title: Hemodynamics in the Circle of Willis with Internal Carotid Artery Stenosis under Cervical Rotatory Manipulation: A Finite Element Analysis.
abstract: BACKGROUND
  The circle of Willis (CoW) plays an important role in cerebral collateral circulation. The hemodynamics changes in the CoW have usually been associated with the internal carotid artery (ICA) stenosis, but whether rotatory manipulation will affect it remains unknown.
  
  
  METHODS
  In this study we attempted to analyze the influence of rotatory manipulation on the hemodynamics in the CoW in models with or without ICA stenosis by means of finite element analysis. For this purpose, the CoW was reasonably simplified and a fluid-solid coupling 3D finite element model was created by using MIMICS10.0 and ANSYS14.5. The healthy (without stenosis) and the diseased (ratios of stenosis include 15%, 30%, 45%, 60%, 70%, 80%, and 90%) situations were simulated. A remote displacement of 60° was applied at a distal ICA (the right ICA was chosen here) to imitate the rotatory manipulation. Blood flow was then monitored at the anterior communicating artery (ACoA) and posterior communicating arteries (PCoA).
  
  
  RESULTS
  Before the conduction of rotatory manipulation, blood flow changed significantly only when the stenosis ratio was increased to more than 70%, and the situation did not have significant difference after the application of remote displacement except the model with stenosis ration of 90%.
  
  
  CONCLUSIONS
  The result suggests that the rotatory manipulation does not have an obvious influence on the blood flow in the CoW when the stenosis of ICA is less than 90%, and this kind of manipulation is suggested to be a safe technique in most of the clinical applications.
authors.affiliation: School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China (mainland).
authors.forename: Weishen
authors.initials: W
authors.lastname: Lin
authors.affiliation: PERA GLOBAL-Guangzhou Branch, Guangzhou, Guangdong, China (mainland).
authors.forename: Xiaokang
authors.initials: X
authors.lastname: Ma
authors.affiliation: PERA GLOBAL-Guangzhou Branch, Guangzhou, Guangdong, China (mainland).
authors.forename: Datai
authors.initials: D
authors.lastname: Deng
authors.affiliation: School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, China (mainland).
authors.forename: Yikai
authors.initials: Y
authors.lastname: Li
mesh_terms: D016893:Carotid Stenosis / Q000503:physiopathology*; D002941:Circle of Willis / Q000503:physiopathology*; D005260:Female; D020342:Finite Element Analysis; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D018810:Magnetic Resonance Angiography; D008349:Manipulation, Orthopedic / Q000379:methods*; D008954:Models, Biological; D012399:Rotation; D055815:Young Adult