Computational Modelling of the Haemodynamics in

Coiled and Uncoiled Cerebral Aneurysms

Advanced Computer Applications in Engineering

(MECHGM05/MECHM003/MECHGR05)

Preamble
The purpose of this assignment is to expose the students to some of the key concepts and practicalities
of Computational Fluid Dynamics (CFD).
For this task, a case study that is representative in terms of its computationally challenging nature, but
also suitable for a Module-level assignment, is selected: that of the haemodynamics (blood flow) in a
cerebral aneurysm, a sac-like deformation of a brain artery.
In reality, such aneurysms are of course three-dimensional and their geometric features are derived
from imaging modalities: for example, an MRI (Magnetic Resonance Imaging) dataset, as acquired
from a patient, would be used to reconstruct the vascular geometry of interest.
Three-dimensionality, complex geometric features, as well as other complications, like pulsatile
(beating heart) haemodynamics, have been removed from this exercise: our emphasis here is on the
CFD workflow.
The instructions that follow briefly describe the steps the students have to take to complete the process.
Moreover, where necessary, they provide background information and theory describing the concepts
behind the tools.
Although dealing with a simplified case, we have tried to make the experience as realistic as possible
the level of task definition provided would be representative for an industrial engineer using CFD for
design or R&D purposes, or a researcher using CFD for analysis and research. If there is a piece of
information in the specification that you think is missing, it is probably missing for a reason.

Acknowledgements
The ESI Group (Paris, France), developers of the CFD-ACE+ multiphysics software platform, are
kindly acknowledged for allowing the use of the software for this assignment.

DOs and DONTs

DOs

Explore. Try different things. You cannot break the software, so going outside the instructions
provided and attempting things you find interesting will only enhance your experience.

The manuals of CFD-ACE (or any software of this type) are endless sources of information
(available on MOODLE). Use them wisely: it is probably not prudent to attempt to read them
cover to cover.

Doing the work and the computations in a consistent manner is important. Demonstrating that
you have done so is equally important. Be very meticulous with the report. You are to structure
your report as a technical/scientific paper which means that the space available is limited and
the format is strictly prescribed.

You are given (available on MOODLE) a small number of very well-defined tutorials outlining
the various aspects of the work you will need to do. Complete the tutorials (and explore) before
you engage with the main tasks.

DONTs

The ESI Group has kindly permitted us to use one of the most complete Multiphysics/multiscale
solvers (CFD-ACE+) for this assignment. Interaction with this very mature code, used routinely
in industry of all types all around the world, will offer you as realistic an experience as possible
regarding organizing and conducting CFD studies. Our agreement with ESI is that we (UCL)
shall handle user queries (especially novice users queries!) internally, and we shall not be
bombarding their help line with questions. Please do not call or email the ESI Helpdesk.
Yiannis and a team of experienced users within the research group will be answering all
questions that may emerge.

Remember what you have been told, repeatedly, regarding plagiarism.

Introduction
The purpose of this exercise is to familiarise the students with state-of-the-art CFD software. We shall
explore the haemodynamics of cerebral aneurysms, under steady flow conditions and for a variety of
cases. More specifically, we shall study a 2D symmetric aneurysm, in a coiled and uncoiled setting and
with blood rheology that is both Newtonian and non-Newtonian. All these terms are explained in the
sequel.
It is important to highlight at the very beginning, here, the minimum list of cases we would like to see
in your report:

An uncoiled Newtonian case (the base case), with physiological flow (low inlet velocity)
A coiled Newtonian case, with physiological flow (low inlet velocity)
An uncoiled non-Newtonian case, with physiological flow (low inlet velocity)
A coiled non-Newtonian case, with physiological flow (low inlet velocity)
An uncoiled Newtonian case, with abnormally high inlet velocity
Additionally, for the base case, you are required to demonstrate grid independence.

The order that tasks are to be completed during this assignment is more or less predefined by the nature
of the work you are asked to complete, and falls under the following headers:
o
o
o
o
o

Geometry Definition
Grid Generation
Computation
Post-processing and Visualization
Report preparation

The sections that follow are similarly organized around these themes. In summary, for the first two
sections (Geometry Definition and Grid Generation), you are asked to define an aneurysm geometry
(an idealised basilar bifurcation) by combining straight lines (for the vessels) and by placing an ellipseshaped aneurysm in place, and then to construct a mesh.
The third part (Computation) explains how the solver should be setup and provides the pertinent
elements of the theory behind the numerical solver. Visualization, which is described in a very
rudimentary fashion, involves examining the flow fields obtained. This latter section is, truly, open to
interpretation: we would like you to show initiative and explore alternative ways to interrogate and
compare your results. Finally, your report must capture all of the above. Exercise judgment what to
include and what to reference only or outright exclude form your report. A common mistake such
reports suffer from is inclusion of software-specific trivialities (like menu snapshots): remember that an
important aspect that any report should convey is reproducibility, and this involves the capacity to
repeat a study using different tools. Place emphasis on governing equations and formal algorithms, not
on software-specific terminology.

Geometry Definition and Grid Generation

You shall use the programme CFD-GEOM for this task.
Build a main vasculature branch (resembling the basilar bifurcation) that looks like this:
1.0mm

130 o

1.5mm
10mm

`
1.0mm

This geometry must be perfectly symmetric top-to-bottom, but do not use symmetry boundary
conditions in the solver. The dimensions given are enough to construct this geometry.
Then introduce an ellipse, with Major Radius: 4.5 mm and Minor Radius: 3.5 mm and place it as in the
figure:

1.0mm

130o

1.5mm
10mm

1.0mm

Conduct the necessary splitting/joining/intersection operations to end up with the following geometry:
1.0mm

130 o

1.5mm
10mm

1.0mm

Finally, construct an unstructured triangular mesh with roughly 10,000 - 20,000 elements. You will be
required to construct more than one mesh, to demonstrate grid independence.

Computation
You shall use the programme CFD-ACE+ for this task.

Introduction to CFDACE+1
CFDACE+ is a Computational Fluid Dynamics (CFD) and Multiphysics solver. In the sequel, a short
description of the main functionality of the particular software is given.
Flow Module
Although CFD-ACE+ has many physical modules or models, we will only concentrate on the Flow
module. The Flow module is the heart of CFD-ACE+ and is used in most simulations. It enables the
user to model virtually any gas or liquid system. When coupled with other modules, like
chemistry/mixing, stress, twofluid, this can be used to solve biological problems e.g. drug delivery,
vascular device performance, biological transport. Both internal and external flows, at any speed, can
be simulated yielding numerical solutions of the pressure and velocity fields.
Flow Module Theory
The governing equations for the Flow Module are based on mathematical statements of the
conservation laws of physics for flow:
Fluid mass is conserved, meaning that the system does not lose or gain mass;
The rate of change of momentum equals the sum of the forces on the fluid (Newtons Second
Law of Motion).
Mass Conservation
Conservation of mass requires that the rate of change of mass, in a control volume system, is balanced
by the net mass flow into the same control volume (outflowinflow). Mathematically this is expressed
by:

( V ) 0
(1)
t

where /t is the rate of change of massdensity (mass per unit volume) and ( V) is the convective
term that constitutes the net mass flow across the control volumes boundaries.
Momentum Conservation
The xcomponent of the momentum equation, used in CFD-ACE+, is obtained by setting the rate of
change of xmomentum of the fluid particle equal to the total force in the xdirection on the fluid
particle equal to the total force in the xdirection on the element due to surface stresses plus the rate of
increase of xmomentum due to sources:

( p xx ) yx zx
(u)
( V u)

SM x
t
x
y
z

Similarly, the ycomponent of the momentum equation is given by:

CFD-ACE+ is a registered trademark of the ESI Group

(2a)


xy ( p yy ) zy
(v)
( V v)

SM y
t
x
y
z

(2b)

Finally, the zcomponent of the momentum equation is:

yz ( p zz )

(w)
( V w) xz

SM z
t
x
y
z

(2c)

where is shear stress, p is pressure and SM is the momentum source term. Note, that when dealing
with 2D problems, the latter equation is not used. The above system of conservation laws is generically
called the Navier-Stokes Equations.
i

Numerical Methods: Finite Volume Method [2]

CFD-ACE+ is a pressure correction-based Finite Volume Method (FVM) NavierStokes equation flow
solver. Briefly, the finite volume method is probably the mostwell established and thoroughly
validated general purpose CFD technique. The numerical algorithm rests on the following steps:

Integration of the governing equations of fluid flow over the (finite) control volume (cells) of
the computational domain;
Discretisation involves the substitution of a variety of finitedifferencetype approximations for
the terms in the integrated equations expressing flow processes such as convection, diffusion,
and source terms. This process transforms the integral equations into a set of algebraic
equations;
Solution of the algebraic equations is attained using an iterative approach.

The Newtonian Case

Procedure:
After you have defined the geometry of the aneurysm in GEOM and converted the .GGD file, using the
CFDToolkit, into a .DTF file (a simple format filter) you will select the physical and chemical
phenomena relevant to the problem, assign appropriate boundary conditions, and solve the problem.
The subsequent section will guide you through.
Here are some of the parameters you will need:

Blood mass density, Blood = 1060 kg/m3

Constant (Dynamic) viscosity, Dynamic = 0.00357 kg/ms

Inlet velocity:
o Base case (physiological flow), Vinlet = 0.27 m/s
o Abnormally high flow case, Vinlet = 10 m/s

The following describes the step necessary to define the coiled section:

Change the VC setting mode from

Properties to Porous Media.
Use the model explorer to select the
Volume Condition corresponding to the
Aneurysm.
Tick the porous media checkbox.
Set the Linear Resistance Porosity to
0.8
Set the Linear Resistance Permeability
to 1.0E-8 m2

A recommendation regarding Solver Control Settings is offered here; feel free to explore other options.
The only strict requirement is to use the Central Differencing Scheme (and to achieve converged
solutions of course!)
Press the Solver Conditions [SC] tab to
activate the Solver Condition setting
page.
In the Iteration tab:
Set the Max. Iterations to 4000;
Set the Convergence Crit. to 1E18
Set the Min. Residual to 1E-18

In the Spatial Differencing tab set the

Spatial Differencing Velocity to the
Central scheme assigning a Blending
value of 0.1.

10

In the Solver tab under the Solvers

window:
Set the Velocity to AMG
(Algebraic Multigrid) to 5 Sweeps
with the Criterion of 0.01
Assign the P Correction again to the
AMG option, to 10 Sweeps with the
Criterion being 0.1

Under the Relaxation tab set the Inertial

Relaxation Velocities to 0.1.
Keep the Linear Relaxation Pressure,
Density, and Viscosity to 1.

Ensure the Limits window set the

Density limit to 1E-6 (min.) and 1E+20
(max.) respectively. Fix the Viscosity
limits (if necessary) from 1E-10 (min.)
to 100 (max.). Keep the U, V, and
Pressure limits to their default values of
1E+20 and 1E+20.

In the Advanced tab keep the values as

they appear on the RHS Figure.

11

A recommendation regarding Output Settings feel free to explore other options:

Select the Output
Window. In the Output
tab under the Steady State
Results and in the Output
Results option select the
End of Simulation.
Ensure that the box next
to Write Restart solution
Data is ticked.
Tick the User Sub(uout)
box. ** Only apply this
for using subroutine
subr.dll **
Select the Print tab and
check the Mass Flux
Summary and Include
Interfaces check boxes.

12

Under the Graphic tab, in

the Flow, select the
Velocity Vector, Velocity
Magnitude, Static Pressure
Laminar Viscosity, Stream
Function and Strain Rate.
If you have applied the
porous media condition,
also check the Porosity
tick box.

Once all the settings are in place, you are ready to conduct your simulations. The following figure
shows how a residuals plot should look like for a fully converged solution.

13

The NonNewtonian Case

Newtonian vs. NonNewtonian Fluids
A Newtonian fluid is a fluid whose shear stress is linearly proportional to the velocity gradient in the
direction perpendicular to the plane of shear. This constant of proportionality, usually denoted by or
, as seen in equation (4), is known as the absolute viscosity (or fluidity), and has units of kg/ms.
u

y

(4)

Water and air are the most common examples of Newtonian fluids. However, not all fluids exhibit
Newtonian behaviour. For example, in some fluids, like blood, paint, or toothpaste, viscosity varies
with applied strain rate. These fluids are termed as NonNewtonian or rheological fluids.
Concomitantly, nonNewtonian fluids may not be characterised by a welldefined viscosity. As a
result the concept of viscosity fails to capture the mechanical behaviour of these fluids. Instead, such
substances are analysed using several other rheological properties associated with the relations between
the stress and strain tensors under different flow conditions, such as oscillatory shear, or extensional
flow quantified via different devices or rheometers. NonNewtonian rheological properties are better
studied using tensorvalued constitutive equations, commonly used in continuum mechanics. It is
interesting to note that blood exhibits shear thinning or pseudoplastic behaviour. One of the most
important properties of blood is its ability to precipitously reduce its viscosity (shear thinning), as a
function of vessel diameter and shear stress. This attribute enables blood to reach the smallest
capillaries, and is known as the FahraeusLindqvist effect. However, when the erythrocyte size
becomes comparable to the capillary diameter the latter behaviour is reversed.
Blood Power Law [3]
Due to the NonNewtonian nature of blood it will very illuminating to run the same simulation but this
time modelling the particulate nature of blood. As explained earlier the major difference between a
Newtonian and a nonNewtonian fluid is that in the latter the shear stress () is not directly
proportional to the fluids rate of deformation (u/y). Although CFD-ACE+ offers a variety of
mathematical relationships (and laws) that model blood behaviour we will only deal with the Power
Law (Blood). DO NOT CONFUSE THE NON_NEWTONIAN RHEOLOGY POWER LAW
WITH THE NUMERICAL SCHEME FOR CONVECTION WITH THE SAME NAME! The
model is given by:

n 1

where

b
( ) exp 1 exp

and

d
n( ) n n exp 1 exp

c

where:
= the local calculated shear stress
14

(5)

 = the consistency constant

= 0.035 (Default) [The limiting (Newtonian) viscosity]
= 0.25 (Default)
a = 50 (Default)
b = 3 (Default)
c = 50 (Default)
d = 4 (Default)
Procedure
To setup the NonNewtonian case you need to base your simulation on the Newtonian base case, to
facilitate convergence. Follow the instructions:
1. Specify the Power Law in the Volume Conditions
In the Volume Conditions (VC) window
press the Fluid tab. Select the Power Law
(Blood) the default values (as specified above
and in the image to the right) are acceptable
for this simulation.
Press apply.

15

2. Specify the Initial Conditions

Press the Initial Conditions [IC] tab to
activate the Initial Condition setting page.
Under the IC Option go the Restart
Filename and click on Browse. Go on to
locate the previously solved (Newtonian)
model file and set the IC Applied For All
Volumes

Click on the Run window and press Submit to Solver. Press Submit Job Under Current Name and the
simulation will begin.

Important Notes
Grid Independence: You must compute an appropriate number of meshes to demonstrate that your
results are real and not an artefact of discretisation. Exercise judgement (and literature review)
regarding how best to achieve this and how many meshes you need to include.
Abnormally high inlet velocity: You may experience problems trying to get converged solutions for
this case. A recommendation offered is to compute the Reynolds number (which you should do
anyway, since this is imperative to be outlined in your report) and take a hint regarding what you need
to do to obtain a solution for that flow condition.

16

PostProcessing
You shall use the programme CFD-VIEW for this stage.
One of the challenges in computational modelling is that each simulation generates a vast volume of
data that needs to be manipulated to extract useful information that can be applied to practical science
and engineering problems. For this purpose we are going to use CFDVIEW, which is a 3D graphical
postprocessor.
The number of plots and comparisons you can generate from your simulations results is practically
infinite. Some recommendations include: streamlines, velocity vectors, flooded or contoured
distributions of quantities like velocity magnitude, pressure, shear etc. Possibly more interesting, a
critical comparison between parameters across different cases and composite figures that show, for
example, how flow changes in the aneurysm when the sack is coiled, is to be pursued.

Preparing the report

We shall follow (strictly) the guidelines of IEEE Transactions on Medical Imaging for formatting the
report/paper. You will find all the relevant information on http://www.ieee-tmi.org/authors/submit-amanuscript.asp, including template Word files for fast formatting.
The webpage above includes a link for submitting a paper to the journal for review - Do not submit
your paper to the journal!!! Instead:
Produce a pdf
Upload it on MOODLE
Print it
Hand it in at the Departmental Reception
All before by the deadline!
The maximum size of your report is 10 pages, all inclusive. Do not exceed this limit.
Your report is expected to include a brief Introduction where you describe computational work reported
on the literature involving aneurysms, a Methods section where you outline the numerical analysis
features of the techniques you used; the bulk of your report will of course include your results figures
and a critical discussion of that the figures show. Other elements (Abstract etc.) must abide to the
specification discussed above.
To facilitate and exemplify, a typical IEEE TMI paper (on a topic very relevant to this assignment) is
included at the end of this handout.

References
[1] CFDACE Modules Manual
[2] Versteeg HK, Malalasekera W. (1995) Introduction to CFD. The finite volume method
[3] Ballyk PD, Steinman DA and Ethier CR. (1994). Simulation of NonNewtonian Blood
Flow in an EndtoSide Anastomosis, Biorheology, 31: 565586.
17

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IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 27, NO. 6, JUNE 2008

The Haemodynamics of Endovascular Aneurysm

Treatment: A Computational Modelling Approach for
Estimating the Influence of Multiple Coil Deployment
Nikolaos M. P. Kakalis, Aristotelis P. Mitsos, James V. Byrne, and Yiannis Ventikos*

AbstractThis paper proposes a novel computational methodology for modelling the haemodynamic effects of endovascular
coil embolization for cerebral aneurysms. We employ high-resolution 3-D angiographic data to reconstruct the intracranial
geometry and we model the coiled part of the aneurysm as a
porous medium, with porosity decreasing as coils are inserted.
The actual dimensions of the coils employed are used to determine
the characteristics of the porous medium. Simulation results for
saccular aneurysms from the anterior communicating and middle
cerebral arteries show that insertion of coils rapidly changes intraaneurysmal blood flow and causes reduction in mural pressure
and blood velocity up to stagnation, providing favorable conditions
for thrombus formation and obliteration of the aneurysm.
Index TermsCerebral aneurysms, computational haemodynamics, embolization, porous media, rotational angiography.

I. INTRODUCTION
EREBRAL aneurysms are pathological dilations of a
vessel wall which cause the formation of a thin-walled
sac, usually at a branching point of arteries at the base of the
brain. Such aneurysms are liable to rupture causing spontaneous intracranial bleeding. Because of the special location of
aneurysms, such bleeding causes subarachnoid haemorrhage
and may result in death or severe morbidity to the individual.
Approximately 30% of all aneurysm ruptures are immediately
lethal and an additional 30% lead to death within four weeks
if not treated effectively [1], [2]. Intracranial aneurysms are
relatively common and they are estimated to occur in 1%6% of
the general population [3], though the majority remain asymptomatic. To date, the prevailing treatment technique for ruptured
and many of the unruptured aneurysms is endovascular coil
embolization [4], [5]. This minimally invasive method involves
navigation of a microcatheter under X-ray guidance through
the vasculature into the target cerebral aneurysm and then
releasing detachable platinum coils within the aneurysm sac

Manuscript received September 28, 2007; revised December 4, 2007. The

work of J. V. Byrne and Y. Ventikos was supported by the @neurIST project
(Sixth EU Framework Programme, Information Society Technologies). Asterisk
indicates corresponding author.
N. M. P. Kakalis is with the Department of Engineering Science and the Institute of Biomedical Engineering, University of Oxford, Oxford OX1 3PJ, U.K.
A. P. Mitsos and J. V. Byrne are with the Department of Neuroradiology,
University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, U.K.
*Y. Ventikos is with the Department of Engineering Science and the Institute
of Biomedical Engineering, University of Oxford, Parks Road, Oxford OX1 3PJ,
U.K. (e-mail: yiannis.ventikos@eng.ox.ac.uk).
Color versions of one or more of the figures in this paper are available online
at http://ieeexplore.ieee.org.
Digital Object Identifier 10.1109/TMI.2008.915549

[6]. The coils promote intrasaccular blood thrombosis isolating

the aneurysm from the patients circulation and preventing
future bleeding and aneurysm growth.
Blood flow dynamics are considered to be an important aetiological factor in the pathogenesis of aneurysms [7] and effective
treatment depends on altering the haemodynamics, for instance,
by obstructing the flow within the sac. Haemodynamic parameters such as pressure, wall shear stress, velocity, and residence
time, have been implicated in aneurysm growth and rupture [8]
and their local control may determine the success of endovascular therapies like coiling [9], [10]. Computational fluid dynamics (CFD) techniques have been used to model and simulate
blood flow, in order to study aneurysm pathogenesis and to improve treatment strategies. Previous reports of CFD simulations
have shown that the most important factor for accurate calculation of intraaneurysmal flow patterns is aneurysm geometry
[11]. Improvements in medical imaging can now provide data
for detailed depiction of the brain and cerebral blood vessels. To
harness the potential of computer-based imaging, much research
has been invested in simulating aneurysms using patient-specific angiographic information; see, for instance, Butty et al. [2],
Steinman et al. [7], Chatziprodromou et al. [12], Castro et al.
[13].
Of equal importance with simulating the blood flow dynamics
in real-case cerebral aneurysms, is modelling and simulation of
the local changes in the haemodynamic conditions induced by
endovascular treatment techniques. Jou et al. [14] studied the
haemodynamics within a fusiform basilar artery aneurysm before and after the simulated occlusion of one vertebral artery.
Hassan et al. [15] used CFD to simulate the haemodynamic effects of parent vessel occlusion for the treatment of a giant vertebrobasilar aneurysm. For the coil embolization method, Groden
et al. [16] simulated the coiling process of an idealized geometrical model, where the coils were represented by blocked cells
in the aneurysm lumen mesh. They found that coils immediately relieved the influx of pulsating blood flow. Furthermore,
they estimated that to achieve permanent occlusion and stable
clot formation, at least 20% of the aneurysm volume needs to
be replaced by coil mesh.
In this paper, we introduce a novel computational methodology for patient-specific modelling of endovascular coil embolization, to describe the haemodynamic behavior of the combined vasculature/catheter system during the stages of coil introduction to an aneurysm sac. The anatomically accurate vasculature geometry is reconstructed by employing 3-D rotational angiography datasets and we model the coiled part of the aneurysm

0278-0062/$25.00 2008 IEEE

KAKALIS et al.: THE HAEMODYNAMICS OF ENDOVASCULAR ANEURYSM TREATMENT

815

two sections, we describe the specific modelling of the geometry

and the haemodynamic changes induced during the treatment in
anatomically accurate cases.
B. Anatomically Accurate Modelling of Cerebral Aneurysms

Fig. 1. Angiograph image of cerebral aneurysm coil embolization. The

aneurysm sac is filled with platinum coils via a microcatheter that has been
guided through the patients vasculature.

as a porous medium of decreasing porosity as coils are deployed.

By using a realistic representation of the morphology and of
the effects of aneurysm coiling, we have attempted to simulate
real-time conditions during endovascular treatment of a series
of different ruptured anterior communicating and middle cerebral artery aneurysms.
II. METHODS
A. Overview
The coiling process during the endovascular embolization of
cerebral aneurysms involves the release of platinum coils delivered into the aneurysm sac through the lumen using a microcatheter. A snapshot from a typical coiling embolization procedure is shown in Fig. 1. The coils are manufactured with a shape
memory which causes them to form a sphere of predetermined
diameter when released inside the aneurysm sac (usually of volumes of the order of 10-7 m or less). The coils have typical
lengths of 0.020.3 m and diameter of 0.00025 m, with shorter
coils being used in small aneurysms and for filling the space
within an initial basket of longer coils. The coils are deployed
one after the other and gradually form a uniform network of tiny
spiral tubes inside the sac. This network imposes an increasing
obstruction to circulating blood flow within the available free
space. As blood flow velocity is reduced, the stagnating blood
will thrombose on the surface of the coils and subsequently in
the whole aneurysm volume to fill the gaps between the metal
struts of each coil. Prevention of premature formation of clot,
which would impede in the insertion of further coils and thus
lead to suboptimal thrombus packing and stability, is achieved
by the concurrent administration of anticoagulants (e.g., heparin) during the intervention [17].
Based on the aforementioned characteristics of the process,
we model the coiled part of the aneurysm as a porous medium.
The aneurysm lumen is split in two parts: a pure fluid (blood)
region corresponding to the coil-free part and a porous one corresponding to the actual coiled aneurysmal volume. In the next

In this work, we consider the system of the aneurysm lumen

and surrounding vasculature and we perform patient-specific
computational modelling of its haemodynamic behavior. We
utilize a porous media approach to model the presence of the
coil, which is a novel idea to the simulation of such interventions. We demonstrate the capacity of the method to incorporate the influence of complex interventional devices; in one of
the cases computed we include the microcatheter used to implant the coil, with its tip placed and maintained at a central coil
release position within the sac. Our approach consists of the following steps.
Step 1) Construction of the anatomically accurate vasculature geometry of interest.
a) A set of medical images of the patients cerebral region of interest (aneurysm and adjacent
arteries) is obtained using 3-D magnetic resonance imaging, computer tomography, or
X-ray rotational angiography.
b) A 2-D image stack is processed (i.e., cleaned
and, if necessary, simplified) and then segmented to provide an adequately fine surface
description.
c) If an implantation device is to be included in the
simulation, the geometry of the microcatheter
is virtually inserted and placed to a characteristic coil release position.
d) The combined, lumen-catheter, 3-D domain is
subsequently discretized into an unstructured
tetrahedral volume grid.
Step 2) A haemodynamic model is generated to describe the
flow, pressure and force fields of the system as a
function of time in the cardiac cycle.
As the anatomically derived vasculature is considered here,
we are interested in the patient-specific local conditions that develop. In order to predict this complex behavior, we perform
detailed modelling by discretizing the system (Step 1-d) in an
adequately large number of tetrahedral elements. Tetrahedral
grids offer flexibility in terms of capturing complex geometric
features and speed in mesh generation. The prevailing phenomenon is blood transport; the mathematical model that describes
its dynamic behavior (Step 2) consists of the mass and momentum balance of the system, i.e., the NavierStokes equations
in three dimensions, accompanied by continuity. No biochemical interactions are considered. Note that different variations of
this procedure have also been used in similar studies for pure
aneurysms (i.e., without coils or catheters) modelling [7], [18],
[19]. For the numerical solution of the blood flow in question we
use the CFD-ACE+ package by the ESI Group (Paris, France).
C. Endovascular Coiling Modelling via Porous Media
In this methodology, we model the system of the detachable
coils in the aneurysm volume as a porous medium. This novel

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IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 27, NO. 6, JUNE 2008

approach is a good approximation considering the statistical

uniformity of the process and the relative scales involved (for an
example, see Fig. 1). Mathematical models describing transport
phenomena through porous regions depend on a set of constitutive characteristics of the porous medium, and in particular, the
porosity and the inverse permeability of the porous medium, as
well as the drag factor along the porous flow. The porosity of
the medium represents the volume occupied by the pores to the
total volume of the system. In the context of this work, porosity
is given as a function of the occluded volume according to the
expression
(1)
where NC is the number of coils placed in the aneurysm lumen,
is the volume of the th coil, and
the total volume of
the aneurysm given by
, with
, and the leading dimensions of the aneurysm. The latter
is known to be a problematic way to assess aneurysm volume
(reconstruction-based volumetry is currently proposed as the
method of choice); however, we chose to base our occlusion
quantification on this metric since this is the one currently in
use in clinical practice worldwide.
The permeability, , is a measure of the fluid conductivity
through the porous medium, representing the surface area to
volume ratio of the porous matrix. To approximate the permeability of a porous medium, among various models proposed
in the literature, here we consider a simplified expression
based on the capillary theory of Kozeny. In this approach, the
porous medium is approximated as a layer of solid material
with straight parallel tubes of a fixed cross-sectional shape
intersecting the sample [20]. The permeability in this case is
given as
(2)
where is the Kozeny coefficient depending on the cross section
. is the specific
of the capillaries; for circular cylinders
surface area of the medium defined as the ratio of the interstitial surface area (i.e., the internal surface area of the pores) to
the total volume of the aneurysm. For the porous part of the
systems geometry, the classical NavierStokes equations are
henceforth recast as [21], [22]
(3)

(4)
where
is the pressure of a fluid of density and dynamic
.
viscosity , flowing with velocity vector of magnitude
is the shear stress tensor, is a body force vector acting as
momentum source, and denotes time. Note that for
and
the standard NavierStokes equations are recovered,
corresponding to pure fluid regions.
The remaining piece of information along the porous flow
. To calculate the
for
to be specified is the drag factor,

Fig. 2. Anatomically derived representation of the aneurysm lumen and the

catheter at a characteristic coil release position.

the blood flow in an aneurysm filled with coils, we assume that

locally the flow is perpendicular to an infinite-length cylinder.
This is a reasonable assumption considering that the diameter of
m and the aforementioned
a typical coil is of the order of
PDE is solved on a cell-by-cell basis. Hence, calculating an approximate value for the local Reynolds number,
where is the coil diameter and
an average intraaneurysmal
by using standard
blood velocity, one can determine
versus Re diagrams [23].
III. RESULTS AND DISCUSSION
A. Test System
To demonstrate the capabilities of the methodology, we
model and analyze the coil embolization of an aneurysm of
particular interest. A 36-year-old Caucasian female of good
clinical grade, presented extended subarachnoid haemorrhage
after the rupture of an intracranial aneurysm. The aneurysm was
originated from the anterior communicating artery (ACoA),
with a large sac of dimensions 11 9.4 7.8 mm, and a neck,
5.2 mm (see the aneurysm geometry in Fig. 2). The presumed
rupture point was identified as a bulge at the sac dome (i.e., at
the fundus). Its large volume and wide neck underpins the clinical interest of this case because such a geometry is associated
with an increased treatment complexity and risk of recurrence
after coil embolization [24]. In such circumstances, the risk of
aneurysm rupture during the coiling process is not insignificant
and many interventionists believe that this risk becomes significantly lower after the deployment of the first coil. Moreover,
in aneurysm geometries such as the above, quite often the
physician may decide to leave a small remnant at the neck
in order to secure the undisturbed flow across the important
distal anterior cerebral arteries. Sometimes, this neck remnant
becomes a matter of concern for the stability of endovascular
aneurysm treatment [25][27] regarding coil compaction and
aneurysm regrowth [28]. In this study, we attempt to shed light
on such issues from the point of the haemodynamic changes
induced in the system after the deployment of the first coil,

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817

TABLE I
COILING PROCEDURE FOR THE OCCLUSION OF AN ANEURYSM
OF DIMENSIONS 9.4 7.8 11 MM

2 2

Fig. 3. Partition of the aneurysm volume into a porous medium (blue) and a
pure fluid part (red).
TABLE II
POROSITY CHARACTERISTICS OF AN ANEURYSM
OF DIMENSIONS 9.4 7.8 11 MM

2 2

during the intermediate coiling process (after the seventh coil),

as well as after having completed the procedure (after the 15th
coil). These correspond to 3.6% packing by volume (porosity
0.964), 19.2% packing (porosity 0.808), and 26.5% packing
(porosity 0.735), respectively (Table I).
B. Patient-Specific Model Construction
The anatomically derived representation of the above ACoA
aneurysm is based on the imaging data acquired using 3-D
rotational digital subtraction angiography (DSA) on a Siemens
Axiom-Artis system. The image stack consists of 231 slices of
256 256 pixels resolution. The images are processed using
Amira 3.1 (Visage Imaging, Carlsbad, CA). The region of
interest was narrowed to a bounding volume of approximate
dimensions 63 53 54 pixels, smaller vessels with lower
resolution were removed and a surface mesh was created based
on unconstrained smoothing of the volume. The mesh was
then imported into Gambit 2.2.30 (Fluent Inc., Lebanon, NH)
for volume discretization. To model the aneurysm and the
surrounding vessels without the catheter, the vessel volume was
meshed using an unstructured triangular grid on its surfaces,
and an unstructured tetrahedral grid for the inner volume. To
model the catheter, appropriate discrete points within the vessel
were chosen, and a circular face of diameter 0.65 mm was
swept along a NURBs, interpolated through the points. The
catheter volume was then subtracted from the vessel, and using
a finer grid on the catheter surface the remaining volume was
meshed with tetrahedral elements. Fig. 2 shows the resulting
anatomically accurate representation of the aneurysm lumen
and the catheter at a characteristic position for coil release.
C. Coiling Modelling
In Fig. 3, we illustrate the partition of the aneurysm volume
into porous and pure fluid regions. The blue region is filled with

the porous medium and corresponds to the coiled part of the

aneurysm whereas the red one to the pure fluid part. The thin
green area appearing at the interface corresponds to a small transitory part on the volume in which the porosity is smoothed to 1
(porosity 1 corresponds to pure fluid or no coiled volume). Note
that an appropriate neck remnant has been taken into account,
as a possible clinical practice scenario for aneurysm geometries
of this type.
For the specific aneurysm, in Table I we present a typical
coiling procedure for adequate occlusion, reflecting the choice
of coil series we have actually used in practice. Making the appropriate coil selection, after a series of 15 coils have been deployed, a packing density of 26.5% has been achieved, representing a level that is considered sufficient for a stable result
[29], [30].
Following the above analysis, in Table II, we provide the
porosity, interstitial surface area and permeability values along
the coiling process. Note that in this case the leading dimensions
mm,
mm, and
mm,
of the aneurysm are
giving a total volume of
m .
Considering that all used coils (10 Series, Boston Scim and assuming
entific) have a diameter of
kg/m , viscosity
that blood has density
kg/m s and average velocity of
m/s, the corre. From
sponding local Reynolds number is taken to be
versus Re diagrams [23], it can be derived that
standard
a statistically meaningful drag factor in the porous medium is
.

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Fig. 5. Quantitative comparison of 0.5 and 1.0 M meshes on velocity magnitude after the placement of the seventh coil. The graphs correspond to two
perpendicular lines along the aneurysm and the parent vasculature.

Fig. 4. Qualitative comparison of 0.5 and 1.0 M meshes on velocity magnitude

contours after the placement of the seventh coil. (a) 0.5 M grid. (b) 1.0 M grid.

D. Resolution Dependence
Computations with two different grids for the system volume
have been performed to investigate the grid independence of the
results obtained. Grids consisting of 510 985 and 950 652 tetrahedral elements were used, subsequently denoted as 0.5 and 1.0
M, respectively. Fig. 4 shows velocity magnitude contours after
the placement of the seventh coil. The two meshes yield visually
indistinguishable results. In Fig. 5, we present a detailed quantitative comparison at the same conditions. The graphs correspond to two perpendicular lines along the aneurysm and the
parent vessels. The average difference is below 5% with the
maximum under 10%. This maximum is observed in the very
high velocity regions of the parent vasculature. In the coiled
part, where the focus of this paper is, the results are almost identical. Since the objective of this study is to demonstrate that such
an approach can lead to clinically meaningful and useful results,
computational speed and turnaround time are imperative. Therefore, the 0.5 M grid is deemed sufficient for the purposes of this
study, since it captures all the features of the stagnant flow in
the coiled region.
It should be noted that modelling coiled volumes using a
porosity approach, as described here, offers benefits in terms
of consistency and grid independence, when compared with
methodologies that describe the coils either via blocked cells or
through full resolution of the near-coil environment. Although
the latter is an accurate and consistent approach, that has been
used with success in the modelling of open stents, the resolution
requirements for capturing the significantly longer coil lengths

Fig. 6. Velocity magnitude contours (m/s) for (a) coil-free, and after the deployment of the (b) first, (c) seventh, and (d) 15th coil conditions.

render this approach prohibitingly expensive. In any case, it can

be argued that such approaches converge to grid-independent
solutions only when the fluid dynamics around the actual wire
cross section are resolved; as discussed here and in other works,
this is impossible computationally for fully coiled aneurysms.
The porosity approach, being of a statistically distributed
nature, eliminates the uncertainty introduced by the level of
local grid refinement around individual coils and is therefore
computationally efficient and self-consistent, since it can lead
to grid-independent solutions, as shown above.

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819

Fig. 7. Surface pressure contours (Pa) for (a) coil-free, and after the deployment of the (b) first, (c) seventh, and (d) 15th coil conditions.

E. Computational Haemodynamics
For the case simulated here, certain assumptions were made,
namely noncompliant walls, Newtonian behavior for the blood,
with constant viscosity and steady flow, all corresponding to
simplifications of the realistic flow. Out of these assumptions,
the latter is the most serious and the one in need of further clarification. Although pulsatile flow would provide a more realistic
representation of the fluid dynamics along the cardiac cycle, in
this work we are interested in the relative changes of the local
haemodynamic parameters along the various steps of the coiling
process. In addition, porous media have the tendency to damp
unsteadiness [31]. In a pulsatile environment, therefore, we expect the interior of the coiled region to exhibit less pronounced
transient effects (preliminary data from new computations are
confirming this assertion). Hence, and along the same argumentation lines of clinical relevance and usefulness, the significantly
less computationally intensive steady-state calculations are sufficient to provide all the required information for this work.
Under these conditions, blood flow was modelled using the
CFD-ACE+ platform (ESI Group, Paris, France) by specifying
kg/m and constant
a Newtonian liquid of density
dynamic viscosity
kg/m s. Applying a constant
normal velocity of 0.1 m/s to the inlet, the simulation was
run using an inlet diameter of 6.98 mm, yielding a Reynolds
number of 213 at the inlet up to 363 close to the aneurysm. The

latter conditions are consistent to Ujiie et al. [32] that report

the Reynolds numbers in ACoAs to vary from 150 to 600.
Constant pressure outlets (properly scaled in length to make
such an assumption realistic), and no-slip condition on vessel
and catheter walls close the system. We employ a colocated
cell-centred variable scheme along with second-order central differencing for the spatial derivatives. Pressure-velocity
coupling is achieved via the SIMPLEC approach [33] and
algebraic multigrid acceleration is used to enhance the speed
of convergence [34].
In Fig. 6, we present velocity magnitude contours before and
during the coiling process for a representative section including
the aneurysm lumen and the two surrounding vessels. Coiling
has a significant effect on local haemodynamics from the deployment of the very first coil. The velocity profiles change and
the gradual introduction of coils inside the aneurysm sac results
in rapid decrease of the velocity up to stagnation, thus providing
an ideal haemodynamic environment for thrombus formation.
For instance, at a specific point inside the aneurysm dome, the
deployment of the first coil results in 91% decrease of blood velocity magnitude, after the seventh coil the velocity is reduced
by 97% and after the 15th coil by 99%. This behavior is the
result of purely haemodynamic effects. Note, also, that no significant changes are observed outside the coiled region (see,
for instance, the small vortex at the upper right side of all sections in Fig. 6). Notable blood flow is observed at the aneurysm

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IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 27, NO. 6, JUNE 2008

Fig. 8. Characteristic pathlines for (a) coil-free, and after the deployment of the (b) first, (c) seventh, and (c) the 15th coil conditions.

lumen through the coil-mesh interface, even after completing

the coiling [cf. Fig. 6(d)] which may contribute to the, frequently
seen in such wide-necked aneurysms, future coil compaction
and aneurysm recanalization. This is a realistic representation of
the clinical situation, as the coil-mesh is not acting as an absolute
solid barrier between the aneurysm lumen and the parent vessels but rather obstructs and gradually slows the intraaneurysmal
blood flow circulation.
Fig. 7 shows wall pressure contours before and during coiling
where pressure redistribution is observed. The high pressure
along the aneurysm dome wall at the beginning of the intervention [see Fig. 7(a)] is relieved with coiling, for this particular case. Endovascular embolization, hence, often has an immediate protective effect, as this is the area most susceptible
to a new rupture during the treatment. As the coiling evolves,
there are no significant differences in the pressure distribution
of the aneurysm wall; rather a damping effect on the amplitude
of pressure oscillations would be expected. This is in agreement
with idealized-model CFD findings [16] and canine studies [35].
However, a high-pressure area is detected at the vascular wall
around the neck remnant. This area at the neck remnant is found
to enlarge, and persists after completion of the coiling. This
finding is important as the high pressure at the area of aneurysm
remnant, may play an important role in future aneurysm regrowth.

Fig. 8 presents characteristic pathlines before and during

coiling. Before any coil is inserted into the aneurysm sac, a
clearly complex vortical structure is observed [Fig. 8(a)]. The
placement of the first coil alters significantly the fluid flow
[Fig. 8(b)]. The coil, as distributed in the aneurysm during
implantation, destroys the complex vortex, organizing the flow
in better behaving, concentrated inlet/outlet patterns. This
behavior is characteristic of porous media flows. As coiling
proceeds, the fluid flow pattern converges and the introduction
of more coils has a less pronounced effect on the flow structure.
The above findings of immediate reduction in velocity and
pressure, and the organized flow inside the aneurysm volume
suggest that, from a haemodynamic point of view, the deployment of the first coil creates a favorable intraaneurysmal environment for the next steps of the procedure, altering the blood
flow, velocity, and pressure distributions in a protective way
against a new rupture at the aneurysm dome. Our findings support clinical practice that considers the deployment of the first
coil to be of critical importance after which the process becomes much safer [6], [36][38]. These haemodynamic conditions are sustained and become more stable during the next
steps of coiling, providing optimal conditions for flow stagnation and thrombus formation, thus leading to the obliteration of
the aneurysm. The results are also consistent with in vivo and in
vitro studies [9], [35], [39], [40].

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TABLE III
POROSITY CHARACTERISTICS FOR THE MIDDLE CEREBRAL
ARTERY ANEURYSMS

Fig. 9. Geometry and partition of aneurysms into a porous medium (blue) and
a pure fluid part (red) for (a) patient 2, (b) patient 3, and (c) patient 4.

F. Additional Aneurysm Coiling Simulations

To examine the applicability, reliability, and reproducibility
of our approach, we have utilized the methodology to study
several other cerebral aneurysms. For these cases, again, our
goal is to explore the haemodynamic effects of embolization.
We selected to present three additional cases that we shall identify as Patient 2, Patient 3, and Patient 4, reserving the indication Patient 1 for the case discussed above. These saccular
aneurysms are found at the bifurcation of the middle cerebral

artery (MCA). The aneurysm sac of Patient 2 has dimensions

11.3 13.9 13.4 mm, and a wide neck of 9.9 mm. Patients
3 sac has dimensions 21.8 11.3 10.4 mm, and a neck of 5.2
mm, and Patient 4 sac has dimensions 9.1 7.5 6.7 mm, and
a small neck of 1.7 mm. The corresponding geometries with
the surrounding vasculature are shown in Fig. 9. The resulting
aspect (aneurysm depth/neck width) ratios are 1.14, 4.19, and
5.35, respectively, whereas for Patient 1 the aspect ratio is 2.12.
In Fig. 9, the coiled/porous part of each case during the embolization is also highlighted (blue area). Note that a neck remnant has been considered in Patients 2 and 4. We employ the
same initial, boundary and flow conditions, blood properties and
solution algorithms and parameters as in Patient 1. The inlet velocity, however, is set to 0.64 m/s to match typical blood flow
characteristics of MCAs [41]. Here, we report comparative computational haemodynamic results between the coil free conditions and those developed at an intermediate stage of the embolization, at approximately 19% occlusion. In Table III, the
corresponding porosity parameters values are provided.
In Fig. 10, we present velocity magnitude contours before
and during coiling for a representative section from every
aneurysm lumen. In all cases, velocity profiles change in a similar manner with Patient 1. The presence of the coils reorganizes
the, originally, strongly vortical complex flow in a manner that
creates better haemodynamic conditions for blood/coil contact
and, hence, clot nucleation. Despite the different morphology
of each case (e.g., Patient 3 exhibits dysplastic characteristics
of the parent vessel at the aneurysm neck area) the velocity
profiles change and the gradual introduction of coils inside the
aneurysm sac results in rapid decrease of the velocity up to
stagnation. Notable blood flow is also observed at the aneurysm
lumen through the coil-mesh interface.
On a relevant issue, based on experimental studies showing
an increased tendency for rupture-risk morphologies (e.g., bleb,
dumbbell-like) formation in aneurysms having sluggish flow,
Ujiie et al. [42] suggested that flow stagnation might precipitate aneurysm rupture. Such a condition is more likely to occur
. We would
in aneurysms exhibiting high aspect ratio
like to comment that in our simulation series, the computational haemodynamic model predicts such conditions of very
low blood flow areas around the dome area of Patients 3 and 4,
as shown in Figs. 10(c) and (e), whose aspects ratios are 4.19
and 5.35, respectively.
IV. CONCLUSION
This paper has proposed a novel computational methodology
for haemodynamic modelling of the vasculature/catheter system
in endovascular coil embolization. We employ 3-D rotational

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IEEE TRANSACTIONS ON MEDICAL IMAGING, VOL. 27, NO. 6, JUNE 2008

Fig. 10. Velocity magnitude contours for (left) coil-free and (right) intermediate coiling conditions for [(a), (b)] patient 2, [(c), (d)] patient 3, and [(e), (f)]
patient 4.

angiography datasets to reconstruct anatomically derived vasculature geometries and, for select cases, a microcatheter is virtually inserted and placed at a characteristic coil release position. The coiled part of the aneurysm is modelled as a porous
medium of decreasing porosity based on the series of introduced
coils during the embolization. A computational haemodynamic
model simulates the flow, pressure and force fields of the system
at different stages of the coiling process. The results obtained
from modelling the haemodynamic effects of the embolization

on a large ruptured aneurysm at the anterior communicating

artery and on three aneurysms from the middle cerebral artery
of various geometries and sizes show that the porous medium
can be a realistic and computationally tractable representation
of the coil mesh in the context of haemodynamic studies.
The model proposed in this paper presents us with a number
of limitations at its current state of development. Although the
porous medium is a comprehensive, meaningful and easy to use
method, at present it does not account for detailed specificities

KAKALIS et al.: THE HAEMODYNAMICS OF ENDOVASCULAR ANEURYSM TREATMENT

of the coils placement within the patient topology. As it assumes

a uniformly distributed medium, there is lack of information regarding the orientation of the flow correlating to the local implanting patterns of the coil. This shortcoming will be addressed
in the future, since the porosity model employed is in essence
anisotropic and therefore resistance can be sensitized to local
flow parameters. Moreover, the sometimes uneven distribution
of coils in the near-wall region of the aneurysm and the centre
of the dome may have an impact on the results obtained, especially during the first stages of embolization. To increase the
predictive abilities of the method, patient-specific velocity measurements should be considered as well as the possible effects
that unsteadiness and pulsatility may have, especially towards
the neck of the aneurysm. These are challenging enhancements
that will expand the capabilities of this approach to prepare it
for future reliable clinical use.
The insight derived by computational simulation methodologies, like the one described in this paper, provides us with improved understanding of the consequences and risks of planned
interventional treatments. Larger-scale studies are required to
further validate such methods, which are expected to become a
useful future tool in the decision making process and lead to the
development of new techniques and devices. Moreover, practical problems, like adjustment to typical hospital turnaround
times, introduce computational efficiency and user training requirements, that have to be addressed before utilization in a clinical setting is generalized. To increase the accuracy and clinical
relevance of this type of modelling, the mechanisms of thrombosis should be included, in a form that is realistic and computationally efficient. Once this is realized, the strength of such
approaches, stemming from their capacity to rationalize and optimize empirical aspects of the procedure (like administration
and dosage of anticoagulants, order and length of coil deployment and final packing density), will make them valuable tools
for interventional planning.
ACKNOWLEDGMENT
The authors would like to thank the ESI Group and Dr. M.
Megahed for making the CFD-ACE+ platform available to us.
The authors would also like thank Dr. P. Summers for providing
us the angiographic data and Dr. K. Moyle for numerous helpful
suggestions.
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