Device-Induced Thrombus Formation in Cerebral Aneurysms: Linking Patient-Specific Clot Modeling and Functional Occlusion to Virtual Angiographic Assessment

Abstract

Endovascular treatment of cerebral aneurysms aims to achieve functional occlusion and isolation of the aneurysm sac from bloodflow. In clinical practice, treatment success is assessed primarily through digital subtraction angiography (DSA), which visualizes contrast-agent inflow and washout but does not directly resolve thrombus formation driving early occlusion. We present a computational framework that couples acute fibrin thrombus formation with virtual angiography, enabling early thrombus growth to be interpreted through clinically familiar DSA-like imaging. Three common treatment strategies: endovascular coiling, flow diversion, and stent-assisted coiling, are modeled under pulsatile hemodynamics and linked to simulated contrast transport. Across three representative aneurysm morphologies, the simulations demonstrate that while devices reduce inflow, residual contrast access and trapping may persist, with early thrombus formation contributing substantially to perfusion suppression and altered washout patterns. These effects are clearly reflected in the virtual angiographic imaging. The importance of vortical structures in device-induced thrombosis is highligthed in one of the cases. By seeking to align modelling and simulation tools with clinically-relevant metrics, with a particular focus on occlusion outcome, this work presents a good starting point for bridging the gap between these two paradigms.