Flow Residence Time and Regions of Intraluminal Thrombus Deposition in Intracranial Aneurysms

Thrombus formation in intracranial aneurysms, while sometimes stabilizing lesion growth, can present additional risk of thrombo-embolism. The role of hemodynamics in the progression of aneurysmal disease can be elucidated by patient-specific computational modeling. In our previous work, patient-specific computational fluid dynamics (CFD) models were constructed from MRI data for three patients who had fusiform basilar aneurysms that were thrombus-free and then proceeded to develop intraluminal thrombus. In this study, we investigated the effect of increased flow residence time (RT) by modeling passive scalar advection in the same aneurysmal geometries. Non-Newtonian pulsatile flow simulations were carried out in base-line geometries and a new postprocessing technique, referred to as “virtual ink” and based on the passive scalar distribution maps, was used to visualize the flow and estimate the flow RT. The virtual ink technique clearly depicted regions of flow separation. The flow RT at different locations adjacent to aneurysmal walls was calculated as the time the virtual ink scalar remained above a threshold value. The RT values obtained in different areas were then correlated with the location of intra-aneurysmal thrombus observed at a follow-up MR study. For each patient, the wall shear stress (WSS) distribution was also obtained from CFD simulations and correlated with thrombus location. The correlation analysis determined a significant relationship between regions where CFD predicted either an increased RT or low WSS and the regions where thrombus deposition was observed to occur in vivo. A model including both low WSS and increased RT predicted thrombus-prone regions significantly better than the models with RT or WSS alone

Evaluation of a Desktop 3D Printed Rigid Refractive-Indexed-Matched Flow Phantom for PIV Measurements on Cerebral Aneurysms

Purpose Fabrication of a suitable flow model or phantom is critical to the study of biomedical fluid dynamics using optical flow visualization and measurement methods. The main difficulties arise from the optical properties of the model material, accuracy of the geometry and ease of fabrication. Methods Conventionally an investment casting method has been used, but recently advancements in additive manufacturing techniques such as 3D printing have allowed the flow model to be printed directly with minimal post-processing steps. This study presents results of an investigation into the feasibility of fabrication of such models suitable for particle image velocimetry (PIV) using a common 3D printing Stereolithography process and photopolymer resin. Results An idealised geometry of a cerebral aneurysm was printed to demonstrate its applicability for PIV experimentation. The material was shown to have a refractive index of 1.51, which can be refractive matched with a mixture of de-ionised water with ammonium thiocyanate (NH4SCN). The images were of a quality that after applying common PIV pre-processing techniques and a PIV cross-correlation algorithm, the results produced were consistent within the aneurysm when compared to previous studies. Conclusions This study presents an alternative low-cost option for 3D printing of a flow phantom suitable for flow visualization simulations. The use of 3D printed flow phantoms reduces the complexity, time and effort required compared to conventional investment casting methods by removing the necessity of a multi-part process required with investment casting techniques

Method for estimating pulsatile wall shear stress from one‐dimensional velocity waveforms

Abstract Wall shear stress (WSS)—a key regulator of endothelial function—is commonly estimated in vivo using simplified mathematical models based on Poiseuille's flow, assuming a quasi‐steady parabolic velocity distribution, despite evidence that more rapidly time‐varying, pulsatile blood flow during each cardiac cycle modulates flow‐mediated dilation (FMD) in large arteries of healthy subjects. More exact and accurate models based on the well‐established Womersley solution for rapidly changing blood flow have not been adopted clinically, potentially because the Womersley solution relies on the local pressure gradient, which is difficult to measure non‐invasively. We have developed an open‐source method for automatic reconstruction of unsteady, Womersley‐derived velocity profiles, and WSS in conduit arteries. The proposed method (available online at https://doi.org/10.5281/zenodo.7576408) requires only the time‐averaged diameter of the vessel and time‐varying velocity data available from non‐invasive imaging such as Doppler ultrasound. Validation of the method with subject‐specific computational fluid dynamics and application to synthetic velocity waveforms in the common carotid, brachial, and femoral arteries reveals that the Poiseuille solution underestimates peak WSS 38.5%–55.1% during the acceleration and deceleration phases of systole and underestimates or neglects retrograde WSS. Following evidence that oscillatory shear significantly augments vasodilator production, it is plausible that mischaracterization of the shear stimulus by assuming parabolic flow leads to systematic underestimates of important biological effects of time‐varying blood velocity in conduit arteries

Numerical modeling of the flow in intracranial aneurysms: Prediction of regions prone to thrombus formation

The deposition of intralumenal thrombus in intracranial aneurysms adds a risk of thrombo-embolism over and above that posed by mass effect and rupture. In addition to biochemical factors, hemodynamic factors that are governed by lumenal geometry and blood flow rates likely play an important role in the thrombus formation and deposition process. In this study, patient-specific computational fluid dynamics (CFD) models of blood flow were constructed from MRA data for three patients who had fusiform basilar aneurysms that were thrombus free and then proceeded to develop intralumenal thrombus. In order to determine whether features of the flow fields could suggest which regions had an elevated potential for thrombus deposition, the flow was modeled in the baseline, thrombus-free geometries. Pulsatile flow simulations were carried out using patient-specific inlet flow conditions measured with MR velocimetry. Newtonian and non-Newtonian blood behavior was considered. A strong similarity was found between the intra-aneurysmal regions with CFD-predicted slow, recirculating flows and the regions of thrombus deposition observed in vivo in the follow-up MR studies. In two cases with larger aneurysms, the agreement between the low velocity zones and clotted-off regions improved when non-Newtonian blood behavior was taken into account. A similarity was also found between the calculated low shear stress regions and the regions that were later observed to clot. © 2008 Biomedical Engineering Society

Temporal stability of dysmorphic fusiform aneurysms of the intracranial internal carotid artery

[PubMed Central:\hrefhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3125409PMC3125409] [DOI:\hrefhttps://dx.doi.org/10.1016/j.jvir.2011.01.42510.1016/j.jvir.2011.01.425] [PubMed:\hrefhttps://www.ncbi.nlm.nih.gov/pubmed/2063443120634431]Estimation of the stability of dysmorphic fusiform aneurysms of the intracranial internal carotid artery requires precise monitoring of their volumes. This report describes a method of magnetic resonance (MR) imaging and three-dimensional postprocessing to study the evolution of these aneurysms in a prospective cohort of patients not immediately suitable for surgery or endovascular treatment.\ Ten patients with fusiform aneurysms of the intracranial internal carotid artery underwent serial MR studies. Five patients were studied at two time points and the remainder at multiple time points (mean delay between studies, 12.6 mo ± 3.8). For each patient, studies from all time points were coregistered. The volumes of each vessel component were calculated.\ Mean aneurysm volume was 833 mm(3) ± 878. Mean annual rate of volume progression was 1.37% ± 2.09. All aneurysms were thrombus-free.\ This study indicates that, given the relatively low rate of progression of dysplastic fusiform aneurysms and the complexity of their shape, three-dimensional quantitative volumetric methods can be helpful in monitoring whether any growth has occurred

Computational Modeling of Flow-Altering Surgeries in Basilar Aneurysms

In cases where surgeons consider different interventional options for flow alterations in the setting of pathological basilar artery hemodynamics, a virtual model demonstrating the flow fields resulting from each of these options can assist in making clinical decisions. In this study, image-based computational fluid dynamics (CFD) models were used to simulate the flow in four basilar artery aneurysms in order to evaluate postoperative hemodynamics that would result from flow-altering interventions. Patient-specific geometries were constructed using MR angiography and velocimetry data. CFD simulations carried out for the preoperative flow conditions were compared to in vivo phase-contrast MRI measurements (4D Flow MRI) acquired prior to the interventions. The models were then modified according to the procedures considered for each patient. Numerical simulations of the flow and virtual contrast transport were carried out in each case in order to assess postoperative flow fields and estimate the likelihood of intra-aneurysmal thrombus deposition following the procedures. Postoperative imaging data, when available, were used to validate computational predictions. In two cases, where the aneurysms involved vital pontine perforator arteries branching from the basilar artery, idealized geometries of these vessels were incorporated into the CFD models. The effect of interventions on the flow through the perforators was evaluated by simulating the transport of contrast in these vessels. The computational results were in close agreement with the MR imaging data. In some cases, CFD simulations could help determine which of the surgical options was likely to reduce the flow into the aneurysm while preserving the flow through the basilar trunk. The study demonstrated that image-based computational modeling can provide guidance to clinicians by indicating possible outcome complications and indicating expected success potential for ameliorating pathological aneurysmal flow, prior to a procedure

Numerical modeling of the flow in intracranial aneurysms: prediction of regions prone to thrombus formation

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Numerical simulations of flow in cerebral aneurysms: comparison of CFD results and in vivo MRI measurements

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Phase-contrast magnetic resonance imaging measurements in intracranial aneurysms in vivo of flow patterns, velocity fields, and wall shear stress: comparison with computational fluid dynamics

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