A computational model combining vascular biology and haemodynamics for thrombosis prediction in anatomically accurate cerebral aneurysms

In spite of the fact that controlled thrombosis, induced via coiling, seems to be the optimal approach for the treatment of cerebral saccular aneurysms, the spontaneous and uncontrolled formation of intrasaccular clots results in major embolism risk for the distal vasculature. Progress in non-invasive imaging and geometric reconstruction techniques allow us to apply computational simulation tools for the a priori prediction of thrombotic risk. Prior computational studies have either focused exclusively on modelling the fluid dynamics in realistic geometries or looking at biochemical kinetic descriptions in idealized geometries. The present study provides a comprehensive model for the prediction of thrombus formation by integrating (1) realistic geometries from Computer Tomography data; (2) arterial haemodynamics; and (3) vascular biochemistry. This is accomplished using the framework of a general purpose CFD software (CFD-ACE+). For this study, we demonstrate the capacity of the technique by predicting thrombus formation in a right internal carotid artery with two saccular aneurysms very close to each other. The study reveals a significant difference in haemodynamic and thrombogenesis patterns in the two aneurysms, further illustrating the need for more patient-specific studies based on anatomically realistic geometric models. The framework also allows for the incorporation of more advanced models concerning the particulate nature of platelets, aggregation effects, stenosis development and so on, which will be tackled in future efforts.