This review aims to explore advancements in perioperative ischemic stroke risk estimation for asymptomatic patients with significant carotid artery stenosis, focusing on Circle of Willis (CoW) morphology based on the CTA or MR diagnostic imaging in the current preoperative diagnostic algorithm. Functional transcranial Doppler (fTCD), near-infrared spectroscopy (NIRS), and optical coherence tomography angiography (OCTA) are discussed in the context of evaluating cerebrovascular reserve capacity and collateral vascular systems, particularly the CoW. These non-invasive diagnostic tools provide additional valuable insights into the cerebral perfusion status. They support biomedical modeling as the gold standard for the prediction of the potential impact of carotid artery stenosis on the hemodynamic changes of cerebral perfusion. Intraoperative risk assessment strategies, including selective shunting, are explored with a focus on CoW variations and their implications for perioperative ischemic stroke and cognitive function decline. By synthesizing these insights, this review underscores the potential of non-invasive diagnostic methods to support clinical decision making and improve asymptomatic patient outcomes by reducing the risk of perioperative ischemic neurological events and preventing further cognitive decline.

Purpose: Intracranial aneurysms are malformations forming bulges on the walls of brain arteries. A flow diverter device is a fine braided wire structure used for the endovascular treatment of brain aneurysms. This work presents a rig and a protocol for the measurement of the hydrodynamic resistance of flow diverter stents. Hydrodynamic resistance is interpreted here as the pressure loss versus volumetric flow rate function through the mesh structure. The difficulty of the measurement is the very low flow rate range and the extreme sensitivity to contamination and disturbances. Methods: Rigorous attention was paid to reproducibility, hence a strict protocol was designed to ensure controlled circumstances and accuracy. Somewhat unusually, the history of the development of the rig, including the pitfalls was included in the paper. In addition to the hydrodynamic resistance measurements, the geometrical properties—metallic surface area, pore density, deployed and unconstrained length and diameter—of the stent deployment were measured. Results: Based on our evaluation method a confidence band can be determined for a given deployment scenario. Collectively analysing the hydrodynamic resistance and the geometric indices, a deeper understanding of an implantation can be obtained. Our results suggest that to correctly interpret the hydrodynamic resistance of a scenario, the deployment length has to be considered. To demonstrate the applicability of the measurement, as a pilot study the results of four intracranial flow diverter stents of two types and sizes have been reported in this work. The results of these measurements even on this small sample size provide valuable information on differences between stent types and deployment scenarios.

Purpose: To develop a method of coronary flow reserve (CFR) calculation derived from three-dimensional (3D) coronary angiographic parameters and intracoronary pressure data during fractional flow reserve (FFR) measurement. Methods: Altogether 19 coronary arteries of 16 native and 3 stented vessels were reconstructed in 3D. The measured distal intracoronary pressures were corrected to the hydrostatic pressure based on the height differences between the levels of the vessel orifice and the sensor position. Classical fluid dynamic equations were applied to calculate the flow during the resting state and vasodilatation based on morphological data and intracoronary pressure values. 3D-derived coronary flow reserve (CFR_p-3D) was defined as the ratio between the calculated hyperemic and the resting flow and was compared to the CFR values simultaneously measured by the Doppler sensor (CFR_Doppler). Results: Haemodynamic calculations using the distal coronary pressures corrected for hydrostatic pressures showed a strong correlation between the individual CFRp-3D values and the CFR_Doppler measurements (r = 0.89, p < 0.0001). Hydrostatic pressure correction increased the specificity of the method from 46.1% to 92.3% for predicting an abnormal CFR_Doppler < 2. Conclusions: CFR_p-3D calculation with hydrostatic pressure correction during FFR measurement facilitates a comprehensive hemodynamic assessment, supporting the complex evaluation of macro-and microvascular coronary artery disease.

Background: The image reconstruction of stenotic carotid bifurcation can be managed by medical practitioners and non-medical investigators with semi-automatic or manual segmentation. The outcome of blood flow simulations may vary because of a single mean voxel difference along the examined section, possibly more in the stenotic lesions, which can lead to conflicting results regarding other research findings. The aim of our project is computational geometry reconstruction for blood flow simulations to make it suitable for comparison with plaque image analysis performed by commercially available software. In this paper, a comparison is made between the manual and semi-automatic segmentations performed by non-medical and medical investigators, respectively. Methods: 30 patients were classified into three homogeneous groups. Our group classification was based on the following parameters: plaque calcification score, thickness, extent, remodeling and plaque localization. The images in the first group were segmented individually by medical practitioners and experienced non-medical investigators, the second group was segmented collectively, and the last group was segmented individually again. Cross-sections along the centerline were extracted, then geometrical and statistical analyses were performed. Exploratory flow simulations were carried out on two patients to showcase the effect of geometrical differences on the hemodynamic flow field. Results: The largest centerline-averaged voxel difference between the medical and non-medical investigators occurred in the first group with a positive difference of 1.16 voxels. In the second and third groups, the average voxel difference decreased to 0.65 and 0.75, respectively. The example case from the first group showed that the difference in maximum wall shear stress in the middle of the stenosis is 30% with an average voxel difference of 1.73. Meanwhile, it can decrease to 4% when the average voxel difference is 0.64 for the example case from the third group. Conclusions: A collective review of the medical images should preceded the manual segmentations before applying them in computational simulations in order to ensure a proper comparison with plaque image analysis. Especially complex pathology such as calcifications should be segmented under medical supervision or after specific training. Non-significant differences in the segmentation can lead to significant differences in the computed flow field.