This preliminary proof-of-concept study of four patients found that CFD simulations built from post-recanalization CTA could recreate the contrast agent distribution seen in carotid artery occlusion, including a high-pressure dead space in the distal C1 segment during C4 occlusion, offering preliminary evidence for understanding contrast distribution and imaging assessment of occlusion length.
Conventional imaging in carotid artery occlusion can misestimate occlusion length, which motivated the use of CFD to analyze contrast agent distribution.
The study analyzed four patients with AIS caused by CAO, using CFD simulations built from postoperative CTA and compared with preoperative CTA and intraoperative DSA.
A flame sign at the ICA origin was seen on CTA/DSA in Patients 1-3, with differing underlying etiologies.
Patient 3's DSA showed contrast features distinct from Patients 1 and 2.
CFD simulation using the post-recanalization CTA model replicated the contrast distribution observed in Patient 3, including the vortices and the horizontal interface.
CFD simulations of C4-segment occlusion revealed a high-pressure dead space in the distal C1 segment.
The authors conclude that the study provides preliminary evidence for understanding contrast agent distribution in carotid occlusions that may inform clinical imaging assessment.
When a large artery in the neck or head is blocked and causes a stroke, doctors rely on scans with injected contrast dye to judge how long the blockage is. These scans can be misleading, because the dye may not fill the vessel beyond the blockage in the way people expect. That could affect treatment decisions. This small study looked at four stroke patients with carotid artery blockage. The researchers used computer fluid-flow simulations, built from scans taken after the blockage was reopened, to model how contrast dye would move through the artery. In one patient with a blockage further along the artery (the C4 segment), the simulation reproduced what was seen on the angiogram: swirling dye near the start of the C1 segment, a flat boundary between dye and blood, and no dye reaching the farther part of C1. The model suggested a high-pressure stagnant zone in the distal C1 segment that explains why dye did not fill it. This research suggests that computer simulations might help clinicians interpret contrast patterns and estimate blockage length more accurately. However, the study included only four patients and is a preliminary proof-of-concept, so larger studies would be needed to confirm these findings.
Wu J, Xu G, Gan Q, Shi R, Cao L, Fu P. (2026). Computational Fluid Dynamics Analysis of Contrast Agent Distribution in Acute Large Artery Occlusive Stroke: A Preliminary Proof-of-Concept Study.. Revista de neurologia. https://doi.org/10.31083/RN54176