Hemodynamics and bio-mechanics of morphologically distinct saccular intracranial aneurysms at bifurcations: Idealised vs Patient-specific geometries

Philip, Nimmy Thankom; Bolem, Srinivas; Sudhir, Bhanu Jayanand; Patnaik, B.S.V.

doi:10.1016/j.cmpb.2022.107237

Cited by 17 publications

(7 citation statements)

References 42 publications

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“…Moreover, the CFD method could also simulate blood flow with idealised ICAS models, which can aid in understanding the generalised associations between lesion geometry, haemodynamics and the biomechanical behaviour of the lesion. 48 In the meantime, however, this technique also has many challenges, especially in the modelling methodology that has varied across different studies and research teams. To date, it is mainly used in the research field for ICAD but not in clinical practice.…”

Section: Haemodynamics In Sicas: Assessment Methods and Prognostic Va...mentioning

confidence: 99%

Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implications

Liu

Tian

et al. 2023

Stroke Vasc Neurol

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Intracranial atherosclerotic disease (ICAD) is a common cause of ischaemic stroke and transient ischaemic attack (TIA) with a high recurrence rate. It is often referred to as intracranial atherosclerotic stenosis (ICAS), when the plaque has caused significant narrowing of the vessel lumen. The lesion is usually considered ‘symptomatic ICAD/ICAS’ (sICAD/sICAS) when it has caused an ischaemic stroke or TIA. The severity of luminal stenosis has long been established as a prognostic factor for stroke relapse in sICAS. Yet, accumulating studies have also reported the important roles of plaque vulnerability, cerebral haemodynamics, collateral circulation, cerebral autoregulation and other factors in altering the stroke risks across patients with sICAS. In this review article, we focus on cerebral haemodynamics in sICAS. We reviewed imaging modalities/methods in assessing cerebral haemodynamics, the haemodynamic metrics provided by these methods and application of these methods in research and clinical practice. More importantly, we reviewed the significance of these haemodynamic features in governing the risk of stroke recurrence in sICAS. We also discussed other clinical implications of these haemodynamic features in sICAS, such as the associations with collateral recruitment and evolution of the lesion under medical treatment, and indications for more individualised blood pressure management for secondary stroke prevention. We then put forward some knowledge gaps and future directions on these topics.

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Section: Haemodynamics In Sicas: Assessment Methods and Prognostic Va...mentioning

confidence: 99%

Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implications

Liu

Tian

et al. 2023

Stroke Vasc Neurol

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“…14,15 Due to multiple advantages such as noninvasive and visualization, CFD has become a practical tool for studying the hydrodynamics of flow in the human body 16,17 For example, the relationship between input and hemodynamic indicators can be easily and accurately predicted based on CFD. 16,[18][19][20][21][22][23] The problem of vascular artery-related stenosis has been extensively explored, leading to many clinically meaningful conclusions. [17][18][19][24][25][26] However, previous simulations of hemodynamics were performed at high Reynolds numbers, while bile flow belongs to a low Reynolds number range (<50) with unique characteristics.…”

Section: Introductionmentioning

confidence: 99%

“…1,13 In recent years, computational fluid dynamics (CFD)-based prediction has received increasing attention, which promotes the related understanding of biofluid mechanics and pathology. 14,15 Due to multiple advantages such as noninvasive and visualization, CFD has become a practical tool for studying the hydrodynamics of flow in the human body 16,17 For example, the relationship between input and hemodynamic indicators can be easily and accurately predicted based on CFD. 16,[18][19][20][21][22][23] The problem of vascular artery-related stenosis has been extensively explored, leading to many clinically meaningful conclusions.…”

Section: Introductionmentioning

confidence: 99%

Analysis and numerical investigation of bile flow dynamics within the strictured biliary duct

Peng,

Zhong,

Lin

et al. 2023

Numer Methods Biomed Eng

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The mechanics of bile flow in the biliary system plays an important role in studying bile stasis and gallstone formation. Bile duct stricture is an abnormal phenomenon that refers to the bile duct getting smaller or narrower. The main objective of this study is to study the influence of stricture on bile flow dynamics using numerical methods. We employed a numerical Computational Fluid Dynamics model of the bile flow within a strictured hepatic duct. We studied and compared the influence of stricture severity, stricture length, eccentricity, and bile flow property on the bile flow dynamics. The bile flow velocity, pressure distribution, pressure drop, and wall shear stress are provided in detail. The stricture alters the normal bile flow pattern and increases flow resistance. At the location upstream and downstream of the stricture, bile flow slows down. In the area of the stricture throat, bile flow is accelerated, and recirculation forms behind the stricture. The maximum pressure drop of the biliary system increases with the stricture length. The eccentricity makes the flow deflect away from the duct's centerline. The behavior of the deflected flow is significantly altered downstream of the stricture. Such bile flow behavior as deceleration and recirculation may lead to cholestasis. Stricture alters bile flow in the biliary tract, causing changes in biliary hydrodynamic indexes, which could potentially serve as an omen for gallstone formation and other related diseases. The consideration of the bile duct stricture could lead to better patient stratification.

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“…Intracranial aneurysms (IAs) are usually caused by outpouchings of the weak area of the cerebral arterial wall and have always been the main cause of subarachnoid hemorrhage (SAH; Barak et al, 2021 ; Claassen and Park, 2022 ). Based on the special hemodynamic state of the bifurcation site of intracranial arteries, aneurysms are prone to form there ( Philip et al, 2022 ). Because it is difficult to treat wide-necked IAs or bifurcation IAs with multiple lateral branches, they have always been considered the Achilles’ heel of endovascular treatment ( Webb et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

A systematic review and meta-analysis of Comaneci/Cascade temporary neck bridging devices for the treatment of intracranial aneurysms

Sun,

Lan,

Sawant

et al. 2023

Front. Hum. Neurosci.

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BackgroundThe temporary neck bridging devices represented by Comaneci and Cascade are a type of promising endovascular device for the treatment of intracranial bifurcation or wide-necked aneurysms. This systematic review and meta-analysis aim to assess the efficacy and safety of Comaneci/Cascade devices for the treatment of intracranial aneurysms.MethodsWe performed a systematic literature search on articles in PubMed, Embase, and Web of Science that evaluated the efficacy and safety of Comaneci/Cascade devices for endovascular treatment of intracranial aneurysms, based on the Preferred Reporting Items for Systematic Reviews and Meta Analytics (PRISMA) guideline. We extracted the characteristics and treatment related information of patients included in the study, recorded the rate of technical success, procedural related complications, and angiographic outcomes. The angiographic outcome was evaluated based on Raymond Roy classification, and adequate occlusion was defined as Raymond Ray I + II.ResultsNine studies comprising 253 patients with 255 aneurysms were included. Among them, eight studies were conducted in Europe, one study was conducted in the USA. All these studies were retrospective. 206 aneurysms (80.78%) were ruptured. The vast majority of patients with ruptured aneurysms did not receive antiplatelet therapy. The rate of technical success was 97.1% (95% CI, 94.9 to 99.3%, I2 = 0%). The rate of periprocedural clinical complications was 10.9% (95% CI, 5.4 to 22.1%, I2 = 54%). The rate of complete occlusion (RR1) and adequate occlusion (RR1 + RR2) on immediate angiography after the procedure were 77.7% (95% CI, 72.7 to 83.2%, I2 = 35%) and 98% (95% CI, 95.9 to 100%, I2 = 0%) respectively. The rate of complete occlusion (RR1) and adequate occlusion (RR1 + RR2) on the last follow-up angiography were 81.2% (95% CI, 69.2 to 95.2%, I2 = 81%) and 93.7% (95% CI, 85.6 to 100%, I2 = 69%) respectively, with follow-up range from 3 to 18 months. 22/187 (11.76%) cases of aneurysms progressed during the follow-up period. 39/187 (20.86%) cases of aneurysms received additional treatment during the follow-up period. No fatal complications occurred during the treatment.ConclusionThe Comaneci/Cascade device can be used as an auxiliary treatment for intracranial aneurysms, with a good occlusion effect, but the incidence of complications still needs to be monitored.

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Hemodynamics and bio-mechanics of morphologically distinct saccular intracranial aneurysms at bifurcations: Idealised vs Patient-specific geometries

Cited by 17 publications

References 42 publications

Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implications

Cerebral haemodynamics in symptomatic intracranial atherosclerotic disease: a narrative review of the assessment methods and clinical implications

Analysis and numerical investigation of bile flow dynamics within the strictured biliary duct

A systematic review and meta-analysis of Comaneci/Cascade temporary neck bridging devices for the treatment of intracranial aneurysms

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