Wall Shear Stress and Flow Patterns in Unruptured and Ruptured Anterior Communicating Artery Aneurysms Using Computational Fluid Dynamics

Lee, Ui Yun; Jung, Ju Yeon; Kwak, Hyo Sung; Lee, Dong Hwan; Chung, Gyung Ho; Park, Jung Soo; Koh, Eun Jeong

doi:10.3340/jkns.2018.0155

Cited by 8 publications

(5 citation statements)

References 29 publications

(53 reference statements)

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“…Digital Imaging and Communications in Medicine(DICOM) format of the source image for each patient was obtained and imported into Materialise Mimics software (version 20.0; Materialise NV, Leuven, Belgium) for geometry reconstruction. Based on our previous work [ 11 ], we used threshold segmentation to obtain 3-dimensional geometry and a cropping method to designate the desired region of vessels. Images of small and unnecessary branches were removed and truncated for CFD analysis, and a smoothing method was used for rough and sharp surfaces of the reconstructed 3-dimensional geometry.…”

Section: Methodsmentioning

confidence: 99%

Analysis of Morphological-Hemodynamic Risk Factors for Aneurysm Rupture Including a Newly Introduced Total Volume Ratio

Lee

Kwak

2021

JPM

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The purpose of this study was to evaluate morphological and hemodynamic factors, including the newly developed total volume ratio (TVR), in evaluating rupture risk of cerebral aneurysms using ≥7 mm sized aneurysms. Twenty-three aneurysms (11 unruptured and 12 ruptured) ≥ 7 mm were analyzed from 3-dimensional rotational cerebral angiography and computational fluid dynamics (CFD). Ten morphological and eleven hemodynamic factors of the aneurysms were qualitatively and quantitatively compared. Correlation analysis between morphological and hemodynamic factors was performed, and the relationship among the hemodynamic factors was analyzed. Morphological factors (ostium diameter, ostium area, aspect ratio, and bottleneck ratio) and hemodynamic factors (TVR, minimal wall shear stress of aneurysms, time-averaged wall shear stress of aneurysms, oscillatory shear index, relative residence time, low wall shear stress area, and ratio of low wall stress area) were statistically different between ruptured and unruptured aneurysms (p < 0.05). By simple regression analysis, the morphological factor aspect ratio and the hemodynamic factor TVR were significantly correlated (r2 = 0.602, p = 0.001). Ruptured aneurysms had complex and unstable flow. In ≥7 mm ruptured aneurysms, high aspect ratio, bottleneck ratio, complex flow, unstable flow, low TVR, wall shear stress at aneurysm, high oscillatory shear index, relative resistance time, low wall shear stress area, and ratio of low wall stress area were significant in determining the risk of aneurysm rupture.

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Section: Methodsmentioning

confidence: 99%

Analysis of Morphological-Hemodynamic Risk Factors for Aneurysm Rupture Including a Newly Introduced Total Volume Ratio

Lee

Kwak

2021

JPM

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“…Flow complexity is divided into "simple" and "complex" depending on the number of flow recirculation areas. Simple flow has 1 recirculation area, and complex flow has 2 or more recirculation areas [27]. The inflow jet can be classified into "diffused" and "concentrated" according to the characteristics of inflow into the aneurysm dome.…”

Section: Flow Patternsmentioning

confidence: 99%

Size-Dependent Distribution of Patient-Specific Hemodynamic Factors in Unruptured Cerebral Aneurysms Using Computational Fluid Dynamics

et al. 2020

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Purpose: To analyze size-dependent hemodynamic factors [velocity, shear rate, blood viscosity, wall shear stress (WSS)] in unruptured cerebral aneurysms using computational fluid dynamics (CFD) based on the measured non-Newtonian model of viscosity. Methods: Twenty-one patients with unruptured aneurysms formed the study cohort. Patient-specific geometric models were reconstructed for CFD analyses. Aneurysms were divided into small and large groups based on a cutoff size of 5 mm. For comparison between small and large aneurysms, 5 morphologic variables were measured. Patient-specific non-Newtonian blood viscosity was applied for more detailed CFD simulation. Quantitative and qualitative analyses of velocity, shear rate, blood viscosity, and WSS were conducted to compare small and large aneurysms. Results: Complex flow patterns were found in large aneurysms. Large aneurysms had a significantly lower shear rate (235 ± 341 s−1) than small aneurysms (915 ± 432 s−1) at peak-systole. Two times higher blood viscosity was observed in large aneurysms compared with small aneurysms. Lower WSS was found in large aneurysms (1.38 ± 1.36 Pa) than in small aneurysms (3.53 ± 1.22 Pa). All the differences in hemodynamic factors between small and large aneurysms were statistically significant. Conclusions: Large aneurysms tended to have complex flow patterns, low shear rate, high blood viscosity, and low WSS. The hemodynamic factors that we analyzed might be useful for decision making before surgical treatment of aneurysms.

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“…Several investigations have shown that such complex flow patterns play critical roles in aneurysm rupture via inflammatory remodeling of the aneurysm wall [38,40,[51][52][53]. Xiang et al analyzed 119 aneurysms and found that complex flow patterns appeared in more than 60% of ruptured aneurysms, which were featured by multiple vortices [51].…”

Section: Impacts Of Unilateral Ica Revascularization On Acoaa Flow Pamentioning

confidence: 99%

Impacts of Internal Carotid Artery Revascularization on Flow in Anterior Communicating Artery Aneurysm: A Preliminary Multiscale Numerical Investigation

Zhu

Wei

et al. 2019

Applied Sciences

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The optimal management strategy of patients with concomitant anterior communicating artery aneurysm (ACoAA) and internal carotid artery (ICA) stenosis is unclear. This study aims to evaluate the impacts of unilateral ICA revascularization on hemodynamics factors associated with rupture in an ACoAA. In the present study, a multiscale computational model of ACoAA was developed by coupling zero-dimensional (0D) models of the cerebral vascular system with a three-dimensional (3D) patient-specific ACoAA model. Distributions of flow patterns, wall shear stress (WSS), relative residence time (RRT) and oscillating shear index (OSI) in the ACoAA under left ICA revascularization procedure were quantitatively assessed by using transient computational fluid dynamics (CFD) simulations. Our results showed that the revascularization procedures significantly changed the hemodynamic environments in the ACoAA. The flow disturbance in the ACoAA was enhanced by the resumed flow from the affected side. In addition, higher OSI (0.057 vs. 0.02), prolonged RRT (1.14 vs. 0.39) and larger low WSS area (66 vs. 50 mm2) in ACoAA were found in the non-stenotic case. These acute changes in hemodynamics after revascularization may elevate the rupture risk of ACoAA. The preliminary results validated the feasibility of predicting aneurismal hemodynamics characteristics in revascularization procedures by using multiscale CFD simulations, which would benefit the management of this group of patients.

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Wall Shear Stress and Flow Patterns in Unruptured and Ruptured Anterior Communicating Artery Aneurysms Using Computational Fluid Dynamics

Cited by 8 publications

References 29 publications

Analysis of Morphological-Hemodynamic Risk Factors for Aneurysm Rupture Including a Newly Introduced Total Volume Ratio

Analysis of Morphological-Hemodynamic Risk Factors for Aneurysm Rupture Including a Newly Introduced Total Volume Ratio

Size-Dependent Distribution of Patient-Specific Hemodynamic Factors in Unruptured Cerebral Aneurysms Using Computational Fluid Dynamics

Impacts of Internal Carotid Artery Revascularization on Flow in Anterior Communicating Artery Aneurysm: A Preliminary Multiscale Numerical Investigation

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