Impacts of Internal Carotid Artery Revascularization on Flow in Anterior Communicating Artery Aneurysm: A Preliminary Multiscale Numerical Investigation

The optimal management strategy of patients with concomitant anterior communicating artery aneurysm (ACoAA) and internal carotid artery (ICA) stenosis is unclear. This study aims to evaluate the impacts of unilateral ICA revascularization on hemodynamics factors associated with rupture in an ACoAA. In the present study, a multiscale computational model of ACoAA was developed by coupling zero-dimensional (0D) models of the cerebral vascular system with a three-dimensional (3D) patient-specific ACoAA model. Distributions of flow patterns, wall shear stress (WSS), relative residence time (RRT) and oscillating shear index (OSI) in the ACoAA under left ICA revascularization procedure were quantitatively assessed by using transient computational fluid dynamics (CFD) simulations. Our results showed that the revascularization procedures significantly changed the hemodynamic environments in the ACoAA. The flow disturbance in the ACoAA was enhanced by the resumed flow from the affected side. In addition, higher OSI (0.057 vs. 0.02), prolonged RRT (1.14 vs. 0.39) and larger low WSS area (66 vs. 50 mm²) in ACoAA were found in the non-stenotic case. These acute changes in hemodynamics after revascularization may elevate the rupture risk of ACoAA. The preliminary results validated the feasibility of predicting aneurismal hemodynamics characteristics in revascularization procedures by using multiscale CFD simulations, which would benefit the management of this group of patients.