A computational model for prediction of clot platelet content in flow-diverted intracranial aneurysms

JOURNAL OF BIOMECHANICS

卷:91

Article

Sarrami-Foroushani, Ali¹  Lassila, Toni¹  Hejazi, Seyed Mostafa²  Nagaraja, Sanjoy³  Bacon, Andrew⁴  Frangi, Alejandro F.^1,5 

[1] Univ Leeds, Sch Comp, Ctr Computat Imaging & Simulat Technol Biomed CIS, Leeds, W Yorkshire, England

[2] Univ Sheffield, Dept Elect & Elect Engn, Sheffield, S Yorkshire, England

[3] Sheffield Teaching Hosp, Sheffield, S Yorkshire, England

[4] Royal Hallamshire Hosp, Dept Neurosurg, Sheffield, S Yorkshire, England

[5] Univ Leeds, Sch Med, Leeds Inst Cardiovasc & Metab Med LICAMM, Biomed Imaging Dept, Leeds, W Yorkshire, England

关键词: Flow diverter;    Intracranial aneurysms;    Thrombosis;    Computational fluid dynamics;   

DOI  :  10.1016/j.jbiomech.2019.04.045

来源: Elsevier

【 摘 要 】

Treatment of intracranial aneurysms with flow-diverting stents is a safe and minimally invasive technique. The goal is stable embolisation that facilitates stent endothelialisation, and elimination of the aneurysm. However, it is not fully understood why some aneurysms fail to develop a stable clot even with sufficient levels of flow reduction. Computational prediction of thrombus formation dynamics can help predict the post-operative response in such challenging cases. In this work, we propose a new model of thrombus formation and platelet dynamics inside intracranial aneurysms. Our novel contribution combines platelet activation and transport with fibrin generation, which is key to characterising stable and unstable thrombus. The model is based on two types of thrombus inside aneurysms: red thrombus (fibrin- and erythrocyte-rich) can be found in unstable clots, while white thrombus (fibrin- and platelet-rich) can be found in stable clots. The thrombus generation model is coupled to a CFD model and the flow-induced platelet index (FiPi) is defined as a quantitative measure of clot stability. Our model is validated against an in vitro phantom study of two flow-diverting stents with different sizing. We demonstrate that our model accurately predicts the lower thrombus stability in the oversized stent scenario. This opens possibilities for using computational simulations to improve endovascular treatment planning and reduce adverse events, such as delayed haemorrhage of flow-diverted aneurysms. (C) 2019 The Authors. Published by Elsevier Ltd.

【 授权许可】

Free