Cerebrovascular systems with concomitant pathologies:A computational hemodynamics study

19th Argentinean Bioengineering Society Congress

Castro, Marcelo A.^1 ; Peloc, Nora L.^2 ; Cebral, Juan R.^3

CONICET, Universidad Tecnológica Nacional, Facultad Regional Buenos Aires Grupo de Investigación y Desarrollo en Bioingeniería, Medrano 951, Ciudad Autónoma de Buenos Aires, CP 1179, Argentina^1

Universidad Favaloro, Facultad de Ingeniería, Ciencias Exactas y Naturales, Solís 453, Ciudad Autónoma de Buenos Aires, CP 1078, Argentina^2

George Mason University, College of Sciences, 4400 University Drive, Fairfax, 22030, VA, United States^3

关键词: Aneurysm clippings;    Cerebral circulation;    Computational hemodynamics;    Hemodynamic changes;    Image-based models;    Internal carotid artery;    Management decisions;    Relative positions;   

Others  :  https://iopscience.iop.org/article/10.1088/1742-6596/477/1/012003/pdf
DOI  :  10.1088/1742-6596/477/1/012003

来源: IOP

【 摘 要 】

Although unusual, cerebral aneurysms may coexist with a proximal artery stenosis. In that small percent of patients, such coexistence poses a challenge for interventional neuroradiologists and neurosurgeons to make the best treatment decision. According to previous studies, the incidence of cerebral aneurysms in patients with internal carotid artery stenosis is not greater than 5%, where the aneurysm is usually incidentally detected, being 2% for aneurysms and stenoses in the same cerebral circulation. Those cases pose a difficult management decision for the physician. Case reports showed patients who died due to aneurysm rupture months after endarterectomy but before aneurysm clipping, while others did not show any change in the aneurysm after plaque removal, having optimum outcome after aneurysm coiling. The aim of this study is to investigate the intraaneurysmal hemodynamic changes before and after treatment of stenotic plaque. Idealized models were constructed with different stenotic grade, distance and relative position to the aneurysm. Digital removal of the stenotic plaque was performed in the reconstructed model of a patient with both pathologies. Computational fluid dynamic simulations were performed using a finite element method approach. Blood velocity field and hemodynamic forces were recorded and analyzed. Changes in the flow patterns and wall shear stress values and distributions were observed in both ideal and image-based models. Detailed investigation of wall shear stress distributions in patients with both pathologies is required to make the best management decision.