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. 2021 Jul 27:12:378.
doi: 10.25259/SNI_439_2021. eCollection 2021.

Virtual test occlusion for assessing ischemic tolerance using computational fluid dynamics

Tomoyoshi Kuribara  1 , Takeshi Mikami  1 , Satoshi Iihoshi  2 , Toru Hirano  3 , Daisuke Sasamori  4 , Tadashi Nonaka  5 , Nobuhiro Mikuni  1
Affiliations

Virtual test occlusion for assessing ischemic tolerance using computational fluid dynamics

Tomoyoshi Kuribara et al. Surg Neurol Int. .

Abstract

Background: Ischemic tolerance has been evaluated by the balloon test occlusion (BTO) for cerebral aneurysms and tumors that might require parent artery occlusion during surgery. However, because of its invasiveness, a non-invasive evaluation method is needed. In this study, we assessed the possibility of virtual test occlusion using computational fluid dynamics (CFD) as a non-invasive alternative to BTO for evaluating ischemic tolerance.

Methods: Twenty-one patients who underwent BTO were included in the study. Virtual test occlusion was performed using CFD analysis, and the flow rate (FR) and wall shear stress (WSS) of the middle cerebral artery on the occlusion side were calculated. The correlations between these parameters and examination data including the parameters of computed tomography perfusion during BTO were assessed and the cutoff value of CFD parameters for detecting the good collateral group was calculated.

Results: The FR was strongly correlated with mean transit time (MTT) during BTO and moderately correlated with collateral flow grade based on angiographic appearance. The WSS was moderately correlated with collateral flow grade, mean stump pressure (MSP), and MTT. Furthermore, the FR and WSS were strongly correlated with the total FR and the diameters of the inlet vessels. The cutoff value of FR for detecting the good collateral group was 126.2 mL/min, while that of the WSS was 4.54 Pa.

Conclusion: The parameters obtained through CFD analysis were correlated with collateral flow grade and MSP in addition to MTT. CFD analysis may be useful to evaluate ischemic tolerance as a non-invasive alternative to BTO.

Keywords: Balloon test occlusion; Computational fluid dynamics; Computed tomography perfusion; Flow rate; Wall share stress.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
A case of left middle fossa tumor. Three-dimensional imaging data were obtained through CTA using a volume-rendering algorithm. (a) The white arrow shows the ICA on the lesion side. Extraction of the center lines and segmentation and labeling of the associated vessels were performed (b). ICA on the lesion side was set as a wall (white arrowhead), while that of the contralateral ICA and bilateral VA were set as the inlet, and the on-site analysis was run (c). After the analysis, the steam line contributing to M1 on the lesion side is shown (d). CTA: Computed tomography angiography, ICA: Internal carotid artery, M1: First segment of the middle cerebral artery, VA: vertebral artery.
Figure 2:
Figure 2:
Scatter diagrams showing the correlations between FR and collateral flow grade (a), MTTAR obtained through CT perfusion (b) and MSPBR (c), WSS and collateral flow grade (d), and MTTAR (e) and MSPBR (f). CT: Computed tomography, FR: Flow rate; AR: Asymmetry ratio, BR: Ratio before and after temporal occlusion, MTT: Mean transit time; MSP: Mean stump pressure, WSS: Wall share stress.
Figure 3:
Figure 3:
The gray and black lines showing a ROC curve analysis of the good collateral group detected by FR and WSS, respectively. FR: Flow rate, ROC: Receiver operating characteristic, WSS: Wall share stress.
See this image and copyright information in PMC

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