title: Computational fluid dynamics evaluation of flow reversal treatment of giant basilar tip aneurysm.
abstract: Therapeutic parent artery flow reversal is a treatment option for giant, partially thrombosed basilar tip aneurysms. The effectiveness of this treatment has been variable and not yet studied by applying computational fluid dynamics. Computed tomography images and blood flow velocities acquired with transcranial Doppler ultrasonography were obtained prior to and after bilateral endovascular vertebral artery occlusion for a giant basilar tip aneurysm. Patient-specific geometries and velocity waveforms were used in computational fluid dynamics simulations in order to determine the velocity and wall shear stress changes induced by treatment. Therapeutic parent artery flow reversal lead to a dramatic increase in aneurysm inflow and wall shear stress (30 to 170 Pa) resulting in an increase in intra-aneurysmal circulation. The enlargement of the circulated area within the aneurysm led to a re-normalization of the wall shear stress and the aneurysm remained stable for more than 8 years thereafter. Therapeutic parent artery flow reversal can lead to unintended, potentially harmful changes in aneurysm inflow which can be quantified and possibly predicted by applying computational fluid dynamics.
authors.affiliation: Simula Research Laboratory, Oslo, Norway.
authors.forename: Martin Sandve
authors.initials: MS
authors.lastname: Alnæs
authors.affiliation: Simula Research Laboratory, Oslo, Norway.
authors.forename: Kent-Andre
authors.initials: KA
authors.lastname: Mardal
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway.
authors.forename: Søren
authors.initials: S
authors.lastname: Bakke
authors.affiliation: Department of Neurosurgery, Oslo University Hospital, Norway asortebe@ous-hf.no.
authors.forename: Angelika
authors.initials: A
authors.lastname: Sorteberg
mesh_terms: D001241:Aspirin; D001488:Basilar Artery; D001783:Blood Flow Velocity; D003198:Computer Simulation; D000075202:Contraindications; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging* / Q000601:surgery*; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors; D012008:Recurrence; D014057:Tomography, X-Ray Computed; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Basilar tip aneurysm; computational fluid dynamics; parent artery flow reversal