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Research Papers

Computational Assessment of the Relation Between Embolism Source and Embolus Distribution to the Circle of Willis for Improved Understanding of Stroke Etiology

[+] Author and Article Information
Debanjan Mukherjee

Department of Mechanical Engineering,
University of California, Berkeley,
Berkeley, CA 94720
e-mail: debanjan@berkeley.edu

Neel D. Jani, Kartiga Selvaganesan, Christopher L. Weng

Department of Mechanical Engineering,
University of California, Berkeley,
Berkeley, CA 94720

Shawn C. Shadden

Department of Mechanical Engineering,
University of California, Berkeley,
Berkeley, CA 94720
e-mail: shadden@berkeley.edu

Manuscript received February 26, 2016; final manuscript received June 19, 2016; published online July 12, 2016. Assoc. Editor: Ender A. Finol.

J Biomech Eng 138(8), 081008 (Jul 12, 2016) (13 pages) Paper No: BIO-16-1072; doi: 10.1115/1.4033986 History: Received February 26, 2016; Revised June 19, 2016

Stroke caused by an embolism accounts for about a third of all stroke cases. Understanding the source and cause of the embolism is critical for diagnosis and long-term treatment of such stroke cases. The complex nature of the transport of an embolus within large arteries is a primary hindrance to a clear understanding of embolic stroke etiology. Recent advances in medical image-based computational hemodynamics modeling have rendered increasing utility to such techniques as a probe into the complex flow and transport phenomena in large arteries. In this work, we present a novel, patient-specific, computational framework for understanding embolic stroke etiology, by combining image-based hemodynamics with discrete particle dynamics and a sampling-based analysis. The framework allows us to explore the important question of how embolism source manifests itself in embolus distribution across the various major cerebral arteries. Our investigations illustrate prominent numerical evidence regarding (i) the size/inertia-dependent trends in embolus distribution to the brain; (ii) the relative distribution of cardiogenic versus aortogenic emboli among the anterior, middle, and posterior cerebral arteries; (iii) the left versus right brain preference in cardio-emboli and aortic-emboli transport; and (iv) the source–destination relationship for embolisms affecting the brain.

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Figures

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Fig. 1

Patient models used for this study

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Fig. 2

Schematic overview of the overall computational framework

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Fig. 3

Variations in the probability of emboli reaching the circle of Willis, based on emboli size and instance of release in a cardiac cycle. For each patient, cardio-emboli transport probabilities are depicted on the top and aorto-emboli on the bottom. A detailed labeling has been included to clearly describe the visualizations along the individual axis and an inset for the cardiac cycle, with original release instants used in the experiments depicted as dots overlaid on the flow profile.

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Fig. 4

The proportion in which emboli reaching the brain get distributed across the six major cerebral arteries. L/R denote left/right. A, M, and P denote anterior, middle, and posterior, respectively. The distribution of flow across the six arteries is indicated by “flow.”

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Fig. 5

The sample distribution across the six cerebral arteries for cardiogenic and aortogenic emboli obtained from the numerical experiments. The data on the right are scaled by the fraction of cerebral flow supplying the corresponding arteries. (L, R) denote (left, right), (ACA, PCA, MCA) denote (anterior, posterior, middle) cerebral arteries, and (“-A,” “-C”) denote (aortogenic, cardiogenic).

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Fig. 6

The sample distribution for posterior, middle, and anterior cerebral arteries obtained from the numerical experiments. The data on the right have been scaled by the fraction of cerebral flow supplying the corresponding arteries.

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Fig. 7

Quantifying the left–right preference of embolus transport. The size-dependent variations for each patient are shown on the top panels (cardio-emboli on panel (a) and aorto-emboli on panel (b)). The relative distribution statistics with and without considerations of volumetric flow have been presented on the bottom (panels (c) and (d), respectively).

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Fig. 8

Surface map indicating embolism source locations and the relative tendency of the released emboli traveling to the brain for aortogenic emboli

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