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A computational study of the connection between coronary revascularization and cardio-cerebral hemodynamics
Zhengzheng Yan1, Dandan Shang2, Rongliang Chen1
1Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, PR China.
Insights
Coronary revascularization improves heart blood flow but may increase stroke risk by reducing cerebral blood flow. Patient-specific simulations reveal this dual impact, aiding clinical decisions.
Area of Science:
- Cardiovascular Science
- Neuroscience
- Medical Simulation
Background:
- Coronary revascularization can lead to life-threatening strokes.
- Few studies numerically investigate the hemodynamic impact of revascularization on cardio-cerebral systems.
- Understanding these effects is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the effects of eliminating coronary stenosis on coronary and cerebral blood flow.
- To utilize patient-specific simulations for hemodynamic analysis.
- To address the gap in numerical studies on cardio-cerebral hemodynamics post-revascularization.
Main Methods:
- Reconstruction of a patient-specific cardio-cerebral arterial network with left main coronary artery stenosis.
- Application of computational fluid dynamics (CFD) using Navier-Stokes equations.
- Discretization via stabilized P1-P1 Galerkin finite element method and implicit second-order backward differentiation formula.
- Coupling of regional blood flow and lumped Windkessel models at outlet boundaries.
- Solving 3D pulsatile blood flow with a parallel scalable Newton-Krylov-Schwarz algorithm.
Main Results:
- Coronary revascularization significantly increased myocardial blood flow and coronary fractional flow reserve (0.742 to 0.904).
- Cerebral hemodynamics were negatively impacted, showing a 2.49% reduction in main cerebral artery blood flow.
- The computational framework exhibited excellent parallel scalability on numerous processor cores.
Conclusions:
- Coronary revascularization has a dual effect: enhancing myocardial perfusion while potentially increasing cerebral ischemic risk.
- The developed computational approach is effective for patient-specific cardio-cerebral hemodynamic evaluation.
- This method supports complex, time-intensive simulations for clinical decision-making.
Background And Objective:
Some patients experience life-threatening strokes during coronary revascularization. Despite its clinical importance, few numerical studies have investigated the impact of coronary revascularization on cardio-cerebral hemodynamics. This study aims to address this gap by evaluating the effects of eliminating coronary stenosis on both coronary and cerebral blood flow using patient-specific simulations.
Methods:
A patient-specific cardio-cerebral arterial network with a 70% stenosis in the left main coronary artery was reconstructed, and computational fluid dynamics were employed to evaluate the effects of eliminating coronary stenosis. The three-dimensional time-dependent incompressible Navier-Stokes equations were discretized using a stabilized P1-P1 Galerkin finite element method and an implicit second-order backward differentiation formula. A regional blood flow distribution model, coupled with a lumped Windkessel model, was applied at the outlet boundaries. The 3D pulsatile blood flow was solved using a parallel solver based on a scalable Newton-Krylov-Schwarz algorithm, enabling fast and efficient simulations.
Results:
Coronary revascularization significantly improved myocardial blood flow, increasing the coronary fractional flow reserve from 0.742 to 0.904, indicating enhanced myocardial perfusion. However, cerebral hemodynamics were negatively affected, with a 2.49% reduction in blood flow through the main cerebral artery, suggesting an elevated risk of cerebral ischemia. The proposed computational framework demonstrated good parallel scalability across thousands of processor cores.
Conclusions:
This study highlights the dual impact of coronary revascularization, improving myocardial perfusion while potentially elevating the risk of cerebral ischemic complications. The efficient computational approach provides a valuable tool for evaluating cardio-cerebral hemodynamics in patient-specific settings, making it suitable for complex and time-intensive simulations.
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