Ryo Torii

Finite element simulation of blood flow in the cerebral artery

Abstract The purpose of the paper is to develop a numerical simulation system for the clinical study of a cerebral aneurysm. This paper presents the system, which consists of three processes: pre-processing, numerical simulation and post-processing. In the pre-processing process, the three-dimensional solid model was constructed from the computed tomography (CT) angiography raw data. The finite element method (FEM) is used in order to simulate flow in a complicated geometry. The simulation is conducted to investigate hemodynamics of blood flow in the carotid siphon under real flow conditions measured by Doppler ultrasound velocimetry technique. The results are visualized for a better understanding of the flow characteristics such as distributions of the flow pattern and the wall shear stress in the carotid siphon.

Role of the Bloodstream Impacting Force and the Local Pressure Elevation in the Rupture of Cerebral Aneurysms

Background and Purpose— Inertial force of the bloodstream results in the local elevation of intravascular pressure secondary to flow impact. Previous studies suggest that this “impacting force” and the local pressure elevation at the aneurysm may have a large contribution to the development of cerebral aneurysms. The goal of the present study is to evaluate how the bloodstream impacting force and the local pressure elevation at the aneurysm influences the rupture of cerebral aneurysms. Methods— A total of 29 aneurysms were created in 26 patient-specific vessel models, and computer simulations were used to calculate pressure distributions around the vessel branching points and the aneurysms. Results— Direct impact of the parent artery bloodstream resulted in local elevation in pressure at branch points, and bends in arteries (231.2±198.1 Pa; 100 Pa=0.75 mm Hg). The bloodstream entered into the aneurysm with a decreased velocity after it impacted on the branching points or bends. Thus, the flow impact at the aneurysm occurred usually weakly. At the top or the rupture point of the aneurysm, the flow velocity was always delayed. The local pressure elevation at the aneurysm was 119.3±91.2 Pa. Conclusions— The pressure elevation at the area of flow impact and at the aneurysm constituted only 1% to 2% of the peak intravascular pressure. The results suggest that the bloodstream impacting force and the local pressure elevation at the aneurysm may have less contribution to the rupture of cerebral aneurysms than was expected previously.

Kissing balloon or sequential dilation of the side branch and main vessel for provisional stenting of bifurcations: lessons from micro-computed tomography and computational simulations

OBJECTIVES This study sought to evaluate post-dilation strategies in bifurcation stenting. BACKGROUND In bifurcation stenting practice, it is still controversial how post-dilation should be performed and whether the kissing balloon (KB) technique is mandatory when only the main vessel (MV) receives a stent. METHODS A series of drug-eluting stents (DES) (n = 26) were deployed in a coronary bifurcation model following a provisional approach. After the deployment of the stent in the MV, post-dilation with the KB technique was compared with a 2-step, sequential post-dilation of the side branch (SB) and MV without kissing. RESULTS The percentage of the SB lumen area free of stent struts was similar after KB (79.1 ± 8.7%) and after the 2-step sequence (74.4 ± 11.6%, p = 0.25), a considerable improvement compared with MV stenting only without dilation of the stent at the SB ostium (30.8 ± 7.8%, p < 0.0001). The rate of strut malapposition in the ostium was 21.3 ± 9.2% after KB and 24.9 ± 10.4% after the 2-step sequence, respectively, a significant reduction compared with a simple SB dilation (55.3 ± 16.8%, p < 0.0001) or MV stenting only (47.0 ± 8.5%, p < 0.0005). KB created a significant elliptical overexpansion of the MV lumen, inducing higher stress concentration proximal to the SB. KB also led to a higher risk of incomplete stent apposition at the proximal stent edge (30.7 ± 26.4% vs. 2.8 ± 9.6% for 2-step, p = 0.0016). CONCLUSIONS Sequential 2-step post-dilation of the SB and MV may offer a simpler and more efficient alternative to final KB technique for provisional stenting of bifurcations.

FLUID-STRUCTURE INTERACTION ANALYSIS OF WALL STRESS AND FLOW PATTERNS IN A THORACIC AORTIC ANEURYSM

In this study, fluid-structure interaction (FSI) simulation was carried out to predict wall shear stress (WSS) and blood flow patterns in a thoracic aortic aneurysm (TAA) where haemodynamic stresses on the diseased aortic wall are thought to lead to the growth, progression and rupture of the aneurysm. Based on MR images, a patient-specific TAA model was reconstructed. A newly developed two-equation laminar-turbulent transitional model was employed and realistic velocity and pressure waveforms were used as boundary conditions. Analysis of results include turbulence intensity, wall displacement, WSS, wall tensile stress and comparison of velocity profiles between MRI data, rigid and FSI simulations. Velocity profiles demonstrated that the FSI simulation gave better agreement with the MRI data while results for the time-averaged WSS (TAWSS) and oscillatory shear index (OSI) distributions showed no qualitative differences between the simulations. With the FSI model, the maximum TAWSS value was 13% lower, whereas the turbulence intensity was significantly higher than the rigid model. The FSI simulation also provided results for wall mechanical stress in terms of von Mises stress, allowing regions of high wall stress to be identified.

MR image-based geometric and hemodynamic investigation of the right coronary artery with dynamic vessel motion.

The aim of this study was to develop a fully subject-specific model of the right coronary artery (RCA), including dynamic vessel motion, for computational analysis to assess the effects of cardiac-induced motion on hemodynamics and resulting wall shear stress (WSS). Vascular geometries were acquired in the right coronary artery (RCA) of a healthy volunteer using a navigator-gated interleaved spiral sequence at 14 time points during the cardiac cycle. A high temporal resolution velocity waveform was also acquired in the proximal region. Cardiac-induced dynamic vessel motion was calculated by interpolating the geometries with an active contour model and a computational fluid dynamic (CFD) simulation with fully subject-specific information was carried out using this model. The results showed the expected variation of vessel radius and curvature throughout the cardiac cycle, and also revealed that dynamic motion of the right coronary artery consequent to cardiac motion had significant effects on instantaneous WSS and oscillatory shear index. Subject-specific MRI-based CFD is feasible and, if scan duration could be shortened, this method may have potential as a non-invasive tool to investigate the physiological and pathological role of hemodynamics in human coronary arteries.

Stress phase angle depicts differences in coronary artery hemodynamics due to changes in flow and geometry after percutaneous coronary intervention

The effects of changes in flow velocity waveform and arterial geometry before and after percutaneous coronary intervention (PCI) in the right coronary artery (RCA) were investigated using computational fluid dynamics. An RCA from a patient with a stenosis was reconstructed based on multislice computerized tomography images. A nonstenosed model, simulating the same RCA after PCI, was also constructed. The blood flows in the RCA models were simulated using pulsatile flow waveforms acquired with an intravascular ultrasound-Doppler probe in the RCA of a patient undergoing PCI. It was found that differences in the waveforms before and after PCI did not affect the time-averaged wall shear stress and oscillatory shear index, but the phase angle between pressure and wall shear stress on the endothelium, stress phase angle (SPA), differed markedly. The median SPA was -63.9 degrees (range, -204 degrees to -10.0 degrees ) for the pre-PCI state, whereas it was 10.4 degrees (range, -71.1 degrees to 25.4 degrees ) in the post-PCI state, i.e., more asynchronous in the pre-PCI state. SPA has been reported to influence the secretion of vasoactive molecules (e.g., nitric oxide, PGI(2), and endothelin-1), and asynchronous SPA ( approximately -180 degrees ) is proposed to be proatherogenic. Our results suggest that differences in the pulsatile flow waveform may have an important influence on atherogenesis, although associated with only minor changes in the time-averaged wall shear stress and oscillatory shear index. SPA may be a useful indicator in predicting sites prone to atherosclerosis.

The effect of dynamic vessel motion on haemodynamic parameters in the right coronary artery: a combined MR and CFD study

Human right coronary artery (RCA) haemodynamics is investigated using computational fluid dynamics (CFD) based on subject-specific information from magnetic resonance (MR) acquisitions. The dynamically varying vascular geometry is reconstructed from MR images, incorporated in CFD in conjunction with pulsatile flow conditions obtained from MR velocity mapping performed on the same subject. The effects of dynamic vessel motion on instantaneous and cycle-averaged haemodynamic parameters, such as wall shear stress (WSS), time-averaged WSS (TAWSS) and oscillatory shear index (OSI), are examined by comparing an RCA model with a time-varying geometry and those with a static geometry, corresponding to nine different time-points in the cardiac cycle. The results show that the TAWSS is similar for the dynamic and static wall models, both qualitatively and quantitatively (correlation coefficient 0.89-0.95). Conversely, the OSI shows much poorer correlations (correlation coefficient 0.38-0.60), with the best correspondence being observed with the static models constructed from images acquired in late diastole (at t = 0 and 800 ms, the cardiac cycle is 900 ms). These findings suggest that neglecting dynamic motion of the RCA is acceptable if TAWSS is the primary focus but may result in underestimation of haemodynamic parameters related to the oscillatory nature of the blood flow.

Patient-Specific Modeling and Multi-Scale Blood Simulation for Computational Hemodynamic Study on the Human Cerebrovascular System

To develop a targeted drug delivery system for cerebrovascular disorders such as stroke, it is important to obtain detailed information on flow rates and hemodynamics of the human cerebrovascular system for individual patients. A patient-specific integrated numerical simulation system has been developed by the authors such that vascular geometry is constructed from medical images such as magnetic resonance imaging (MRI) or computed tomography (CT) data, and computational conditions are modeled mathematically to represent the realistic in vivo environments. In general, the three-dimensional numerical simulation using a patient-specific model is conducted only for a localized diseased region with atherosclerosis or an aneurysm. Although the analysis region is only a part of the circulatory system, the simulation should include the effects from the entire circulatory system. Since the peripheral network determines the flow distributions in the cerebrovascular system, the paper reviews the recent simulation methods to take into account the network by coupling the image-based three-dimensional simulation with a one- and zero-dimensional simulations as an outflow boundary condition The paper shows the mathematical modeling of the multi-scale outflow boundary condition and its applications to patient- specific models of the arterial circle of Willis. The results are compared to those using the conventional, free-stream boundary condition. As a result, the multi-scale outflow boundary condition shows a significant difference in flow rate of each artery and in flow distribution in the arterial circle of Willis.

An integrated geometric modelling framework for patient-specific computational haemodynamic study on wide-ranged vascular network

Patient-specific haemodynamic computations have been used as an effective tool in researches on cardiovascular disease associated with haemodynamics such as atherosclerosis and aneurysm. Recent development of computer resource has enabled 3D haemodynamic computations in wide-spread arterial network but there are still difficulties in modelling vascular geometry because of noise and limited resolution in medical images. In this paper, an integrated framework to model an arterial network tree for patient-specific computational haemodynamic study is developed. With this framework, 3D vascular geometry reconstruction of an arterial network and quantification of its geometric feature are aimed. The combination of 3D haemodynamic computation and vascular morphology quantification helps better understand the relationship between vascular morphology and haemodynamic force behind ‘geometric risk factor’ for cardiovascular diseases. The proposed method is applied to an intracranial arterial network to demonstrate its accuracy and effectiveness. The results are compared with the marching-cubes (MC) method. The comparison shows that the present modelling method can reconstruct a wide-ranged vascular network anatomically more accurate than the MC method, particularly in peripheral circulation where the image resolution is low in comparison to the vessel diameter, because of the recognition of an arterial network connectivity based on its centreline.

Numerical evaluation of elastic models in blood flow–arterial wall interaction

In order to obtain a better understanding of mechanism of cerebral aneurysms, the interaction between blood flow and arterial walls plays an important role. However, it is difficult to measure the in vivo behavior of blood flow and arterial walls in the cerebral circulation using medical imaging techniques due to the limitation of resolution and data acquisition of the current available systems. The authors have been developing a medical image-based simulation and database system to investigate the effects of vascular morphology on cerebral hemodynamics. This paper focuses on the blood flow–arterial wall interaction to investigate how the wall deformation affects the characteristics of blood flow. The simulation is conducted for a patient-specific model of a middle cerebral aneurysm, which is constructed from CT images. The effects of elastic models are examined using two types of elastic models: (1) linear elastic model; and (2) non-linear elastic model.