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What does computational fluid dynamics tell us about intracranial aneurysms? A meta-analysis and critical review

Journal

JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
Volume 40, Issue 5, Pages 1021-1039

Publisher

SAGE PUBLICATIONS INC
DOI: 10.1177/0271678X19854640

Keywords

Cerebral aneurysm; cerebrovascular blood flow; CFD; fluid dynamics; non-Newtonian fluids

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Despite the plethora of published studies on intracranial aneurysms (IAs) hemodynamic using computational fluid dynamics (CFD), limited progress has been made towards understanding the complex physics and biology underlying IA pathophysiology. Guided by 1733 published papers, we review and discuss the contemporary IA hemodynamics paradigm established through two decades of IA CFD simulations. We have traced the historical origins of simplified CFD models which impede the progress of comprehending IA pathology. We also delve into the debate concerning the Newtonian fluid assumption used to represent blood flow computationally. We evidently demonstrate that the Newtonian assumption, used in almost 90% of studies, might be insufficient to describe IA hemodynamics. In addition, some fundamental properties of the Navier-Stokes equation are revisited in supplementary material to highlight some widely spread misconceptions regarding wall shear stress (WSS) and its derivatives. Conclusively, our study draws a roadmap for next-generation IA CFD models to help researchers investigate the pathophysiology of IAs.

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