Mind the Gap: Impact of Computational Fluid Dynamics Solution Strategy on Prediction of Intracranial Aneurysm Hemodynamics and Rupture Status Indicators

BACKGROUND AND PURPOSE: Computational fluid dynamics has become a popular tool for studying intracranial aneurysm hemodynamics, demonstrating success for retrospectively discriminating rupture status; however, recent highly refined simulations suggest potential deficiencies in solution strategies normally used in the aneurysm computational fluid dynamics literature. The purpose of the present study was to determine the impact of this gap.

MATERIALS AND METHODS: Pulsatile flow in 12 realistic MCA aneurysms was simulated by using both high-resolution and normal-resolution strategies. Velocity fields were compared at selected instants via domain-averaged error. We also compared wall shear stress fields and various reduced hemodynamic indices: cycle-averaged mean and maximum wall shear stress, oscillatory shear index, low shear area, viscous dissipation ratio, and kinetic energy ratio.

RESULTS: Instantaneous differences in flow and wall shear stress patterns were appreciable, especially for bifurcation aneurysms. Linear regressions revealed strong correlations (R² > 0.9) between high-resolution and normal-resolution solutions for all indices except kinetic energy ratio (R² = 0.25) and oscillatory shear index (R² = 0.23); however, for most indices, the slopes were significantly <1, reflecting a pronounced underestimation by the normal-resolution simulations. Some high-resolution simulations were highly unstable, with fluctuating wall shear stresses reflected by the poor oscillatory shear index correlation.

CONCLUSIONS: Typical computational fluid dynamics solution strategies may ultimately be adequate for augmenting rupture risk assessment on the basis of certain highly reduced indices; however, they cannot be relied on for predicting the magnitude and character of the complex biomechanical stimuli to which the aneurysm wall may be exposed. This impact of the computational fluid dynamics solution strategy is likely greater than that for other modeling assumptions or uncertainties.