaluate intracranial aneurysm (IA) haemodynamics to aid in the prediction of morphological changes and rupture risk. However, these models vary and differences in published results warrant the investigation of IA-CFD reproducibility. This study aims to explore sources of intra-team variability and determine its impact on the aneurysm morphology and CFD parameters. A team of four operators were given six sets of magnetic resonance angiography data spanning a decade from one patient with a middle cerebral aneurysm. All operators were given the same protocol and software for model reconstruction and numerical analysis. The morphology and haemodynamics of the operator models were then compared. The segmentation, smoothing factor, inlet and outflow branch lengths were found to cause intra-team variability. There was 80% reproducibility in the time-averaged wall shear stress distribution among operators with the major difference attributed to the level of smoothing. Based on these findings, it was concluded that the clinical applicability of CFD simulations may be feasible if a standardised segmentation protocol is developed. Moreover, when analysing the aneurysm shape change over a decade, it was noted that the co-existence of positive and negative values of the wall shear stress divergence (WSSD) contributed to the growth of a daughter sac

Hemodynamics of Cerebral Aneurysms: Computational Analyses of Aneurysm Progress and Treatment

The progression of a cerebral aneurysm involves degenerative arterial wall remodeling. Various hemodynamic parameters are suspected to be major mechanical factors related to the genesis and progression of vascular diseases. Flow alterations caused by the insertion of coils and stents for interventional aneurysm treatment may affect the aneurysm embolization process. Therefore, knowledge of hemodynamic parameters may provide physicians with an advanced understanding of aneurysm progression and rupture, as well as the effectiveness of endovascular treatments. Progress in medical imaging and information technology has enabled the prediction of flow fields in the patient-specific blood vessels using computational analysis. In this paper, recent computational hemodynamic studies on cerebral aneurysm initiation, progress, and rupture are reviewed. State-of-the-art computational aneurysmal flow analyses after coiling and stenting are also summarized. We expect the computational analysis of hemodynamics in cerebral aneurysms to provide valuable information for planning and follow-up decisions for treatment

Comparison of existing aneurysm models and their path forward

The two most important aneurysm types are cerebral aneurysms (CA) and abdominal aortic aneurysms (AAA), accounting together for over 80\% of all fatal aneurysm incidences. To minimise aneurysm related deaths, clinicians require various tools to accurately estimate its rupture risk. For both aneurysm types, the current state-of-the-art tools to evaluate rupture risk are identified and evaluated in terms of clinical applicability. We perform a comprehensive literature review, using the Web of Science database. Identified records (3127) are clustered by modelling approach and aneurysm location in a meta-analysis to quantify scientific relevance and to extract modelling patterns and further assessed according to PRISMA guidelines (179 full text screens). Beside general differences and similarities of CA and AAA, we identify and systematically evaluate four major modelling approaches on aneurysm rupture risk: finite element analysis and computational fluid dynamics as deterministic approaches and machine learning and assessment-tools and dimensionless parameters as stochastic approaches. The latter score highest in the evaluation for their potential as clinical applications for rupture prediction, due to readiness level and user friendliness. Deterministic approaches are less likely to be applied in a clinical environment because of their high model complexity. Because deterministic approaches consider underlying mechanism for aneurysm rupture, they have improved capability to account for unusual patient-specific characteristics, compared to stochastic approaches. We show that an increased interdisciplinary exchange between specialists can boost comprehension of this disease to design tools for a clinical environment. By combining deterministic and stochastic models, advantages of both approaches can improve accessibility for clinicians and prediction quality for rupture risk.Comment: 46 pages, 5 figure

IMPACT OF HEMODYNAMIC VORTEX SPATIAL AND TEMPORAL CHARACTERISTICS ON ANALYSIS OF INTRACRANIAL ANEURYSMS

Subarachnoid hemorrhage is a potentially devastating pathological condition in which bleeding occurs into the space surrounding the brain. One of the prominent sources of subarachnoid hemorrhage are intracranial aneurysms (IA): degenerative, irregular expansions of area(s) of the cerebral vasculature. In the event of IA rupture, the resultant subarachnoid hemorrhage ends in patient mortality occurring in ~50% of cases, with survivors enduring significant neurological damage with physical or cognitive impairment. The seriousness of IA rupture drives a degree of clinical interest in understanding these conditions that promote both the development and possible rupture of the vascular malformations. Current metrics for the assessment of this pathology rely on measuring the geometric characteristics of a patient\u27s vessel and/or IA, as well as the hemodynamic stressors existing along the vessel wall. Comparatively less focus has been granted toward understanding the characteristics of much of the bulk-flow within the vasculature and how it may play a role in IAs. Specifically, swirling hemodynamic flow (vortices) have been suggested as a condition which exacerbates vascular changes leading to IAs, yet quantified measurements of the spatial and temporal characteristics of vortices remain overlooked. This dissertation studies the role of the spatial and temporal characteristics of vortex flow and how it plays a role on IA pathology. Its chapters are a collection of five (5) works into this matter. First, established methods for the identification of vortices was investigated, and a novel method for vortex identification and quantification of their characteristics was developed to overcome the limitations of previous methods. Second, the developed method for vortex identification/quantification was then applied to a simulation study to improve predictive models aimed at predicting areas of IA development from those unlikely to suffer this pathology. Third, assessing how the simulated repair of one IA impacts changes to hemodynamic conditions within other nearby un-repaired IAs in a multiple IA system. Fourth, it was determined if vortex identification/quantification improved predictive models aimed at differentiation ruptured from unruptured IAs. Fifth, impart vortical flow of differing characteristics onto cultured vascular cells to determine if vortex stability imparts varied levels of cellular changes

Understanding the role of hemodynamics in the initiation, progression, rupture, and treatment outcome of cerebral aneurysm from medical iamge-based computational studies

About a decade ago, the first image-based computational hemodynamic studies of cerebral aneurysms were presented. Their potential for clinical applications was the results of a right combination of medical image processing, vascular reconstruction, and grid generation techniques used to reconstruct personalziaed domains for computational fluid and solid dynamics solvers and data analysis and visualization techniques. A considerable number of studies have captivated the attention of clinicians, neurosurgeons, and neuroradiologists, who realized the ability of those tools to help in understanding the role played by hemodynamics in the natural history and management of intracranial aneurysms. This paper intends to summarize the most relevant results in the filed reported during the last years.Fil: Castro, Marcelo Adrian. Universidad Tecnológica Nacional. Facultad Regional Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

The energy loss may predict rupture risks of anterior communicating aneurysms: A preliminary result

Anterior communicating artery (ACoA) aneurysms are well documented to have a higher rupture risk compared with aneurysms at other locations. However, the risk predicting factors for these aneurysms still remain unclear due to the complex arteries geometries and flow patterns involved. The authors introduce a comprehensive method to quantitatively illustrate the development of ACoA aneurysms using a computational fluid dynamics (CFD) approach. Seven ACoA aneurysms, which included 2 ruptured and 5 unruptured aneurysms, were employed. Patient-specific whole anterior circulation geometries were segmented to simulate the real circumstances in vivo. The energy losses (EL) and flow architectures of these 7 aneurysms were evaluated using an algorithm modality. Overall, the 2 ruptured aneurysms, along with 1 unruptured aneurysm that was defined as highly likely to rupture due to ACoA location and a bleb sitting at the top of the dome, had a significantly larger EL and more complex and unstable flow architecture than the others. Two aneurysms had a negative value of EL indicating that the geometries with aneurysms of the anterior communicating complex (ACC) had a smaller loss of energy than the geometries without aneurysms. Despite a small sample size resulting in a low statistical significance, EL may serve as a development predictor of ACoA aneurysms