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

Yukinao Kambayashi, Hiroyuki Takao, Kouichi Shinohara, Takashi Suzuki, Sho Takayama, Soichiro Fujimura, Shunsuke Masuda, Mituyoshi Watanabe, Tomoaki Suzuki, Chihebeddine Dahmani, Toshihiro Ishibashi, Makoto Yamamoto (+1 others)
2016 Technology and Health Care  
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
more » ... (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.
doi:10.3233/thc-161217 pmid:27233087 fatcat:uihwbule65djpefvkgcekypedy