title: Computational modelling of clot development in patient-specific cerebral aneurysm cases.
abstract: ESSENTIALS: Clotting in cerebral aneurysms is a process that can either stabilize the aneurysm or lead to rupture. A patient-specific computational model capable of predicting cerebral aneurysm thrombosis is presented. The different clotting outcomes highlight the importance of personalization of treatment. Once validated, the model can be used to tailor treatment and to clarify clotting processes in aneurysms.
  
  
  BACKGROUND
  In cerebral aneurysms, clotting can either stabilize the aneurysm sac via aneurysm occlusion, or it can have a detrimental effect by giving rise to embolic occlusion.
  
  
  OBJECTIVE
  The work presented in this study details the development of an in silico model that combines all the salient, clinically relevant features of cerebral aneurysm clotting. A comprehensive computational model of clotting that accounts for biochemical complexity coupled with three-dimensional hemodynamics in image-derived patient aneurysms and in the presence of virtually implanted interventional devices is presented.
  
  
  METHODS
  The model is developed and presented in two stages. First, a two-dimensional computational model of clotting is presented for an idealized geometry. This enables verification of the methods with existing, physiological data before the pathological state is considered. This model is used to compare the results predicted by two different underlying biochemical cascades. The two-dimensional model is then extended to image-derived, three-dimensional aneurysmal topologies by incorporating level set methods, demonstrating the potential use of this model.
  
  
  CONCLUSIONS
  As a proof of concept, comparisons are then made between treated and untreated aneurysms. The prediction of different clotting outcomes for different patients demonstrates that with further development, refinement and validation, this methodology could be used for patient-specific interventional planning.
authors.affiliation: Institute of Biomedical Engineering and Department of Engineering Science, University of Oxford, Oxford, UK.|Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Rosebank, Cape Town, South Africa.|Centre for High Performance Computing, CSIR, Rosebank, Cape Town, South Africa.
authors.forename: M N
authors.initials: MN
authors.lastname: Ngoepe
authors.affiliation: UCL Mechanical Engineering, University College London, London, UK.
authors.forename: Y
authors.initials: Y
authors.lastname: Ventikos
mesh_terms: D001777:Blood Coagulation; D002560:Cerebrovascular Circulation; D003198:Computer Simulation; D003661:Decision Support Techniques; D006439:Hemodynamics; D006801:Humans; D002532:Intracranial Aneurysm / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D020767:Intracranial Thrombosis / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D007700:Kinetics; D008955:Models, Cardiovascular; D009716:Numerical Analysis, Computer-Assisted; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors
keywords: blood coagulation; blood vessel prosthesis; computer simulation; intracranial aneurysm; patient-specific modeling