Turbulence intensity as an indicator for ischemic stroke in the carotid web
【Abstract】 Carotid web (CaW) is reported as one of the causes of cryptogenic strokes. However, its pathophysiology has not been known, which makes clinicians debate CaW treatment. The current study presents the mechanism of ischemic stroke in CaW and finds a potential indicator for ischemic stroke in CaW. Computational fluid dynamics (CFD) was applied to computer-aided artificial human CaW models for the investigation of the correlation between the stenosis rate and the CaW angle. The CFD results were compared with stroke or symptomatic CaW including adequate reported images for anatomic analysis of the stenosis rate and CaW angle. The CFD result of the CaW models reveals that the velocity drops and the turbulence generation of blood flow arise in the area under CaW (AuCaW). In the AuCaW, turbulence intensity (TI) is high in the high stenosis rate and small angle conditions. Moreover, high TI remained in the AuCaW throughout the cardiac cycles. The analysis of 67 anatomic figures appeared in 36 articles merged with CFD results, and a CaW scoring system was introduced for clinicians to determine CaW patients with a high risk of ischemic strokes. This study is believed to be the first to apply TI to CaW. Since most ischemic strokes in CaW occurred at a high stenosis rate and small angle. Hence, TI may be used as a potential indicator of ischemic stroke in CaW. Furthermore, TI is easily used in the daily clinical field by applying CaW scores.
【Author】 TaewoongBaeMD1, Jung HoKoMD, PhD2, JaewooChungMD, PhD2
【Keywords】 carotid web, cryptogenic stroke, ischemic stroke, computational fluid dynamics, turbulence intensity, AuCaW, Area under CaW, CaW, Carotid web, CCA, common carotid artery, CFD, computational fluid dynamics simulation, ECA, external carotid artery, ECST, European Carotid Surgery Trial, ICA, internal carotid artery, MDR, mean difference ratio, NASCET, North American Symptomatic Carotid Endarterectomy Trial, TI, turbulence intensity, WSS, wall shear stress
【Journal】 World Neurosurgery(IF：1.7) Time：2021-07-27