A16 3D Digital model of the middle cerebral artery and its perforators for computational fluid dynamics study aimed at the treatment of acute intracerebral hemorrhage

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Background/Introduction Intracerebral hemorrhage (ICH), the second most common subtype of stroke, affects approximately 3.5 million people each year. Its incidence is increasing due to population aging and the growing use of antithrombotic therapies. It represents the most severe form of stroke, characterized by a high early mortality rate (~40%) and disabling sequelae in nearly half of survivors. Hematoma expansion (HE), occurring within the first six hours, is a key factor associated with worsening prognosis. Current therapeutic strategies aimed at limiting HE, including hemostatic agents and blood pressure control, have shown limited efficacy. Objective/Purpose Within the framework of the TIPITCH project (Transforming the Prognosis of Intra Cerebral Haemorrhage), we propose an innovative approach based on an acute-phase endovascular intervention aimed at temporarily modulating blood flow. The objective is to develop a device capable of mechanically modulating flow within lenticulostriate perforating arteries in order to limit hematoma growth. A computational fluid dynamics (CFD) approach is used to evaluate different device concepts, designs, and geometries. The goal is to create a large-scale 3D digital vascular model enabling in silico testing of various devices. Methods/Case Description Anatomical 3D vascular models are reconstructed from Flat-Panel Computed Tomography images (ARTIS Icono, Siemens Healthineers, Germany) with selective intra-arterial contrast injection. Physiological hemodynamic conditions are then applied to simulate blood flow within perforating arteries arising from the middle cerebral artery. The models are validated through comparison with clinical data reported in the literature. Results/Findings Two vascular models were reconstructed through segmentation and subsequently used to perform both steady-state and pulsatile CFD simulations. The resulting hemodynamic parameters are consistent with those reported in the literature. Discussion/Conclusions/Learning Points This framework enables realistic anatomical and hemodynamic modeling. Future work will include the integration of a larger number of models to account for anatomical variability, as well as the evaluation of medical devices to optimize their efficacy.

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