Hemodynamic investigation of hemorrhagic stroke treatment options for a patient-specific aneurysm using a porous medium model

Abstract

A ruptured intracranial aneurysm is a serious life-threatening medical condition. Bleed in the cerebral circulation causes subarachnoid hemorrhage, which is known as hemorrhagic stroke. The present study investigates cerebral blood circulation and aneurysm bleed using the principle of fluid mechanics. Ruptured wide-neck aneurysms are difficult to treat either by surgical clipping or stent-assisted coiling in the acute phase of rupture. Quick and intentional partial coiling (IPC) around the aneurysm rupture region is preferred for an immediate cessation of rebleed after rupture. Furthermore, the stent-assisted complete coiling (SACC) may be performed once the patient is stable and able to withstand the antiplatelet therapy at a later stage. The aneurysm recurrence and rupture after the treatment are the major issues associated with the treatment of a wide-necked aneurysm. The present study analyzes the hemodynamics of IPC followed by SACC using a novel multi-domain porous medium approach. Simulations are performed assuming a hypothesized rupture spot for the aneurysm using flow features and hemodynamic parameters. The optimal coil packing density (PD) required to fill the vicinity of the ruptured spot to prevent early rebleed and facilitate aneurysm occlusion is numerically determined. It is observed that partial coiling requires higher packing density (PD > 30%) than complete coiling to reduce the chances of aneurysm recurrence after the treatment. The insertion of the stent does not affect the aneurysm hemodynamics significantly. The stent-assisted complete coiling requires more than 20% PD to enhance the long-term stability of the treatment.