Research Projects

A wide spectrum of cerebral circulation related abnormalities lead to the lack of blood supply to the brain, resulting in stroke. This will need immediate intervention within the golden period. Stroke risk in children and adults is increasingly being detected due to various coupled factors such as, occlusion of the internal carotid artery (ICA), aneurysms, arterio-venous malformations, cardiogenic emboli to cerebral circulation etc. ICA constriction leading to the development of collateral blood supply, is characteristic of Moyamoya Angiopathy (MMA). Unfortunately, stroke in children is both under-studied and under-recognized. Debilitating stroke occurring in childhood is a social burden and dictates the need for social support to the patient and caregivers. It is important to identify early signs of stroke to undertake timely preventive and therapeutic measures. However, understanding the pathogenesis of stroke in children is crucial for effective preventive strategies. Some of the causes of pediatric stroke are not clearly understood and most medical strategies rely on speculation. The blood vessels supplying the brain of infants and children are in various stages of dynamic development. The blood vessels remodel based on growth characteristics of the head and neck as well as based on haemodynamic triggers, angiogenic responses and vascular growth factors. The anatomical disposition of the ICAs and vasculature thus could be instrumental in causing stroke in childhood and future strokes in adulthood. Preliminary investigations using computational fluid dynamics (CFD) based fluid structure interaction (FSI) studies have shown that, as the ICA tortuosity decreases, haemodynamic stresses increase at the ICA bifurcation and the supraclinoid (SCL) ICA [1]. The SCL segment of ICA suffers, as it encounters varying haemodynamic stresses. These haemodynamic patterns can be effectively understood by performing CFD and FSI simulations on the major blood vessels supplying the brain. An increase in tortuosity with resultant stroke is also noted in Sickle cell disease. This has been attributed to aberrations in hemodynamics in the ICA of these patients. An association also exists between Sickle cell disease and Moyamoya angiopathy. However, stroke risk requires a more comprehensive evaluation of a wide spectrum of parameters in cerebral circulation, with emphasis on morphological abnormalities of the major blood vessels supplying the brain. To this end, we intend to use patient specific 3D models of the blood vessels and perform CFD/FSI studies to evaluate the stroke risk. Special focus on children as well as adults would provide a holistic view of the stroke risk, by developing patient specific studies. To this end, we intend to develop virtual platforms for simulated clot retrieval, aneurysm clipping/ coiling, flow-divertor placement and simulator training modules, leading to the delivery of the best clinical management option for patients.