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Computational fluid dynamics analysis of tandem carotid artery stenoses: Investigation of neurological complications after carotid artery stenting

Article type: Research Article

Authors: Kambayashi, Yukinaoa | Takao, Hiroyukia; b; e; * | Shinohara, Kouichib | Suzuki, Takashib | Takayama, Shob | Fujimura, Soichirob | Masuda, Shunsukea | Watanabe, Mituyoshia | Suzuki, Tomoakia | Dahmani, Chihebeddinea; c | Ishibashi, Toshihiroa | Yamamoto, Makotod | Murayama, Yuichia

Affiliations: [a] Department of Neurosurgery, The Jikei University School of Medicine, Tokyo, Tokyo, Japan | [b] Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan | [c] Siemens Healthcare K.K., Tokyo, Japan | [d] Department of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan | [e] Department of Innovation for Medical Information Technology, Jikei University School of Medicine, Tokyo, Japan

Correspondence: [*] Corresponding author: Hiroyuki Takao, Department of Neurosurgery, Jikei University School of Medicine Hospital, 3-25-8 Nishishinbashi, Minato-ku, Tokyo 105-0003, Japan. Tel.: +81 03 3433 1111; Fax: +81 03 3433 1111; E-mail:takao@jikei.ac.jp

Keywords: Carotid artery stenting, carotid stenosis, cerebral blood flow, computational fluid dynamics, neurological complication

DOI: 10.3233/THC-161217

Journal: Technology and Health Care, vol. 24, no. 5, pp. 673-679, 2016

Received 14 February 2016
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Accepted 23 April 2016
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Published: 14 September 2016
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Abstract

BACKGROUND:

Combined extra- and intracranial carotid artery stenoses, particularly involving multiple lesions, show complex hemodynamic properties and represent a therapeutic dilemma. We used computational fluid dynamics (CFD) to investigate whether insufficient cerebral blood flow (CBF) in a 70-year-old man with tandem stenoses was the cause of aphasia and right hemiparesis after carotid artery stenting (CAS) of the extracranial stenosis.

METHOD:

Three-dimensional digital subtraction angiography (3D-DSA) was performed before and after balloon angioplasty and CAS in the patient. The geometrical and rheological conditions of the carotid arteries were determined, and computational meshes were generated from the patient-specific 3D-DSA datasets. CFD analysis was performed, and hemodynamic parameters such as mass flow, pressure, fractional flow reserve, and streamlines were calculated.

RESULTS:

Post-CAS simulations showed that the percentage of internal carotid artery mass flow from common carotid artery mass flow increased from 9% to 14% and CBF improved by only 5%.

CONCLUSIONS:

CFD analysis suggested that the neurological complications were caused by insufficient CBF rather than embolic events, and in tandem carotid stenoses, CAS for an extracranial lesion alone may not always sufficiently increase CBF. CFD enabled the noninvasive quantitative estimation of the effects of CAS of each stenotic segment on carotid flow.

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