Agrawal - 2014 - Effect of Coil Embolization On Fluid Loading in Cerebral Aneurysms

Effect of Coil Embolization on fluid loading
in cerebral aneurysms
A Thesis Submitted
in Partial Fulfillment of the Requirements
for
B.Tech - M.Tech Dual Degree

by
Vishal Agrawal
(Roll No. – Y9227658)
DEPARTMENT OF MECHANICAL ENGINEERING

INDIAN INSTITUTE OF TECHNOLOGY, KANPUR
June, 2014
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CERTIFICATE
It is certified that the work contained in the thesis titled Effect of Coil Embolization on fluid
loading in cerebral aneurysms by Vishal Agrawal (Roll No. Y9227658) has been carried out
under my supervision and that this work has not been submitted elsewhere for a degree.
Dr. K. Muralidhar
Department of Mechanical Engineering
Indian Institute of Technology Kanpur
Kanpur-208016
June, 2014
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Dedicated to my parents, sister, brother and all

those who made me who I am today…
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ACKNOWLEDGEMENTS
I would like to extend my gratitude towards my supervisors Dr. K. Muralidhar for giving me
the opportunity to work with him. He has been a constant source of inspiration and motivation
for me. He introduced me to the world of research, helped me in understanding the subject and
leading to conclusions through his constant cooperation, help and encouragement.
I would also like to thank Dr. M. K. Das for his invaluable suggestions and tips
throughout my work time and during teaching assistantship duties.
I am thankful to the Department of Mechanical Engineering at IIT Kanpur for providing
me with excellent technical facilities. I am thankful to the institute for the excellent infrastructure
and facilities provided to us.
I would like to thank my friends especially Nikhil and Nishchal for being there with me
in times of need and making my stay at IIT Kanpur memorable.
Last but not least, I would like to thank my parents, sister and brother for the
encouragement they have given me all my life.
Vishal Agrawal
ABSTRACT
The present work is concerned with the fluid dynamics aspects of pulsatile flow through a porous
medium and its application in biomedical systems. Coil embolization is a mildly invasive
endovascular method for treatment of a cerebral aneurysm (Kakalis, Mitsos et al. 2008). The
presence of a coil reduces fluid loading of the blood vessel and delays further deformation of the
walls. Its effectiveness depends on the coil porosity and permeability apart from the nature of
flow pulsations and its geometry.
In the present work, a three dimensional numerical study of pulsatile flow of blood
through an artery with saccular cerebral aneurysm and a patient-specific cerebral aneurysm is
reported. The flow is unsteady but is taken to be laminar and incompressible. The coil is treated
as homogeneous and isotropic porous medium.
For the case of saccular aneurysm, a comparative study has been carried out on
aneurysms with and without a coil insert considering blood as a non-Newtonian fluid. A shear
thinning characteristic model of viscosity is incorporated for the realistic model of blood. The
simulation is carried out for Reynolds numbers Re = 500 and 1500. Results show that the
velocity magnitude within the coil embolized aneurysm becomes negligible after coil insertion.
The wall shear stress within the aneurysm decreases to a great extent for both Reynolds numbers.
Pressure levels remain relatively unchanged. Overall, reduced wall loading with a coil stabilizes
the growth of the aneurysm and thus provides an advantage.
In the second case, coil embolization treatment of a patient-specific geometry under rest
and exercise condition is reported. The geometry is constructed from angiographic images using
vascular modeling tools. Simulations are carried out for rest and exercise condition. Exercise
condition is incorporated with a different physiological velocity waveform than that of rest
condition. A comparative study with and without coil insert with the fluid model being both,
Newtonian and non-Newtonian, is carried out for the rest and exercise condition. Results show
the stabilization of coil induced aneurysm with both rest and exercise condition The coils reduce
blood flow inside the aneurysm which can eventually lead to thrombosis formation and
eventually to aneurysm clotting.
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TABLE OF CONTENTS
CERTIFICATE ............................................................................................................................... ii
ACKNOWLEDGEMENTS ........................................................................................................... iv
ABSTRACT .................................................................................................................................... v
TABLE OF CONTENTS ............................................................................................................... vi
LIST OF TABLES ....................................................................................................................... viii
LIST OF FIGURES ....................................................................................................................... ix
NOMENCLATURE .................................................................................................................... xiv
CHAPTER 1 INTRODUCTION AND LITERATURE REVIEW ............................................. 1
1.1. DIAGNOSIS .................................................................................................................... 2
1.2. TREATMENT OF THE DISEASES ............................................................................... 2
1.3. RELATED WORK .......................................................................................................... 5
1.3.1. Coil Embolization treatment of cerebral aneurysm .................................................. 5
1.3.2. Flow in porous medium ............................................................................................ 6
1.4. SCOPE OF THE PRESENT WORK ............................................................................... 7
1.5. THESIS OUTLINE .......................................................................................................... 7
CHAPTER 2 MATHEMATICAL MODELING ........................................................................ 8
2.1. POROUS MEDIUM ........................................................................................................ 8
2.2. FLOW PARAMETERS ................................................................................................... 8
2.3. GOVERNING EQUATIONS .......................................................................................... 9
2.4. NON-NEWTONIAN CHARACTERISTICS OF BLOOD ........................................... 10
2.4.1. Realistic Model of Blood ........................................................................................ 11
2.5. PROBLEM FORMULATION FOR NUMERICAL FORMULATION ....................... 12
2.5.1. Pulsatile flow through a Spherical-shaped Cerebral Aneurysm ............................. 12

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vii
2.5.1. Coil embolization treatment of patient-specific cerebral aneurysm ....................... 14
CHAPTER 3 NUMERICAL SIMULATION ........................................................................... 19
3.1. DISCRETIZATION ....................................................................................................... 19
3.2. NUMERICAL ALGORITHM ....................................................................................... 22
3.3. NUMERICAL SOLVER................................................................................................ 23
3.3.1. Code parallelization ................................................................................................ 23
3.4. GRID GENERATION ................................................................................................... 24
3.4.1. Patient-Specific Cerebral aneurysm ........................................................................ 25
3.4.2. Sphere-shaped Saccular Aneurysm......................................................................... 26
CHAPTER 4 PULSATILE FLOW IN A SACCULAR CEREBRAL ANEURYSM .............. 27
4.1. RESULTS AND DISCUSSIONS .................................................................................. 27
CHAPTER 5 PULSATILE FLOW IN A PATIENT-SPECIFIC CEREBRAL ANEURYSM. 39
5.1. RESULT AND DISCUSSIONS .................................................................................... 39
CHAPTER 6 CONCLUSIONS AND FUTURE WORK ......................................................... 58
6.1. SUMMARY AND CONCLUSIONS ............................................................................ 58
6.1.1. Pulsatile flow in a saccular cerebral aneurysm ....................................................... 58
6.1.2. Pulsatile flow in a patient-specific cerebral aneurysm under rest and exercise
condition ................................................................................................................................ 59
6.2. FUTURE WORK ........................................................................................................... 59
APPENDIX ................................................................................................................................... 61
A.1 PULSATILE FLOW THROUGH A TUBE: WOMERSLEY SOLUTION .................. 61
A.2 PULSATILE FLOW THROUGH A TUBE FILLED WITH POROUS MEDIUM ...... 64
REFERENCES ............................................................................................................................. 68
LIST OF TABLES
Table 2.1: Terms used for normalization ...................................................................................... 10
Table 2.2: Flow Parameters for pulsatile flow within the aneurysm ............................................ 14
Table 2.3: Flow Parameters for pulsatile flow within the patient-specific aneurysm .................. 18
Table 3.1: Generalized representation of the governing equations............................................... 20
viii
LIST OF FIGURES
Figure 1.1: (a) Atherosclerosis [http://www.webmd.com] (b) AAA [http://www.nlm.nih.

gov/medlineplus] (c) Cerebral Aneurysm [http://www.nlm.nih.gov/medlineplus]. ....................... 3
Figure 1.2: (a) Open surgical repair of AAA [http://www.vascularweb.org]. (b) Endovascular
stent graft treatment for AAA [http://www.vascularweb.org]. (c) Clipping treatment for cerebral
aneurysm [http://www.bafound.org]. (d) Coil embolization for cerebral aneurysm
[http://www.mayfieldclinic.com]. ................................................................................................... 4
Figure 2.1: Schematic diagram of the geometric model considered for analysis ......................... 12
Figure 2.2: Inlet average velocity waveform (Valencia, Morales et al. 2008). Points a and b
indicate the time instants at which the solution has been presented in Section 4.1. ..................... 13
Figure 2.3: Model of the patient-specific geometry considered for analysis. ............................... 15
Figure 2.4: Inlet mean velocity waveform for resting condition. Points a and b indicate the time
instants at which the solution has been presented in Chapter 5. ................................................... 16
Figure 2.5: Inlet mean velocity waveform for exercise condition (Bowker, Watton et al. 2010).
Points a and b indicate the time instants at which the solution has been presented in Chapter 5. 17
Figure 3.1: Tetrahedral control Volume ....................................................................................... 21
Figure 3.2: Grid description of patient-specific cerebral aneurysm. (i) Inlet surface mesh. (ii)
Aneurysm cross section. (iii) Surface mesh. ................................................................................. 25
Figure 3.3: Grid description of the aneurysm. (i) Front view, (ii) Crossection view from side
plane. ............................................................................................................................................. 26
Figure 4.1: Time-averaged distribution of absolute velocity (at mid-plane in front view), wall
pressure and wall shear stress for clear medium (first column), porous medium (second column)
and porous medium with non-Newtonian flow (third column) at Reynolds number Re=500 and
Womersley number Wo=7.82 ....................................................................................................... 28
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x
Figure 4.2: RMS deviation of absolute velocity (at mid-plane in front view), wall pressure and
wall shear stress from the time-averaged values of the flow variables for clear medium (first
column), porous medium (second column) and porous medium with non-Newtonian flow (third
column) at Reynolds number Re=500 and Womersley number Wo=7.82 ................................... 29
Figure 4.3: Time averaged distribution of absolute velocity (at mid-plane in front view), wall
and porous medium with non-Newtonian flow (third column) at Reynolds number Re=1500 and
Womersley number Wo=7.82 ....................................................................................................... 30
Figure 4.4: RMS deviation of absolute velocity (at mid-plane in front view), wall pressure and
wall shear stress from the time-averaged values of the flow variables for clear medium (first
column), porous medium (second column) and porous medium with non-Newtonian flow (third
column) at Reynolds number Re=1500 and Womersley number Wo=7.82 ................................. 31
Figure 4.5: Comparison of absolute velocity (at mid-plane in front view), wall pressure and wall
shear stress in clear media at selected phases of the cycle as shown in Figure 2.2 for Reynolds
number, Re=500 and Re=1500 and Womersley number, Wo=7.82.............................................. 32
Figure 4.6: Comparison of absolute velocity (at mid-plane in front view), wall pressure and wall
shear stress in porous media with non-Newtonian model at selected phases of the cycle as shown
in Figure 2.2 for Reynolds number, Re=500 and Re=1500 and Womersley number, Wo=7.82 .. 33
Figure 4.7: Stream traces at the mid-plane in front view at selected phases of the cycle as shown
in Figure 2.2 for Reynolds number, Re=500 and Re=1500 and Womersley number, Wo=7.82.
First row represents the clear medium, second row is porous medium with Newtonian model,
third row being porous medium with non-Newtonian model. ...................................................... 34
Figure 4.8: Schematic model of the bulge region. Points A, B and C indicate the points at which
the pressure and wall shear stress variation .................................................................................. 35
Figure 4.9: Wall shear stress and pressure variation with time at selected points A, B and C in the
bulge region for clear media (first row), porous media (second row) and porous media with non-
Newtonian flow (third row) at Re = 500 (left column) and Re = 1500 (right column) ................ 36
xi
Figure 4.10: Wall Vorticity and wall shear rate contours for the time-averaged distribution at Re
= 500 for (i) Clear medium and (ii) porous medium. ................................................................... 37
Figure 4.11: Wall viscosity variation on the wall (first column) and in the mid-plane section
(second column) of the time-averaged distribution in porous media with non-Newtonian fluid
model for Re 500 and 1500. .......................................................................................................... 38
Figure 5.1: Planes across the geometry at which the velocity contours are shown. ..................... 39
Figure 5.2: Porous medium modeling of coil embolization. A, B, C and D are the points at which
the flow variables are discussed later............................................................................................ 40
Figure 5.3: Time-averaged distribution of the field variables in clear media with rest and exercise
condition: first row, absolute velocity at the planes shown in Figure 5.1; second row, wall
pressure and third row, wall shear stress. ..................................................................................... 42
Figure 5.4: RMS deviation of the field variables from their time-averaged values in clear media
with rest and exercise condition: first row, absolute velocity at the planes shown in Figure 5.1;
second row, wall pressure and third row, wall shear stress. ......................................................... 43
Figure 5.5: Time-averaged distribution of the field variables in porous media with Newtonian
model under rest and exercise condition: first row, absolute velocity at the planes shown in
Figure 5.1; second row, wall pressure and third row, wall shear stress. ....................................... 44
Figure 5.6: RMS deviation of the field variables from their time-averaged values in porous media
with Newtonian model under rest and exercise condition: first row, absolute velocity at the
planes shown in Figure 5.1; second row, wall pressure and third row, wall shear stress. ............ 45
Figure 5.7: Time-averaged distribution of the field variables in porous media with non-
Newtonian model under rest and exercise condition: first row, absolute velocity at the planes
shown in Figure 5.1; second row, wall pressure and third row, wall shear stress. ....................... 46
with non-Newtonian model under rest and exercise condition: first row, absolute velocity at the
planes shown in Figure 5.1; second row, wall pressure and third row, wall shear stress. ............ 47
xii
Figure 5.9: Instantaneous distribution of the field variables in clear media at selected phases of
the cycle (shown in Figure 2.4) with resting condition: first row, absolute velocity at the planes
Figure 5.10: Instantaneous distribution of the field variables in porous media with Newtonian
model at selected phases of the cycle (shown in Figure 2.4) with resting condition: first row,
absolute velocity at the planes shown in Figure 5.1; second row, wall pressure and third row,
wall shear stress. ........................................................................................................................... 50
Figure 5.11: Instantaneous distribution of the field variables in porous media with non-
Newtonian model at selected phases of the cycle (shown in Figure 2.4) with resting condition:
first row, absolute velocity at the planes shown in Figure 5.1; second row, wall pressure and third
row, wall shear stress. ................................................................................................................... 51
the cycle (shown in Figure 2.5) with exercise condition: first row, absolute velocity at the planes
model at selected phases of the cycle (shown in Figure 2.5) with exercise condition: first row,
wall shear stress. ........................................................................................................................... 53
Newtonian model at selected phases of the cycle (shown in Figure 2.5) with exercise condition:
row, wall shear stress. ................................................................................................................... 54
Figure 5.15: Wall shear stress and pressure variation with time under resting condition at
selected points A, B, C and D in the bulge region for clear media (first row), porous media
(second row) and porous media with non-Newtonian flow (third row). ...................................... 55
xiii
Figure 5.16: Wall shear stress and pressure variation with time under exercise condition at
(second row) and porous media with non-Newtonian flow (third row). ...................................... 56
NOMENCLATURE
A ϕ / Da for clear medium; ( iReωn + ϕ / Da ) for porous medium
G ϕ Re G
n for clear medium; n for porous medium
B
iω iReω + ϕ / Da
n n
Cf inertia coefficient
D maximum diameter of bulge (m)
d diameter of the tube (m)
Da darcy number (K/d2)
f frequency of oscillation (Hz)
Ik modified Bessel function of kth order.
K permeability (m2)
L length of bulge (m)
m relaxation time (sec)
M1 coefficient of Darcy term
M2 coefficient of Forchheimer term
n harmonic
p intrinsic phase average pressure (Pa)
ρU ref d
Re reynolds number ( )
µ∞
t time (s)
T time period of oscillation (s)
u x-component of velocity (m/s)
ui tensor notation for velocity component (m/s)
Uref reference velocity (time-averaged velocity of mean velocity waveform) (m/s)
v y-component of velocity (m/s)
V ui + vj + wk , velocity vector (m/s)
V* dimensionless velocity vector V
Vt tangential velocity at a point on wall (m/s)
w z-component of velocity (m/s)
xiv
xv
ω
Wo womersley number ( 0.5d )
ν
WSS wall shear stress (N/m2)
xi direction tensor (x, y, z)
Greek symbols
ϕ porosity
Γ exchange coefficient
η normal direction to surface
µ dynamic viscosity (Pa-s)
ν kinematic viscosity (m2/s)
ρ density (kg/m3)
ω 2 , angular frequency of waveform (rad/s)
Suffixes
i denotes the ith direction
n harmonic
CHAPTER 1
INTRODUCTION AND LITERATURE REVIEW
The human body is a complex system that requires transport of materials such as air, water,
minerals and nutrients for survival and functioning. The fluid systems in the human body operate
at different scales. The cardiovascular system is the most important transport system which is
responsible for adequate blood circulation ranging from macro to nano and much smaller scales.
It consists of the heart, blood vessels (arteries, arterioles, venules, veins and capillaries),
lymphatic vessels, and the lungs. . The circulations associated with the cardiovascular system
may be considered under three subsystems. These are the (i) systemic circulation, (ii) pulmonary
circulation, and (iii) coronary circulation.
However, the diseases associated with the cardiovascular system are the leading causes of the
death worldwide. These diseases are mainly caused due to the wrong eating habits of the
individuals. The most common cardiovascular diseases are:
(i) Atherosclerosis: It is known as hardening of the arteries due to formation of plaque,
caused by the deposition of fats and cholesterol. Such deposition causes the arteries to
lose its elasticity, as the arterial wall thickens. It also makes the arteries narrow, thus
impairing the normal blood circulation (Figure 1.1).
(ii) Abdominal Aortic Aneurysm (AAA): Aneurysm is the abnormal localized dilation of
any vessel. AAA is a localized dilatation of the abdominal aorta exceeding the normal
diameter by more than 50 percent, and is the most common form of aortic aneurysm
(Figure 1.1).
(iii) Cerebral Aneurysm: A cerebral aneurysm is a cerebrovascular disorder in which
weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning
of the blood vessel. A common location of cerebral aneurysms is on the arteries at the
base of the brain, known as the Circle of Willis. Cerebral aneurysms can leak or rupture
causing symptoms from severe headache to stroke-like symptoms, or death (Figure 1.1).
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There are several other common diseases of the cardiovascular system including
Hypertension, Varicose veins and Chronus venous insufficiency. In the present work we restrict
out analysis to cerebral aneurysm of different kinds.
1.1. DIAGNOSIS
The diagnosis of different cardiovascular diseases is performed using various methods:
(i) Radiography: In AAA cases, X-ray images show the calcium deposits on the wall of the
aneurysm. Plain radiographs are accurate in their diagnosis as many as 90% of their cases
(www.medicinenet.com). In case of suspected AAA, X-rays are followed by ultrasound
and CT scans for confirmation. Both walls of the aorta are to be clearly seen for the AAA
aneurysm to be conclusive.
(ii) CT scan: A CT scan accurately shows the dilation of the aorta and the involvement of the
major vessels in close proximity. The treatment method, surgical or endovascular, can be
decided by knowing the degree of calcification. CT scans are considered as 100%
accurate in diagnosis of AAA.
(iii) Angiography: This method is generally employed as a preoperative evaluation technique
in patients with atherosclerotic vascular disease. This method leads to better examination
of the length of the aneurysm as catheters that are used to make measurements in this
method follow the contours of the vessels.
(iv) Medical Ultrasonography: USG is a low cost, highly efficient tool for the diagnosis
where abdominal aorta is entirely seen.
1.2. TREATMENT OF THE DISEASES

(i) Open Surgical therapy or Endovascular stenting: The treatment of AAA is performed
mainly by open surgical repair and endovascular stent graft. When the size of the
aneurysm becomes very large open surgical repair is performed. An incision is made at
the abdomen and replaced by a tube-like replacement. Compared to open aneurysm
repair, endovascular stent graft is less invasive. An incision is made in the skin at the
groin through which a catheter is passed into the femoral artery and directed to the aortic
aneurysm. A stent graft is compressed into a small diameter within the catheter. The stent
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(a)
(b)
(c)
Figure 1.1: (a) Atherosclerosis [http://www.webmd.com] (b) AAA [http://www.nlm.nih.

gov/medlineplus] (c) Cerebral Aneurysm [http://www.nlm.nih.gov/medlineplus].
4
graft is advanced to the aneurysm, and then opened, creating new walls in the blood
vessel through which blood flows (Figure 1.2).
(ii) Endovascular coil embolization: A catheter is inserted into the blood vessel and guided
to ane aneurysm position using the X-rays. Once it is done, tiny metal coils are inserted
inside the aneurysm. The coils cause the aneurysm to clot off and prevent rupture. The
risk in this technique is very low (Figure 1.2).
(a) (b)
(c) (d)
Figure 1.2: (a) Open surgical repair of AAA [http://www.vascularweb.org]. (b) Endovascular
stent graft treatment for AAA [http://www.vascularweb.org]. (c) Clipping treatment for cerebral
aneurysm [http://www.bafound.org]. (d) Coil embolization for cerebral aneurysm
[http://www.mayfieldclinic.com].
5
1.3. RELATED WORK

1.3.1. Coil Embolization treatment of cerebral aneurysm
Fundamental and applied research in flow, heat and mass transfer in porous media has received
increased attention during the past several decades. This is due to the importance of this research
area in many engineering applications. Pulsatile flow through porous medium has a great impact
on different kinds of engineering applications especially in biological applications. For example
the in-growth of tissues in stenosis can be modeled. The coil embolization in cerebral aneurysm
is a model porous medium.
Over the years several experimental and numerical studies have been conducted for
cerebral aneurysms. Saccular cerebral aneurysm, also known as berry aneurysm refers to the
cerebro-vascular disorder of weakening and out pouching of cerebral blood vessel (Yu and Zhao
1999). Hemodynamic factors such as wall shear stress, wall pressure and the time-dependent
blood flow rate play major roles in the initiation, evolution and the possible rupture of the
aneurysm (Lieber, Livescu et al. 2002). Treatment options of cerebral aneurysm focus on
reducing the wall pressure and shear at the weakened blood vessel (Liou, Liou et al. 2004). For
instance, the coil embolization technique, a proposed procedure for aneurysm treatment attempts
load reduction in the weakened vessel via insertion of a porous medium. The effectiveness of this
procedure is judged by the extent to which it can alter wall loading in terms of pressure and shear
stress. Canton et al. (2005) experimentally studied the influence of stents on intra-aneurismal
flow using an idealized geometry. Stuhne and Steinman (2004) conducted a numerical study to
analyze WSS distribution on a stented sidewall aneurysm using a model geometry.
Early studies on blood flow simulation through an aneurysm (Khanafer, Gadhoke et al.
2006) investigated pulsatile flow through a bulge (Sheard 2009) without any reference to the
aneurysm treatment. Byun and Rhee (2004) numerically studied coil embolization by modeling
the coil as a small solid sphere placed at various locations within the aneurysm. Groden et al.
(2001) studied three dimensional pulsatile flow in a cerebral aneurysm numerically before and
after coil embolization. The authors used cube-shaped cells to represent the coils. Preliminary
studies have also been carried out treating coil embolization using porous medium models (Vafai
2011).
6
1.3.2. Flow in porous medium

Transport through porous medium has been investigated experimentally, numerically and
analytically by many researchers over the last few decades (Kaviany 1999). Earlier studies of
porous medium dealt with the Darcy’s law which relates flow velocity linearly to the pressure
gradient. Later developments led to a refined model where two more forcing terms were added in
the momentum equation. The Brinkman term captures the confining boundary effect while the
Forchheimer term accounts for fluid acceleration (Nield, Bejan, 2006). Later Vafai and Kim
(1989) provided an exact solution for steady laminar flow in a porous channel using
Forchheimer-Brinkman extended Darcy model. Haji-Sheikh and Vafai (2004) used Brinkman
extended Darcy model to analyze steady flow field in various shaped ducts using method of
weighted residuals. Morosuk (2005) and Teamah et al. (2011) studied the entropy change and
laminar forced convection in a pipe fully and partially filled with porous medium using
Brinkman extended Darcy equation.
While a few studies are available for fluid flow through a bulge, no specific study has
been reported so far for pulsatile flow simulation through a bulge filled with porous medium
using the Forchheimer-Brinkman extended Darcy model. Several pathological diseases such as
thrombosis, atherosclerosis have been investigated by modeling pulsatile flow of blood through
porous medium. Dash et al. (1996) investigated blood flow in a tube filled with homogeneous
porous medium. El-Shahed (2003) studied pulsatile flow of blood through a stenosed porous
medium under periodic body acceleration. Ogulu and Amos (2007) provided a model for blood
flow in cardio vascular system considering it as porous medium. Zhang et al. (2007) studied the
effect of AAA (Abdominal Aortic Aneurysm) stent-grafts with porous media model.
Ide and Secher (2000) analysed the human body metabolism and blood flow in the
cerebral region during exercise. Egelhoff et al. (1999) examined the effect of pulsatile flow in
AAA (Abdominal Aortic Aneurysms) during rest and exercise conditions and understand the
hemodynamics for the growth of an aneurysm. Several other studies were conducted to examine
the effect of exercise in human metabolism and aneurysm, but to the author’s knowledge no
particular study is found to study its effect in the region of cerebral region and discuss the
various ways of treatment.
7
1.4. SCOPE OF THE PRESENT WORK

The present study deals with the flow in clear and porous regions and their modeling for the
following two cases:
(i) Coil embolization treatment of a sphere-shaped saccular cerebral aneurysm is modeled
considering coils as isotropic porous medium. Numerical simulation is carried out for
both clear medium and porous medium, with Newtonian and non-Newtonian fluid
models considered for porous medium. The effect of the flow field variables are reported
for the three cases.
(ii) Rest and Exercise conditions are considered separately to analyze the effect of exercise
on the growth of an aneurysm and understand the effectiveness of coil embolization
technique and its range of application to prevent the aneurysm growth. The simulation is
run for the same three cases mentioned above for both the rest and exercise condition. A
comparative study between the flow variables for both the conditions is reported.
1.5. THESIS OUTLINE

The thesis below is organized into the following manner:
(i) Chapter 1 presents the introduction, literature review and scope of present work.
(ii) Chapter 2 presents mathematical modeling of clear and porous medium. Also the geometry
and boundary conditions of numerical simulations are elaborated.
(iii) Chapter 3 presents the numerical technique used for the simulation.
(iv) Chapter 4 presents the result of numerical simulation for pulsatile flow through a saccular
cerebral aneurysm.
(v) Chapter 5 presents the result of numerical simulation for coil embolization treatment of
patient specific cerebral aneurysm under rest and exercise condition.
(vi) Chapter 6 summarizes the work with conclusions.
(vii) Appendix contains derivation of the analytical solution for womersley profile presented in
Chapter 2.
CHAPTER 2
MATHEMATICAL MODELING
The primary purpose of this work is to determine the progression of aneurysm in a human artery
using the technique of coil embolization. The method is applied by modeling pulsatile flow
through porous media within the aneurysm region. In this chapter, the generalized model of flow
through a porous region and is mathematical modeling is described. Also, the rheological
properties of blood are described to consider blood as a Newtonian or non-Newtonian model.
Futhermore, the geometry and boundary conditions are elaborated.
2.1. POROUS MEDIUM

Porous media is defined as a two-phase system, solid and liquid. The fluid flows in the form of
liquid through the pores of the solid phase. Any fluid property is defined in terms of its
volumetric phase average as Eq. (2.1):
1
V V∫f
< B f >= B dv (2.1)
Intrinsic phase average of any quantity of fluid phase is defined as:

1
< Bf > f =
Vf ∫ B dv
Vf
(2.2)
Here Vf is the fluid volume and V is the total volume of solid and liquid phase.
2.2. FLOW PARAMETERS

Dimensional parameters relevant to the work are Darcy number, Reynolds number and
Womersley number. Darcy number is defined as the ratio of permeability to the square of the
characteristic dimension:
K
Da =
d2
Reynolds number (Re) is a measure of the ratio of inertial forces to viscous forcesand is defined
as:
8
9
ρUd
Re =
µ
Here U is the reference velocity (generally taken as peak average velocity attained within a
cycle) at the inflow plane.
The Womersley number is measured as the ratio of the oscillatory inertia force to the viscous and
is defined as:
ω 2π f
Wo = 0.5d = 0.5d
ν ν
where f is the frequency of the pulsatile waveform in units of Hz.
2.3. GOVERNING EQUATIONS

Flow is considered incompressible and it remains in the laminar region. The porous medium
within the aneurysm is considered homogeneous, isotropic and saturated with fluid. The
governing equations in clear and porous media in dimensional form are given below.
Clear medium:
∇iV = 0 (2.3)
 ∂V 
ρ + ( V i∇ ) V  = −∇p + ∇. ( µ [ ∇V + ∇V T ]) (2.4)
 ∂t 
Porous medium:
∇iV = 0 (2.5)
C ρ
ρ  ∂V 1  1 µ f
 + ( V i∇ ) V  = −∇p + ∇. ( µ [∇V + ∇V ]) − V −
T VV (2.6)
ϕ  ∂t ϕ  ϕ K K
The meaning of each symbol is given in the nomenclature. For porous medium, V represents
volumetric phase averaged velocity and p represents intrinsic phase averaged pressure. The
continuity equations remains the same for both the media ( Equation (2.3) and (2.5)) whereas the
clear momentum equation does not contain the Darcy and Forchheimer terms (last two terms in
Equation (2.6)).
The governing equations can be presented in the following non-dimensional form:
Clear medium:
∇i V * = 0 (2.7)
10
∂V * 1  µ 
+ ( V * i∇ ) V * = −∇p + ∇.  [∇V * + ∇V *T ]  (2.8)
∂t Re  µ∞ 
Porous medium (Nield and Bejan 2006):
∇i V * = 0 (2.9)
ϕC
∂V * 1 * 1  µ  ϕ f * *
+ ( V .∇ ) V = −ϕ∇p +
*
∇.  [∇V + ∇V ]  −
* * T *
V − V V (2.10)
∂t ϕ Re  µ∞  Re Da Da
The meaning of each symbol is given in nomenclature. The terms used for normalization are
mentioned in the table below. For Newtonian fluid viscosity μ/ ∞ is considered unity.
Table 2.1: Terms used for normalization

Length d (diameter of tube in the Velocity Uref (reference velocity based on
geometry) which Reynolds number is
calculated.)
Pressure ρ(Uref) 2 Vorticity Uref /d
WSS μUref /d Time d/ Uref
Angular Uref /d Viscosity ∞ - reference viscosity based on the

frequency viscosity model.
2.4. NON-NEWTONIAN CHARACTERISTICS OF BLOOD

Blood is a multi-phase fluid mixture that includes particulate matter. The solid phase contains
red blood cells (RBCs), white blood cells (WBCs) and platelets. These elements are carried in
the liquid phase, called the plasma containing organic molecules, such as enzymes, antibodies,
and electrolytes. Other components in blood present in very low quantities. The viscosity of
blood is not constant and depends on several factors including plasma and its protein content,
hematocrit, temperature, shear rate and narrowness of the vessel. However, the effect of plasma
content and temperature are much less compared to other factors. The concentration of plasma
protein contributes to the blood viscosity.
Hematocrit is defined as the percentage of blood volume made up of red blood cells.
Hematocrit decreases from large vessel to small vessels. An increase in hematocrit results in rise
of blood viscosity.
11
For low shear rates γɺ < 200 sec-1 the variation of shear stress with strain rate is non-
linear. At higher shear rates this relationship become linear. Generally low shear rates is
observed in small vessels (capillaries and small arteries) and high shear rates are observed in
large vessels.
Several studies have been conducted over the years to study the nature of solid particles
in blood flow. Boryczko et al. (2003) modeled the dynamics of red blood cells and plasma using
a discrete particle approach. It is now understood that the solid phase constitutes almost 45% of
the total blood composition - red blood cells are predominant.
2.4.1. Realistic Model of Blood
A realistic blood model of blood should consider the prominent characteristics of blood, in
particular shear thinning viscosity, viscoelasticity and thixotropy. When blood flows through the
vessels the interaction between blood and solid walls (fluid structure interaction (FSI))
significantly affect hemodynamics. Therefore, FSI also needs to be incorporated to get a realistic
view of a cardiovascular system. However, blood is weakly viscoelastic and shear-thinning
behavior is the more prominent non-Newtonian characteristics of blood. Hence, in this study,
only shear-thinning property of blood is taken into account. A model, called as Carreau-Yashuda
model, is incorporated for the shear-thinning characteristics of blood (Leuprecht and Perktold
2001).
1
µ0 − µ∞ 1 2  ∂u ∂u 
µ (γɺ ) = µ∞ + where γɺ =  eij eij  and eij =  i + j  (2.11)
a  ∂x j ∂xi 
(1 + mγɺ n ) 2   
Here, µ o and µ ∞ represents the viscosity at zero and infinite shear rate respectively and m denotes
the relaxation time. The shear rate ( γɺ ) is obtained from the strain-rate tensor (eij) as defined
below. On calculation, the shear rate ( γɺ ) comes out to be:
2 2 2 2
  ∂u   ∂v   ∂w   ∂u ∂v 
γɺ =  2   + 2   + 2   +  + 
  ∂x   ∂y   ∂z   ∂y ∂x 
1
2 22 (2.12)
 ∂u ∂w   ∂v ∂w 
+ +  +  ∂z + ∂y  
 ∂ z ∂ x    
Here, u, v and w are the x, y and z components of velocity, respectively.

12
2.5. PROBLEM FORMULATION FOR NUMERICAL FORMULATION

2.5.1. Pulsatile flow through a Spherical
Spherical-shaped Cerebral Aneurysm
The geometry considered is a bent tube with a sphere
sphere-shaped
shaped aneurysm modeled as a bulge
located at the central location (Figure
Figure 2.1).. The dimensions shown are greater by a factor of four
in comparison to those of a human subject (Weir 1987).. Other parameters are set in such a way
that the dimensionless variables of the flow field, specifically Reynolds and Womersley numbers
(Re and Wo) are matched. The angle between the inlet and outlet of the tube is kept as 75°. For
the model in Figure 2.1,, the bulge parameter is D/d=3.. The lengths of the inlet and exit sections
are longer than in a human patient and are selected to minimize flow development effects. Real
aneurysms of the shape considered in Figure 2.1 have been found in patients (Gobin,
Gobin, Counord et
al. 1994).. In addition, it is known that aneurysms are prone to appear at tube junctions, bends,
and bifurcations (Sazonov,
Sazonov, Yeo et al. 2011
2011).
Figure 2.1:: Schematic diagram of the geometric model considered for analysis
Pulsatile flow of blood through the bulge is unsteady but is considered incompressible and
laminar. The porous medium fills the bulge but the legs carry clear fluid
fluid. The porous medium is
considered as homogeneous, isotropic and sat
saturated with fluid.
13
At the inflow plane, the Womersley profile (Womersley 1955), derived from a
physiological velocity waveform of internal carotid artery is specified as the boundary condition
for both clear and porous media (Valencia, Morales et al. 2008). The no slip condition is used at
the solid walls. Pressure is specified as constant at the outlet while for velocity, the gradient
outflow condition is prescribed. The time-dependent waveform for the inlet velocity profile is
shown in Figure 2.2.
Figure 2.2: Inlet average velocity waveform (Valencia, Morales et al. 2008). Points a and b
indicate the time instants at which the solution has been presented in Section 4.1.
The boundary condition at the inlet is given by:
∞  I (r A )   I (0.5 A )  iω t
n  / 1 − 4
∑ Wavgn  1 −
w( z ) = 2Wavg 0 (1 − 4r 2 ) + 0 1 n  e n (2.13)
n = −∞  I (0.5 A )   A I (0.5 A ) 
 0 n   n 0 n 
n≠0
This is the Womersley profile (Appendix A.1). Here r is the non-dimensional radial coordinate
measured from the center point of the inlet. Harmonics Wavgn could be calculated from the
physiological waveform (Figure 2.2), such that:

∞ iω t
wavg (t ) = ∑ Wavgn e n (2.14)
n = −∞
In mathematical terms:
14
w (t ) = 0.1459 − 0.00463cos(ωt ) + 0.03531sin(ωt ) − 0.007573cos(2ωt ) + 0.02124 sin(2ωt )

avg
− 0.01585cos(3ωt ) + 0.006377sin(3ωt ) − 0.008524 cos(4ωt ) + 0.003339sin(4ωt )
− 0.0122 cos(5ωt ) − 0.003238sin(5ωt ) − 0.003216 cos(6ωt ) − 0.008239 sin(6ωt )
+ 0.000074 cos(7ωt ) − 0.003993sin(7ωt ) + 0.0002781cos(8ωt ) − 0.003594 sin(8ωt )
where ω (angular frequency) is 7.203 and t is time.
The comparative study is carried out between clear and porous medium for varying
Reynolds number. The porous medium parameters depend upon experimental study of coil
packing density. Here, the porous medium properties have been taken from Mitsos et al.
(2008).The parameters used are given in Table 2.2.
Table 2.2: Flow Parameters for pulsatile flow within the aneurysm
Study Parameters
f = 1.17 Hz
1. Aneurysm without coil inserts. Wo = 7.82
2. Aneurysm with coil and = 0.735
Comparison 1 Da = 1.55 × 10-4 (Based on
Newtonian fluid model.
(For Re 500) inlet diameter)
3. Aneurysm with coil and non-
Newtonian fluid model. Cf = 0.2
ρ = 1050 kg/m3
Carreau-Yashuda Model:
1. Aneurysm without coil inserts. µ o = 0.16 Pa-s
2. Aneurysm with coil and µ ∞ = 0.0035 Pa-s
Comparison 2
Newtonian fluid model. m = 8.2
(For Re 1500)
3. Aneurysm with coil and non- n = 0.64
Newtonian fluid model. a = 1.23
2.5.1. Coil embolization treatment of patient-specific cerebral aneurysm

The patient-specific geometry used in this simulation is reconstructed from angiographic images
using vascular reconstruction tools. The geometry is obtained as open source mesh from the
CISTIB lab at the Universitat Pompeu Fabra of Barcelona. Using open source imaging tools
GIMIAS and VMTK, the geometry in Figure 2.3 is constructed. At the inlet and outlet, a straight
tube section is added such that boundary conditions could be applied correctly and flow becomes
fully developed before entering the patient specific region. The inlet diameter for both the
geometries is 4.5 mm. The flow is considered laminar and incompressible.
15
Figure 2.3: Model of the patient-specific geometry considered for analysis.
The simulation is carried out for two flow conditions: Rest and Exercise condition. A
comparative study with and without the coil inserts is carried out for both the conditions. The
aim of the study is to determine the effect of exercise condition as compared to the rest condition
within the aneurysm region and to find the effect of coil insertion under these conditions. The
coils are treated as homogeneous and isotropic porous media. A constant pressure condition is
specified at the outlet in this study for both the rest and exercise conditions. No slip condition is
used at the walls. At the inflow plane, different womersley profiles for rest and exercise
conditions, derived from separate physiological velocity waveforms of internal carotid artery, are
specified as the boundary condition.
Rest Condition:
The boundary condition specified at the outlet and wall is same for both the rest and exercise
conditions. However, different physiological velocity waveforms are applied at the inlet plane.
The boundary condition at the inlet is given by:
16
∞  I (r A )   I (0.5 A )  iω t
n  / 1 − 4
∑ Wavgn  1 −
w( z ) = 2Wavg 0 (1 − 4r 2 ) + 0 1 n  e n (2.15)
n = −∞  I (0.5 A )   A I (0.5 A ) 
 0 n   n 0 n 
n≠0
The derivation of the above equation can be seen in Appendix A.1. Harmonics Wavgn could be
calculated from the physiological waveform (Figure 2.4) (Bowker, Watton et al. 2010):
∞ iω t
wavg (t ) = ∑ Wavgn e n (2.16)
n = −∞
In mathematical terms:
w (t ) = 0.3811 − 0.01235cos(ωt ) + 0.08866sin(ωt ) − 0.02383cos(2ωt ) + 0.04194 sin(2ωt )

avg
− 0.04155cos(3ωt ) + 0.01266sin(3ωt ) − 0.02257 cos(4ωt ) − 0.01sin(4ωt )
− 0.01662 cos(5ωt ) − 0.01503sin(5ωt ) + 0.000079 cos(6ωt )
− 0.01914 sin(6ωt ) + 0.007216 cos(7ωt ) − 0.009266sin(7ωt )
Figure 2.4: Inlet mean velocity waveform for resting condition. Points a and b indicate the time
instants at which the solution has been presented in Chapter 5.
17
Exercise condition:
The boundary condition at the inlet is specified by the same equation as Eq. (2.15). However, the
physiological velocity waveform (Figure 2.5) differs from the rest condition waveform. In
mathematical terms, the waveform is specified as:
w (t ) = 0.419 − 0.05898cos(ωt ) + 0.1674 sin(ωt ) − 0.08523cos(2ωt ) + 0.001272 sin(2ωt )

avg
− 0.04578cos(3ωt ) − 0.02677 sin(3ωt ) + 0.01098cos(4ωt ) − 0.03029 sin(4ωt )
+0.01449 cos(5ωt ) − 0.00782sin(5ωt ) + 0.007332 cos(6ωt ) + 0.0045sin(6ωt )
+ 0.0005723cos(7ωt ) + 0.005696sin(7ωt ) − 0.001469 cos(8ωt ) + 0.0003979 sin(8ωt )
Figure 2.5: Inlet mean velocity waveform for exercise condition (Bowker, Watton et al. 2010).
Points a and b indicate the time instants at which the solution has been presented in Chapter 5.
A comparative study is done between the rest and exercise condition and to analyze the
effect of coil embolization under both the conditions. The coils are treated as homogeneous and
isotropic porous media. The porous medium properties have been taken from Mitsos et al.
(2008).
18
Table 2.3: Flow Parameters for pulsatile flow within the patient-specific aneurysm
Study Parameters
Re = 500 (based on inlet

1. Aneurysm without coil diameter, time-averaged mean
velocity and µ∞ ) Carreau-Yashuda
inserts.
Model:
2. Aneurysm with coil f = 1.16 Hz µ o = 0.16 Pa-s
Rest and Newtonian fluid Wo = 3.29 µ ∞ = 0.00357 Pa-s
Condition model. = 0.735 m = 8.2
3. Aneurysm with coil Da = 7.65 × 10-4 (Based on inlet n = 0.64
and non-Newtonian diameter) a = 1.23
fluid model. Cf = 0.2
ρ = 1050 kg/m3
Re = 500 (based on inlet

1. Aneurysm without coil diameter, time-averaged mean
velocity and µ∞ ) Carreau-Yashuda
inserts.
Model:
2. Aneurysm with coil f = 2.01 Hz µ o = 0.16 Pa-s
Exercise and Newtonian fluid Wo = 4.14 µ ∞ = 0.00392 Pa-s
Condition model. = 0.735 m = 8.2
3. Aneurysm with coil Da = 7.65 × 10-4 (Based on inlet n = 0.64
and non-Newtonian diameter) a = 1.23
fluid model. Cf = 0.2
ρ = 1050 kg/m3
CHAPTER 3
NUMERICAL SIMULATION
In this chapter, numerical technique, grid generation and code validation are presented. The
governing transport equations are given in Section 2.3.
3.1. DISCRETIZATION
The governing equations ((2.7), (2.8), (2.9) and (2.10)) are solved by using finite volume method
(FVM) on unstructured tetrahedral meshes. Date (2005) has proposed a method for solution of
transport equations on unstructured meshes with cell centered collocated variables approach. The
same approach is followed for simulating pulsatile flow in a clear medium. However, for porous
medium the method specified by Date (2005) is extended to incorporate Darcy and Forchheimer
terms. A method of solution for the transport equations on unstructured meshes with cell-
centered collocated variables approach was discussed earlier by Gohil et al. (2012). This
approach has been extended to incorporate Darcy and Forchheimer terms in the governing
equation as well as the non-Newtonian nature of blood. Equations (2.7)-(2.10) can be rewritten
in the following conservative tensorial form:
∂ ( B) ∂q
j
+ +M B+M V B =S
∂t ∂x 1 2 B
j (3.1)
∂ ( B)
⇒ + div ( q ) + M B + M V B = S
∂t 1 2 B
1 ∂B
where V = u1i + u2 j + u3k , q = q1i + q2 j + q3k and q = u B − Γ B
j ϕ j eff ∂x
i
Here B refers to any flow field variables (e.g. velocity, vorticity). Meanings of rest of the
B
symbols are given in the nomenclature. The expressions of Γ
eff
, SB, M1 and M2 are listed in
Table 3.1. The approach specified by Date (2005) belongs to family of SIMPLE algorithms.
However the concept of pressure smoothing is added by Date (2005). By pressure smoothing the
numerical algorithm could provide reasonably accurate results with very coarse grids. On an
unstructured mesh, it is convenient to employ collocated variables so that scalar and vector
19
20
variables are defined at identical locations. Convective terms are discretized by a hybrid upwind
scheme that combines first and second order schemes. Geometry invariant features of the
tetrahedral element are used so that the calculation of gradients at cell faces is simplified using
nodal quantities of a particular variable. Nodal quantities in turn are calculated as a weighted
average of the surrounding cell-centered values. Diffusion terms are discretized using a second
order central-difference scheme.
Table 3.1: Generalized representation of the governing equations

B
Equation B Γeff SB M1 M2
Continuity equation
1 0 0 0 0
(porous and clear medium)
Momentum equation (clear 1 µ ∂p
− 0 0
medium) Re µ∞ ∂xi
Momentum equation 1 µ ∂p ϕ ϕ
−ϕ
(porous medium) Re µ∞ ∂xi Re Da Da
The tetrahedral control volume is shown in Figure 3.1. The final form of the discretized
momentum equation (where B refers to velocity) is:
4 ρ∆V 4
AP u P + ∑ AEK u E ,k = S ∆V + u 0p + ∑ Dk (3.2)
k =1 ∆t k =1
Here, p – suffix, signifies control volume cell, k − suffix, signifies neighboring cells
u P − velocity component (either x or y or z)
u 0p − velocity at the last time step
∆V − control volume
∆V 4
AP = − ∑ AE + M1∆V + M 2 VP ∆V , coefficient of control volume cell
∆t k =1 k
1
AEk = − d − (1 − f ck ) Cck  , coefficient of neighboring cells
ϕ  ck 
th
d − diffusion coefficient for k face
ck
Cck − convection coefficient for kth face

21
f ck − weighting factor
Dk − source term based on convection and diffusion coefficients.
Full expression of d , Cck and Dk is given in Date (2005).

ck
The final form of the discretized pressure correction equation is:

4 4 4
AP pP' + ∑ AEK pE' ,k = − ∑ C + ∑ D p' (3.3)
ck k
k =1 k =1 k =1
Here, pP' − pressure correction in control volume cell

4
AP = ∑ AE , coefficient of control volume cell
k
k =1
α A2fk
AEk = u , coefficient of neighboring cells
APcki
α − under-relaxation factor for velocity

A − kth cell face area
fk
u
APcki − coefficient of AP in Equation (3.2)
C − convection coefficient, same as for momentum equation

ck
D p ' − contains the gradient of pressure correction terms. These terms are neglected
k
Figure 3.1: Tetrahedral control Volume

22
3.2. NUMERICAL ALGORITHM

The algorithm specified in Date (2005) is followed. Here is the brief outline of the algorithm.
(i) At a given time step guess a pressure field p.
(ii) Solve discretized momentum transport Equation (3.2) and get provisional velocity (u*) at
each cell.
(iii) Solve discretized pressure correction Equation (3.3) with help of provisional velocity (u*)
and get p ' for each cell.
(iv) Calculate the smoothing pressure correction (Date (2005)) such that the predicted pressures
do not exhibit zig-zag behavior.
(v) Get corrected pressure and velocity in each cell by following formulas (l is iteration step):
pPl +1 = pPl + pP'
α ∆V  ∂p ' 
uil,+P1 = uil, P +  
APui  ∂xi  P
(vi) Evaluate residuals from the imbalance equation for all velocity components according to:
0.5
  4  
2
Rϕ =  ∑  AP u + ∑ AE u − S 
 all nodes  P K E ,k total  
k =1  
Here, S is the total source term, which is the sum of all the term in right hand side of
total
Equation (3.2).
(vii) The mass residual is evaluated as:
0.5
  4 
2
Rm =  ∑  AP p ' − ∑ AE p '  
 all nodes  P
k =1
K E ,k
 
(viii) Check the convergence criteria based on Rϕ and Rm .
(ix) If convergence criterion is not satisfied, then set pPl +1 = pPl and u Pl +1 = u Pl and go back to
step (ii).
(x) If convergence criterion is satisfied go to next time step and set the solution of the present
time step as the initial solution of next step.
23
3.3. NUMERICAL SOLVER

The present study deals with transport within clear and porous media in three dimensional
complex geometries. The numerical code is implemented in C++. External open source hdf5
library is used to manage extremely large mesh datasets. Shared memory parallalization is
implemented using OpenMP framework. The discretized system of algebraic equations is solved
by the stabilized bi-conjugate gradient method (BiCGStab) with a diagonal pre-conditioner.
3.3.1. Code parallelization
Parallel computer architectures traditionally can either be thought of as shared-memory or

distributed memory architectures. For distributed memory architectures, where the memory on
remote processors is not directly addressable, inter-processor communication must be
implemented through message-passing operations, using for example, the MPI message-passing
library. For shared memory architectures, thread-level parallelism has often been advocated. One
way of achieving thread-parallelism is through the use of the OpenMP programming model.
In shared memory parallel (SMP) architectures the user can supply compiler directives to
parallelize the code without explicit data partitioning. Computation is distributed inside a loop
based on the index range regardless of data location and the scalability is achieved by taking
advantage of hardware cache coherence. OpenMP overcomes the portability issues encountered
by machine-specific directives without sacrificing much of the performance. Parallel
programming with directives offers many advantages over programming with the message
passing such as:
(i) Simple to program, with incremental path to full parallelization;
(ii) Shared memory model, no need for explicit data distribution;
(iii) Scalability achieved by taking advantage of hardware cache coherence; and
(iv) Portability via standardization activities.
In this study, we parallelize incompressible three-dimensional Navier-Stokes based
pressure correction solver using OpenMP directives. A fork-join execution model is employed in
OpenMP. A program written with OpenMP begins execution as a single process, called the
master thread. The master thread executes sequentially until the first parallel construct is
encountered (such as a PARALLEL and END PARALLEL pair). The master thread, then,
creates a team of threads, including itself as part of the team. The statements enclosed in the
24
parallel construct are executed in parallel by each thread in the team until a work sharing
construct is encountered. The PARALLEL DO or DO directive is such a work sharing construct
which distributes the workload of a DO loop among the members of the current team. An
implied synchronization occurs at the end of the DO loop unless an END DO NOWAIT is
specified. Data sharing of variables is specified at the start of parallel or work sharing constructs
using the SHARED and PRIVATE clauses. In addition, reduction operations (such as
summation) can be specified by the REDUCTION clause. Upon completion of the parallel
construct, the threads in the team synchronize and only the master thread continues execution.
The concept of orphan directives in OpenMP allows user to specify control or synchronization
from anywhere inside the parallel region, not just from the lexically contained region.
3.4. GRID GENERATION
ICEM-CFD tool (a commercial software) is used to generate high quality unstructured
tetrahedral meshes within the geometry. A very high quality mesh is used for both clear and
porous medium (85 % of the tetrahedrons have quality greater than 0.9 and minimum quality of
0.65 is ensured).
25
3.4.1. Patient-Specific Cerebral aneurysm

Figure 3.2 shows the grid description for patient specific cerebral aneurysm. Over 1×106
grid points are used for numerical simulation. The grid quality of the mesh was ascertained to be
greater than 0.9 at all locations.
(i) (ii)
(iii)
Figure 3.2: Grid description of patient-specific cerebral aneurysm. (i) Inlet surface mesh. (ii)
Aneurysm cross section. (iii) Surface mesh.
26
3.4.2. Sphere-shaped
shaped Saccular Aneurysm
The mesh used for pulsatile through through a sphe
sphere-shaped
shaped aneurysm is shown in
Figure 3.3.. The grid is quite refined with over 1.1 x 106 elements. It contains a total of 1,92,640
nodes to form a tetrahedral mesh where each cell is highly regular with a near
near-unity
unity aspect ratio.
Code validation of the FVM solver is further discussed by Sikarwar et al. (2013)).
(i)
(ii)
Figure 3.3:: Grid description of the aneurysm. (i) Front view
view, (ii) Crossection view from side
plane.
CHAPTER 4
PULSATILE FLOW IN A SACCULAR CEREBRAL ANEURYSM
In this chapter the simulation results of flow in a tube with sphere-shaped aneurysm at the
bending location are reported.
4.1. RESULTS AND DISCUSSIONS

Results presented below are in non-dimensional form. The non-dimensionalization is carried out
with respect to the reference velocity and other parameters specified in Table 2.1. Quantities of
interest are flow distribution in the bulge along with the wall shear stress and wall pressure. Data
have been presented for the region close to the bulge since the legs are less important for the
present study. The time-averaged flow in the model is small but non-zero and net flow prevails
form left to right. However, the oscillatory part of the flow is quite significant and flow
distribution has been shown in terms of the RMS values. From a biological perspective, static
loading is not as critical as the time-dependent counterpart since the latter, by the mechanism of
fatigue, leads to progressive failure of the walls of the blood vessel. In the following paragraphs,
Re of 500 and 1500 are compared at a Wo of 7.82. Flow in a clear geometry, one with a coil in
the bulge, and simulation of blood as a non-Newtonian fluid are compared. Time-averaged and
RMS values are obtained by averaging the flow signals at each cell over three cycles of Figure
2.2. The differences between Newtonian and non-Newtonian characteristics are seen in the
present study to be small. However, the presence of a coil substantially alters the flow properties
in the bulge.
Figure 4.1 shows the time-averaged distribution of total velocity, wall pressure and wall
shear stress around the bulge. The first column is for a clear bulge, the second is for the bulge
with a coil, and the third column presents data when the fluid is taken to be non-Newtonian. For
a clear bulge, a certain fluid velocity is attained within, though the flow shows circulation. With
a coil in place, the main stream bypasses the bulge, and velocities obtained within are much
smaller - by a factor of ten, essentially showing a suppression of flow in this region. The slow
flow through the bulge with a coil is unidirectional and does not classify as flow separation. The
results obtained with a non-Newtonian fluid model are quite similar. A reduction in flow in the
bulge shows a simultaneous reduction in wall shear stress - by a factor of 8. For pressure, the
27
28
Velocity
averaged distribution of absolute velocity (at mid

Figure 4.1: Time-averaged mid-plane
plane in front view), wall
and porous medium with non-Newtonian
Newtonian flow (third column) at Reynolds number Re=500 and
Womersley number Wo=7.82
bulge is a zone of separation and hence spatially uniform pressure. This trend continues with the
bulge carrying the coil, uniform pressure arising from slow unidirectional flow through the
model. Figure 4.1 also shows that the increase in overall resistance to flow in the presence of a
coil is small, mainly because flow has bypassed the bulge region.
Figure 4.2 presents RMS variation of total velocity, wall pressure, and wall shear stress
after removing the time-averaged
averaged value at every cell. The trends here are similar to Figure 4.1 in
29
Velocity
Figure 4.2: RMS deviation of absolute velocity (at mid

mid-plane
plane in front view), wall pressure and
wall shear stress from the time--averaged
averaged values of the flow variables for clear medium (first
column), porous medium (second column) and porous medium with non non-Newtonian
Newtonian flow
flo (third
column) at Reynolds number Re=500 and Womersley number Wo=7.82
the sense that (a) flow in the bulge significantly reduces in the presence of a coil, (b) coil reduces
the wall shear stress, and (c) the difference between Newtonian and non
non-Newtonian
Newtonian treatments is
small. The changes in RMS wall pressure are however quite sm
small.
all. Consequently, wall pressure
is mostly unaffected by the presence of the coil in the bulge. This result arises from the small
absolute velocity prevailing in the bulge with and without the coils in place.
Figure 4.3 represents the time
time-averaged
averaged values for a higher Reynolds number, i.e. Re =
30
Velocity
Figure 4.3: Time averaged distribution of absolute velocity (at mid

mid-plane
plane in front view), wall
and porous medium with non-Newtonian
Newtonian flow (third column) at Reynolds number Re=1500 and
Womersley number Wo=7.82
1500. On increasing the Reynolds number from 500 to 1500 with the same flow conditions, the
embolization technique still works effectively. The wall loading factors increase to very high
values, without any coil insertion, in the bulge region. The extent of the embolization method can
be gaged by the decrement seen in the wall loading factors after coil insertion. The velocity
within the bulge region comes down to zero order values, as is the case observed with the
th wall
shear stress. However, the pressure values remain the same within the bulge region. The velocity
and wall shear stress decreases to 1/10th of their values in the porous medium as compared to the
31
Velocity
Figure 4.4: RMS deviation of absolute velocity (at mid

mid-plane
plane in front view), wall pressure and
wall shear stress from the time--averaged
averaged values of the flow variables for clear medium (first
column), porous medium (secondnd column) and porous medium with non non-Newtonian
Newtonian flow (third
column) at Reynolds number Re=1500 and Womersley number Wo=7.82
clear medium. The aneurysm region is fully stabilized after coil insertion in both the cases with
Reynolds number, Re = 500 and 150
1500.
Calculations were repeated at a Re of 1500 for the geometry of interest (see Figure 4.4
for RMS data). The trends seen at Re=500 were realized here as well, except that the velocity
magnitude in the bulge was higher; so was the dimensionless pressure magnitude. With the
insertionn of a coil, velocity and shear stress values fell by nearly a factor of ten. The pressure
values stayed nearly constant. Hence, the wall loading of a clear bulge increased with Re but
32
diminished in the presence of the coil. This trend is significant becau

because
se it proves the utility of
using a coil to stabilize wall loading over a range of Re.
Figure 4.5 and Figure 4.66 present instantaneous flow data at phases ‘a’ and ‘b’ defined in
Figure 2.2.. These correspond to the peak phase and one of the prom
prominent
inent minimum. The flow
direction is from left to right in both instances, except for a difference in magnitude. Reynolds
numbers of 500 and 1500 are jointly compared. Figure 4.5 is for clear medium while Figure 4.6
includes a coil placed in the bulge, the fluid being non
non-Newtonian. The bulge experiences flow
separation at the two time instants studied and at both Reynolds numbers. At phase ‘a’, flow in
the bulge is stronger than at ‘b’ and the corresponding velocities, shear, and pressure are greater
Phase a Phase b Phase a Phase b

Re=500 Re=1500
Velocity
Figure 4.5: Comparison of absolute velocity (at mid

mid-plane
plane in front view), wall pressure and wall
shear stress in clear media at selected phases of the cycle as shown in Figure 2.2 for Reynolds
number, Re=500 and Re=1500 and Womersley number, Wo=7.82
33
as well for a clear medium. With the placement of a coil, circulating velocities in the bulge
reduce, wall shear reduces, while pressure levels remain relatively unaffected. Instantaneous
Instantaneo
flow patterns confirm that the coil creates a bypass that stabilizes wall loading of the bulge.
Thus, the instantaneous variation in the flow properties from phase ‘a’ to ‘b’ is analogous to a
change in Reynolds number in the time
time-averaged and RMS data.
The stream traces of the flow field within the aneurysm are depicted at selected phases of
the cycle in Figure 4.7.. The first and second column shows the stream traces
trace for Reynolds
number 500, while the other two are for Reynolds number 1500. The flow is observed to be
recirculated within the aneurysm in the case of clear medium for both the Reynolds number
thereby increasing the pressure and stress on the walls. Howev
However,
er, there is no recirculation pattern
Re=500 Re=1500
Velocity
Figure 4.6: Comparison of absolute velocity (at mid

mid-plane
plane in front view), wall pressure and wall
shear stress in porous media with non
non-Newtonian
Newtonian model at selected phases of the cycle as shown
in Figure 2.2 for Reynolds number, Re=500 and Re=1500 and Womersley number, Wo=7.82
34
after coil insertion and the flow is redirected towards the main artery from the aneurysm region.
After coil insertion, the streamlines tend to redirect towards the main tube and the density of
stream traces within the aneurysm also decreases.
Apart from overall trends in the bulge, it is of interest to know if the loading is particularly high
at selected locations. For this purpose, instantaneous wall shear and pressure are provided in
Figure 4.9 at points A, B, and C of the bulge (shown in Figure 4.8). Reynolds numbers of 500
and 1500 are shown. Wall shear stresses at points A, B, and C are distinctly different for a bulge
with clear fluid. In the presence of a coil, the flow pattern is regularized and the differences are
smaller. Wall shear stresses increase substantially with Reynolds number in a

Re=500 Re=1500
Figure 4.7: Stream traces at the mid-plane in front view at selected phases of the cycle as shown
in Figure 2.2 for Reynolds number, Re=500 and Re=1500 and Womersley number, Wo=7.82.
First row represents the clear medium, second row is porous medium with Newtonian model,
third row being porous medium with non-Newtonian model.
35
clear bulge but the increase is smaller in the bulge with a coil. For a clear bulge, point A shows
the largest wall shear and is expected to be the point of highest wall loading. Point B shows
lower wall shear over a cycle and is also a point of interest. These differences are broadly
submerged when a coil is used since the flow in the bulge is homogenized.
The pressure variation, plotted in the Figure 4.9, shows that the three points A, B and C
are largely indistinguishable in terms of pressure and consistently reveal the effect of Re. Thus,
pressure is spatially uniform in the bulge at all time instants. Pressure increases with Re and is
slightly lowered when the coil is placed within the aneurysm. A non-Newtonian fluid treatment
shows a slight augmentation in pressure because of the shear-thinning behavior of the fluid. As
shown in Figure 4.9, the presence of a porous medium inside the bulge softens the flow pulsation
and prohibits the inflow pulsation to reach the wall. A comparison between Figure 4.9 (second
and third row) shows that Newtonian fluid suppresses flow pulsation more efficiently than the
shear-thinning fluid. Suppression of flow pulsation indicates the dominance of diffusive
momentum-transport promoted by the presence of the porous medium. The shear thinning
rheology of blood, on the other hand, reduces viscosity in the regions of high velocity gradients
promoting the convective and Darcian transport mechanisms. Dominance of such transport
mechanisms preserves the inflow pulsation, as shown in Figure 4.9 (third row). The shear
thinning behavior of blood dominates the near-wall region of the blood vessel, including points
A, B, C. These points, therefore, experience the rheology-induced low viscosity effect and
transport the inflow pulsation up to the wall, Figure 4.9 (third row).
Figure 4.8: Schematic model of the bulge region. Points A, B and C indicate the points at which
the pressure and wall shear stress variation
36
Figure 4.9: Wall shear stress and pressure variation with time at selected points A, B and
a C in the
bulge region for clear media (first row), porous media (second row) and porous media with non-
non
Newtonian flow (third row) at Re = 500 (left column) and Re = 1500 (right column)
37
Figure 4.10 depicts the comparison between wall vorticity and wall shear rate (Eq, (2.12))
calculated for the time-averaged distribution in clear and porous media. The difference obtained
in of considerable value. The latter one is used for calculating the wall shear stress on the
aneurysm walls. Figure 4.11 shows the variation of normalized wall viscosity with reference to
the Carreau-Yashuda model used for the shear-thinning characteristics of fluid. The viscosity is
Wall vorticity Wall shear rate
(i) (i)
(ii) (ii)
Figure 4.10: Wall Vorticity and wall shear rate contours for the time-averaged distribution at Re
= 500 for (i) Clear medium and (ii) porous medium.
38
normalized with the reference viscosity given in Table 2.1. The contours show that the variation
in viscosity with respect to Carreau-Yashuda model decreases with increase in Reynolds number.
The difference decreases on moving towards the wall region from the middle of the aneurysm.
This shear-thinning characteristic can be seen near the wall region where the shear stress is
critical near the walls while the viscosity decreases moving towards the walls.
Re = 500
Mid-plane Wall Region
Re = 1500
Figure 4.11: Wall viscosity variation on the wall (first column) and in the mid-plane section
(second column) of the time-averaged distribution in porous media with non-Newtonian fluid
model for Re 500 and 1500.
CHAPTER 5
PULSATILE FLOW IN A PATIENT
PATIENT-SPECIFIC
SPECIFIC CEREBRAL
ANEURYSM
In this chapter the simulation results of oscillatory flow in a patient-specific

specific cerebral aneurysm
are reported.
5.1. RESULT AND DISCUSSIONS
Results presented below are in non
non-dimensional form. The non-dimensionalization
dimensionalization is carried out
with respect to the parameters
eters specified in Table 2.1. Here, d is the inlet diameter, U is the
average peak velocity of the inlet waveform ((Figure 2.4 and Figure 2.5).
). The calculations were
conducted for 10 cycles of oscillation. Quantities of interest are flow distribution in the bulge
along with the wall shear stress and wall pressure. In the following pa
paragraphs,
ragraphs, flow in rest and
exercise condition with Re 500 are compared
compared.. Flow in a clear geometry, one with a coil in the
bulge, and one with coil in the bulge considering blood as a non-Newtonian
Newtonian fluid are compared.
Time-averaged
averaged and RMS values are obtained by averaging the flow signals at each cell over last
three cycles of Figure 2.4 and Figure 2.5.. The differences between Newtonian and non-
non
Newtonian characteristics are seen in the present study to be small. However, the presence of a
coil substantially
tially alters the flow properties in the bulge.
The velocity contours are presented along the two planes shown in Figure 5.1.
plane A plane B
Figure 5.1: Planes across the geometry at which the velocity contours are shown.
39
40
Continuity of velocity is imposed at the clear and porous medium interface for coil
insertion within the aneurysm (Figure
Figure 5.2).
). The points A, B, C and D indicate the points at which
the wall pressure and wall shear stress are discussed later in this section.
Figure 5.2: Porous medium modeling of coil embolization. A, B, C and D are the points at which
the flow variables are discussed later
later.
The results are presented for the rest and exercise flow conditions of blood as mentioned in
Figure 2.4 and Figure 2.5.. A constant pressure condition is specified at the outlet for these
simulation conditions.
Figure 5.3 and Figure 55.4 show the time-averaged
averaged and RMS deviation contours of
velocity, wall pressure and wall shear stress in clear medium. The first two columns represent the
contours for the rest condition while the other two columns represent the contours generated for
the exercise condition. Without any coil insertion significant flow can be seen inside the
aneurysm for both the conditions. The magnitude of the field variables are slightly escalated for
the flow under exercise conditions than the rest conditions. The ve
velocity
locity difference is not visible
after averaging the values for three cycles but the difference can be seen at selective instants of
time. The difference in wall pressure for the rest and exercise conditions is clearly visible in the
contours. This shows that
hat the blood flows faster during exercise than the rest condition and the
pressure and wall shear stress magnitudes exerted on the walls are slightly increased in case of
exercise, thus increasing the chances of rupture.
The deviation shown for the exerc
exercise
ise condition is also higher for wall pressure and wall
shear stress. This show the fluctuations in pressure and wall shear stress during the exercise
41
condition are of higher order than in rest condition. The fluctuation observed in wall pressure is
almost as of the same order as its time-averaged value.
After considering the flow in clear media, the effectiveness of the coil embolization
technique can be gaged from the contours mentioned in Figure 5.5 and Figure 5.6. The contours
show the results obtained after inserting coils inside the aneurysm region, with Newtonian fluid
model. The bulge region acts as porous medium after coil insertion. In case of clear bulge,
certain fluid velocity is attained within the region. After placing a coil in the region, the flows
seems to be bypassing the bulge region, thereby reducing the velocities by a factor of five,
suppressing the flow in the bulge region. Almost similar results are obtained with the use of non-
Newtonian model (Figure 5.7 and Figure 5.8). The pressure contours are .however, mostly
unchanged with or without any coil insertion. It can be said that the bulge acts as a zone of
separation for pressure and so spatially uniform pressure is obtained. The slow flow through the
bulge with coils is unidirectional and thus helps in arising a uniform pressure in the bulge region.
The wall shear stress in the bulge region reduces by a factor of three and also nullifies any
deviation in the region. The figures thus far show that the coils inside the aneurysm are effective
during both the rest and exercise condition.
The trends generated in case of Figure 5.7 and Figure 5.8 are similar to the trends in
Newtonian model. The similarity in trends can be judged in the following way (a) flow is
suppressed inside the aneurysm after coil insertion (b) the wall shear stress is reduced
significantly in the region (c) the wall pressure is mostly unaffected by the presence of coil inside
the bulge region, which arises due to the small velocity prevailing in the bulge region after coil
insertion.
Figure 5.9 to Figure 5.14 present instantaneous flow data at selective phases ‘a’ and ‘b’
defined in Figure 2.4 and Figure 2.5. The phases ‘a’ and ‘b’ correspond to the peak phase and
one of the prominent minimums. Figure 5.9 and Figure 5.12 are for clear medium, 5.10 and 5.13
are for porous medium with Newtonian model, and 5.11 and 5.14 include porous medium (coil in
the bulge region) with the fluid being non-Newtonian. The peak phases for rest and exercise
condition are at different time instants as shown in their waveforms and compared accordingly.
Figures 5.9 to 5.11 show the contours under rest condition while Figures 5.12 to 5.14 under
exercise condition.
42
Rest condition Exercise condition
plane A plane B plane A plane B
Figure 5.3: Time-averaged distribution of the field variables in clear media with rest and exercise
condition: first row, absolute velocity at the planes shown in Figure 5.1; second row, wall
pressure and third row, wall shear stress.
43
Figure 5.4: RMS deviation of the field variables from their time-averaged values in clear media
with rest and exercise condition: first row, absolute velocity at the planes shown in Figure 5.1;
second row, wall pressure and third row, wall shear stress.
44
Figure 5.5: Time-averaged distribution of the field variables in porous media with Newtonian
model under rest and exercise condition: first row, absolute velocity at the planes shown in
Figure 5.1; second row, wall pressure and third row, wall shear stress.
45
with Newtonian model under rest and exercise condition: first row, absolute velocity at the
planes shown in Figure 5.1; second row, wall pressure and third row, wall shear stress.
46
Figure 5.7: Time-averaged distribution of the field variables in porous media with non-
Newtonian model under rest and exercise condition: first row, absolute velocity at the planes
shown in Figure 5.1; second row, wall pressure and third row, wall shear stress.
47
with non-Newtonian model under rest and exercise condition: first row, absolute velocity at the
planes shown in Figure 5.1; second row, wall pressure and third row, wall shear stress.
48
The flow is stronger in phase ‘a’ than phase ‘b’ and the velocity, pressure and wall shear
stress magnitudes are also greater in phase ‘a’ for simulation results in clear medium. Pressure
within the aneurysm at phase ‘a’ is approximately three times higher than that of phase ‘b’. After
the placement of a coil in Figure 5.10, the velocities reduce upto seven times inside the bulge
region also reducing the wall shear stress while the pressure levels remain unaffected as observed
in the previous contours. The instantaneous variation in the flow properties from phase ‘a’ to ‘b’
defines the range of flow magnitudes for which the coil embolization treatment stabilizes the
aneurysm region, or in other words the instantaneous variation in the flow properties from phase
‘a’ to ‘b’ is analogous to a change in Reynolds number in the time-averaged and RMS data.
Figure 5.11 shows the results obtained with the non-Newtonian fluid model. The trends obtained
are quite similar to those in Figure 5.10.
Figure 5.12, 5.13 and 5.14 show the flow being simulated in exercise condition at
selective instants of time. The contours obtained depict the same trend observed under rest
condition. The magnitudes of field variables are slightly heightened in case of clear bulge but
stabilized after the placement of coils inside the bulge region.
It is interesting to know if there are certain locations in the aneurysm region which are
more prone to rupture than the rest of the aneurysm. The chances of rupture starting from these
locations are very high compared to the other parts of the aneurysm. Analyzing the pressure and
shear stress on the walls of these region is more important. Figure 5.15 and 5.16 depict the
variations of wall shear stress and wall pressure at certain locations A, B, C and D within the
aneurysm region (Figure 5.2) for one physiological waveform cycle. Figure 5.15 shows the
variation at locations A, B, C and D under rest condition while Figure 5.16 shows the same under
exercise condition.
In Figure 5.15, the pressure variation is nearly same for all the locations after coil
insertion. However, in clear bulge the pressure at location ‘C’ is slightly more than the rest of the
locations, but after placing the coils, the pressure distribution seems spatially uniform at all time
instants irrespective of the fluid being Newtonian or non-Newtonian. There is no major change
in magnitude of the pressure region after coil insertion. The pressure variation at different
locations is hardly distinguishable after coil insertion. A non-Newtonian fluid treatment shows a
slight augmentation in pressure because of the shear-thinning behavior of the fluid.
49
Rest condition
Phase a Phase b
the cycle (shown in Figure 2.4) with resting condition: first row, absolute velocity at the planes
50
Rest condition
Phase a Phase b
model at selected phases of the cycle (shown in Figure 2.4) with resting condition: first row,
wall shear stress.
51
Rest condition
Phase a Phase b
Newtonian model at selected phases of the cycle (shown in Figure 2.4) with resting condition:
row, wall shear stress.
52
Exercise condition
Phase a Phase b
the cycle (shown in Figure 2.5) with exercise condition: first row, absolute velocity at the planes
53
Exercise condition
Phase a Phase b
model at selected phases of the cycle (shown in Figure 2.5) with exercise condition: first row,
wall shear stress.
54
Exercise condition
Phase a Phase b
Newtonian model at selected phases of the cycle (shown in Figure 2.5) with exercise condition:
row, wall shear stress.
55
Figure 5.15: Wall shear stress and pressure variation with time under resting condition at
(second row) and porous media with non-Newtonian flow (third row).
56
Figure 5.16: Wall shear stress and pressure variation with time under exercise condition at
(second row) and porous media with non-Newtonian flow (third row).
57
In case of exercise condition also, the pressure variation is quite similar to what we
observed in rest condition plots. The cycle time is reduced in exercise condition which enables
the pressure to achieve peak values much faster than in rest condition. The magnitudes remain
unaffected and decreases slightly after coil insertion. The increased frequency in the exercise
condition increases the chances of aneurysm getting ruptured.
Wall shear stress at location C (Figure 5.15) is much different than the other locations A,
B, and D. The magnitude of wall shear stress at ‘C’ is two times the value at other regions. In the
presence of a coil, the flow variation is regularized and the differences are of very small order.
With exercise condition (Figure 5.16), the wall shear stress increase substantially in a clear bulge
than the rest condition. The magnitudes of wall shear stress increase with the increase in flow
magnitudes. The variation at ‘C’ is distinctively different than the other locations with both the
rest and exercise conditions. However, the difference is very much small after placing the coils.
As observed in the figures, Point ‘C’ shows the largest wall shear in the two figures followed by
point ‘B’, then point ‘A’ and the lowest wall shear is observed at point ‘D’. These differences are
broadly submerged after placing the coils and a uniform distribution nature is seen in the
aneurysm since the flow is also homogenized in the region. The increase in frequency due to
exercise condition is not of much concern in terms of wall shear stress as the stress is reduced to
zero order values.
The presence of coils inside the bulge region softens the flow pulsation inside the
aneurysm and restricts these pulsations to reach the wall of the aneurysm. From Figure 5.16
(second and third row), it is evident that Newtonian fluid is much more efficient in suppressing
flow than the non-Newtonian fluid. The shear-thinning rheology of blood reduces viscosity in the
regions of high velocity gradients in favor of Darcian transport mechanisms.
CHAPTER 6
CONCLUSIONS AND FUTURE WORK
The work done in this thesis is summarized in this chapter and possible future extension of the
work is also suggested.
6.1. SUMMARY AND CONCLUSIONS
6.1.1. Pulsatile flow in a saccular cerebral aneurysm
In the present study coil embolization modeling of saccular cerebral aneurysm is reported. The
coils are modeled as porous medium and represented using Forchheimer-Brinkman extended
Darcy model. A realistic velocity waveform is applied on the inflow plane. The unsteady form of
the governing equations is solved in three dimensions by a finite volume method. Results
obtained in the present work show that the bulge is a region of flow recirculation. In the presence
of a coil, the bulge is bypassed and flow intensity in the bulge is greatly reduced. Consequently,
wall shear stress is also diminished. The pressure distribution in the bulge remains spatially
uniform with and without the coil. The effect of treating blood as non-Newtonian is to increase
wall shear and pressure levels, though the differences with respect to the Newtonian model are
only marginal. The particulate nature of blood is not expected to alter the results obtained since
the suspended RBCs are much smaller than the pore dimensions of the coil.
The sizes of the blood cells in the solid phase vary from 5 µm to 20 µm in case of RBC to
WBC, respectively. The dynamic clustering of red blood cells leads up to a dimension of 20-30
µm. The aneurysm region in the model used is quite large, with a diameter of 30 mm. The
packing density by volume for the coils placed will be 26.5 % (porosity 0.735). The pore length
scale for this volume can now be estimated as 10 mm. Since the pore-scale is much larger than
the blood particles, one can make an approximation that the coil will not selectively block the
passage of particulates. The possibility of the coil porosity diminishing with time is also
minimal.
58
59
6.1.2. Pulsatile flow in a patient-specific cerebral aneurysm under rest and exercise
condition
In the present study coil embolization modeling of patient-specific cerebral aneurysm is

considered with the application of rest and exercise condition. The 3D patient-specific is
reconstructed from MRA images using vascular modeling tools. The shear-thinning
characteristic of blood is incorporated in the Carreau-Yashuda model. The coils are considered as
a porous medium and represented using Forchheimer-Brinkman extended Darcy model. The
physiological waveform in exercise is different than rest condition. The frequency increases
almost twice its value in the rest condition. A constant pressure condition is specified at the
outlet.
Computation of hemodynamics in a patient-specific cerebral aneurysm under exercise
condition provides valuable information for a person to go on planning for this treatment or not.
Due to high frequency in case of exercise, the cyclic loading on the walls of the aneurysm is
more dangerous for its survival. It is important to determine the effectiveness of this technique
under extreme conditions. The impingement forces on the walls are mainly quantified by the
pressure and wall shear stress. After placing the coils inside, the pressure distribution remains
unchanged within the aneurysm but becomes spatially uniform in the region. However, the
reduction in wall shear stress is very beneficial in terms of a patient’s perspective. In
hemodynamic studies, it is mainly the wall shear stress responsible for the growth and rupture of
an aneurysm as it weakens the tissues of the walls and reduces the thickness of the arterial wall.
The coils reduce the impingement force in terms of wall shear stress. The knowledge obtained
based on this limited study suggests that a person can go for this treatment even if he prefers to
go for exercise, but he should keep a regular tab on the growth of the aneurysm.
6.2. FUTURE WORK
The work can be extended in a few possible ways.

One of the main direction is to incorporate the fluid-solid interactions (FSI) in the
simulation method. In the present study the artery walls are considered as rigid. In reality the
artery walls are deformable. The interaction between the deformable artery wall and blood affect
the flow patterns and fluid loading. To model FSI the governing stress equations of the artery
60
need to be taken into account. The governing equations of blood and artery wall are solved
simultaneously. The complexity of the problem leads to a large computational effort. In this
direction, the article of Takizawa et al. (2011) could be referred.
One can also continue to examine the shear stress and pressure levels in the solid arterial
walls. The solutions of the present study can be taken as the initial condition for this work. The
governing equations would require a complex numerical solver for the solid mechanics
equations. It will help in understanding the impact of fluid loading on the walls more
extensively.
APPENDIX
DERIVATION OF WOMERSLEY ANALYTICAL SOLUTION
A.1 PULSATILE FLOW THROUGH A TUBE: WOMERSLEY SOLUTION

The governing momentum equation in this case is:
∂w ∂p 1  ∂ 2 w 1 ∂w 
= −ϕ +  +  (C.4)
∂t ∂z Re  ∂r 2 r ∂r 
 
As the flow is oscillatory we could represent the velocity and pressure gradient in following
form:
∞ iω t
w= ∑ W ( r )e n
n
n = −∞ (C.5)
dp ∞ iω t ∞
dz
=− ∑ G e n = ∑
n = −∞
n
n = −∞
p
z n ( )
Here, ωn = nω . Now substituting Equation (C.5) in Equation (C.4) and equating both sides for
each harmonic will give following equation:
1  d 2Wn 1 dWn 
iωnWn = Gn +  +  (C.6)
Re  dr 2 r dr 
Equation (C.6) could be written in following form:
d 2Wn dWn
r2 +r + r 2 ( −i Re ωnWn + Re Gn ) = 0 (C.7)
dr 2 dr
The boundary conditions are:

Wn = finite at r = 0 and Wn = 0 at r = 0.5 (C.8)
For n = 0 , Equation (C.7) has following solution:
W (r ) = W (1 − 4r 2 )
0 c0
G (C.9)
W = 0
c 0 16 Re
Now for n ≠ 0 consider,
−i Re ωnWn + Re Gn = U n (C.10)
61
62
Therefore, Equation (C.7) can be written as:
d 2U n dU n
r2 +r + r 2 ( −i Re ωn ) U n = 0 (C.11)
dr 2 dr
Now consider
r 2 ( −i Re ω n ) = x 2 (C.12)
Therefore, Equation (C.11) can be written as:
2 d 2U n dU n
x +x + x 2U n = 0 (C.13)
dx 2 dx
This is a Bessel’s differential equation, and the solution would involve Bessel functions of zeroth
order and complex arguments. Thus
U n = C1 J 0 ( x) + C2Y0 ( x) (C.14)
Now substituting Equation (C.10) and (C.12) in (C.14):
1
Wn = − (
C J (r −i Re ωn ) + C2Y0 (r −i Re ωn ) − Re Gn
i Re ωn 1 0
) (C.15)
Re Gn
Applying boundary condition (C.8) it can be shown that: C1 = and C2 = 0
J 0 (0.5 −i Re ωn )
Hence Equation (C.15) can be written as:

 I (r A )   
 0 n   1 
W (r ) = W 1 − / 1−
n cn  I (0.5 A )   I (0.5 A ) 
 0 n   0 n 
(C.16)
 
1
W = B 1 − 
cn n  I (0.5 A ) 
 0 n 
G
where, I ( x) = J 0 (ix) is the modified Bessel function, B = n and A = iReω .
0 n iω n n
n
CALCULATION OF DISCHARGE AND AVERAGE VELOCITY PROFILE

Discharge is calculated as follows:
0.5
Q (t ) = ∫ 2π rw(t ) dr
0
(C.17)
63
Using the analytical solution (C.5)
πW ∞ W  I (0.5 A )  iω t
1 − 1 1 n e n
Q (t ) =
2
c0 + 2π
∑
n=−∞ 
cn
8 2 A I (0.5 A ) 
(C.18)
n≠ 0  1 − 1  n 0 n 
 I (0.5 A ) 
 0 n 
Now average velocity is represented in the following form:
∞ iω t
wavg (t ) = ∑ Wavgn e n (C.19)
n = −∞
Again
π ∞ iω t
Q (t ) = π (0.5)2 wavg (t ) = ∑
4 n =−∞
Wavgn e n (C.20)
Therefore, comparing Equation (C.18) and (C.20) it could be said that:
8W  I (0.5 A ) 
Wavgn = cn 1− 1 1 n  for n ≠ 0 (C.21)
 8 2 A I (0.5 A ) 
1 − 1  n 0 n 
 I (0.5 A ) 
 0 n 
W
Wavg 0 = c0 for n = 0 (C.22)
2
With the help of Equation (C.21), (C.22) and (C.19) the average velocity is calculated.
DIMENSIONAL FORM OF THE SOLUTION

In dimensional form Equation (C.9) and (C.16) are written as:
 r2 
W (r ) = W 1 − 2 
0 c0  R 
G
W = 0 R2 (C.23)
c 0 4 ρµ
 I (r A )   
1
W (r ) = W 1 − 0 n  / 1 − 
n cn  I (R A )   I (R A ) 
 0 n   0 n 
64
 
 1 
W = B 1−
cn n I (R A ) 
 0 n 
ρω G
A =i n, B = n
n µ n i ρω
n
In dimensional form Equation (C.21) is as:
2W  I (R A ) 
Wavgn = cn 1 − 1 1 n  (C.24)
 2 2 A I (R A ) 
1 − 1  n 0 n 
 I (R A ) 
 0 n 
where, R is the radius of tube.
A.2 PULSATILE FLOW THROUGH A TUBE FILLED WITH POROUS MEDIUM
The governing momentum equation in this case is:
∂w ∂p 1  ∂ 2 w 1 ∂w  ϕ
= −ϕ +  + − w (C.25)
∂t ∂z Re  ∂r 2 r ∂r  Re Da
 
Similar to the Womersley solution, consider:
∞ iω t
w= ∑ W ( r )e n
n
n = −∞ (C.26)
dp ∞ iω t ∞
dz
=− ∑ G e n = ∑
n = −∞
n
n = −∞
p
z n ( )
Now substituting Equation (C.26) in Equation (C.25) and equating both sides for each harmonic
will give following equation:
d 2Wn  
+ r 2  −  i Re ωn +
dWn ϕ 
r2 +r  Wn + ϕ Re Gn  = 0 (C.27)
dr 2 dr   Da  
The boundary conditions are:
Wn = finite at r = 0 and Wn = 0 at r = 0.5 (C.28)
Now consider
65
−  i Re ωn +
ϕ 
Wn + ϕ Re Gn = U n (C.29)
 Da 
Therefore, Equation (C.27) is written as:
d 2U n  ϕ 
+ r 2  −  i Re ωn +
dU n
r2 +r  Un = 0 (C.30)
dr 2 dr   Da  
Now consider
  ϕ  2
r 2  −  i Re ωn +  =x (C.31)
  Da  
Therefore Equation (C.30) could be written as:
d 2U n dU n
x2 +x + x 2U n = 0 (C.32)
dx 2 dx
This is a Bessel’s differential equation, and the solution would involve Bessel functions of zeroth
order and complex arguments. Thus
U n = C1 J 0 ( x) + C2Y0 ( x) (C.33)
Substituting Equation (C.29) and (C.31) in (C.33):
1
Wn = −
An 1 0
(
C J (ir An ) + C2Y0 (ir An ) − ϕ Re Gn ) (C.34)
ϕ
where, A = iReω + .
n n Da
ϕ Re Gn
Applying boundary condition (C.28) we get: C1 = and C2 = 0 .
J 0 (0.5i An )
Hence, Equation (C.34) reduces to

 I (r A )   
1
W (r ) = W  1 − 0 n  / 1 − 
n cn  I (0.5 A )   I (0.5 A ) 
 0 n   0 n 
(C.35)
 
1
W = B 1 − 
cn n  I (0.5 A ) 
 0 n 
ϕ Re G
where, B = n .
n ϕ
iReω +
n Da
66
CALCULATION OF DISCHARGE AND AVERAGE VELOCITY PROFILE

Discharge is calculated as follows:
0.5
Q(t ) = ∫ 2π rw(t ) dr
0
(C.36)
Using Equation (C.26)
∞ W  I (0.5 A )  iω t
Q(t ) = 2π ∑ cn 1 − 1 1 n e n (C.37)
n =−∞  8 2 A I (0.5 A ) 
1 − 1  n 0 n 
 I (0.5 A ) 
 0 n 
Now average velocity is represented in the following form:
∞ iω t
wavg (t ) = ∑ Wavgn e n (C.38)
n = −∞
Again
π ∞ iω t
Q(t ) = π (0.5)2 wavg (t ) = ∑
4 n=−∞
Wavgn e n (C.39)
Therefore,
8W  I (0.5 A ) 
Wavgn = cn 1− 1 1 n  (C.40)
 8 2 A I (0.5 A ) 
1 − 1  n 0 n 
 I (0.5 A ) 
 0 n 
With help of Equation (C.38) and (C.40) the average velocity is calculated.
DIMENSIONAL FORM OF THE SOLUTION

In dimensional form Equation (C.35) is written as:
67
 I (r A )   
 0 n   1 
W (r ) = W 1− / 1−
n cn  I ( R A )   I ( R A ) 
 0 n   0 n 
 
 1 
W = B 1− (C.41)
cn n  I (R A ) 
 0 n 
ρω ϕG
A =i n+ϕ , B = n
n µ K n ϕµ
i ρω +
n K
In dimensional form Equation (C.21) is written as:
2W  I (R A ) 
Wavgn = cn 1 − 1 1 n  (C.42)
 2 2 A I (R A ) 
1 − 1  n 0 n 
 I (R A ) 
 0 n 
where, R is the radius of tube.
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Agrawal - 2014 - Effect of Coil Embolization On Fluid Loading in Cerebral Aneurysms

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Effect of Coil Embolization on fluid loading

B.Tech - M.Tech Dual Degree

DEPARTMENT OF MECHANICAL ENGINEERING

Dedicated to my parents, sister, brother and all

TABLE OF CONTENTS ............................................................................................................... vi

LIST OF TABLES ....................................................................................................................... viii

LIST OF FIGURES ....................................................................................................................... ix

NOMENCLATURE .................................................................................................................... xiv

CHAPTER 1 INTRODUCTION AND LITERATURE REVIEW ............................................. 1

1.1. DIAGNOSIS .................................................................................................................... 2

1.2. TREATMENT OF THE DISEASES ............................................................................... 2

1.3. RELATED WORK .......................................................................................................... 5

1.3.1. Coil Embolization treatment of cerebral aneurysm .................................................. 5

1.3.2. Flow in porous medium ............................................................................................ 6

1.4. SCOPE OF THE PRESENT WORK ............................................................................... 7

1.5. THESIS OUTLINE .......................................................................................................... 7

CHAPTER 2 MATHEMATICAL MODELING ........................................................................ 8

2.1. POROUS MEDIUM ........................................................................................................ 8

2.2. FLOW PARAMETERS ................................................................................................... 8

2.3. GOVERNING EQUATIONS .......................................................................................... 9

2.4. NON-NEWTONIAN CHARACTERISTICS OF BLOOD ........................................... 10

2.4.1. Realistic Model of Blood ........................................................................................ 11

2.5. PROBLEM FORMULATION FOR NUMERICAL FORMULATION ....................... 12

2.5.1. Pulsatile flow through a Spherical-shaped Cerebral Aneurysm ............................. 12

2.5.1. Coil embolization treatment of patient-specific cerebral aneurysm ....................... 14

CHAPTER 3 NUMERICAL SIMULATION ........................................................................... 19

3.1. DISCRETIZATION ....................................................................................................... 19

3.2. NUMERICAL ALGORITHM ....................................................................................... 22

3.3. NUMERICAL SOLVER................................................................................................ 23

3.3.1. Code parallelization ................................................................................................ 23

3.4. GRID GENERATION ................................................................................................... 24

3.4.1. Patient-Specific Cerebral aneurysm ........................................................................ 25

3.4.2. Sphere-shaped Saccular Aneurysm......................................................................... 26

CHAPTER 4 PULSATILE FLOW IN A SACCULAR CEREBRAL ANEURYSM .............. 27

4.1. RESULTS AND DISCUSSIONS .................................................................................. 27

CHAPTER 5 PULSATILE FLOW IN A PATIENT-SPECIFIC CEREBRAL ANEURYSM. 39

5.1. RESULT AND DISCUSSIONS .................................................................................... 39

CHAPTER 6 CONCLUSIONS AND FUTURE WORK ......................................................... 58

6.1. SUMMARY AND CONCLUSIONS ............................................................................ 58

6.1.1. Pulsatile flow in a saccular cerebral aneurysm ....................................................... 58

6.2. FUTURE WORK ........................................................................................................... 59

A.1 PULSATILE FLOW THROUGH A TUBE: WOMERSLEY SOLUTION .................. 61

Table 2.1: Terms used for normalization ...................................................................................... 10

Table 3.1: Generalized representation of the governing equations............................................... 20

Figure 1.1: (a) Atherosclerosis [http://www.webmd.com] (b) AAA [http://www.nlm.nih.

Figure 3.1: Tetrahedral control Volume ....................................................................................... 21

A ϕ / Da for clear medium; ( iReωn + ϕ / Da ) for porous medium

1.2. TREATMENT OF THE DISEASES

Figure 1.1: (a) Atherosclerosis [http://www.webmd.com] (b) AAA [http://www.nlm.nih.

1.3. RELATED WORK

1.3.2. Flow in porous medium

1.4. SCOPE OF THE PRESENT WORK

1.5. THESIS OUTLINE

2.1. POROUS MEDIUM

Intrinsic phase average of any quantity of fluid phase is defined as:

2.2. FLOW PARAMETERS

2.3. GOVERNING EQUATIONS

Table 2.1: Terms used for normalization

Pressure ρ(Uref) 2 Vorticity Uref /d

WSS μUref /d Time d/ Uref

Angular Uref /d Viscosity ∞ - reference viscosity based on the

2.4. NON-NEWTONIAN CHARACTERISTICS OF BLOOD

Here, u, v and w are the x, y and z components of velocity, respectively.