Abstract
Ischaemic stroke is responsible for up to 80 % of stroke cases. Prevention of the reoccurrence of ischaemic attack or stroke for patients who survived the first symptoms is the major treatment target. Accurate diagnosis of the emboli source for a specific infarction lesion is very important for a better treatment for the patient. However, due to the complex blood flow patterns in the cerebral arterial network, little is known so far of the embolic particle flow trajectory and its behaviour in such a complex flow field. The present study aims to study the trajectories of embolic particles released from carotid arteries and basilar artery in a cerebral arterial network and the influence of particle size, mass and release location to the particle distributions, by computational modelling. The cerebral arterial network model, which includes major arteries in the circle of Willis and several generations of branches from them, was generated from MRI images. Particles with diameters of 200, 500 and 800 upmu hbox {m} and densities of 800, 1,030 and 1,300 hbox {kg/m}^{3} were released in the vessel’s central and near-wall regions. A fully coupled scheme of particle and blood flow in a computational fluid dynamics software ANASYS CFX 13 was used in the simulations. The results show that heavy particles (density large than blood or a diameter larger than 500 upmu hbox {m}) normally have small travel speeds in arteries; larger or lighter embolic particles are more likely to travel to large branches in cerebral arteries. In certain cases, all large particles go to the middle cerebral arteries; large particles with higher travel speeds in large arteries are likely to travel at more complex and tortuous trajectories; emboli raised from the basilar artery will only exit the model from branches of basilar artery and posterior cerebral arteries. A modified Circle of Willis configuration can have significant influence on particle distributions. The local branch patterns of internal carotid artery to middle cerebral artery and anterior communicating artery can have large impact on such distributions.
Highlights
Stroke is the major cause of serious long-term disability and the third most significant cause of death in developed countries, more than 5 million people dying of stroke every year
The problem of pinpointing a potential emboli source from a known infarction site, by medical diagnosis, is an inverse problem which makes the accuracy of such diagnosis impossible
The results showed that it is difficult to predict the trajectory for a specific particle, the above mentioned probability of particle distribution repeated very well, together with all other parameters
Summary
Stroke is the major cause of serious long-term disability and the third most significant cause of death in developed countries, more than 5 million people dying of stroke every year. The Oxford Community Stroke Project classification (OCSP, known as the Bamford or Oxford classification) relies primarily on the initial symptoms to describe the influence region of infarction It can be classified as anterior circulation, posterior circulation infarct and lacunar infarct (infarct possibly caused by the blockage of penetrating arteries). The TOAST (Trial of Org 10172 in Acute Stroke Treatment) classification is based on clinical symptoms and results of further investigations. It denotes five subtypes of ischaemic stroke: (1) thrombosis or embolism due to atherosclerosis of a large artery, (2) embolism of cardiac origin, (3) occlusion of a small blood vessel, (4) other determined aetiology, (5) undetermined aetiology. In a significant number of cases, the cause remains undetermined, even after exhaustive diagnosis tests (Grotta and Alexandrov 2001; Murtagh and Smalling 2006; Weir 2008)
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