Aneurysm

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Aneurysm

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Benjamin Khoo

AbstractWith an objective to introduce and familiarise with The treatment for cerebral aneurysms consist of either

CFD software. An investigation on the haemodynamic of cerebral microsurgical clipping or endovascular aneurysm occlusion.

aneurysms for uncoiled and coiled cases have been conducted For microsurgical clipping, the aneurysm is clipped through a

using the CFD software. A simplified aneurysm geometry is crantiotomy, which is a surgical procedure in which the brain

constructed to model various different flow. To model the coiled

and the affected blood vessel is accessed through opening of the

part of the aneurysm, a technique developed by Nikolas et al was

employed, where porosity medium was used. Simulation results human skull [1]. The clip will separate the aneurysm from the

showed that the increase in number of coil would reduce the blood vessel hence restoring the normal blood vessel anatomy.

pressure within the aneurysm should blood flow into the aneurysm As for endovascular coiling, platinum wire spiral is deployed

is completely obstructed. The simulations also showed that the into an aneurysm via a microcatheter through a femoral artery

current simplified CFD model is insufficient to properly project of the leg. The microcatheter then slowly advance to the

the actual condition in the aneurysm as the Non-Newtonian effect selected aneurysm and release the platinum coil into the

are not significant on steady flow simulation and energy from the aneurysm. With the coil in the aneurysm, the blood pattern is

flow are not absorb into the coil which results in higher pressure changed and this will encourage blood clotting at the aneurysm.

in coiled aneurysm compared to uncoiled aneurysm.

This clot will resist entry of blood into the aneurysm, providing

KeywordsCerebral Aneurysm, Computational Fluid similar effect to a clip [1].

Dynamics, Porosity, Newtonian Fluid, Non-Newtonian Fluid In this paper, the effect of endovascular coiling is

investigated. To do this, CFD modelling was used to model the

I. INTRODUCTION flow structure under several flow condition including both

coiled and uncoiled aneurysms, Newtonian and non-Newtonian

Many engineering application requires knowledge of flow

flow, physiological flow and abnormally high flow case and

structure to enable engineers to design and manufacture products

also the effect of porosity and permeability.

that are efficient or even functional. To familiarise with the used

of Computational Fluid Dynamics (CFD), an analysis on the II. METHODS

haemodynamic of cerebral aneurysms under various condition

was conducted. A. Overview

A cerebral aneurysm is an abnormal focal dilation of To investigate the effect of the coil in the aneurysm. To identify

how different parameter would affect the flow structure, several

an artery in the brain that results from a weakening of inner

muscular layer of a blood vessel wall [1]. Autopsy studies has simulations had been run. Below are the lists of simulations ran:

shown that cerebral aneurysm is common with approximately 5 1. Uncoiled Newtonian Case with physiological flow

percent of the population will or have cerebral aneurysm [2]. 2. Coiled Newtonian Case with physiological flow

Although studies suggest that most cerebral aneurysms do not 3. Uncoiled Non-Newtonian Case with physiological

rupture, due to the location of the aneurysm, sudden rupture of flow

4. Coiled Non-Newtonian Case with physiological flow

the aneurysm is normally lethal with approximately 30% of the

patient pass away immediately and another 30% within 4 weeks 5. Uncoiled Newtonian Case with abnormally high inlet

[3]. Studies have found that aneurysms of diameter less than 10 velocity

mm are less likely to rupture than those 10 mm and above. The 6. Grid independence case

rate of rupture for diameter 10 mm or more is about 20 times 7. Various porosity and permeability case with

that of the rate of smaller aneurysm [2]. The formation of physiological flow

cerebral aneurysms was believed to be due to several factors

such as genetic, injury, hypertension and cigarette smoking. B. Modelling of Cerebral Aneurysms

However, it is believed that smoking is the major cause for the In this work, the system of aneurysm considered is a simple

formation of cerebral aneurysms with one study shows that 47 2D bifurcation aneurysm. Although the construction of the

percent of the patient were current smokers and 32 percent were anatomically accurate vasculature geometry of interest is

former smokers. important, due to the amount of computational resource

available, only a 2D aneurysm will be modelled and the effect

between different flow condition will only be compared

qualitatively.

Benjamin Khoo is a 4th year Mechanical Engineering Student in the The bifurcation aneurysm modelled has three 10 mm

Mechanical Engineering Department of UCL

length main vasculature branches with 1.5 mm diameter inlet

branch and two 1 mm diameter outlet branches which are Rate of Transport Transport of

angled at 130. The aneurysm modelled in is an ellipse with 4.5 change + of by = by + Source

mm major radius and 3.5 mm minor radius. The ellipse is of convection diffusion

modelled with its edge located at the apex point between the

two branches. The final model used is as shown Figure 1. To interpolate the cell face value of of both convection and

diffusion term over to other cells, the central differencing

scheme (CDS) was chosen as the discretisation scheme. CDS is

a second-order accurate scheme hence is more accurate than the

first order upwind differencing scheme (UDS) when Peclet

number is smaller than 2 due to UDS solution tend to over-

diffuse [5]. For this reason, CDS is preferred over UDS in this

report. However, since CDS is well known for giving rise to non-

physical oscillation in the numerical solution, damping is used

to stabilise the solution. The CDS with damping is constructed

as shown:

= + (1 ) (5)

for UDS, eCD the e for CDS and is the blending factor that

combines the CDS scheme with UDS [6].

Figure 1 Final Model Used for Simulations C. Newtonian and Non-Newtonian Fluid

Newtonian fluid is a fluid whose shear stress is linearly

The system is discretized into triangular elements. To proportional to the velocity gradient. However, in reality most

then solve these problems, the modelling involves the fluid exhibit non-Newtonian behaviour and this include blood.

numerical solution of the conservation equation of mass, Blood is a pseudoplatic Non-Newtonian Fluid which

momentum and energy. To simplify the model, the fluid flow is means that its viscosity decreases when its velocity increases.

assumed to incompressible and isothermal (it is assumed that This is because when velocity of the red blood cell is high, it

the heat transfers and biochemical interaction between the fluid becomes oriented in direction of flow, resulting in lower

and vasculature branches is negligible), the energy equation can viscosity. On the other hand, when velocity is low, the red blood

be neglected and the continuity and conservation of momentum cells rouleaux and hence higher viscosity [7]. Research showed

equation can be written in a constant density form as shown in that if shear rate is more than 100 s-1, the blood will behave like

(1), (2) and (3) respectively. Newtonian fluid with a constant of 0.0345 Pa s

Since the shear stress between Newtonian and Non-

2 u 2 u

=

+(

x2

+

y2

) (1) Newtonian model are not the same with the latters dynamic

2 v 2 v viscosity not directly proportional to the velocity gradient, the

= + ( + ) (2) dynamic viscosity of the blood will be modelled using a

x2 y2

mathematical relationship. In this report, the Generalised Power

+ =0 (3)

Law is applied and is shown as below.

where is the density of the fluid; this case =1060. u is the x- = ||1 (5)

direction velocity and v is the y-direction velocity. P is the

pressure acting normal to the surface of the cell with the negative Where

sign by definition giving it a compressive stress. is the dynamic

viscosity of the flow where 0.00357 Pa s is used for the ||

Newtonian case. () = + exp [ (1 + ( )) ( ||)] (6)

Although it is not so obvious from (1), (2) and (3), there are ||

significant commonalities between these equations that a () = [ (1 + ( )) ( ||)] (7)

general transport equation can be establish with a general

variable in the following form [4]: Where is the local calculated shear stress, is the consistency

constant, is limiting Newtonian viscosity set at 0.0035, is

0.25, a is 50, b is 3, c is 50 and d is 4.

+ () = ( ) + (4)

The Generalised Power Law consist of Power Law

model at low strain, the Newtonian model at midrange and high

In words the equation means:

strain from about 200s-1 and has the Casson model as a special

case [7].

D. Laminar Flow and Turbulent Modelling The K- turbulence model have two model equations, one for

To simulate the physiological flow in the body, direct numerical K (kinetic energy) and one for (rate of turbulent dissipation).

solution is used to obtain simulated result. The direct numerical Both k and were used to define velocity scale, and length

solution solves the Navier-Stokes equation without any scale l representative of the large scale turbulence as follows:

turbulence modelling hence able to give a much more accurate The K- turbulence model is one of the most widely

result. used turbulence model in the industry as it performs excellently

However, as the Reynolds number grow, the grid for many industrial relevant flows and is widely validated.

resolution needed increases by Re3 due to memory requirement However, the K- turbulence model performs poorly with large

to be able to deal with all scale of motion and also the time adverse pressure gradient and tends to suppress flow separation

stepping used to advance the equation has to be computed [8]. [4].

Hence with the Reynolds number of the abnormally high flow The K- turbulence model also consist of two model

around 4453, the grid resolution required exceed 8 X 10 10 and equations, the K (kinetic energy) and (specific rate of

the computational resources available is insufficient to simulate dissipation). The main attraction of the K- turbulence model

the case. To overcome this issue, Reynolds-Averaged Navier- is that integration to the wall does not require wall-damping

Stokes (RANS) turbulence model is used to greatly reduce the function in low Reynolds number application. [14] However,

required grid number by compromising some accuracy. its fatal flaws is that it is dependent on the assumed free stream

To solve turbulent flow for RANS, the Navier Stokes value of and also tends to over predict the flow reattachment

equation have to rewritten for time average flow as define length [4] [8].

below: In this simulation, the inlet velocity for the

1 physiological flow is 0.27 m/s and for abnormally high velocity

= 0

is 10 m/s

= (9)

E. Endovascular Coiling Modelling via Porous Media

Where u is the fluctuating term, U is the mean velocity and u To model the system of detachable coil, the approach taken by

is the instantaneous velocity Kakalis et al where the aneurysm volume is modelled as porous

medium is chosen [7]. This approach is taken because of the

Using this new definition, the Navier-Stokes equation can be good approximation of the coiling and also reduce the

rewritten as shown: complexity of the model. The two parameter that needs defining

under this approach is the porosity, , and permeability, k.

In reality, both porosity and permeability is a function

+ =0 of dimension of aneurysm and number of coil placed in the

2 u 2 u aneurysm lumen which can be described in a mathematical

+ ( ) = + ( 2 + 2) model [9]. The porosity and closely related to the permeability

x y

2 and both value can have huge effect on the flow structure of the

v 2 v

+ (

) = + ( 2 + 2) fluid as the porous part of the system geometry uses a modified

x y Navier-Stokes equations with both porosity and permeability

parameter. In this study, a chosen set of porosity and

Note that there is a new term that appears in these instantaneous permeability calculated by Nikolaos et al is used to model the

equations which is the result of the introduction of time coiled aneurysm. Table 1 shows the porosity and permeability

averaged flow. This term involves the fluctuating velocity that of different cases.

is responsible for the convection momentum transfer due to

turbulent eddies and are an additional turbulent stresses on the Table 1 Different Porosity Used for Simulations

mean velocity.

These extra turbulent stresses are called Reynolds Coil Porosity Permeability

stresses and it gave rise to more unknowns to solve both

continuity and conservation of momentum equations. To solve Base Case 0.8 1.00 X 10-8

these new equations, Reynolds stresses needs to be modelled 1 0.964 1.44 X 10-6

which is achieved by using turbulence models. There is various 3 0.892 1.37 X 10-7

turbulent model that are currently available in commercial

CFD, the present work however only evaluates two turbulent 7 0.808 3.57 X 10-8

model due their extensive use in the industry. The two models 10 0.766 2.16 X 10-8

used are: 12 0.749 1.80 X 10-8

K- Turbulence Model 15 0.735 1.55 X 10-8

K- Turbulence Model

III. RESULTS computational resources, a grid dependency test was performed

on an uncoiled bifurcation aneurysm. The test consists of various

A. Grid Dependence.

To ensure simulation on the haemodynamic of aneurysm are

reasonably accurate without compromising too much on

0.45

0.4

Velocity Mangnitude m/s

0.35

0.3

0.25

0.2

Grid Number 2320

0.15

Grid Number 11903

0.1

Grid Number 20246

0.05

0 Grid Number 39826

-0.003 -0.002 -0.001 0 Y-axis, m0.001 0.002 0.003 0.004

Figure 2 Velocity Profile along the y axis at x=0.0114m

0.45

Velocity Magnitude against Y-axis

0.4

0.35

Velocity Mangnitude m/s

0.3

0.25

0.2

0.15 Grid Number 2320

0.1 Grid Number 11903

Grid Number 20246

0.05

Grid Number 39826

0

-0.003 -0.002 -0.001 0 Y-axis, m0.001 0.002 0.003 0.004

Figure 3 Velocity Profile along the y-axis at x=0.0114m after flipping flow

unstructured grid with number of triangular element results obtained are all flipped to one side to allow better

ranging between 2 320 to 39 826. Quantitative comparison at comparison between different grid as shown in Figure 3.

the same condition is performed. The Figure 2 below shows From the results from the test suggest that the grid

the velocity profile along the y axis 0.0114 m from the inlet. with 20 246 elements shows that the results are almost

One interesting result obtained from the grid identical to the grid that consist of 39 826 elements. Hence, it

dependency test shows that the blood flow to the top or bottom is deemed sufficient for the purpose of this study.

branch in the bifurcation branch are independent of the

amount of mesh created as shown in Figure 4. Since the

geometry of the bifurcation aneurysm is symmetrical, the flow

structure in the system is too expected to be symmetrical.

However, results obtained shows that flow pattern flips

regardless of the resolution of the grid. Such change is

believed to be due to the algorithm used to create the

unstructured grid where the grid created are never

symmetrical and hence flow might be biased towards one side

where grid number is higher. Hence, the grid dependency

The simulation results from both uncoiled

Newtonian and Non-Newtonian shows that the maximum

wall shear stress is at the inlet. This is not surprising as the

velocity of the flow near the wall at the inlet is the highest

because the flow not completely developed. Despite the strain

rate near the wall at this area is more than 200 s-1, and hence

the wall shear stress is expected to be the same, the simulation

shows that the wall shear stress of the Newtonian model is

higher by 1.6%. This is likely due to the viscosity limit set on

Figure 4 Flow Structure Flipped due to asymmetrical mesh the Generalised Power Law which sets the viscosity limit at

generation. which is 2% lower than the Newtonian model used.

A comparison between both Newtonian and Non-Newtonian

case for the uncoiled case shows that there isnt any significant

difference between the two. Figure 5.

strain rate is more than 200)

When comparing the simulation result from both

base case coiled Newtonian and Non-Newtonian, similar

observation was made on majority of the area. However, in

the aneurysm, due to the porosity media used, the strain rate

rapidly reduced to 0 as shown in the Figure 7. The wall shear

stress correctly reflects the effect on the change of strain rate

with the Newtonian model having a higher stress and as the

strain rate reduces, the wall shear stress of the Non-Newtonian

model increases above the Newtonian Model albeit

insignificant to the overall result as shown in Figure 8

Flow Structure (Bottom)

Since the Generalised Power law is used, the fluid

will be modelled as Newtonian fluid when strain rate is more

than 200 s-1. Figure 6 show that majority of the flow has a Figure 7 Strain Rate of the coiled aneurysm

strain rate of more or equal to 200 s-1, hence flow in these area

exhibit Newtonian behaviour.

2 Results from the simulations showed that the

difference between Newtonian and Non-Newtonian are

Wall Shear Stress, Pa

Wall Shear Stress against X insignificant despite both model are very distinct. One of the

1.5

possible reason for such observations is due to cardiac cycle

not being used for the simulation. While studies show that

1 Newtonian

steady state simulation does not differ much on average

Non Newtonian compared to cardiac cycle, when blood slows down during the

0.5 cardiac cycle, the wall stress between Newtonian and Non-

Newtonian fluid will differ greatly with Non-Newtonian

0 model having higher Wall shear stress [10]. The steady state

0.0115 0.0135 0.0155 0.0175 0.0195 simulation used in this study might have reduced the overall

X, m importance of the Non-Newtonian model and may lead false

Figure 8 Newtonian model has higher Wall Shear Stress initially interpretation of experimental observation.

which later overtook by Non Newtonian Model

Figure 9 K- Model (Top Left), K- (Top Right), Physiological Flow Model (Bottom) flow structure

C. Abnormally high velocity flow different from both model, this is expected due to its poor

prediction of flow reattachment which suggest its result

An abnormally high inlet velocity on the aneurysm was

might not be reliable. Hence, in this case only K- model is

studied to determine its effect on an uncoiled aneurysm.

considered.

Figure 9 shows the flow structure of both Turbulent Model

The wall shear stress along the top half of the

compared to the physiological flow model with the K-

aneurysm as shown Figure 10 shows a very noisy graph with

model having very similar flow structure to the physiological

its peak value several hundred times larger than those found

flow. The result obtained from K- model however is very

in laminar flow. While the higher wall shear stress is expected 10000

from a turbulent flow with have higher energy compared to

Wall Shear

Stress, Pa

laminar flow, the noise from the graph is unexpected. It is

unknown whether the noise is due to the turbulent nature of 5000

the flow or insufficient resolution at near wall flow, hence

further work on this area in the future is required.

0

0.011 0.016 0.021

X, m

Figure 10 Wall Shear Stress of Top half of the aneurysm

=0.964 =0.892

=0.808 =0.766

=0.749 =0.735

= 0 . 8 9 2

Figure 11 Velocity Magnitude in the Aneurysm of Various Porosity from top left clockwise, , =0.892. =0.808, =0.766, =0.749 and =0.735

One key observation made on the porosity result of the 1 126.956

simulation is there are false porosity gradient as shown in 3 128.387

Figure 12. This false porosity gradient is expected due to

interpolating scheme used. While CDS should minimise the 7 143.069

false gradient, the damping scheme used to improve stability 10 151.322

introduced UDS which increases the false porosity gradient. 12 147.529

To further reduce the false porosity gradient, higher-order

interpolation scheme and greater fine refinement should be 15 144.274

used.

The results from the pressure probes shows that the

pressure in the aneurysm reduces with amount of coil when

the flow is completely obstructed by the coils. However,

when the flow is able to penetrate into the aneurysm, the

pressure in the aneurysm is much lower than the coiled

aneurysm. The reason for this could be likely due to the

simulations physics used that doesnt account for the energy

absorption by the aluminium coil.

IV. CONCLUSION

The study showed that coiled cerebral aneurysms is a

Figure 12 False Porosity Gradient from the Model treatment that successfully reduce the risk of aneurysm

rapture. The Newtonian model was found to be a very good

Figure 11 shows the result of velocity magnitude

representative of the Non-Newtonian model in a steady state

from different porosity and permeability according to Table

flow. This finding require further study to ensure that cardiac

1. The figures show that with more coil inserted into the cycle would not change the result significantly. The change

aneurysm, the blood flow into the aneurysm are slowly

of porosity and permeability has also show that it could

obstructed and no longer able penetrate deep into the

represent the different stages of coiling within the aneurysm

aneurysm when =0.766. To measure the effect of how the

but suitable grid resolution and interpolation scheme should

coil reduces the pressure in the aneurysm, a pressure probe is

be further studied to ensure the false porosity gradient would

used to study the pressure at the tip of the aneurysm. Table 2

not affect the result.

shows the pressure at the tip of the wall of an uncoiled

aneurysm and coiled aneurysm.

Table 2 Pressure read from probe at tip of aneurysm

V. REFERENCES

Surgeons," AANS, March 2015. [Online]. Available:

http://www.aans.org/patient%20information/condition

s%20and%20treatments/cerebral%20aneurysm.aspx.

[Accessed 13 December 2016].

[2] N. E. J. Med, "Unruptured Intracranial Aneurysms

Risk of Rupture and Risks of Surgical Intervention,"

The New England Journal of Medicine, vol. 339, pp.

1725-1733, 1998.

[3] N. F. Kassel, J. C. Torner, E. C. Haley, J. A. Jane, H.

P. Adams and L. G. Kongable, "The International

Cooperative Study on the Timing of aneurysm surgery.

Part 1: Overall management results," J. Neurosurg, vol.

73, pp. 18-36, 1990.

[4] H. K. Versteeg and W. Malalasekera, An Introduction

to Computational FLuid Dynamics: The Finite Volume

Method, 2nd ed., Essex: Pearson Education, 2007.

[5] Y. Ventikos, "Second Set of CFD Notes," in Advanced

Computer Application in Engineering, London, UCL,

2016, p. 159.

[6] ESI Group, CFD-ACE V2014.0 User Manual, Part 2,

Paris: ESI Group, 2014.

[7] P. W. Serruys, "Non-Newtonian CFD study in

Bifurcations," in XIth EUROPEAN BIFURCATION

CLUB MEETING, Athens, 2015.

[8] P. Ballyk, D. Steinman and C. Ethier, "Simulation of

non-Newtonian blood flow in an end-to-side,"

Biorheology, vol. 31, no. 5, pp. 565-586, 1994.

[9] J. -P. Laval, B. Dubrulle and S. Nazarenko, "Fast

numerical simulations of 2D turbulence using a

dynamic model for subfilter motions," Journal of

Computational Physics , vol. 196, pp. 187-207, 2004.

[10] F. R. Menter, M. Kuntz and R. Langtry, "Ten Years of

Industrial Experience with the SST," Turbulence, Heat

and Mass Transfer 4, vol. 4, no. 1, 2003.

[11] N. M. P. Kakalis, A. P. Mitsos, J. V. Byrne and Y.

Ventikos, "The Haemodynamics of Endovascular

Aneurysm Treatment: A Computational Modelling

Approach for Estimating the Influence of Multiple Coil

Deployment," IEEE Transaction on Medical Imaging,

vol. 27, no. 6, pp. 814-824, 2008.

[12] B. M. Johnstona, P. R. Johnston, S. Corney and D.

Kilpatrick, "Non-Newtonian blood flow in human right

coronary arteries: steady state simulations," Journal of

Biomechanics, vol. 37, p. 709720, 2004.

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