Computational Fluid Dynamics of a Fatal Ruptured Anterior Communicating Artery Aneurysm

Aleš Hejčl; Helena Švihlová; Alena Sejkorová; Tomáš Radovnický; Daniel Adámek; Jaroslav Hron; Dan Dragomir-Daescu; Josef Málek; Martin Sameš

doi:10.1055/s-0037-1604286

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2017; 78(06): 610-616
DOI: 10.1055/s-0037-1604286

Case Report

Georg Thieme Verlag KG Stuttgart · New York

Computational Fluid Dynamics of a Fatal Ruptured Anterior Communicating Artery Aneurysm

Aleš Hejčl

¹Department of Neurosurgery of the J.E. Purkyně University, Masaryk Hospital, Ústí nad Labem, Czech Republic

²International Clinical Research Center, Fakultni Nemocnice Brno, Brno, Czech Republic

,

Helena Švihlová

²International Clinical Research Center, Fakultni Nemocnice Brno, Brno, Czech Republic

³Charles University, Faculty of Mathematics and Physics, Mathematical Institute, Prague, Czech Republic

,

Alena Sejkorová

¹Department of Neurosurgery of the J.E. Purkyně University, Masaryk Hospital, Ústí nad Labem, Czech Republic

,

Tomáš Radovnický

¹Department of Neurosurgery of the J.E. Purkyně University, Masaryk Hospital, Ústí nad Labem, Czech Republic

,

Daniel Adámek

⁴Department of Radiology, Masaryk Hospital, Usti nad Labem, Czech Republic

,

Jaroslav Hron

³Charles University, Faculty of Mathematics and Physics, Mathematical Institute, Prague, Czech Republic

,

Dan Dragomir-Daescu

⁵Department of Physiology and Biomedical Engineering, Associate Professor of Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota

,

Josef Málek

³Charles University, Faculty of Mathematics and Physics, Mathematical Institute, Prague, Czech Republic

,

Martin Sameš

¹Department of Neurosurgery of the J.E. Purkyně University, Masaryk Hospital, Ústí nad Labem, Czech Republic

› Author Affiliations

Abstract

Computational fluid dynamics (CFD) has been studied as a tool for the stratification of aneurysm rupture risk. We performed CFD analysis in a patient operated on for a ruptured anterior communicating artery aneurysm. The point of rupture was identified during surgery. The aneurysm and blood vessels were segmented from computed tomography angiography to prepare a model for simulations. We found that the streamlines showed a concentrated inflow jet directed straight at the rupture point, and high wall shear stress was found at the point of rupture in the aneurysm sac. Thus specific local hemodynamics may be indicative of the aneurysm rupture site.

Keywords

aneurysm - computational fluid dynamics - rupture risk - surgery - wall shear stress

Full Text

References

References
1 Castro MA. Understanding the role of hemodynamics in the initiation, progression, rupture, and treatment outcome of cerebral aneurysm from medical image-based computational studies. ISRN Radiol 2013; 2013: 602707
2 Ventikos Y, Holland EC, Bowker TJ. , et al. Computational modelling for cerebral aneurysms: risk evaluation and interventional planning. Br J Radiol 2009; 82 (Spec No. 1): S62-S71
3 Cebral JR, Mut F, Weir J, Putman C. Quantitative characterization of the hemodynamic environment in ruptured and unruptured brain aneurysms. AJNR Am J Neuroradiol 2011; 32 (01) 145-151
4 Zhang Y, Yang X, Wang Y. , et al. Influence of morphology and hemodynamic factors on rupture of multiple intracranial aneurysms: matched-pairs of ruptured-unruptured aneurysms located unilaterally on the anterior circulation. BMC Neurol 2014; 14: 253
5 Lu G, Huang L, Zhang XL. , et al. Influence of hemodynamic factors on rupture of intracranial aneurysms: patient-specific 3D mirror aneurysms model computational fluid dynamics simulation. AJNR Am J Neuroradiol 2011; 32 (07) 1255-1261
6 Yushkevich PA, Piven J, Hazlett HC. , et al. User-guided 3D active contour segmentation of anatomical structures: significantly improved efficiency and reliability. Neuroimage 2006; 31 (03) 1116-1128
7 Qianqian FB, Boas DA. Tetrahedral mesh generation from volumetric binary and gray-scale images. ISBI'09 Proc Sixth IEEE Int Conf Symp Biomed Imaging: From Nano to Macro 2009; 1142-1145
8 MATLAB. MathWorks I. Available at: http://www.mathworks.com/products/matlab/ . Accessed August 31, 2015
9 Computational Geometry Algorithms Library (CGAL). Available at: http://www.cgal.org
10 Hron J, Mádlík M. Fluid-structure interaction with applications in biomechanics. Nonlinear Anal Real World App 2007; 8 (05) 1431-1458
11 Balay S, Abhyankar S, Adams MF. , et al. Portable, Extensible Toolkit for Scientific Computation (PETSc) users manual. Available at: http://www.mcs.anl.gov/petsc
12 Arnold DN, Brezzi F, Fortin M. A stable finite element for the Stokes equations. Calcolo 1984; 21 (04) 337-344
13 Ohkuma H, Tsurutani H, Suzuki S. Incidence and significance of early aneurysmal rebleeding before neurosurgical or neurological management. Stroke 2001; 32 (05) 1176-1180
14 Zhao B, Fan Y, Xiong Y. , et al; AMPAS Study Group. Aneurysm rebleeding after poor-grade aneurysmal subarachnoid hemorrhage: predictors and impact on clinical outcomes. J Neurol Sci 2016; 371: 62-66
15 Cebral JR, Castro MA, Burgess JE, Pergolizzi RS, Sheridan MJ, Putman CM. Characterization of cerebral aneurysms for assessing risk of rupture by using patient-specific computational hemodynamics models. AJNR Am J Neuroradiol 2005; 26 (10) 2550-2559
16 Hodis S, Uthamaraj S, Lanzino G, Kallmes DF, Dragomir-Daescu D. Computational fluid dynamics simulation of an anterior communicating artery ruptured during angiography. BMJ Case Rep 2013; 2013: 201
17 Cebral JR, Hendrickson S, Putman CM. Hemodynamics in a lethal basilar artery aneurysm just before its rupture. AJNR Am J Neuroradiol 2009; 30 (01) 95-98
18 Kono K, Fujimoto T, Shintani A, Terada T. Hemodynamic characteristics at the rupture site of cerebral aneurysms: a case study. Neurosurgery 2012; 71 (06) E1202-E1208 ; discussion 1209
19 Meng H, Tutino VM, Xiang J, Siddiqui A. High WSS or low WSS? Complex interactions of hemodynamics with intracranial aneurysm initiation, growth, and rupture: toward a unifying hypothesis. AJNR Am J Neuroradiol 2014; 35 (07) 1254-1262
20 Xiang J, Natarajan SK, Tremmel M. , et al. Hemodynamic-morphologic discriminants for intracranial aneurysm rupture. Stroke 2011; 42 (01) 144-152
21 Omodaka S, Sugiyama S, Inoue T. , et al. Local hemodynamics at the rupture point of cerebral aneurysms determined by computational fluid dynamics analysis. Cerebrovasc Dis 2012; 34 (02) 121-129
22 Fukazawa K, Ishida F, Umeda Y. , et al. Using computational fluid dynamics analysis to characterize local hemodynamic features of middle cerebral artery aneurysm rupture points. World Neurosurg 2015; 83 (01) 80-86
23 Weir B, Disney L, Karrison T. Sizes of ruptured and unruptured aneurysms in relation to their sites and the ages of patients. J Neurosurg 2002; 96 (01) 64-70
24 Yaşargil MG. Microneurosurgery. Stuttgart, Germany: Thieme Medical; 1987
25 Jou LD, Lee DH, Mawad ME. Cross-flow at the anterior communicating artery and its implication in cerebral aneurysm formation. J Biomech 2010; 43 (11) 2189-2195
26 Castro MA, Putman CM, Cebral JR. Patient-specific computational modeling of cerebral aneurysms with multiple avenues of flow from 3D rotational angiography images. Acad Radiol 2006; 13 (07) 811-821
27 Castro MA, Putman CM, Cebral JR. Patient-specific computational fluid dynamics modeling of anterior communicating artery aneurysms: a study of the sensitivity of intra-aneurysmal flow patterns to flow conditions in the carotid arteries. AJNR Am J Neuroradiol 2006; 27 (10) 2061-2068
28 Peach T, Spranger K, Ventikos Y. Virtual flow-diverter treatment planning: the effect of device placement on bifurcation aneurysm haemodynamics. Proc Inst Mech Eng H 2017; 231 (05) 432-443
29 Kallmes DF. Point: CFD—computational fluid dynamics or confounding factor dissemination. AJNR Am J Neuroradiol 2012; 33 (03) 395-396
30 Schneiders JJ, Marquering HA, van den Berg R. , et al. Rupture-associated changes of cerebral aneurysm geometry: high-resolution 3D imaging before and after rupture. AJNR Am J Neuroradiol 2014; 35 (07) 1358-1362
31 Lall RR, Eddleman CS, Bendok BR, Batjer HH. Unruptured intracranial aneurysms and the assessment of rupture risk based on anatomical and morphological factors: sifting through the sands of data. Neurosurg Focus 2009; 26 (05) E2
32 Wiebers DO, Whisnant JP, Huston III J. , et al; International Study of Unruptured Intracranial Aneurysms Investigators. Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet 2003; 362 (9378): 103-110