Sergey Sindeev

The use of flow-diverters for non-saccular cerebral posterior circulation aneurysms requires complex deployment techniques and is associated with high mortality and morbidity. Therefore, further studies are required to clarify the effect of stenting on post-treatment hemodynamics in such aneurysms. In this study, we evaluated flow alterations in a treated giant fusiform aneurysm of the vertebrobasilar junction and correlated them with the clinical outcome. A patient-specific aneurysm model was acquired by rotational angiography, and three SILK flow-diverters (4.5 × 40, 5 × 40 and 5.5 × 40 mm) were virtually deployed in series along the basilar and right vertebral arteries. Image-based blood flow simulations before and after the treatment were performed under realistic pulsatile flow conditions. The flow reduction, velocity and wall shear stress (WSS) distribution, streamlines and WSS-derived parameters were evaluated before and after the treatment. The computed velocity streamlines showed substantial alterations of the flow pattern in the aneurysm and successful redirection of blood flow along the series of flow-diverters with no flow through the overlapping stents. The obtained flow reduction of 86% was sufficient to create thrombogenic flow conditions. Moreover, a 6.2-fold increase in relative residence time and a decrease by 87% of time-averaged WSS contributed to a successful treatment outcome observed during the follow-up. We found a correlation between the numerically predicted flow alterations and the available treatment outcome. This shows the potential of image-based simulations to be used in clinical practice for treatment planning and estimation of possible risk factors associated with a complex stent deployment in fusiform aneurysms of the posterior circulation.

A method of Monte Carlo simulation of low-coherence radiation propagation in turbid media with consideration of speckle noise (the result of mutual interference of secondary spherical waves) is described. The process of photon propagation within investigated object, such as biological tissue, includes the following steps: the photon injection, mean free path determination, the verification of the fulfillment of the boundary condition, the absorption and scattering. Structural image reconstruction in optical coherence tomography (OCT) with consideration of speckle fluctuations is made by summation the statistical weight of the beam coming out of the investigated object inside the detector area with the intensity of a series of pixels of the current A-scan. The key feature of the presented method is the description of the investigated object geometry. Three-dimensional array of voxels combined into parallelograms, and the border cross checking is carried out by using an improved Smith algorithm. The described method can be used to obtain high-quality endoscopic structural OCT images of body cavities and tracts (diagnosis of the respiratory tract, cardiovascular system, gastrointestinal tract, genitourinary system, etc.).

Advanced morphology analysis and image-based hemodynamic simulations are increasingly used to assess the rupture risk of intracranial aneurysms (IAs). However, the accuracy of those results strongly depends on the quality of the vessel wall segmentation.

Despite of the recent achievements in the research of blood rheology, the effect of non-Newtonian blood viscosity on hemodynamic parameters in cerebral aneurysms is not clarified. The purpose of this study is to investigate the role of different rheological models for prediction of hemodynamic parameters in the patient-specific model of a saccular aneurysm. Transient flow simulations were conducted using OpenFOAM CFD Toolbox. The simulations employed different viscosity models: Newtonian, Power Law, Bird-Carreau, Casson and Local viscosity model. The similar flow patterns were observed both for Newtonian and non- Newtonian fluids in the patient-specific model of the aneurysm. The average difference between Newtonian and non-Newtonian models was about 12%. However for some specific points in the region of recirculating flow the difference was significantly higher - from 20% to 63%. The non-Newtonian blood behaviour influenced the streamlines distribution in the aneurysm region, producing a larger recirculating zone in the center of the aneurysm. The results showed that the major differences between Newtonian and non-Newtonian fluids were found in regions of low velocities and recirculating zones.

The presence of high-frequency velocity fluctuations in aneurysms have been confirmed by in-vivo measurements and by several numerical simulation studies. Only a few studies have located and recorded wall vibrations in in-vitro experiments using physiological patient models. In this study, we investigated the wall fluctuations produced by a flowing perfusion fluid in a true-to-scale elastic model of a cerebral fusiform aneurysm using a laser Doppler vibrometer (LDV). The model was obtained from patient data. The experimental setup reproduced physiologically relevant conditions using a compliant perfusion system, physiological flow parameters, unsteady flow and a non-Newtonian fluid. Three geometrically identical models with different wall elasticities were used for measurements. The influence of five different flow rates was considered. Wall vibrations were predominantly found at frequencies in the range 40–60 Hz and 255–265 Hz. Their amplitude increased with increasing elasticity of the model, but the spectral peaks remained at about the same frequency. Varying the flow rate produced almost no changes in the frequency domain of the models. The frequency of the spectral peaks varied slightly between points at the lateral wall and at the bottom of the aneurysm. Indeed, embedding the model in a fluid during measurements produced higher and smoother amplitude fluctuations.

Cerebral aneurysms are a major risk factor for intracranial bleeding with devastating consequences for the patient. One recently established treatment is the implantation of flow-diverters (FD). Methods to predict their treatment success before or directly after implantation are not well investigated yet. The aim of this work was to quantitatively study hemodynamic parameters in patient-specific models of treated cerebral aneurysms and its correlation with the clinical outcome. Hemodynamics were evaluated using both computational fluid dynamics (CFD) and phase contrast (PC) MRI. CFD simulations and in vitro MRI measurements were done under similar flow conditions and results of both methods were comparatively analyzed. For preoperative and postoperative distribution of hemodynamic parameters, CFD simulations and PC-MRI velocity measurements showed similar results. In both cases where no occlusion of the aneurysm was observed after six months, a flow reduction of about 30-50% was found, while in the clinically successful case with complete occlusion of the aneurysm after 6 months, the flow reduction was about 80%. No vortex was observed in any of the three models after treatment. The results are in agreement with recent studies suggesting that CFD simulations can predict post-treatment aneurysm flow alteration already before implantation of a FD and PC-MRI could validate the predicted hemodynamic changes right after implantation of a FD.