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Computational fluid dynamics analysis of tandem carotid artery stenoses: Investigation of neurological complications after carotid artery stenting

Abstract

BACKGROUND:

Combined extra- and intracranial carotid artery stenoses, particularly involving multiple lesions, show complex hemodynamic properties and represent a therapeutic dilemma. We used computational fluid dynamics (CFD) to investigate whether insufficient cerebral blood flow (CBF) in a 70-year-old man with tandem stenoses was the cause of aphasia and right hemiparesis after carotid artery stenting (CAS) of the extracranial stenosis.

METHOD:

Three-dimensional digital subtraction angiography (3D-DSA) was performed before and after balloon angioplasty and CAS in the patient. The geometrical and rheological conditions of the carotid arteries were determined, and computational meshes were generated from the patient-specific 3D-DSA datasets. CFD analysis was performed, and hemodynamic parameters such as mass flow, pressure, fractional flow reserve, and streamlines were calculated.

RESULTS:

Post-CAS simulations showed that the percentage of internal carotid artery mass flow from common carotid artery mass flow increased from 9% to 14% and CBF improved by only 5%.

CONCLUSIONS:

CFD analysis suggested that the neurological complications were caused by insufficient CBF rather than embolic events, and in tandem carotid stenoses, CAS for an extracranial lesion alone may not always sufficiently increase CBF. CFD enabled the noninvasive quantitative estimation of the effects of CAS of each stenotic segment on carotid flow.

References

[1] 

Silver FL, , Mackey A, , Clark WM, , Brooks W, , Timaran CH, , Chiu D, et al. Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke. 2011; 42(3): 675-680. doi: 10.1161/STROKEAHA.110.610212.

[2] 

Njemanze PC, , Beck OJ, , Gomez CR, , Horenstein S, , Cujec B, , Polasek P, et al. North American Symptomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progress. Stroke. 1991; 22(6): 711-720.

[3] 

Marzewski DJ, , Furlan AJ, , St Louis P, , Little JR, , Modic MT, , Williams G. Intracranial internal carotid artery stenosis: longterm prognosis. Stroke. 1982; 13(6): 821-824.

[4] 

Siddiqui FM, , Hassan AE, , Tariq N, , Yacoub H, , Vazquez G, , Suri MF, et al. Endovascular management of symptomatic extracranial stenosis associated with secondary intracranial tandem stenosis. A multicenter review. J Neuroimaging. 2012; 22(3): 243-248. doi: 10.1111/j.1552-6569.2011.00611.x.

[5] 

Stelagowski M, , Bogusiak K, , Kasielska A, , Ƚysakowski M, , Kaźmierski P, , Szostek M. Intracranial occlusions and internal carotid artery stenoses: clinical implications. Ann Vasc Surg. 2010; 24(6): 786-793. doi: 10.1016/j.avsg.2010.02.033.

[6] 

Chimowitz MI, , Kokkinos J, , Strong J, , Brown MB, , Levine SR, , Silliman S, et al. The Warfarin-Aspirin Symptomatic Intracranial Disease Study. Neurology. 1995; 45(8): 1488-1493.

[7] 

Hoi Y, , Wasserman BA, , Xie YJ, , Najjar SS, , Ferruci L, , Lakatta EG, et al. Characterization of volumetric flow rate waveforms at the carotid bifurcations of older adults. Physiol Meas. 2010; 31(3): 291-302. doi: 10.1088/0967-3334/31/3/002.

[8] 

Mylonas SN, , Moulakakis KG, , Antonopoulos CN, , Kakisis JD, , Liapis CD. Carotid artery stenting-induced hemodynamic instability. J Endovasc Ther. 2013; 20(1): 48-60. doi: 10.1583/12-4015.1.

[9] 

Li ZY, , Taviani V, , Tang T, , Sutcliffe MP, , Gillard JH. The hemodynamic effects of in-tandem carotid artery stenosis: implications for carotid endarterectomy. J Stroke Cerebrovasc Dis. 2010; 19(2): 138-145. doi: 10.1016/j.jstrokecerebrovasdis.2009.03.014.

[10] 

Horie N, , Kitagawa N, , Morikawa M, , Kaminogo M, , Nagata I. Monitoring of regional cerebral oxygenation by near-infrared spectroscopy in carotid arterial stenting: preliminary study. Neuroradiology. 2005; 47(5): 375-379. doi: 10.1007/ s00234-004-1326-8.

[11] 

Matsubara S, , Moroi J, , Suzuki A, , Sasaki M, , Nagata K, , Kanno I, , Miura S. Analysis of cerebral perfusion and metabolism assessed with positron emission tomography before and after carotid artery stenting. J Neurosurg. 2009; 111(1): 28-36. doi: 10.3171/2008.09.17663.

[12] 

Taylor CA, , Fonte TA, , Min JK. Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis. J Am Coll Cardiol. 2013; 61(22): 2233-2241. doi: 10.1016/j.jacc.2012.11.083.

[13] 

Tonino PA, , De Bruyne B, , Pijls NH, , Siebert U, , Ikeno F, , van't Veer M, et al. Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009; 360(3): 213-224. doi: 10.1056/NEJMoa0807611.