07.02 Towards Non-Invasive Assessment of Renal Artery Stenosis Severity in the Individual Patient with the Aid of Numerical Computer Simulations

Abstract

Introduction

Severe renal artery stenosis is responsible for 5% of all hypertension cases. Treatment of the stenosis is often decided upon catheterisation, with a pressure gradient (DP) of 10mmHg used as cut-off, thus requiring invasive measurements. The aim of the present study was to assess the feasibility and accuracy of a non-invasive estimate of DP through numerical simulation in a patient-specific model.

Methods

We constructed a computer model of the abdominal aorta, coeliac trunk, mesenteric superior aorta and two renal arteries from a patient with unilateral renal stenosis (77% area stenosis). Images were obtained from MR angiography scans and segmented to obtain the 3D patient-specific model. Blood flow was simulated assuming an aortic inflow rate of 2.7l/min and prescribed outflow rates at the different arterial outlets. The calculated DP was compared to in vivo measurements.

Results

The numerical calculations yielded a DP of 11.7mmHg, which was in excellent agreement with the value of 10.5mmHg measured in vivo in the same patient (with pressure guide-wires) and with values measured in a silicon hydraulic bench model of the same geometry. A parameter study demonstrated a rapid increase in DP beyond 60% stenosis. In the post-stenotic dilatation zone, secondary flow patterns with recirculation were observed.

Conclusion

These promising results demonstrate the feasibility and utility of patient-specific computer simulations in the diagnosis of individual patients, although further steps will be necessary to include pulsatile blood flow, distensible walls and patient-specific boundary conditions.