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Chen XQ, Jiang J, Xing J, Ming ZK, Zhu M, Bao Q, Hu MC. Hemodynamic characteristics of vertebrobasilar artery fenestration combined with vertebrobasilar dolichoectasia: a study based on magnetic resonance angiography. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2024; 14:253-260. [PMID: 39309419 PMCID: PMC11411188 DOI: 10.62347/tlnn8316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 07/31/2024] [Indexed: 09/25/2024]
Abstract
PURPOSE This study delves into the hemodynamic characteristics of Vertebrobasilar Artery Fenestration (VBAF) combined with Vertebrobasilar Dolichoectasia (VBD) using Magnetic Resonance Angiography (MRA). By summarizing the hemodynamic features and identifying high-risk populations, we aim to provide insights for clinical treatment. METHODS Utilizing MRA images as a foundation, arterial three-dimensional geometric models were constructed. A total of 22 cases were categorized into control, S, L, U, and Spiral groups, and numerical simulation analysis of the vessels was conducted using computational fluid dynamics methods. RESULTS Hemodynamic parameters of the VBAF combined with the VBD model were obtained, including blood flow velocity, oscillatory shear stress (OSI), wall shear stress (WSS), and aneurysm formation indicator (AFI). The V, OSI, and WSS indices of the L, U, and Spiral groups were significantly higher than those of the control group (P < 0.05). High-speed blood flow, elevated WSS, and increased OSI in these groups were concentrated at the fenestration site, with scattered distribution along the tortuous vertebral artery and basilar artery segments, accompanied by significant differences in the parameters of the bilateral vertebral arteries. CONCLUSION This preliminary investigation identifies the L, U, and Spiral groups as high-risk populations. Abnormal hemodynamics may lead to a vicious cycle in vascular wall pathology, increasing the likelihood of adverse events such as cerebral infarction. Clinical attention should focus on individuals within these groups and their corresponding vascular regions.
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Affiliation(s)
- Xiao-Qin Chen
- Department of Radiology, West China Hospital, Sichuan UniversityChengdu, Sichuan, China
| | - Jie Jiang
- Department of Infectious Diseases, Mudanjiang Forestry Central HospitalMudanjiang, Heilongjiang, China
| | - Jian Xing
- Department of Magnetic Resonance Imaging, Hongqi Hospital Affiliated to Mudanjiang Medical UniversityMudanjiang, Heilongjiang, China
| | - Zhao-Kai Ming
- Department of Radiology, The First Hospital of QiqiharQiqihar, Heilongjiang, China
| | - Min Zhu
- Department of Magnetic Resonance Imaging, Hongqi Hospital Affiliated to Mudanjiang Medical UniversityMudanjiang, Heilongjiang, China
| | - Quan Bao
- Department of Magnetic Resonance Imaging, Hongqi Hospital Affiliated to Mudanjiang Medical UniversityMudanjiang, Heilongjiang, China
| | - Ming-Cheng Hu
- Department of Magnetic Resonance Imaging, Hongqi Hospital Affiliated to Mudanjiang Medical UniversityMudanjiang, Heilongjiang, China
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Wang Y, Chen B, Song L, Li Y, Xu M, Huang T, Zeng F. Effect of Siphon Morphology on the Risk of C7 Segment Aneurysm Formation : A Case-control CFD Study. Clin Neuroradiol 2024; 34:485-494. [PMID: 38416142 PMCID: PMC11130050 DOI: 10.1007/s00062-024-01394-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/26/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Tortuosity of the internal carotid artery (ICA) is associated with intracranial aneurysms (IAs). The siphon is the most curved segment of the ICA, but its morphology has controversial effects on IAs. This study aimed to explore the morphometric features of the siphon and the potential hemodynamic mechanisms that may affect C7 aneurysm formation. METHODS In this study 32 patients with C7 aneurysms diagnosed at Xiangya Hospital between 2019 and 2021 and 32 control subjects were enrolled after propensity score matching. Computed tomography angiography (CTA) images were acquired to measure morphologic features, and then, by combining clinical data, simplified carotid siphon models were constructed, and computational fluid dynamics (CFD) analysis was performed. RESULTS The presence of C7 aneurysms was associated with the height of the C4-C6 curved arteries (odds ratio [OR] 0.028, 95% confidence interval [CI] 0.003-0.201; P < 0.001). The heights of the C4-C6 curved arteries in the aneurysm group were significantly shorter than those in the control group. The CFD analysis revealed that shorter C4-C6 bends led to greater blood velocity and pressure in the C7 segment arteries. CONCLUSION A shorter C4-C6 bend was associated with distal C7 aneurysm formation, and an elaborate hemodynamic mechanism may underlie this association.
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Affiliation(s)
- Ying Wang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bo Chen
- Department of Surgery, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Laixin Song
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuzhe Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ming Xu
- Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Tianxiang Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Feiyue Zeng
- Department of Radiology, Xiangya Hospital, Central South University, No. 87 Xiangya Rd, 410008, Changsha, Kaifu District, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China.
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Epshtein M, Shazeeb MS, Kühn AL, Anagnostakou V, Raskett CM, King RM, Goyal M, Mendes Pereira V, Arthur AS, Puri AS, Fiorella D, Gounis MJ. Development of an in-vitro model based on patient vessel geometry for simulated use testing in neurointerventional surgery. Interv Neuroradiol 2023:15910199231158444. [PMID: 36872879 DOI: 10.1177/15910199231158444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Neurointerventionalists use in-vitro vascular models to train for worst-case scenarios and test new devices in a simulated use environment to predict clinical performance. According to the Food and Drug Administration (FDA), any neurovascular navigation device should be able to successfully navigate two 360-degree turns and two 180-degree turns at the distal portion of the anatomical model. Here, we present a device benchmarking vascular model that complies with FDA recommendations. METHODS Our vascular model was assembled from quantitative characterization of 49 patients who underwent CT angiography either for acute ischemic stroke caused by large vessel occlusion or for aneurysm treatment. Following complete characterization of these data, the vascular segments were 3D reconstructed from CT angiograms of 6 selected patients that presented with challenging anatomy. The curvature and total rotational angle were calculated for each segment and the anatomical parts that complied with FDA recommendations were fused together into a single in-vitro model. RESULTS The model was constructed containing two common carotid branches arising from a type two aortic arch and the dimensions of the overall model exceeded the recommendations of the FDA. Two experienced neurointerventionalists tested the model for navigation difficulty using several devices on an in-vitro perfusion system and concluded that the model provided a realistic, challenging scenario. CONCLUSIONS This model provides a first prototype designed according to FDA recommendations of cumulative angle while also integrating an aggregation of actual patient-specific anatomy. The availability of this clinically relevant benchmark model presents a potential standardized approach for neurovascular device testing.
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Affiliation(s)
- Mark Epshtein
- New England Center for Stroke Research, Department of Radiology, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Mohammed Salman Shazeeb
- New England Center for Stroke Research, Department of Radiology, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
- Image Processing & Analysis Core (iPAC), Department of Radiology, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Anna Luisa Kühn
- New England Center for Stroke Research, Department of Radiology, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
- Image Processing & Analysis Core (iPAC), Department of Radiology, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Vania Anagnostakou
- New England Center for Stroke Research, Department of Radiology, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Christopher M Raskett
- New England Center for Stroke Research, Department of Radiology, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Robert M King
- New England Center for Stroke Research, Department of Radiology, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Mayank Goyal
- Department of Clinical Neurosciences, Foothills Medical Center, 2129University of Calgary, Calgary, AB, Canada
| | - Vitor Mendes Pereira
- Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Adam S Arthur
- Department of Neurosurgery, Semmes-Murphey Clinic, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Ajit S Puri
- New England Center for Stroke Research, Department of Radiology, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - David Fiorella
- Department of Neurosurgery, Stony Brook University- Cerebrovascular Center, Stonybrook, NY, USA
| | - Matthew J Gounis
- New England Center for Stroke Research, Department of Radiology, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
- Image Processing & Analysis Core (iPAC), Department of Radiology, 12262University of Massachusetts Chan Medical School, Worcester, MA, USA
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Influence of blood viscosity models and boundary conditions on the computation of hemodynamic parameters in cerebral aneurysms using computational fluid dynamics. Acta Neurochir (Wien) 2023; 165:471-482. [PMID: 36624234 DOI: 10.1007/s00701-022-05467-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Computational fluid dynamics (CFD) is widely used to calculate hemodynamic parameters that are known to influence cerebral aneurysms. However, the boundary conditions for CFD are chosen without any specific criteria. Our objective is to establish the recommendations for setting the analysis conditions for CFD analysis of the cerebral aneurysm. METHOD The plug and the Womersley flow were the inlet boundary conditions, and zero and pulsatile pressures were the outlet boundary conditions. In addition, the difference in the assumption of viscosity was analyzed with respect to the flow rate. The CFD process used in our research was validated using particle image velocimetry experiment data from Tupin et al.'s work to ensure the accuracy of the simulations. RESULTS It was confirmed that if the entrance length was sufficiently secured, the inlet and outlet boundary conditions did not affect the CFD results. In addition, it was observed that the difference in the hemodynamic parameter between Newtonian and non-Newtonian fluid decreased as the flow rate increased. Furthermore, it was confirmed that similar tendencies were evaluated when these recommendations were utilized in the patient-specific cerebral aneurysm models. CONCLUSIONS These results may help conduct standardized CFD analyses regardless of the research group.
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Chandrashekar A, Handa A, Lapolla P, Shivakumar N, Ngetich E, Grau V, Lee R. Prediction of Abdominal Aortic Aneurysm Growth Using Geometric Assessment of Computerized Tomography Images Acquired During the Aneurysm Surveillance Period. Ann Surg 2023; 277:e175-e183. [PMID: 33630463 PMCID: PMC8691375 DOI: 10.1097/sla.0000000000004711] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We investigated the utility of geometric features for future AAA growth prediction. BACKGROUND Novel methods for growth prediction of AAA are recognized as a research priority. Geometric feature have been used to predict cerebral aneurysm rupture, but not examined as predictor of AAA growth. METHODS Computerized tomography (CT) scans from patients with infra-renal AAAs were analyzed. Aortic volumes were segmented using an automated pipeline to extract AAA diameter (APD), undulation index (UI), and radius of curvature (RC). Using a prospectively recruited cohort, we first examined the relation between these geometric measurements to patients' demographic features (n = 102). A separate 192 AAA patients with serial CT scans during AAA surveillance were identified from an ongoing clinical database. Multinomial logistic and multiple linear regression models were trained and optimized to predict future AAA growth in these patients. RESULTS There was no correlation between the geometric measurements and patients' demographic features. APD (Spearman r = 0.25, P < 0.05), UI (Spearman r = 0.38, P < 0.001) and RC (Spearman r =-0.53, P < 0.001) significantly correlated with annual AAA growth. Using APD, UI, and RC as 3 input variables, the area under receiver operating characteristics curve for predicting slow growth (<2.5 mm/yr) or fast growth (>5 mm/yr) at 12 months are 0.80 and 0.79, respectively. The prediction or growth rate is within 2 mm error in 87% of cases. CONCLUSIONS Geometric features of an AAA can predict its future growth. This method can be applied to routine clinical CT scans acquired from patients during their AAA surveillance pathway.
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Affiliation(s)
- Anirudh Chandrashekar
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
- Department of Engineering Science, University, of Oxford, Oxford, United Kingdom
| | - Ashok Handa
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Pierfrancesco Lapolla
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Natesh Shivakumar
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Elisha Ngetich
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Vicente Grau
- Department of Engineering Science, University, of Oxford, Oxford, United Kingdom
| | - Regent Lee
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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Yao Y, Tong X, Mei Y, Yu F, Shan Y, Liu A, Chen D. Hemodynamic indicators of the formation of tandem intracranial aneurysm based on a vascular restoration algorithm. Front Neurol 2022; 13:1010777. [DOI: 10.3389/fneur.2022.1010777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/12/2022] [Indexed: 11/11/2022] Open
Abstract
BackgroundHemodynamic factors are believed to be closely related to IA growth. However, the underlying pathophysiological mechanism that induces the growth sequence in tandem intracranial aneurysms (IAs) remains unclear.Methods and resultsThis study involved five patients with tandem IAs. Aneurysm models were reconstructed based on image datasets. A novel vascular restoration algorithm was proposed to generate the hypothetical geometry of the healthy parent vessel before each IA formation in the concatenated structure. Detailed hemodynamic patterns and morphological features were revealed under various growth sequences of tandem IAs to investigate the flow-driven mechanism of IA growth. Potential hemodynamic indicators of IA formation were proposed.ResultsThe patient cases were divided into two groups based on the size difference of tandem IAs. In the group with a similar size of tandem IAs, the position of the vortex core was associated with the site of the secondary aneurysm, while in the group with a significant size difference of the IAs, the position with the maximum curvature of the parent vessel plays a significant role in aneurysm formation.ConclusionsThis study preliminarily revealed key hemodynamic and morphological indicators that determine the formation of tandem IAs. The proposed vascular restoration algorithm that provided the pre-aneurysm vasculature might be useful in investigating the flow-driven mechanism of IA growth, thus contributing to the risk evaluation of secondary aneurysm formation.
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van Laarhoven CJHCM, Willemsen SI, Klaassen J, de Vries EE, van der Vliet QMJ, Hazenberg CEVB, Bots ML, de Borst GJ. Carotid tortuosity is associated with extracranial carotid artery aneurysms. Quant Imaging Med Surg 2022; 12:5018-5029. [PMID: 36330172 PMCID: PMC9622451 DOI: 10.21037/qims-22-89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/19/2022] [Indexed: 09/03/2023]
Abstract
BACKGROUND Tortuous arteries may be associated with carotid dissection. The intima disruption caused by a carotid dissection is a possible cause of extracranial carotid artery aneurysms (ECAAs). The aim was to investigate if carotid tortuosity is also associated with ECAA in patients without presence or history of a carotid artery dissection. METHODS A retrospective case-control study was performed including 35 unilateral ECAA patients (cases) and 105 age- and sex-matched controls. Tortuosity was expressed as tortuosity-index (TI), curvature, and torsion measured on computed tomography angiography (CTA) data in 3Mensio Vascular and MATLAB by two independent investigators. Primary comparison was tortuosity in ipsi- versus contralateral carotid artery within the cohort of ECAA patients. Secondary comparison was tortuosity with ipsilateral carotid arteries in control patients. All observations were assessed on inter- and intra-operator reproducibility. RESULTS Carotid tortuosity was comparable within the cohort of ECAA patients (Spearman correlation 0.76, P<0.001), yet distinctively higher in comparison with unilateral controls. After adjustment for patient characteristics, presence of ECAA was associated with TI (β 0.146, 95% CI: 0.100-0.192). All tortuosity observations showed excellent inter- and intra-operator reproducibility. CONCLUSIONS Carotid tortuosity seems to be a risk factor for development of ECAA. Surveillance of individuals with increased carotid tortuosity therefore potentially ensures prompt diagnosis and treatment of ECAA. However, future research should investigate if persons with an increased tortuosity do indeed develop ECAA.
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Affiliation(s)
| | - Saskia I. Willemsen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jurre Klaassen
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Evelien E. de Vries
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Quirine M. J. van der Vliet
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gert J. de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carotid Aneurysm Registry (CAR) study groupBjörckMartinChiesaRobertoDavidovicLazarDósaEditJaaskelainenJuha ELindgrenAnttiMarkovicMiroslavMasciaDanieleNordanstigJoakimKumakuraHarue SantiagoSimão da SilvaErasmoSzeberinZoltán
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Technical Medicine, University of Twente, Enschede, The Netherlands
- Department of Trauma Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Predicting the risk of postsplenectomy thrombosis in patients with portal hypertension using computational hemodynamics models: A proof-of-concept study. Clin Biomech (Bristol, Avon) 2022; 98:105717. [PMID: 35834965 DOI: 10.1016/j.clinbiomech.2022.105717] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/05/2022] [Accepted: 07/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The high incidence of thrombosis in the portal venous system following splenectomy (a frequently adopted surgery for treating portal hypertension in patients with splenomegaly and hypersplenism) is a critical clinical issue. The aim of this study was to address whether quantification of postsplenectomy hemodynamics has potential value for assessing the risk of postsplenectomy thrombosis. METHODS Computational models were constructed for three portal hypertensive patients treated with splenectomy based on their preoperative clinical data to quantify hemodynamics in the portal venous system before and after splenectomy, respectively. Each patient was followed up for three or five months after surgery and examined with CT to screen potential thrombosis. FINDINGS The area ratio of wall regions exposed to low wall shear stress was small before splenectomy in all patients, which increased markedly after splenectomy and exhibited enlarged inter-patient differences. The largest area ratio of low wall shear stress and most severe flow stagnation after splenectomy were predicted for the patient suffering from postsplenectomy thrombosis, with the wall regions exposed to low wall shear stress corresponding well with the CT-detected distribution of thrombus. Further analyses revealed that postoperative hemodynamic characteristics were considerably influenced by the anatomorphological features of the portal venous system. INTERPRETATION Postoperative hemodynamic conditions in the portal venous system are highly patient-specific and have a potential link to postsplenectomy thrombosis, which indicates that patient-specific hemodynamic studies may serve as a complement to routine clinical assessments for refining risk stratification and postoperative patient management.
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Song X, Qiu H, Wang S, Cao Y, Zhao J. Hemodynamic and Geometric Risk Factors for In-Stent Restenosis in Patients with Intracranial Atherosclerotic Stenosis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:6951302. [PMID: 35936215 PMCID: PMC9348934 DOI: 10.1155/2022/6951302] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/12/2022] [Accepted: 07/05/2022] [Indexed: 12/03/2022]
Abstract
Methods Severe ICAS patients managed with percutaneous transluminal angioplasty and stenting (PTAS) were included in the retrospective cohort study and were divided into two groups according to whether ISR occurred at follow-up (ISR group and no-ISR group). Computational fluid dynamics models were built based on digital subtraction angiography before and after PTAS to simulate blood flow and quantify hemodynamic parameters. The associations between vessel geometry, hemodynamics, and ISR in ICAS patients were investigated. Results Among 39 patients, ISR occurred in seven patients (17.95%) after a mean follow-up period of 6.69 ± 3.24 months. Stenting decreased vessel angulation (51.11° [40.07°-67.27°] vs. 15.97° [0.00°-36.16°], P = 0.000) and vessel tortuosity (0.09 [0.06-0.13] vs. 0.01 [0.00-0.03], P = 0.000). Meanwhile, the translational pressure ratio (PR) dramatically increased (0.07 [0.00-0.31] vs. 0.62 [0.41-0.82], P = 0.000) with the wall shear stress ratio decreased (13.93 [8.37-40.30] vs. 2.90 [1.69-4.48], P = 0.000). In the multivariate analysis, smaller Δ tortuosity (P = 0.038) was independently associated with the occurrence of ISR, and smaller post-PTAS translesional PR was also a predictive factor of marginal significance (P = 0.059). Conclusion PTAS decreased vessel angulation, vessel tortuosity, and translesional wall shear stress ratio while it increased translesional pressure ratio (PR) dramatically in ICAS patients. Smaller Δ tortuosity was found to be a risk factor for ISR, and smaller post-PTAS translesional PR was also a predictive factor of marginal significance, indicating that both geometric and hemodynamic parameters played important roles in the occurrence of ISR after PTAS.
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Affiliation(s)
- Xiaowen Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Hancheng Qiu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
- Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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Liu S, Jin Y, Wang X, Zhang Y, Jiang L, Li G, Zhao X, Jiang T. Increased Carotid Siphon Tortuosity Is a Risk Factor for Paraclinoid Aneurysms. Front Neurol 2022; 13:869459. [PMID: 35620791 PMCID: PMC9127410 DOI: 10.3389/fneur.2022.869459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Geometrical factors associated with the surrounding vasculature can affect the risk of aneurysm formation. The aim of this study was to determine the association between carotid siphon curvature and the formation and development of paraclinoid aneurysms of the internal carotid artery. Methods Digital subtraction angiography (DSA) data from 42 patients with paraclinoid aneurysms (31 with non-aneurysmal contralateral sides) and 42 age- and gender-matched healthy controls were analyzed, retrospectively. Morphological characteristics of the carotid siphon [the posterior angle (α), anterior angle (β), and Clinoid@Ophthalmic angle (γ)] were explored via three-dimensional rotational angiography (3D RA) multiplanar reconstruction. The association between carotid siphon morphology and the formation of paraclinoid aneurysms was assessed through univariate analysis. After this, logistic regression analysis was performed to identify independent risk factors for aneurysms. Results Significantly smaller α, β, and γ angles were reported in the aneurysmal carotid siphon group when compared with the non-aneurysmal contralateral healthy controls. The β angle was best for discriminating between aneurysmal and non-aneurysmal carotid siphons, with an optimal threshold of 18.25°. By adjusting for hypertension, smoking habit, hyperlipidemia, and diabetes mellitus, logistic regression analysis demonstrated an independent association between the carotid siphons angles α [odds ratio (OR) 0.953; P < 0.05], β (OR 0.690; P < 0.001), and γ (OR 0.958; P < 0.01) with the risk of paraclinoid aneurysms. Conclusions The present findings provide evidence for the importance of morphological carotid siphon variations and the likelihood of paraclinoid aneurysms. These practical morphological parameters specific to paraclinoid aneurysms are easy to assess and may aid in risk assessment in these patients.
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Affiliation(s)
- Shilin Liu
- Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu Jin
- Department of Neurology, Bozhou City Peoples Hospital, Bozhou, China
| | - Xukou Wang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yang Zhang
- Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Luwei Jiang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guanqing Li
- Department of Neurology, Bozhou City Peoples Hospital, Bozhou, China
| | - Xi Zhao
- Philips Healthcare China, Shanghai, China
| | - Tao Jiang
- Department of Neurosurgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Hefei, China
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11
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Zhai X, Wang Y, Fang G, Hu P, Zhang H, Zhu C. Case Report: Dynamic Changes in Hemodynamics During the Formation and Progression of Intracranial Aneurysms. Front Cardiovasc Med 2022; 8:775536. [PMID: 35127854 PMCID: PMC8814101 DOI: 10.3389/fcvm.2021.775536] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022] Open
Abstract
Despite the devastating consequences of aneurysmal subarachnoid hemorrhage (SAH), the mechanisms underlying the formation, progression, and rupture of intracranial aneurysms (IAs) are complex and not yet fully clear. In a real-world situation, continuously observing the process of aneurysm development in humans appears unrealistic, which also present challenges for the understanding of the underlying mechanism. We reported the relatively complete course of IA development in two real patients. On this basis, computational fluid dynamics simulation (CFD) was performed to evaluate the changes in hemodynamics and analyze the mechanism underlying the formation, progression, and rupture of IAs. Our results suggested that the formation and progression of IAs can be a dynamic process, with constantly changing hemodynamic characteristics. CFD analysis based on medical imaging provides the opportunity to study the hemodynamic conditions over time. From these two rare cases, we found that concentrated high-velocity inflow jets, flows with vortex structures, extremely high WSS, and a very steep WSSG were correlated with the formation of IAs. Complex multi-vortex flows are possibly related to IAs prior to growth, and the rupture of IAs is possibly related to low WSS, extreme instability and complexity of flow patterns. Our findings provide unique insight into the theoretical hemodynamic mechanism underlying the formation and progression of IAs. Given the small sample size the findings of this study have to be considered preliminary and exploratory.
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12
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Kjeldsberg HA, Bergersen AW, Valen-Sendstad K. Automated landmarking of bends in vascular structures: a comparative study with application to the internal carotid artery. Biomed Eng Online 2021; 20:120. [PMID: 34838018 PMCID: PMC8626959 DOI: 10.1186/s12938-021-00957-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022] Open
Abstract
Automated tools for landmarking the internal carotid artery (ICA) bends have the potential for efficient and objective medical image-based morphometric analysis. The two existing algorithms rely on numerical approximations of curvature and torsion of the centerline. However, input parameters, original source code, comparability, and robustness of the algorithms remain unknown. To address the former two, we have re-implemented the algorithms, followed by sensitivity analyses. Of the input parameters, the centerline smoothing had the least impact resulting in 6-7 bends, which is anatomically realistic. In contrast, centerline resolution showed to completely over- and underestimated the number of bends varying from 3 to 33. Applying the algorithms to the same cohort revealed a variability that makes comparison of results between previous studies questionable. Assessment of robustness revealed how one algorithm is vulnerable to model smoothness and noise, but conceptually independent of application. In contrast, the other algorithm is robust and consistent, but with limited general applicability. In conclusion, both algorithms are equally valid albeit they produce vastly different results. We have provided a well-documented open-source implementation of the algorithms. Finally, we have successfully performed this study on the ICA, but application to other vascular regions should be performed with caution.
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Affiliation(s)
- Henrik A Kjeldsberg
- Department of Computational Physiology, Simula Research Laboratory AS, Kristian Augusts gate 23, 0164 Oslo, Norway
| | - Aslak W Bergersen
- Department of Computational Physiology, Simula Research Laboratory AS, Kristian Augusts gate 23, 0164 Oslo, Norway
| | - Kristian Valen-Sendstad
- Department of Computational Physiology, Simula Research Laboratory AS, Kristian Augusts gate 23, 0164 Oslo, Norway
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13
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Lu YH, Cai Y, Zhang Y, Wang R, Li ZY. Digital Subtraction Angiography Contrast Material Transport as a Direct Assessment for Blood Perfusion of Middle Cerebral Artery Stenosis. Front Physiol 2021; 12:716173. [PMID: 34421658 PMCID: PMC8375590 DOI: 10.3389/fphys.2021.716173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Digital subtraction angiography (DSA) is a fluoroscopic technique used extensively in interventional radiology for visualizing blood vessels. It has also been used to evaluate blood perfusion. However, the perfusion obtained in previous techniques was extracted from signal intensity rather than by the transport of contrast material (CM) through blood flow. The main aim of this study is to evaluate the morphological effects on the hemodynamics and the CM concentration in the middle cerebral artery (MCA) stenosis. We proposed a quantitative parameter, i.e., contrast material remaining time (CMRT), to describe the variation in the transport of CM over time. Computational fluid dynamics simulations were performed on both reconstructive synthetic and patient-derived models. In the synthetic models, we evaluated the variation of flow patterns and the transport of CM with different degrees of stenosis and the location of the lesion. It was found that an increase in the degree of stenosis (from 30 to 80%) resulted in a significant increase in CMRT at the anterior cerebral artery (ACA) outlet (p = 0.0238) and a significant decrease in CMRT at the MCA outlet (p = 0.012). The patient-derived models were reconstructed from the pre- and post-interventional DSA images of a patient with MCA stenosis. Both blood flow velocity and CMRT increased at the ACA outlet but decreased at the MCA outlet. The perfusion analysis demonstrated that the perfusion function was improved after interventional surgery. In conclusion, changes in stenotic degree at MCA may lead to apparent differences in the hemodynamic distribution and the transport of CM. CMRT could be a quantitative indicator to evaluate the changes in blood perfusion after the intervention for MCA stenosis.
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Affiliation(s)
- Yun-Hao Lu
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
| | - Yan Cai
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China
| | - Yi Zhang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Rui Wang
- Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
| | - Zhi-Yong Li
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China.,School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD, Australia
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14
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Zimny M, Kawlewska E, Hebda A, Wolański W, Ładziński P, Kaspera W. Wall shear stress gradient is independently associated with middle cerebral artery aneurysm development: a case-control CFD patient-specific study based on 77 patients. BMC Neurol 2021; 21:281. [PMID: 34281533 PMCID: PMC8287678 DOI: 10.1186/s12883-021-02251-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background Previously published computational fluid dynamics (CFD) studies regarding intracranial aneurysm (IA) formation present conflicting results. Our study analysed the involvement of the combination of high wall shear stress (WSS) and a positive WSS gradient (WSSG) in IA formation. Methods We designed a case-control study with a selection of 38 patients with an unruptured middle cerebral artery (MCA) aneurysm and 39 non-aneurysmal controls to determine the involvement of WSS, oscillatory shear index (OSI), the WSSG and its absolute value (absWSSG) in aneurysm formation based on patient-specific CFD simulations using velocity profiles obtained from transcranial colour-coded sonography. Results Among the analysed parameters, only the WSSG had significantly higher values compared to the controls (11.05 vs − 14.76 [Pa/mm], P = 0.020). The WSS, absWSSG and OSI values were not significantly different between the analysed groups. Logistic regression analysis identified WSS and WSSG as significant co-predictors for MCA aneurysm formation, but only the WSSG turned out to be a significant independent prognosticator (OR: 1.009; 95% CI: 1.001–1.017; P = 0.025). Significantly more patients (23/38) in the case group had haemodynamic regions of high WSS combined with a positive WSSG near the bifurcation apex, while in the control group, high WSS was usually accompanied by a negative WSSG (14/39). From the analysis of the ROC curve for WSSG, the area under the curve (AUC) was 0.654, with the optimal cut-off value −0.37 Pa/mm. The largest AUC was recognised for combined WSS and WSSG (AUC = 0.671). Our data confirmed that aneurysms tend to form near the bifurcation apices in regions of high WSS values accompanied by positive WSSG. Conclusions The development of IAs is determined by an independent effect of haemodynamic factors. High WSS impacts MCA aneurysm formation, while a positive WSSG mainly promotes this process.
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Affiliation(s)
- Mikołaj Zimny
- Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland
| | - Edyta Kawlewska
- Department of Biomechatronics, Silesian University of Technology, Zabrze, Poland
| | - Anna Hebda
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice, Poland
| | - Wojciech Wolański
- Department of Biomechatronics, Silesian University of Technology, Zabrze, Poland
| | - Piotr Ładziński
- Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland
| | - Wojciech Kaspera
- Department of Neurosurgery, Medical University of Silesia, Regional Hospital, Sosnowiec, Poland.
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15
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Kim JJ, Yang H, Kim YB, Oh JH, Cho KC. The quantitative comparison between high wall shear stress and high strain in the formation of paraclinoid aneurysms. Sci Rep 2021; 11:7947. [PMID: 33846487 PMCID: PMC8041878 DOI: 10.1038/s41598-021-87126-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 03/24/2021] [Indexed: 11/12/2022] Open
Abstract
In the hemodynamic study, computational fluid dynamics (CFD) analysis has shown that high wall shear stress (WSS) is an important parameter in cerebral aneurysm formation. However, CFD analysis is not more realistic than fluid–structure interaction (FSI) analysis given its lack of considering the involvement of vascular structures. To investigate the relationship between the hemodynamic parameters and the aneurysm formation, the locations of high WSS and high strain were extracted from the CFD and FSI analyses, respectively. Then the distances between the aneurysm formation site and the locations of high WSS or high strain were calculated. A total of 37 intracranial paraclinoid aneurysms were enrolled for quantitative comparison. Additionally, the dura mater was modeled to facilitate realistic results in FSI analysis. The average distance from the location of the aneurysm formation site to the high strain (1.74 mm \documentclass[12pt]{minimal}
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\begin{document}$$\pm $$\end{document}± 1.04 mm) was smaller than the average distance to the high WSS (3.33 mm \documentclass[12pt]{minimal}
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\begin{document}$$\pm $$\end{document}± 1.18 mm). The presence of dura mater also influenced the findings in the aneurysm formation site. High strain extracted by FSI analysis is an important hemodynamic factor related to the formation of cerebral aneurysms. Strain parameter could help to predict the formation of aneurysms and elucidate the appropriate treatment.
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Affiliation(s)
- Jung-Jae Kim
- Department of Neurosurgery, College of Medicine, Ewha Womans University, Ewha Womans University Seoul Hospital, Seoul, Korea
| | - Hyeondong Yang
- Department of Mechanical Engineering and BK21 FOUR ERICA-ACE Center, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, 15588, Gyeonggi-do, Korea
| | - Yong Bae Kim
- Department of Neurosurgery, College of Medicine, Yonsei University, Severance Hospital, Seoul, Korea
| | - Je Hoon Oh
- Department of Mechanical Engineering and BK21 FOUR ERICA-ACE Center, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, 15588, Gyeonggi-do, Korea.
| | - Kwang-Chun Cho
- Department of Neurosurgery, College of Medicine, Catholic Kwandong University, International St. Mary's Hospital, Simgokro 100gil 25, Seo-gu, Incheon, Korea.
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16
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Zhai XD, Hu P, He C, Feng YS, Li GL, Zhang HQ. Current Knowledge of and Perspectives about the Pathogenesis of Blood Blister-like Aneurysms of the Internal Carotid Artery: A Review of the Literature. Int J Med Sci 2021; 18:2017-2022. [PMID: 33850472 PMCID: PMC8040398 DOI: 10.7150/ijms.53154] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/07/2021] [Indexed: 11/05/2022] Open
Abstract
Blood blister-like aneurysms (BBAs) are rare and usually appear at nonbranching sites in the supraclinoid portion of the internal carotid artery (ICA). Because it is difficult to obtain histological specimens of the aneurysm wall and because experimental models are challenging to establish, the pathogenesis of BBAs remains uncertain. In this paper, we reviewed the diagnostic, radiological, and pathophysiological characteristics of patients with BBAs. We also summarized the existing evidence and potential mechanisms related to the causes of BBAs. Current evidence indicates that atherosclerosis and dissection are the main prerequisites for the formation of BBAs. Hemodynamics may play a role in the process of BBA formation due to the unique vascular anatomy of the supraclinoid ICA. Further research on histopathology and hemodynamics is warranted in this field.
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Affiliation(s)
- Xiao-Dong Zhai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Peng Hu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Yue-Shan Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Gui-Lin Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
| | - Hong-Qi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,China International Neuroscience Institute (China-INI), Beijing, China
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17
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Kobayashi M, Hoshina K, Nemoto Y, Takagi S, Shojima M, Hayakawa M, Yamada S, Oshima M. A penalized spline fitting method to optimize geometric parameters of arterial centerlines extracted from medical images. Comput Med Imaging Graph 2020; 84:101746. [PMID: 32745635 DOI: 10.1016/j.compmedimag.2020.101746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 04/21/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
Abstract
In order to grasp the spatial and temporal evolution of vascular geometry, three-dimensional (3D) arterial bending structure and geometrical changes of arteries and stent grafts (SG) must be quantified using geometrical parameters such as curvature and torsion along the vasculature centerlines extracted from medical images. Here, we develop a robust method for constructing smooth centerlines based on a spline fitting method (SFM) such that the optimized geometric parameters of curvature and torsion can be obtained independently of digitization noise in the images. Conventional SFM consists of the 3rd degree spline basis function and 2nd derivative penalty term. In contrast, the present SFM uses the 5th degree spline basis function and 3rd and 4th derivative penalty terms, the coefficients of which are derived by the Akaike information criterion. The results show that the developed SFM can reduce the errors of curvature and torsion compared to conventional SFM. We then apply the present SFM to the centerline of the SG in an abdominal aortic aneurysm (AAA), and those of bilateral internal carotid arteries (ICA) in 6 cases: 3 cases with aneurysms and 3 cases without any aneurysm. The SG centerlines were obtained from temporal medical images at three scan times. The strong peak of the curvature could be clearly observed in the distal area of the SG, the inversion of the torsion at 0 months in the middle area of SG disappeared over time, and the torsions around the SG bifurcation at the three time periods were inverted. The curvature-torsion graphs along the ICA centerlines superimposing five aneurysmal positions were useful for investigating the relationship between arterial bending structure and aneurysmal positions. Both ICAs had curvature peak values higher than 0.4 within the ICA syphons. The ICA torsion graphs indicated that left and right ICA tended to be a right- and left-handed helix, respectively. In the left ICA syphon, the biggest aneurysm could be observed downstream of the salient torsion inversion. All aneurysms for 3 cases were positioned at the downstream of the inverted torsion.
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Affiliation(s)
- Masaharu Kobayashi
- Graduate School of Interdisciplinary Information Studies, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8505, Japan.
| | - Katsuyuki Hoshina
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Youkou Nemoto
- Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Shu Takagi
- Department of Mechanical Engineering, Graduate School of Engineering, The University of Tokyo, Bunkyo, Tokyo 113-8656, Japan.
| | - Masaaki Shojima
- Department of Neurosurgery, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Motoharu Hayakawa
- Department of Neurosurgery, Fujita Health University, 1-98 Kengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan.
| | - Shigeki Yamada
- Department of Neurosurgery, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.
| | - Marie Oshima
- Interfaculty in Information Studies/Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8505, Japan.
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18
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Rosato R, Comptdaer G, Mulligan R, Breton JM, Lesha E, Lauric A, Malek AM. Increased focal internal carotid artery angulation in patients with posterior communicating artery aneurysms. J Neurointerv Surg 2020; 12:1142-1147. [DOI: 10.1136/neurintsurg-2020-015883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 11/04/2022]
Abstract
BackgroundAneurysms at the posterior communicating artery (PCOM) origin represent the most common location on the internal carotid artery (ICA), and are associated with greater recurrence following endovascular treatment. We evaluate the association between ICA angulation in three-dimensional (3D) space and PCOM aneurysmal development, using high-resolution 3D rotational angiography (3DRA) studies.Methods3DRA datasets were evaluated in 70 patients with PCOM aneurysms, 31 non-aneurysmal contralateral, and 86 healthy controls (187 total). The local angle formed by upstream and downstream ICA segments at the PCOM origin, αICA@PCOM, was measured using 3DRA multiplanar reconstruction. Computational fluid dynamics (CFD) analysis was performed on parametric and patient-based models.ResultsαICA@PCOM was significantly larger in aneurysm-bearing ICA segments (68.14±11.91°) compared with non-aneurysmal contralateral (57.17±10.76°, p<0.001) and healthy controls (48.13±13.68°, p<0.001). A discriminant threshold αICA@PCOM value of 61° (87% specificity, 80% sensitivity) was established (area under the curve (AUC)=0.88). Ruptured PCOM aneurysms had a significantly larger αICA@PCOM compared to unruptured (72.65±15.16° vs 66.35±9.94°, p=0.04). In parametric and patient-based CFD analysis, a large αICA@PCOM induces high focal pressure at the PCOM origin, relatively low wall shear stress (WSS), and high proximal WSS spatial gradients (WSSG).ConclusionICA angulation at PCOM origin is significantly higher in vessels harboring PCOM aneurysms compared with contralateral and healthy ICAs. This sharper bend in the ICA leads to high focal pressure at the aneurysm neck, low focal WSS and high proximal WSSG. These findings underline the importance of morphological ICA variations and the likelihood of PCOM aneurysm, an association which can inform clinical decisions and may serve in predictive analytics.
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19
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Saqr KM, Rashad S, Tupin S, Niizuma K, Hassan T, Tominaga T, Ohta M. What does computational fluid dynamics tell us about intracranial aneurysms? A meta-analysis and critical review. J Cereb Blood Flow Metab 2020; 40:1021-1039. [PMID: 31213162 PMCID: PMC7181089 DOI: 10.1177/0271678x19854640] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Despite the plethora of published studies on intracranial aneurysms (IAs) hemodynamic using computational fluid dynamics (CFD), limited progress has been made towards understanding the complex physics and biology underlying IA pathophysiology. Guided by 1733 published papers, we review and discuss the contemporary IA hemodynamics paradigm established through two decades of IA CFD simulations. We have traced the historical origins of simplified CFD models which impede the progress of comprehending IA pathology. We also delve into the debate concerning the Newtonian fluid assumption used to represent blood flow computationally. We evidently demonstrate that the Newtonian assumption, used in almost 90% of studies, might be insufficient to describe IA hemodynamics. In addition, some fundamental properties of the Navier-Stokes equation are revisited in supplementary material to highlight some widely spread misconceptions regarding wall shear stress (WSS) and its derivatives. Conclusively, our study draws a roadmap for next-generation IA CFD models to help researchers investigate the pathophysiology of IAs.
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Affiliation(s)
- Khalid M Saqr
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan.,Department of Mechanical Engineering, College of Engineering and Technology, Arab Academy for Science, Technology and Maritime Transport, Alexandria, Egypt
| | - Sherif Rashad
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Simon Tupin
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan
| | - Kuniyasu Niizuma
- Department of Neurosurgical Engineering and Translational Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.,Department of Neurosurgical Engineering and Translational Neuroscience, Graduate School of Biomedical Engineering, Tohoku University, Sendai, Japan
| | - Tamer Hassan
- Department of Neurosurgery, Alexandria University School of Medicine, Azarita Medical Campus, Alexandria, Egypt
| | - Teiji Tominaga
- Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Makoto Ohta
- Biomedical Flow Dynamics Laboratory, Institute of Fluid Science, Tohoku University, Sendai, Miyagi, Japan
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20
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Bergersen AW, Kjeldsberg HA, Valen-Sendstad K. A framework for automated and objective modification of tubular structures: Application to the internal carotid artery. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3330. [PMID: 32125768 DOI: 10.1002/cnm.3330] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 06/10/2023]
Abstract
Patient-specific medical image-based computational fluid dynamics has been widely used to reveal fundamental insight into mechanisms of cardiovascular disease, for instance, correlating morphology to adverse vascular remodeling. However, segmentation of medical images is laborious, error-prone, and a bottleneck in the development of large databases that are needed to capture the natural variability in morphology. Instead, idealized models, where morphological features are parameterized, have been used to investigate the correlation with flow features, but at the cost of limited understanding of the complexity of cardiovascular flows. To combine the advantages of both approaches, we developed a tool that preserves the patient-specificness inherent in medical images while allowing for parametric alteration of the morphology. In our open-source framework morphMan we convert the segmented surface to a Voronoi diagram, modify the diagram to change the morphological features of interest, and then convert back to a new surface. In this paper, we present algorithms for modifying bifurcation angles, location of branches, cross-sectional area, vessel curvature, shape of bends, and surface roughness. We show qualitative and quantitative validation of the algorithms, performing with an accuracy exceeding 97% in general, and proof-of-concept on combining the tool with computational fluid dynamics. By combining morphMan with appropriate clinical measurements, one could explore the morphological parameter space and resulting hemodynamic response using only a handful of segmented surfaces, effectively minimizing the main bottleneck in image-based computational fluid dynamics.
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Affiliation(s)
- Aslak W Bergersen
- Department of Computational Physiology, Simula Research Laboratory, Fornebu, Akershus, Norway
| | - Henrik A Kjeldsberg
- Department of Computational Physiology, Simula Research Laboratory, Fornebu, Akershus, Norway
| | - Kristian Valen-Sendstad
- Department of Computational Physiology, Simula Research Laboratory, Fornebu, Akershus, Norway
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21
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Sunderland K, Jiang J. Multivariate analysis of hemodynamic parameters on intracranial aneurysm initiation of the internal carotid artery. Med Eng Phys 2019; 74:129-136. [PMID: 31548156 DOI: 10.1016/j.medengphy.2019.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 07/30/2019] [Accepted: 09/08/2019] [Indexed: 01/10/2023]
Abstract
Although fluctuating hemodynamic wall stressors are known to impact intracranial aneurysms (IA) initiation, specificity of those stressors has not been evaluated. In this study, using human IA data, we investigated: (1) specificity of stressors in regions with and without IA eventual IA formation; and (2) how combinations of multiple stressors could improve IA formation prediction. 3D computational vasculatures were constructed based on angiographic images of 18 subjects having multiple closely-spaced IAs in the internal carotid artery. Two models were created: Model A with all IAs computationally removed, Model B which kept keep one IA. Computational fluid dynamics (CFD) simulated flow within models. Based on simulated flow fields, wall shear stress and its gradient (WSS, WSSG), oscillatory shear index (OSI), gradient oscillatory number (GON), aneurysm formation index (AFI), and mean number of swirling flow vortices (MV) were analysed. Multivariate logistic regression determined the accuracy of different combinations of those above-mentioned stressors. Overall, we found that combining hemodynamic stressors improves IA formation prediction over individual indices. Both Model A and Model B's parsimonious model was MV+WSS+GON: AUROC 0.88 and 0.83, respectively. Future studies are planned to understand biological meanings induced by fluctuating stressors.
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Affiliation(s)
- K Sunderland
- Michigan Technological University, 1400 Townsend Drive, Houghton, MI, USA.
| | - J Jiang
- Michigan Technological University, 1400 Townsend Drive, Houghton, MI, USA.
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22
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Tortuosity of the superficial femoral artery and its influence on blood flow patterns and risk of atherosclerosis. Biomech Model Mechanobiol 2019; 18:883-896. [DOI: 10.1007/s10237-019-01118-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
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23
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A new hypothesis on the role of vessel topology in cerebral aneurysm initiation. Comput Biol Med 2018; 103:244-251. [PMID: 30391796 DOI: 10.1016/j.compbiomed.2018.10.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/17/2018] [Accepted: 10/16/2018] [Indexed: 01/10/2023]
Abstract
Aneurysm pathogenesis is thought to be strongly linked with hemodynamical effects. According to our current knowledge, the formation process is initiated by locally disturbed flow conditions. The aim of the current work is to provide a numerical investigation on the role of the flow field at the stage of the initiation, before the aneurysm formation. Digitally reconstructed pre-aneurysmal geometries are used to examine correlations of the flow patterns to the location and direction of the aneurysms formed later. We argue that a very specific rotational flow pattern is present in all the investigated cases marking the location of the later aneurysm and that these flow patterns provide the mechanical load on the wall that can lead to a destructive remodelling in the vessel wall. Furthermore, these patterns induce elevated vessel surface related variables (e.g. wall shear stress (WSS), wall shear stress gradient (WSSG) and oscillatory shear index (OSI)), in agreement with the previous findings. We emphasise that the analysis of the flow patterns provides a deeper insight and a more robust numerical methodology compared to the sole examination of the aforementioned surface quantities.
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Rinaldo L, Brinjikji W, Cloft HJ, Kallmes DF, Rangel-Castilla L. Effect of Carotid Siphon Anatomy on Aneurysm Occlusion After Flow Diversion for Treatment of Internal Carotid Artery Aneurysms. Oper Neurosurg (Hagerstown) 2018; 17:123-131. [DOI: 10.1093/ons/opy340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/27/2018] [Indexed: 11/13/2022] Open
Abstract
AbstractBACKGROUNDFlow diversion (FD) is effective for treatment of intracranial internal carotid artery (ICA) aneurysms.OBJECTIVETo determine whether carotid siphon (CS) geometry influences the efficacy of FD when employed for ICA aneurysms.METHODSOutcomes of a consecutive series of patients with ICA aneurysms treated with FD were retrospectively reviewed. CS anatomy was quantified through measurement of the posterior, anterior, and anterosuperior bend angles in accordance with previously described methodology. The relationship of CS geometry to likelihood of incomplete aneurysm occlusion at 1 yr after treatment was assessed with multivariate logistic regression analysis.RESULTSThere were 167 ICA aneurysms in 164 patients treated with FD during the study period. The mean age of our cohort was 55.7 yr (standard deviation [SD]: 12.3) and a majority of patients were female (145/164, 86.8%). Anterior (47.4 degrees vs 8.5, P < .001) and anterosuperior bend angles (100.9 vs 76.5, P = .002) were significantly greater in aneurysms that required repeat FD after initial treatment. On multivariate logistic regression analysis, increasing patient age (unit odds ratio [OR]: 1.05, 95% confidence interval [CI] 1.01-1.08; P = .003) and anterior bend angle ≥–3.5 (OR: 2.47, 95% CI 1.04-5.86; P = .046) were associated with increased odds of incomplete aneurysm occlusion at 1 yr after treatment.CONCLUSIONThese findings suggest that variations in CS anatomy may influence the efficacy of FD treatment and should be analyzed prior to offering FD for treatment of ICA aneurysms. Further investigation into the hemodynamic effects of CS geometry is warranted.
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Affiliation(s)
- Lorenzo Rinaldo
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
- Joint Department of Medical Imaging and Neuroradiology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Harry J Cloft
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - David F Kallmes
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Leonardo Rangel-Castilla
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
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Wall shear stress at the initiation site of cerebral aneurysms. Biomech Model Mechanobiol 2016; 16:97-115. [DOI: 10.1007/s10237-016-0804-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 06/24/2016] [Indexed: 11/30/2022]
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Jamil M, Tan GXY, Huq M, Kang H, Lee ZR, Tang PH, Hu XH, Yap CH. Changes to the geometry and fluid mechanics of the carotid siphon in the pediatric Moyamoya disease. Comput Methods Biomech Biomed Engin 2016; 19:1760-1771. [DOI: 10.1080/10255842.2016.1184655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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