Computational Fluid Dynamics Modeling of Symptomatic Intracranial Atherosclerosis May Predict Risk of Stroke Recurrence
Open Access
- 12 May 2014
- journal article
- research article
- Published by Public Library of Science (PLoS) in PLOS ONE
- Vol. 9 (5), e97531
- https://doi.org/10.1371/journal.pone.0097531
Abstract
Patients with symptomatic intracranial atherosclerosis (ICAS) of ≥70% luminal stenosis are at high risk of stroke recurrence. We aimed to evaluate the relationships between hemodynamics of ICAS revealed by computational fluid dynamics (CFD) models and risk of stroke recurrence in this patient subset. Patients with a symptomatic ICAS lesion of 70–99% luminal stenosis were screened and enrolled in this study. CFD models were reconstructed based on baseline computed tomographic angiography (CTA) source images, to reveal hemodynamics of the qualifying symptomatic ICAS lesions. Change of pressures across a lesion was represented by the ratio of post- and pre-stenotic pressures. Change of shear strain rates (SSR) across a lesion was represented by the ratio of SSRs at the stenotic throat and proximal normal vessel segment, similar for the change of flow velocities. Patients were followed up for 1 year. Overall, 32 patients (median age 65; 59.4% males) were recruited. The median pressure, SSR and velocity ratios for the ICAS lesions were 0.40 (−2.46–0.79), 4.5 (2.2–20.6), and 7.4 (5.2–12.5), respectively. SSR ratio (hazard ratio [HR] 1.027; 95% confidence interval [CI], 1.004–1.051; P = 0.023) and velocity ratio (HR 1.029; 95% CI, 1.002–1.056; P = 0.035) were significantly related to recurrent territorial ischemic stroke within 1 year by univariate Cox regression, respectively with the c-statistics of 0.776 (95% CI, 0.594–0.903; P = 0.014) and 0.776 (95% CI, 0.594–0.903; P = 0.002) in receiver operating characteristic analysis. Hemodynamics of ICAS on CFD models reconstructed from routinely obtained CTA images may predict subsequent stroke recurrence in patients with a symptomatic ICAS lesion of 70–99% luminal stenosis.Keywords
This publication has 26 references indexed in Scilit:
- Aggressive medical treatment with or without stenting in high-risk patients with intracranial artery stenosis (SAMMPRIS): the final results of a randomised trialThe Lancet, 2013
- Computational Fluid Dynamics Applied to Cardiac Computed Tomography for Noninvasive Quantification of Fractional Flow Reserve: Scientific BasisJournal of the American College of Cardiology, 2013
- High-Resolution Magnetic Resonance ImagingStroke, 2013
- Novel MRI Approaches for Assessing Cerebral Hemodynamics in Ischemic Cerebrovascular DiseaseStroke, 2012
- Stenting versus Aggressive Medical Therapy for Intracranial Arterial StenosisNew England Journal of Medicine, 2011
- Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic AttackStroke, 2011
- Collaterals dramatically alter stroke risk in intracranial atherosclerosisAnnals of Neurology, 2010
- Fractional Flow Reserve versus Angiography for Guiding Percutaneous Coronary InterventionNew England Journal of Medicine, 2009
- Predictors of Ischemic Stroke in the Territory of a Symptomatic Intracranial Arterial StenosisCirculation, 2006
- Comparison of Warfarin and Aspirin for Symptomatic Intracranial Arterial StenosisNew England Journal of Medicine, 2005