The Effects of Aortic Coarctation on Cerebral Hemodynamics and its Importance in the Etiopathogenesis of Intracranial Aneurysms

Objectives:

Hemodynamic changes in the cerebral circulation in presence of coarctation of aorta (CoA) and their significance in the increased intracranial aneurysms (IAs) formation in these patients remain unclear. In the present study, we measured the flow-rate waveforms in the cerebral arteries of a patient with CoA, followed by an analysis of different hemodynamic indices in a coexisting IA.

Materials and Methods:

Phase-contrast Magnetic Resonance (pc-MR) volumetric flow-rate (VFR) measurements were performed in cerebral arteries of a 51 years old woman with coexisting CoA, and five healthy volunteers. Numerical predictions of a number of relevant hemodynamic indices were performed in an IA located in sub-clinoid part of left internal carotid artery (ICA) of the patient. Computations were performed using Ansys®-CFX™ solver using the VFR values measured in the patient as boundary conditions (BCs). A second analysis was performed using the average VFR values measured in healthy volunteers. The VFR waveforms measured in the patient and healthy volunteers were compared followed by a comparison of the hemodynamic indices obtained using both approaches. The results are discussed in the background of relevant literature.

Results:

Mean flow-rates were increased by 27.1% to 54.9% (2.66–5.44 ml/sec) in the cerebral circulation of patients with CoA as compared to healthy volunteers (1.2–3.95 ml/sec). Velocities were increased inside the IA by 35–45%. An exponential rise of 650% was observed in the area affected by high wall shear stress (WSS>15Pa) when flow-rates specific to CoA were used as compared to population average flow-rates. Absolute values of space and time averaged WSS were increased by 65%. Whereas values of maximum pressure on the IA wall were increased by 15% the area of elevated pressure was actually decreased by 50%, reflecting a more focalized jet impingement within the IA of the CoA patient.

Conclusions:

IAs can develop in patients with CoA several years after the surgical repair. Cerebral flow-rates in CoA patients are significantly higher as compared to average flow-rates in healthy population. The increased supra-physiological WSS (>15Pa), OSI (>0.2) and focalized pressure may play an important role in the etiopathogenesis of IAs in patients with CoA.