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Virtual test occlusion for assessing ischemic tolerance using computational fluid dynamics.

Tomoyoshi Kuribara1, Takeshi Mikami1, Satoshi Iihoshi2

  • 1Department of Neurosurgery, Sapporo Medical University, Sapporo, Hokkaido, Japan.

Surgical Neurology International
|September 13, 2021
PubMed
Summary

Computational fluid dynamics (CFD) offers a non-invasive method to assess ischemic tolerance, correlating well with traditional balloon test occlusion (BTO) parameters. This virtual test occlusion can help evaluate collateral flow in patients undergoing neurovascular procedures.

Keywords:
Balloon test occlusionComputational fluid dynamicsComputed tomography perfusionFlow rateWall share stress

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Area of Science:

  • Neurosurgery
  • Medical Imaging
  • Computational Fluid Dynamics

Background:

  • Ischemic tolerance evaluation is crucial for neurovascular procedures like aneurysm surgery.
  • The traditional balloon test occlusion (BTO) is invasive, necessitating a non-invasive alternative.
  • Computational fluid dynamics (CFD) presents a potential non-invasive method for assessing ischemic tolerance.

Purpose of the Study:

  • To assess the feasibility of virtual test occlusion using CFD as a non-invasive alternative to BTO.
  • To evaluate the correlation between CFD-derived parameters and established measures of collateral circulation.
  • To determine cutoff values for CFD parameters indicative of good collateral flow.

Main Methods:

  • Twenty-one patients undergoing BTO were analyzed.
  • Virtual test occlusion was simulated using CFD.
  • Flow rate (FR) and wall shear stress (WSS) of the middle cerebral artery were calculated.
  • Correlations with BTO parameters (CT perfusion, angiographic grade, mean stump pressure) were assessed.

Main Results:

  • CFD-derived FR strongly correlated with mean transit time (MTT) and moderately with collateral flow grade.
  • CFD-derived WSS moderately correlated with collateral flow grade, mean stump pressure (MSP), and MTT.
  • Cutoff values for good collateral group detection were established: FR of 126.2 mL/min and WSS of 4.54 Pa.

Conclusions:

  • CFD parameters correlate with collateral flow grade and MSP, in addition to MTT.
  • Virtual test occlusion using CFD shows promise as a non-invasive method for evaluating ischemic tolerance.
  • CFD analysis may serve as a valuable non-invasive alternative to BTO for surgical planning.