Haemodynamic analysis of vessel remodelling in STA-MCA bypass for Moyamoya disease and its impact on bypass patency.
The purpose of this study is to estimate the remodelling characteristics of STA-MCA bypass and its influence on patency via the use of computational fluid dynamic (CFD) technology. The reconstructed three-dimensional geometries from MRA were segmented to create computational domains for CFD simulations. Eleven patients, who underwent regular MRA both immediately following surgery and at the six months follow-up, were studied. The flow velocities at STA were measured via the use of quantitative MRA (QMRA) to validate simulation results. STA-MCA bypass patency was confirmed for each patient immediately following surgery. The simulation indicated that the remodelling of the arterial pedicle in nine patients was associated with a reduction in the resistance to flow through the bypass. For these cases, the modelling of a driving pressure of 10mmHg through the bypass at 6 months post-surgery resulted in a 50% greater blood flow than those found immediately following surgery. However, two patients were found to exhibit contradictory patterns of remodelling, in which a highly curved bending at the bypass immediately post-surgery underwent progression, with increased resistance to flow through the bypass at 6 months follow-up, thereby resulting in a modelled flow rate reduction of 50% and 25%, respectively. This study revealed that STA-MCA bypass has a characteristic remodelling that usually reduces flow resistance. The initial morphology of the bypass may have had a significant effect on the outcome of vessel remodelling.
Australian School of Advanced Medicine, Macquarie University, Sydney, Australia; Department of Neurosurgery, Hua Shan Hospital, Fudan University, Shanghai, China.
Feng-Ping
FP
Zhu
Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
Yu
Y
Zhang
Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
Masakazu
M
Higurashi
Department of Neurosurgery, Hua Shan Hospital, Fudan University, Shanghai, China.
Bin
B
Xu
Department of Neurosurgery, Hua Shan Hospital, Fudan University, Shanghai, China.
Yu-Xiang
YX
Gu
Department of Neurosurgery, Hua Shan Hospital, Fudan University, Shanghai, China. Electronic address: maoying@fudan.edu.cn.
Ying
Y
Mao
Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
Michael Kerin
MK
Morgan
Australian School of Advanced Medicine, Macquarie University, Sydney, Australia. Electronic address: yi.qian@mq.edu.au.
Yi
Y
Qian
D000328:Adult; D000465:Algorithms; D002548:Cerebral Revascularization / Q000379:methods*; D002560:Cerebrovascular Circulation / Q000502:physiology; D003198:Computer Simulation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery; D008955:Models, Cardiovascular; D009072:Moyamoya Disease / Q000503:physiopathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D020257:Ventricular Remodeling
Computational fluid dynamic; Flow resistance; Moyamoya disease; STA-MCA bypass