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Intracranial bypass for giant aneurysms treatment assessed by computational fluid dynamics (CFD) analysis
Royal Melbourne Hosp, Dept Neurosurg, 300 Grattan St, Parkville, Vic 3050, Australia.;Med Univ Lodz, Dept Neurosurg & Neurooncol, Kopcinskiego 22, PL-90153 Lodz, Poland.;Lodz Univ Technol, Inst Turbomachinery, 219-223 Wolczanska Str, PL-90924 Lodz, Poland..
Lodz Univ Technol, Inst Turbomachinery, 219-223 Wolczanska Str, PL-90924 Lodz, Poland..
Lodz Univ Technol, Inst Turbomachinery, 219-223 Wolczanska Str, PL-90924 Lodz, Poland..
Royal Melbourne Hosp, Dept Neurosurg, 300 Grattan St, Parkville, Vic 3050, Australia..
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2024 (English)In: Scientific Reports, E-ISSN 2045-2322, Vol. 14, no 1, article id 21548Article in journal (Refereed) Published
Abstract [en]

Unruptured giant intracranial aneurysms (GIA) are those with diameters of 25 mm or greater. As aneurysm size is correlated with rupture risk, GIA natural history is poor. Parent artery occlusion or trapping plus bypass revascularization should be considered to encourage intra-aneurysmal thrombosis when other treatment options are contraindicated. The mechanistic background of these methods is poorly studied. Thus, we assessed the potential of computational fluid dynamics (CFD) and fluid-structure interaction (FSI) analyses for clinical use in the preoperative stage. A CFD investigation in three patient-specific flexible models of whole arterial brain circulation was performed. A C6 ICA segment GIA model was created based on CT angiography. Two models were then constructed that simulated a virtual bypass in combination with proximal GIA occlusion, but with differing middle cerebral artery (MCA) recipient vessels for the anastomosis. FSI and CFD investigations were performed in three models to assess changes in flow pattern and haemodynamic parameters alternations (wall shear stress (WSS), oscillatory shear index (OSI), maximal time averaged WSS (TAWSS), and pressure). General flow splitting across the entire domain was affected by virtual bypass procedures, and any deficiency was partially compensated by a specific configuration of the circle of Willis. Following the implementation of bypass procedures, a reduction in haemodynamic parameters was observed within the aneurysm in both cases under analysis. In the case of the temporal MCA branch bypass, the decreases in the studied parameters were slightly greater than in the frontal MCA branch bypass. The reduction in the magnitude of the chosen area-averaged parameters (averaged over the aneurysm wall surface) was as follows: WSS 35.7%, OSI 19.0%, TAWSS 94.7%, and pressure 24.2%. FSI CFD investigation based on patient-specific anatomy models with subsequent stimulation of virtual proximal aneurysm occlusion in conjunction with bypass showed that this method creates a pro-thrombotic favourable environment whilst reducing intra-aneurysmal pressure leading to shrinking. MCA branch recipient selection for optimum haemodynamic conditions should be evaluated individually in the preoperative stage.

Place, publisher, year, edition, pages
Springer Nature, 2024. Vol. 14, no 1, article id 21548
Keywords [en]
Computational fluid dynamics, Intracranial bypass, Giant aneurysms, Thrombosis, Cerebral blood flow hemodynamics
National Category
Medical Engineering
Identifiers
URN: urn:nbn:se:uu:diva-539476DOI: 10.1038/s41598-024-72591-wISI: 001312686700001PubMedID: 39278964OAI: oai:DiVA.org:uu-539476DiVA, id: diva2:1903233
Available from: 2024-10-03 Created: 2024-10-03 Last updated: 2024-10-03Bibliographically approved

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Fahlström, Andreas

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