title: Computational Fluid Dynamics to Evaluate the Management of a Giant Internal Carotid Artery Aneurysm.
abstract: BACKGROUND
  Giant intracranial aneurysms are rare lesions that present uniquely complex therapeutic challenges. Computational fluid dynamics (CFD) has been used to simulate the hemodynamic environments of developing and ruptured cerebral aneurysms. In this study, we use CFD to examine retrospectively hemodynamic changes during the complicated clinical course of a giant carotid aneurysm.
  
  
  OBJECTIVE
  To take an innovative, CFD-based approach to retrospective analysis of the surgical management and clinical course of a giant carotid aneurysm.
  
  
  METHODS
  Pre- and posttreatment image data were first segmented to produce computational aneurysm models. Flow within the models was then simulated using CFD. Simulated flow and wall shear stress (WSS) profiles were analyzed and used to examine hemodynamic changes during the clinical course of the patient, after 2 independent treatments.
  
  
  RESULTS
  Greater WSS magnitudes and a more localized flow impingement region were observed at the distal portion of the aneurysm after both clinical interventions. These relative, acute changes in hemodynamic features at the distal aneurysm wall were greatest after the second intervention and may have preceded rupture of the aneurysm in that region.
  
  
  CONCLUSIONS
  The application of CFD to the management of a giant intracranial aneurysm showed unexpected posttreatment changes in flow and WSS profiles. The simulation results offer a viable explanation for the observed clinical course. This study demonstrates potential for the use of CFD preoperatively for decision-making in the surgical and endovascular management of intracranial aneurysms.
authors.affiliation: Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA. Electronic address: jonathan.russin@med.usc.edu.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Russin
authors.affiliation: School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA.
authors.forename: Haithem
authors.initials: H
authors.lastname: Babiker
authors.affiliation: School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Ryan
authors.affiliation: Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Rangel-Castilla
authors.affiliation: School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA.
authors.forename: David
authors.initials: D
authors.lastname: Frakes
authors.affiliation: Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Nakaji
mesh_terms: D000208:Acute Disease; D000328:Adult; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D002533:Cerebral Angiography; D002560:Cerebrovascular Circulation; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D018056:Hemorheology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D002532:Intracranial Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D012189:Retrospective Studies; D033081:Shear Strength; D013314:Stress, Mechanical; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed
keywords: Cerebrovascular; Computational fluid dynamics; Extracranial/intracranial bypass; Flow modeling; Giant cerebral aneurysm; Wall shear stress