A Model of Cerebrovascular Reactivity Including the Circle of Willis and Cortical Anastomoses |
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Authors: | Mauro Ursino Massimo Giannessi |
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Institution: | (1) Department of Electronics, Computer Science, and Systems, University of Bologna, via Venezia 52, 47023 Cesena, FC, Italy |
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Abstract: | Cerebrovascular pathologies are extremely complex, due to the multitude of factors acting simultaneously on cerebral hemodynamics.
In this work, a mathematical model of cerebral hemodynamics and intracranial pressure (ICP) dynamics, developed in previous
years, is extended to account for heterogeneity in cerebral blood flow. The model includes the Circle of Willis, six regional
districts independently regulated by autoregulation and CO2 reactivity, distal cortical anastomoses, venous circulation, the cerebrospinal fluid circulation, and the ICP–volume relationship.
Results agree with data in the literature and highlight the existence of a monotonic relationship between transient hyperemic
response and the autoregulation gain. During unilateral internal carotid artery stenosis, local blood flow regulation is progressively
lost in the ipsilateral territory with the presence of a steal phenomenon, while the anterior communicating artery plays the
major role to redistribute the available blood flow. Conversely, distal collateral circulation plays a major role during unilateral
occlusion of the middle cerebral artery. In conclusion, the model is able to reproduce several different pathological conditions
characterized by heterogeneity in cerebrovascular hemodynamics and cannot only explain generalized results in terms of physiological
mechanisms involved, but also, by individualizing parameters, may represent a valuable tool to help with difficult clinical
decisions. |
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Keywords: | |
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