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Technical Brief

Two Closely Spaced Aneurysms of the Supraclinoid Internal Carotid Artery: How Does One Influence the Other?

[+] Author and Article Information
Kevin Sunderland

Department of Biomedical Engineering,
Michigan Technological University,
Houghton, MI 49931

Qinghai Huang

Department of Neurosurgery,
Changhai Hospital,
Second Military Medical University,
Shanghai 200433, China

Charles Strother

Department of Radiology,
School of Medicine and Public Health,
University of Wisconsin,
Madison, WI 53705

Jingfeng Jiang

Department of Biomedical Engineering,
Michigan Technological University,
Houghton, MI 49931
e-mail: jjiang1@mtu.edu

1Corresponding author.

Manuscript received September 5, 2017; final manuscript received May 24, 2019; published online July 30, 2019. Assoc. Editor: Alison Marsden.

J Biomech Eng 141(11), 114501 (Jul 30, 2019) (10 pages) Paper No: BIO-17-1393; doi: 10.1115/1.4043868 History: Received September 05, 2017; Revised May 24, 2019

The objective of this study was to use image-based computational fluid dynamics (CFD) techniques to analyze the impact that multiple closely spaced intracranial aneurysm (IAs) of the supra-clinoid segment of the internal carotid artery (ICA) have on each other's hemodynamic characteristics. The vascular geometry of fifteen (15) subjects with 2 IAs was gathered using a 3D digital subtraction angiography clinical system. Two groups of computer models were created for each subject's vascular geometry: both IAs present (model A) and after removal of one IA (model B). Models were separated into two groups based on IA separation: tandem (one proximal and one distal) and adjacent (aneurysms directly opposite on a vessel). Simulations using a pulsatile velocity waveform were solved by a commercial CFD solver. Proximal IAs altered flow into distal IAs (5 of 7), increasing flow energy and spatial-temporally averaged wall shear stress (STA-WSS: 3–50% comparing models A to B) while decreasing flow stability within distal IAs. Thus, proximal IAs may “protect” a distal aneurysm from destructive remodeling due to flow stagnation. Among adjacent IAs, the presence of both IAs decreased each other's flow characteristics, lowering WSS (models A to B) and increasing flow stability: all changes statistically significant (p < 0.05). A negative relationship exists between the mean percent change in flow stability in relation to adjacent IA volume and ostium area. Closely spaced IAs impact hemodynamic alterations onto each other concerning flow energy, stressors, and stability. Understanding these alterations (especially after surgical repair of one IA) may help uncover risk factor(s) pertaining to the growth of (remaining) IAs.

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Figures

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Fig. 1

Angiographic appearances of closely spaced multiple ICA IAs in 15 subjects. In each vascular model, arrows point to IAs. Each IA is label following the same convention: group, case number, and IA number. For instance, AA-1.1 stands for the first aneurysm in the case 1 of the Adjacent IA group.

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Fig. 2

Example of the vessel modification process: (a) Original vessel structure (model A). (b) Semi-automated computational removal of the IAs: resultant vessel and original vessel overlapped, top arrow indicates unintended IA removal, bottom arrows showing altered vessel curvature. (c) Modified vessel from part B, projected onto original vessel to reclaim vessel curvature and create area (top arrow) for needed IA reattachment, while slight errors due to vessel projection in areas of (intended) removed IA (bottom arrow) were removed by vessel smoothing. (d) Completed modification shows model B overlapped with original vasculature (model A).

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Fig. 3

Example of the degree of volume overlap of vortex iso-surfaces (DVO): (a) time-step i iso-surfaces, (b) time-step i + 1 iso-surfaces, (c) both time-steps with iso-surface overlap. Velocity streamlines show overall flow pattern at each time-step.

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Fig. 4

Box plots of characteristic differences between adjacent (both), proximal, and distal IAs: (a) STA-KED, (b) STA-WSS, and (c) TA-DVO. The top and bottom of boxes indicate 75 and 25 percentiles, respectively. The line inside each box represents their median. Error bars show the minimum and maximum values. Circle markers indicate outliers. P values displayed for comparison between IA types.

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Fig. 5

A plot showing the relation between STA-WSS and the aspect ratio in model A

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Fig. 6

Plots showing spatial patterns of TA-WSS comparing between models A and B. Values were scaled to each IA grouping as to assess spatial TA-WSS patterns. Pre representing all IAs intact (model A), post as proximal IA removed, An1-2 as either An1 or An2 remaining (adjacent IAs).

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Fig. 7

Clustered box plots comparing the geometrical characteristics between the adjacent (both), proximal, and distal IAs: (a) aspect ratio and (b) IA volume. The top and bottom of the boxes indicate 75 and 25 percentiles, respectively. The line through the middle of each box represents the median. The error bars show the minimum and maximum values. The circle markers indicate outliers.

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Fig. 8

A plot shows the relation between STA-WSS and the aspect ratio in model B (i.e., removal of the proximal IA or one of the two adjacent IAs)

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Fig. 9

Two examples illustrating the relationship between the angular histogram and NE: (a) a simple laminar flow case and (b) a rotational flow (eddy) case. In both cases, the right and left plots are the vector flow field and the histogram of angular vector direction, respectively. Vector fields were decimated by a factor of 3 for better visualization.

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