Influence of carotid tortuosity on the hemodynamics in cerebral aneurysms

Clinical observations indicate that the shape and tortuosity of the carotid siphon are some of the contributing factors to the initiation and growth of an aneurysm. The present study explores the validity of this observation by performing systematic numerical simulations. Computational fluid dynamics (CFD) based calculations are performed to compare and contrast four different types of patient-specific carotid siphons, viz., C-, S-, U-, and helical shape, to investigate the hemodynamic influences on flow features, secondary flow patterns, and helicity. Fewer curved regions and the presence of local acute curvature were found to result in higher velocity magnitude, leading to giant sidewall aneurysms in the distal end of this curvature. In contrast, a larger number of curved regions in the parent vessel resulted in disturbed flow and reduced maximum streamwise velocity. When the velocity is lower, smaller aneurysms are observed at the bifurcation carina. The influence of siphon tortuosity, which is exemplified through the Dean number and linked to secondary flows, causes higher helicity when the vessel is more tortuous. It is hypothesized that a highly tortuous vessel protects the further growth of an aneurysm. This is in contrast to a less tortuous vessel with single acute curvature and prone to further expansile behavior of an aneurysm.