Pathological haemodynamics of a middle cerebral artery stenosis validated by computational fluid dynamics
Katsuhiro Tanaka1, Fujimaro Ishida2, Satoru Tanioka2
1Neurosurgery, Mie Chuo Medical Center, Tsu, Mie, Japan tk_0303_ns@yahoo.co.jp.
Insights
Intracranial arterial stenosis (ICAS) can cause stroke. Computational fluid dynamics revealed stagnant flow contributing to thrombus formation, suggesting CFD can predict treatment effectiveness for emboli prevention.
Area of Science:
- Neurology
- Biomedical Engineering
- Cardiovascular Research
Background:
- Intracranial arterial stenosis (ICAS) is a significant cause of ischemic stroke.
- Current treatments for ICAS are suboptimal due to diverse underlying mechanisms.
Observation:
- A case of severe middle cerebral artery stenosis with a floating thrombus causing artery-to-artery emboli is presented.
- The patient received successful treatment with anticoagulants, leading to thrombus resolution.
Findings:
- Computational fluid dynamics (CFD) analysis of a patient-specific model identified stagnant flow in the poststenotic area.
- Low wall shear stress and shear rate below specific thresholds correlated with thrombus formation.
- CFD analysis provided insights into the hemodynamic factors driving thrombosis.
Implications:
- CFD modeling may aid in diagnosing the risk of thrombosis induced by stagnant intracranial blood flow.
- This approach could help predict the efficacy of anticoagulant therapy in preventing distal embolisms in ICAS patients.
- Integrating CFD into clinical practice may optimize stroke prevention strategies for ICAS.
Abstract:
Intracranial arterial stenosis (ICAS) is one of the important causes of ischaemic stroke. However, the treatment for ICAS is not optimised, including medical therapies, because the mechanisms are diverse. The authors report a case of severe middle cerebral arterial stenosis accompanied by a floating thrombus, which caused artery-to-artery cerebral emboli. The patient was successfully treated with multiple antithrombotics including an anticoagulant, and the thrombus disappeared. Local haemodynamics around the middle cerebral arterial stenosis was analysed by computational fluid dynamics (CFD) using the patient-specific model. CFD analysis demonstrated that thrombus formation occurred at the poststenotic area with severe stagnant flow, which was judged by both wall shear stress and shear rate less than the specific thresholds. These findings suggest that CFD may be useful to diagnose the risk of stagnant flow-induced thrombosis and to predict the effectiveness of anticoagulant agents to prevent distal embolisms in ICAS.
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