Hemodynamic Simulation for Safe Surgical Clipping of Intracranial Aneurysms: Temporary Strangulation of the Common Carotid Artery

Intracranial aneurysms (IAs) refer to a weakening and abnormal ballooning of blood vessel walls. Safe surgical clipping to treat IAs requires reducing aneurysmal pressure. We explored a method involving the temporary strangulation of the ipsilateral common carotid artery (CCA) to decrease pressure at middle cerebral artery (MCA) aneurysms.

The study was conducted using computational fluid dynamics with SimVascular. The governing equations were analyzed by discretizing the Navier-Stokes equations using the Petrov-Galerkin method, assuming a Newtonian, incompressible fluid. The boundary conditions included a pulsatile inlet flow rate and an RCR Windkessel model outlet.

Our results indicated that strangling the CCA led to a reduction in both ipsilateral MCA aneurysmal pressure and M2 segment blood flow. When the CCA was strangled by 95%, the mean pressure inside the aneurysm decreased by 50%, and blood flow also decreased by 50%. Additionally, comparing the diversity of the Circle of Willis, the influence of the anterior communicating artery on changes in aneurysmal pressure was dominant. Furthermore, a regression model was created to quantitatively predict the aneurysmal pressure. The R² of the regression, using the M2 segment velocity reduction rate rather than the CCA strangulation rate, was high, indicating reliable prediction.