Bulletin of the American Physical Society
72nd Annual Meeting of the APS Division of Fluid Dynamics
Volume 64, Number 13
Saturday–Tuesday, November 23–26, 2019; Seattle, Washington
Session C03: Minisymposium: Fluid Dynamics in the Clinical Management of Intracranial Aneurysm |
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Chair: Michael Levitt, University of Washington Room: 201 |
Sunday, November 24, 2019 8:00AM - 8:26AM |
C03.00001: The use of fluid dynamics to predict success of intracranial aneurysm endovascular treatment: State of the Art and Potential for Translation to Clinical Use Invited Speaker: M. Levitt Endovascular placement of coils or stents have become the preferred method for treatment of intracranial aneurysms. These minimally invasive procedures aim to create hemodynamics conditions that promote a stable thrombus that fills the entire aneurysmal sac. No accurate method to predict the outcome of endovascular therapy exists, with failure to create a sac-filling thrombus occurring in 15-35% of endovascular treatments that needs retreatment involving significant risk to the patient and cost to the health care system. We simulate 60 patients treated with Flow Diverting Stents (FDS) or coils, both before and immediately after treatment. Synchrotron scans of the actual coils or stents deployed inside phantoms of the aneurysms are generated, allowing for comparison of the hemodynamics modeled with standard porous media versus homogenized anisotropic and heterogeneous models derived from the fully- resolved scans. We have developed both Eulerian and Lagrangian metrics to understand the hemodynamics that promote a successful embolization of the aneurysmal sac, and propose a risk score to predict the need to further treat or follow-up each patient during, or immediately after, endovascular treatment. [Preview Abstract] |
Sunday, November 24, 2019 8:26AM - 8:52AM |
C03.00002: Modeling of ‘patient-specific’ blood flow in the brain: Are we there yet? Invited Speaker: Kristian Valen-Sendstad A brain aneurysm is a focal weakening of the arterial wall, and rupture is associated with high rates of mortality and morbidity. Roughly 5% of the population harbors these asymptomatic ‘ticking-bombs’, with an annual rupture risk of 1%. Cost benefit analyses do not support intervention, so what to do individually when incidentally detected? Wall shear stresses are well known to correlate with vessel wall remodeling and rupture, but cannot be measured. Instead, patient-specific medical images are routinely available and have been widely used in combination with computational fluid dynamics (CFD) to reveal adverse “patient-specific” hemodynamic environments correlated with disease initiation, progression, and outcome. However, results are equivocal and clinicians question whether CFD is actually ‘confounding factor dissemination’. In this talk, we present a brief review of the state of the art and also provide an alternative perspective on the results. We discuss basic assumptions, sources of variability, and variability of community challenge results. In short, inconsistency seems to be the only consistency, which begs for standardization. We also address whether results from (bio-) engineering tools really reflect the physics of fluids. Finally, we outline future directions that are essential for translating engineering tools to clinical practice. [Preview Abstract] |
Sunday, November 24, 2019 8:52AM - 9:18AM |
C03.00003: Improving clinical decision-making with data: defining roles for computational fluid dynamics in aneurysm management Invited Speaker: Jason M. Davies Subjectivity plays an outsized role in the management of intracranial aneurysms (IA). Computational fluid dynamics may reduce variability and improve outcomes. In this study, we aimed to explore the utility of CFD in the management of UIAs in two domains, 1) identification of aneurysms that should be treated, and 2) prediction of occlusion outcomes for flow-diverter-treated aneurysms.\\ \\Methods: We identified aneurysm patients between September 2018 and June 2019 and computed the unruptured intracranial aneurysm treatment score (UIATS) as well as the Rupture Resemblance Score (RRS). We further identified patients treated with flow-diverters between 2011 and 2018. We computed 6 geometrical (G), 2 FD device-related (D), 4 pre-treatment (untreated, U*) and 4 post-treatment (treated, T*) hemodynamic features, which were then used in combination to train four neural network models.\\ \\Results: Treatment decisions were analyzed for 49 patients with 84 UIAs. Of the 42% for which UIATS did not have definitive recommendations, RRS was able to stratify risk based on their hemodynamic resemblance to ruptured IAs. Flow diversion outcomes were assessed for 145 aneurysms in 98 patients. Removing post-treatment hemodynamics resulted in the significant model performance drops. Conclusions: Hemodynamics contribute information relevant to the management of intracranial aneurysms. Incorporating data-driven management strategies should reduce variability in outcomes and improve patient care.\\ \\In collaboration with: Nikhil Paliwal, Dept. of Mechanical & Aerospace Eng. & Canon Stroke and Vascular Research Center, Univ., of Buffalo; Hui Meng, Dept. of Mechanical & Aerospace Engineering, Canon Stroke and Vascular Research Center, Dept. of Biomedical Engineering, Dept. of Neurosurgery, Univ., of Buffalo. [Preview Abstract] |
Sunday, November 24, 2019 9:18AM - 9:44AM |
C03.00004: Hemodynamics and Aneurysm Formation Invited Speaker: Min Park Aneurysms develop due to a multitude of factors. Traditionally, research surrounding aneurysm formation has examined an individual’s lifestyle and medical co-morbidities, such as hypertension, nicotine use, and a pre-existing family history. With improvements in technology and the ability to more accurately model hemodynamic forces, research has also focused on the role of hemodynamic forces on aneurysm development, remodeling, and the risk of aneurysm rupture. Computational fluid dynamic studies allow researchers to quantify the effects of fluid movement within a vessel and aneurysm. They can also identify parameters, such as wall shear stress and oscillatory shear index, which likely induce changes within the vessel to promote aneurysm formation and remodeling through complex biological pathways. We will review the current knowledge and beliefs regarding aneurysm formation and examine how computational fluid dynamics has added to our understanding of aneurysm pathophysiology and how it influences clinical decision making. [Preview Abstract] |
Sunday, November 24, 2019 9:44AM - 10:10AM |
C03.00005: Computational Fluid Dynamics and aneurysm wall mechanobiology: correlations between CFD, MRI vessel wall imaging and histology Invited Speaker: Mahmoud Mossa-Basha TBD [Preview Abstract] |
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