Computational Fluid Dynamics of a Fatal Ruptured Anterior Communicating Artery Aneurysm

Hejčl, Aleš; Švihlová, Helena; Sejkorová, Alena; Ripollés, Tomás; Adámek, Daniel; Hron, J.; Dan, Dragomir-Daescu; Málek, Josef; Sameš, Martin

doi:10.1055/s-0037-1604286

Cited by 8 publications

(6 citation statements)

References 28 publications

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“…Several previous studies have analyzed the local hemodynamics at rupture sites, either identified during open surgery (or intraoperative videos) 13,17,[21][22][23][24] or by analyzing blood extravasation in 3D images. [14][15][16][18][19][20]25 Although these studies did not analyze the location of the rupture site with respect to different aneurysm regions, it was possible to determine the rupture site location with respect to the different aneurysm regions considered here of some aneurysms that were visible in the figures presented in these papers.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…The hemodynamics at the rupture site have been analyzed in very limited cases, with roughly 58 rupture sites from 13 published studies. [13][14][15][16][17][18][19][20][21][22][23][24][25] However, the results are confusing, particularly the role of WSS.…”

Section: Introductionmentioning

confidence: 99%

“…On the one hand, Cebral et al 16 and Hejcl et al 21 have suggested that high WSS at the rupture point is a common feature. This is further supported by Hodis et al, 15 who also found elevated WSS and pressure near the rupture site.…”

Section: Introductionmentioning

confidence: 99%

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Distribution of rupture sites and blebs on intracranial aneurysm walls suggests distinct rupture patterns in ACom and MCA aneurysms

Karnam,

Mut,

et al. 2024

Numer Methods Biomed Eng

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The mechanisms behind intracranial aneurysm formation and rupture are not fully understood, with factors such as location, patient demographics, and hemodynamics playing a role. Additionally, the significance of anatomical features like blebs in ruptures is debated. This highlights the necessity for comprehensive research that combines patient‐specific risk factors with a detailed analysis of local hemodynamic characteristics at bleb and rupture sites. Our study analyzed 359 intracranial aneurysms from 268 patients, reconstructing patient‐specific models for hemodynamic simulations based on 3D rotational angiographic images and intraoperative videos. We identified aneurysm subregions and delineated rupture sites, characterizing blebs and their regional overlap, employing statistical comparisons across demographics, and other risk factors. This work identifies patterns in aneurysm rupture sites, predominantly at the dome, with variations across patient demographics. Hypertensive and anterior communicating artery (ACom) aneurysms showed specific rupture patterns and bleb associations, indicating two pathways: high‐flow in ACom with thin blebs at impingement sites and low‐flow, oscillatory conditions in middle cerebral artery (MCA) aneurysms fostering thick blebs. Bleb characteristics varied with gender, age, and smoking, linking rupture risks to hemodynamic factors and patient profiles. These insights enhance understanding of the hemodynamic mechanisms leading to rupture events. This analysis elucidates the role of localized hemodynamics in intracranial aneurysm rupture, challenging the emphasis on location by revealing how flow variations influence stability and risk. We identify two pathways to wall failure—high‐flow and low‐flow conditions—highlighting the complexity of aneurysm behavior. Additionally, this research advances our knowledge of how inherent patient‐specific characteristics impact these processes, which need further investigation.

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Section: Comparison With Previous Studiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Distribution of rupture sites and blebs on intracranial aneurysm walls suggests distinct rupture patterns in ACom and MCA aneurysms

Karnam,

Mut,

et al. 2024

Numer Methods Biomed Eng

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“…The outlet condition that prescribes zero stress vectors [41] is considered to be the same as Eq. (8).…”

Section: Conditions On Velocity Gradientmentioning

confidence: 99%

“…It might be inappropriate to impose the traction-free condition onto cases when daughter arteries are extended by adding straight pipes because flows are being developed in the straight pipes. In fact, researchers using the tractionfree condition simply truncated distal arteries, not applying the outlet extension to their 3-D models [28,[41][42][43][44]. Xu et al [29], instead, adopted zero velocity-gradient in the normal direction for models with extended outlets.…”

Section: Conditions On Velocity Gradientmentioning

confidence: 99%

Understanding of boundary conditions imposed at multiple outlets in computational haemodynamic analysis of cerebral aneurysm

et al. 2019

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Computational fluid dynamics (CFD) is considered to be a promising tool for haemodynamic analysis of the intracranial aneurysm. However, aneurysm CFD is still not regarded as fully reliable mainly because the computational result is influenced by too many factors such as the luminal geometry of the model, spatiotemporal resolutions and boundary conditions. Among the influential factors, this paper focuses on outflow boundary conditions used when the computational domain has multiple outlets. Four outflow strategies found in published articles are reviewed: 1) prescription of constant or zero pressure, 2) flow splitting based on the power law, 3) traction-free and zero velocitygradient conditions and 4) coupling of CFD with a reducedorder model. None of them has proved definitely superior or inferior to others. For accurate quantification of the haemodynamic state in the aneurysm, it is crucial to incorporate the physiologically correct flow splitting ratio in CFD analysis by means of accurate specification of pressure or flow rate at the outlets. A coupling of CFD and a 0-d model (a subtype of the reduced-order model) appears to be the most promising although further study is necessary to achieve accurate estimation of model parameters.

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Description of the local hemodynamic environment in intracranial aneurysm wall subdivisions

Karnam,

Mut,

et al. 2024

Numer Methods Biomed Eng

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Intracranial aneurysms (IAs) pose severe health risks influenced by hemodynamics. This study focuses on the intricate characterization of hemodynamic conditions within the IA walls and their influence on bleb development, aiming to enhance understanding of aneurysm stability and the risk of rupture. The methods emphasized utilizing a comprehensive dataset of 359 IAs and 213 IA blebs from 268 patients to reconstruct patient‐specific vascular models, analyzing blood flow using finite element methods to solve the unsteady Navier–Stokes equations, the segmentation of aneurysm wall subregions and the hemodynamic metrics wall shear stress (WSS), its metrics, and the critical points in WSS fields were computed and analyzed across different aneurysm subregions defined by saccular, streamwise, and topographical divisions. The results revealed significant variations in these metrics, correlating distinct hemodynamic environments with wall features on the aneurysm walls, such as bleb formation. Critical findings indicated that regions with low WSS and high OSI, particularly in the body and central regions of aneurysms, are prone to conditions that promote bleb formation. Conversely, areas exposed to high WSS and positive divergence, like the aneurysm neck, inflow, and outflow regions, exhibited a different but substantial risk profile for bleb development, influenced by flow impingements and convergences. These insights highlight the complexity of aneurysm behavior, suggesting that both high and low‐shear environments can contribute to aneurysm pathology through distinct mechanisms.

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Computational Fluid Dynamics of a Fatal Ruptured Anterior Communicating Artery Aneurysm

Cited by 8 publications

References 28 publications

Distribution of rupture sites and blebs on intracranial aneurysm walls suggests distinct rupture patterns in ACom and MCA aneurysms

Distribution of rupture sites and blebs on intracranial aneurysm walls suggests distinct rupture patterns in ACom and MCA aneurysms

Understanding of boundary conditions imposed at multiple outlets in computational haemodynamic analysis of cerebral aneurysm

Description of the local hemodynamic environment in intracranial aneurysm wall subdivisions

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