Abstract

BackgroundNewtonian fluid model has been commonly applied in simulating cerebral blood flow in intracranial atherosclerotic stenosis (ICAS) cases using computational fluid dynamics (CFD) modeling, while blood is a shear-thinning non-Newtonian fluid. We aimed to investigate the differences of cerebral hemodynamic metrics quantified in CFD models built with Newtonian and non-Newtonian fluid assumptions, in patients with ICAS.MethodsWe built a virtual artery model with an eccentric 75% stenosis and performed static CFD simulation. We also constructed CFD models in three patients with ICAS of different severities in the luminal stenosis. We performed static simulations on these models with Newtonian and two non-Newtonian (Casson and Carreau-Yasuda) fluid models. We also performed transient simulations on another patient-specific model. We measured translesional pressure ratio (PR) and wall shear stress (WSS) values in all CFD models, to reflect the changes in pressure and WSS across a stenotic lesion. In all the simulations, we compared the PR and WSS values in CFD models derived with Newtonian, Casson, and Carreau-Yasuda fluid assumptions.ResultsIn all the static and transient simulations, the Newtonian/non-Newtonian difference on PR value was negligible. As to WSS, in static models (virtual and patient-specific), the rheological difference was not obvious in areas with high WSS, but observable in low WSS areas. In the transient model, the rheological difference of WSS areas with low WSS was enhanced, especially during diastolic period.ConclusionNewtonian fluid model could be applicable for PR calculation, but caution needs to be taken when using the Newtonian assumption in simulating WSS especially in severe ICAS cases.

Highlights

  • Intracranial atherosclerotic stenosis (ICAS) is a major cause for ischemic stroke and transient ischemic attack (TIA) in Asian populations (Wong, 2006)

  • This was a substudy of the SOpHIA study (Stroke Risk and Hemodynamics in Intracranial Atherosclerotic Disease), a cohort study conducted at three teaching hospitals to investigate cerebral hemodynamics in patients with symptomatic ICAS, using routine CT angiography (CTA)-based computational fluid dynamics (CFD) models (Leng et al, 2019)

  • The differences of pressure ratio (PR) value were within 1%

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Summary

Introduction

Intracranial atherosclerotic stenosis (ICAS) is a major cause for ischemic stroke and transient ischemic attack (TIA) in Asian populations (Wong, 2006). The relative change of wall shear stress (WSS) at the stenotic throat as compared to WSS at proximal “normal” vessel segment, has been proposed to reflect the hemodynamic impact of an ICAS lesion on plaque growth and rupture (Lan et al, 2020). Both indices have been associated with the risk of stroke relapse in patients with symptomatic ICAS: those with a lower PR (i.e., larger translesional pressure gradient) and excessively elevated focal WSS at the ICAS lesion had significantly higher risk of recurrent stroke despite optimal medical treatment (Leng et al, 2019). We aimed to investigate the differences of cerebral hemodynamic metrics quantified in CFD models built with Newtonian and non-Newtonian fluid assumptions, in patients with ICAS

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