J Stroke.
2016 Jan;18(1):66-72. 10.5853/jos.2015.01445.
Post-stenotic Recirculating Flow May Cause Hemodynamic Perforator Infarction
- Affiliations
-
- 1Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sukwon@amc.seoul.kr
- 2Center for Biofluid and Biomimic Research, Department of Mechanical Engineering, Pohang University of Science and Technology, Pohang, Korea.
- 3Asan Institute of Life Science, Asan Medical Center, Seoul, Korea.
- 4Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 5Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- KMID: 2223637
- DOI: http://doi.org/10.5853/jos.2015.01445
Abstract
- BACKGROUND AND PURPOSE
The primary mechanism underlying paramedian pontine infarction (PPI) is atheroma obliterating the perforators. Here, we encountered a patient with PPI in the post-stenotic area of basilar artery (BA) without a plaque, shown by high-resolution magnetic resonance imaging (HR-MRI). We performed an experiment using a 3D-printed BA model and a particle image velocimetry (PIV) to explore the hemodynamic property of the post-stenotic area and the mechanism of PPI.
METHODS
3D-model of a BA stenosis was reconstructed with silicone compound using a 3D-printer based on the source image of HR-MRI. Working fluid seeded with fluorescence particles was used and the velocity of those particles was measured horizontally and vertically. Furthermore, microtubules were inserted into the posterior aspect of the model to measure the flow rates of perforators (pre-and post-stenotic areas). The flow rates were compared between the microtubules.
RESULTS
A recirculating flow was observed from the post-stenotic area in both directions forming a spiral shape. The velocity of the flow in these regions of recirculation was about one-tenth that of the flow in other regions. The location of recirculating flow well corresponded with the area with low-signal intensity at the time-of-flight magnetic resonance angiography and the location of PPI. Finally, the flow rate through the microtubule inserted into the post-stenotic area was significantly decreased comparing to others (P<0.001).
CONCLUSIONS
Perforator infarction may be caused by a hemodynamic mechanism altered by stenosis that induces a recirculation flow. 3D-printed modeling and PIV are helpful understanding the hemodynamics of intracranial stenosis.
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