Carotid artery mechanical properties and stresses quantified using in vivo data from normotensive and hypertensive humans

In Vivo Material Properties of Human Common Carotid Arteries: Trends and Sex Differences

INTRODUCTION

In vivo estimation of material properties of arterial tissue can provide essential insights into the development and progression of cardiovascular diseases. Furthermore, these properties can be used as an input to finite element simulations of potential medical treatments.

MATERIALS AND METHODS

This study uses non-invasively measured pressure, diameter and wall thickness of human common carotid arteries (CCAs) acquired in 103 healthy subjects. A non-linear optimization was performed to estimate material parameters of two different constitutive models: a phenomenological, isotropic model and a structural, anisotropic model. The effect of age, sex, body mass index and blood pressure on the parameters was investigated.

RESULTS AND CONCLUSION

Although both material models were able to model in vivo arterial behaviour, the structural model provided more realistic results in the supra-physiological domain. The phenomenological model predicted very high deformations for pressures above the systolic level. However, the phenomenological model has fewer parameters that were shown to be more robust. This is an advantage when only the physiological domain is of interest. The effect of stiffening with age, BMI and blood pressure was present for women, but not always for men. In general, sex had the biggest effect on the mechanical properties of CCAs. Stiffening trends with age, BMI and blood pressure were present but not very strong. The intersubject variability was high. Therefore, it can be concluded that finding a representative set of parameters for a certain age or BMI group would be very challenging. Instead, for purposes of patient-specific modelling of surgical procedures, we currently advise the use of patient-specific parameters.

Rapid, non-invasive, in vivo measurement of tissue mechanical properties using gravitational loading and a nonlinear virtual fields method

Measuring the mechanical properties of soft tissues in vivo is important in biomechanics and for diagnosis and staging of diseases, but challenging because it is difficult to control the boundary conditions. We present a novel, non-invasive method for measuring tissue properties using gravitational loading. MRI images of an organ in different positions are registered to measure tissue displacements due to gravitational forces in different positions. Considering equilibrium between stresses and gravity, we established a nonlinear virtual fields method to identify the tissue properties. The method was applied to the human brain as a proof of concept, using an Ogden model. Sensitivity analysis showed that the bulk modulus could be identified accurately while the shear modulus was identified with greater uncertainty; the strains were too small to identify the strain stiffening exponent. The measured properties agreed well with published in vitro data. The technique offers very promising perspectives, allowing the non-invasive measurement of otherwise inaccessible tissues and providing new information such as the bulk modulus under static loading, which has never previously been measured in vivo.

Probing the Mechanical Properties of Large Arteries by Measuring Their Deformation In Vivo with Ultrasound

Aging and cardiovascular diseases (CVDs) may alter the microstructures of arteries and hence their mechanical properties. Therefore, the measurement of intrinsic artery mechanical properties in vivo can provide valuable information in understanding aging and CVDs and is of clinical significance. The accuracy of advanced ultrasound imaging techniques in measuring the deformation of large arteries under blood pressure is good. However, the assessment of arterial stiffness in vivo remains a challenge. An inverse method to infer the constitutive parameters of arteries in vivo from the blood pressure-arterial radius relationship (P-r curve) is proposed here. The stability analysis reveals that a key constitutive parameter, b_θ, which measures the circumferential hardening of an artery, can be reliably identified. An in vivo experiment was performed on the common carotid arteries of 41 healthy volunteers (age: 37 ± 17 y). The value of b_θ varies significantly (from 0.55 ± 0.15 for the young group to 0.93 ± 0.29 for the older group, p < 0.01) and is positively correlated with age (r = 0.673, p < 0.01). Furthermore, our theoretical analysis and experimental study have revealed a strong correlation between the clinic-used stiffness index β and b_θ. This study shows that the arterial material parameter b_θ can be measured in vivo, which makes it promising as a new biomarker in the diagnosis of CVDs.

Improved Quantification of Cell Density in the Arterial Wall-A Novel Nucleus Splitting Approach Applied to 3D Two-Photon Laser-Scanning Microscopy

Accurate information on vascular smooth muscle cell (VSMC) content, orientation, and distribution in blood vessels is indispensable to increase understanding of arterial remodeling and to improve modeling of vascular biomechanics. We have previously proposed an analysis method to automatically characterize VSMC orientation and transmural distribution in murine carotid arteries under well-controlled biomechanical conditions. However, coincident nuclei, erroneously detected as one large nucleus, were excluded from the analysis, hampering accurate VSMC content characterization and distorting transmural distributions. In the present study, therefore, we aim to (1) improve the previous method by adding a "nucleus splitting" procedure to split coinciding nuclei, (2) evaluate the accuracy of this novel method, and (3) test this method in a mouse model of VSMC apoptosis. After euthanasia, carotid arteries from SM22α-hDTR Apoe -/- and control Apoe -/- mice were bluntly dissected, excised, mounted in a biaxial biomechanical tester and brought to in vivo axial stretch and a pressure of 100 mmHg. Nuclei and elastin fibers were then stained using Syto-41 and Eosin-Y, respectively, and imaged using 3D two-photon laser scanning microscopy. Nuclei were segmented from images and coincident nuclei were split. The nucleus splitting procedure determines the likelihood that voxel pairs within coincident nuclei belong to the same nucleus and utilizes these likelihoods to identify individual nuclei using spectral clustering. Manual nucleus counts were used as a reference to assess the performance of our splitting procedure. Before and after splitting, automatic nucleus counts differed -26.6 ± 9.90% (p < 0.001) and -1.44 ± 7.05% (p = 0.467) from the manual reference, respectively. Whereas the slope of the relative difference between the manual and automated counts as a function of the manual count was significantly negative before splitting (p = 0.008), this slope became insignificant after splitting (p = 0.653). Smooth muscle apoptosis led to a 33.7% decrease in VSMC density (p = 0.008). Nucleus splitting improves the accuracy of automated cell content quantification in murine carotid arteries and overcomes the progressively worsening problem of coincident nuclei with increasing cell content in vessels. The presented image analysis framework provides a robust tool to quantify cell content, orientation, shape, and distribution in vessels to inform experimental and advanced computational studies on vascular structure and function.

Blood flow simulations in patient-specific geometries of the carotid artery: A systematic review

Computational Fluid Dynamics (CFD) and Fluid-Structure Interaction (FSI) are currently widely applied in the study of blood flow parameters and their alterations under pathological conditions, which are important indicators for diagnosis of atherosclerosis. In this manuscript, a systematic review of the published literature was conducted, according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, on the simulation studies of blood flow in patient-specific geometries of the carotid artery bifurcation. Scopus, PubMed and ScienceDirect databases were used in the literature search, which was completed on the 3rd of August 2020. Forty-nine articles were included after the selection process and were organized in two distinct categories: the CFD studies (36/49 articles), which comprise only the fluid analysis and the FSI studies (13/49 articles), which includes both fluid and Fluid-Structure domain in the analysis. The data of the research works was structured in different categories (Geometry, Viscosity models, Type of Flow, Boundary Conditions, Flow Parameters, Type of Solver and Validation). The aim of this systematic review is to demonstrate the methodology in the modelling, simulation and analysis of carotid blood flow and also identify potential gaps and challenges in this research field.

Effect of axial prestretch and adipose tissue on the inflation-extension behavior of the human abdominal aorta

Our study aims to show that perivascular adipose tissue may significantly change the mechanical state of the abdominal aorta. To this end, uniaxial tensile tests with perivascular fat tissue were carried out. In the subsequent regression analysis, stress-strain data were fitted by the polynomial strain energy density. A constitutive model of adipose tissue was used in the analytical simulation of the inflation-extension behavior of the human abdominal aorta. The computational model was based on the theory of the bi-layered thick-walled tube. In addition to the effect of perivascular tissue, the effect of axial prestretch was also studied. It was found that the presence of perivascular tissue reduces the distensibility of the aorta. Axial prestretch applied to the aorta embedded in adipose tissue had an effect opposite to that of adipose tissue. Axially prestrained aorta exhibited higher distensiblity than non-prestrained aorta. It was also shown that the perivascular envelope bears some portion of the pressure loading and thus reduces the mechanical stresses inside the wall of aorta. A similar effect was found for axial prestretch.

Identification of in vivo nonlinear anisotropic mechanical properties of ascending thoracic aortic aneurysm from patient-specific CT scans

Accurate identification of in vivo nonlinear, anisotropic mechanical properties of the aortic wall of individual patients remains to be one of the critical challenges in the field of cardiovascular biomechanics. Since only the physiologically loaded states of the aorta are given from in vivo clinical images, inverse approaches, which take into account of the unloaded configuration, are needed for in vivo material parameter identification. Existing inverse methods are computationally expensive, which take days to weeks to complete for a single patient, inhibiting fast feedback for clinicians. Moreover, the current inverse methods have only been evaluated using synthetic data. In this study, we improved our recently developed multi-resolution direct search (MRDS) approach and the computation time cost was reduced to 1~2 hours. Using the improved MRDS approach, we estimated in vivo aortic tissue elastic properties of two ascending thoracic aortic aneurysm (ATAA) patients from pre-operative gated CT scans. For comparison, corresponding surgically-resected aortic wall tissue samples were obtained and subjected to planar biaxial tests. Relatively close matches were achieved for the in vivo-identified and ex vivo-fitted stress-stretch responses. It is hoped that further development of this inverse approach can enable an accurate identification of the in vivo material parameters from in vivo image data.

Comparative study of variations in mechanical stress and strain of human blood vessels: mechanical reference for vascular cell mechano-biology

The diseases of human blood vessels are closely associated with local mechanical variations. A better understanding of the quantitative correlation in mechanical environment between the current mechano-biological studies and vascular physiological or pathological conditions in vivo is crucial for evaluating numerous existing results and exploring new factors for disease discovery. In this study, six representative human blood vessels with known experimental measurements were selected, and their stress and strain variations in vessel walls under different blood pressures were analyzed based on nonlinear elastic theory. The results suggest that conventional mechano-biological experiments seeking the different biological expressions of cells at high/low mechanical loadings are ambiguous as references for studying vascular diseases, because distinct "site-specific" characteristics appear in different vessels. The present results demonstrate that the inner surface of the vessel wall does not always suffer the most severe stretch under high blood pressures comparing to the outer surface. Higher tension on the outer surface of aortas supports the hypothesis of the outside-in inflammation dominated by aortic adventitial fibroblasts. These results indicate that cellular studies at different mechanical niches should be "disease-specific" as well. The present results demonstrate considerable stress gradients across the wall thickness, which indicate micro-scale mechanical variations existing around the vascular cells, and imply that the physiological or pathological changes are not static processes confined within isolated regions, but are coupled with dynamic cell behaviors such as migration. The results suggest that the stress gradients, as well as the mechanical stresses and strains, are key factors constituting the mechanical niches, which may shed new light on "factor-specific" experiments of vascular cell mechano-biology.

Estimation of in vivo constitutive parameters of the aortic wall using a machine learning approach

The patient-specific biomechanical analysis of the aorta requires the quantification of the in vivo mechanical properties of individual patients. Current inverse approaches have attempted to estimate the nonlinear, anisotropic material parameters from in vivo image data using certain optimization schemes. However, since such inverse methods are dependent on iterative nonlinear optimization, these methods are highly computation-intensive. A potential paradigm-changing solution to the bottleneck associated with patient-specific computational modeling is to incorporate machine learning (ML) algorithms to expedite the procedure of in vivo material parameter identification. In this paper, we developed an ML-based approach to estimate the material parameters from three-dimensional aorta geometries obtained at two different blood pressure (i.e., systolic and diastolic) levels. The nonlinear relationship between the two loaded shapes and the constitutive parameters are established by an ML-model, which was trained and tested using finite element (FE) simulation datasets. Cross-validations were used to adjust the ML-model structure on a training/validation dataset. The accuracy of the ML-model was examined using a testing dataset.

Constitutive interpretation of arterial stiffness in clinical studies: a methodological review

Clinical assessment of arterial stiffness relies on noninvasive measurements of regional pulse wave velocity or local distensibility. However, arterial stiffness measures do not discriminate underlying changes in arterial wall constituent properties (e.g., in collagen, elastin, or smooth muscle), which is highly relevant for development and monitoring of treatment. In arterial stiffness in recent clinical-epidemiological studies, we systematically review clinical-epidemiological studies (2012–) that interpreted arterial stiffness changes in terms of changes in arterial wall constituent properties (63 studies included of 514 studies found). Most studies that did so were association studies (52 of 63 studies) providing limited causal evidence. Intervention studies (11 of 63 studies) addressed changes in arterial stiffness through the modulation of extracellular matrix integrity (5 of 11 studies) or smooth muscle tone (6 of 11 studies). A handful of studies (3 of 63 studies) used mathematical modeling to discriminate between extracellular matrix components. Overall, there exists a notable gap in the mechanistic interpretation of stiffness findings. In constitutive model-based interpretation, we first introduce constitutive-based modeling and use it to illustrate the relationship between constituent properties and stiffness measurements (“forward” approach). We then review all literature on modeling approaches for the constitutive interpretation of clinical arterial stiffness data (“inverse” approach), which are aimed at estimation of constitutive properties from arterial stiffness measurements to benefit treatment development and monitoring. Importantly, any modeling approach requires a tradeoff between model complexity and measurable data. Therefore, the feasibility of changing in vivo the biaxial mechanics and/or vascular smooth muscle tone should be explored. The effectiveness of modeling approaches should be confirmed using uncertainty quantification and sensitivity analysis. Taken together, constitutive modeling can significantly improve clinical interpretation of arterial stiffness findings.

Arterial pulse attenuation prediction using the decaying rate of a pressure wave in a viscoelastic material model

The present study examines the possibility of attenuating blood pulses by means of introducing prosthetic viscoelastic materials able to absorb energy and damp such pulses. Vascular prostheses made of polymeric materials modify the mechanical properties of blood vessels. The effect of these materials on the blood pulse propagation remains to be fully understood. Several materials for medical applications, such as medical polydimethylsiloxane or polytetrafluoroethylene, show viscoelastic behavior, modifying the original vessel stiffness and affecting the propagation of blood pulses. This study focuses on the propagation of pressure waves along a pipe with viscoelastic materials using the Maxwell and the Zener models. An expression of exponential decay has been obtained for the Maxwell material model and also for low viscous coefficient values in the Zener model. For relatively high values of the viscous term in the Zener model, the steepest part of the pulse can be damped quickly, leaving a smooth, slowly decaying wave. These mathematical models are critical to tailor those materials used in cardiovascular implants to the mechanical environment they are confronted with to repair or improve blood vessel function.

Repeated Loading Behavior of Pediatric Porcine Common Carotid Arteries

Rapid flexion and extension of the neck may occur during scenarios associated with traumatic brain injury (TBI), and understanding the mechanical response of the common carotid artery (CCA) to longitudinal stretch may enhance understanding of contributing factors that may influence CCA vasospasm and exacerbate ischemic injury associated with TBI. Immature (4-week-old) porcine CCAs were tested under subcatastrophic (1.5 peak stretch ratio) cyclic loading at 3 Hz for 30 s. Under subcatastrophic cyclic longitudinal extension, the immature porcine CCA displays softening behavior. This softening can be represented by decreasing peak stress and increasing corner stretch values with an increasing number of loading cycles. This investigation is an important first step in the exploration of fatiguelike behavior in arterial tissue that may be subjected to repeated longitudinal loads.

Estimation of in vivo mechanical properties of the aortic wall: A multi-resolution direct search approach

The patient-specific biomechanical analysis of the aorta requires in vivo mechanical properties of individual patients. Existing approaches for estimating in vivo material properties often demand high computational cost and mesh correspondence of the aortic wall between different cardiac phases. In this paper, we propose a novel multi-resolution direct search (MRDS) approach for estimation of the nonlinear, anisotropic constitutive parameters of the aortic wall. Based on the finite element (FE) updating scheme, the MRDS approach consists of the following three steps: (1) representing constitutive parameters with multiple resolutions using principal component analysis (PCA), (2) building links between the discretized PCA spaces at different resolutions, and (3) searching the PCA spaces in a 'coarse to fine' fashion following the links. The estimation of material parameters is achieved by minimizing a node-to-surface error function, which does not need mesh correspondence. The method was validated through a numerical experiment by using the in vivo data from a patient with ascending thoracic aortic aneurysm (ATAA), the results show that the number of FE iterations was significantly reduced compared to previous methods. The approach was also applied to the in vivo CT data from an aged healthy human patient, and using the estimated material parameters, the FE-computed geometry was well matched with the image-derived geometry. This novel MRDS approach may facilitate the personalized biomechanical analysis of aortic tissues, such as the rupture risk analysis of ATAA, which requires fast feedback to clinicians.

Vascular Smooth Muscle Cells and Arterial Stiffening: Relevance in Development, Aging, and Disease

The cushioning function of large arteries encompasses distension during systole and recoil during diastole which transforms pulsatile flow into a steady flow in the microcirculation. Arterial stiffness, the inverse of distensibility, has been implicated in various etiologies of chronic common and monogenic cardiovascular diseases and is a major cause of morbidity and mortality globally. The first components that contribute to arterial stiffening are extracellular matrix (ECM) proteins that support the mechanical load, while the second important components are vascular smooth muscle cells (VSMCs), which not only regulate actomyosin interactions for contraction but mediate also mechanotransduction in cell-ECM homeostasis. Eventually, VSMC plasticity and signaling in both conductance and resistance arteries are highly relevant to the physiology of normal and early vascular aging. This review summarizes current concepts of central pressure and tensile pulsatile circumferential stress as key mechanical determinants of arterial wall remodeling, cell-ECM interactions depending mainly on the architecture of cytoskeletal proteins and focal adhesion, the large/small arteries cross-talk that gives rise to target organ damage, and inflammatory pathways leading to calcification or atherosclerosis. We further speculate on the contribution of cellular stiffness along the arterial tree to vascular wall stiffness. In addition, this review provides the latest advances in the identification of gene variants affecting arterial stiffening. Now that important hemodynamic and molecular mechanisms of arterial stiffness have been elucidated, and the complex interplay between ECM, cells, and sensors identified, further research should study their potential to halt or to reverse the development of arterial stiffness.

The choice of a constitutive formulation for modeling limb flexion-induced deformations and stresses in the human femoropopliteal arteries of different ages

Open and endovascular treatments for peripheral arterial disease are notorious for high failure rates. Severe mechanical deformations experienced by the femoropopliteal artery (FPA) during limb flexion and interactions between the artery and repair materials play important roles and may contribute to poor clinical outcomes. Computational modeling can help optimize FPA repair, but these simulations heavily depend on the choice of constitutive model describing the arterial behavior. In this study finite element model of the FPA in the standing (straight) and gardening (acutely bent) postures was built using computed tomography data, longitudinal pre-stretch and biaxially determined mechanical properties. Springs and dashpots were used to represent surrounding tissue forces associated with limb flexion-induced deformations. These forces were then used with age-specific longitudinal pre-stretch and mechanical properties to obtain deformed FPA configurations for seven age groups. Four commonly used invariant-based constitutive models were compared to determine the accuracy of capturing deformations and stresses in each age group. The four-fiber FPA model most accurately portrayed arterial behavior in all ages, but in subjects younger than 40 years, the performance of all constitutive formulations was similar. In older subjects, Demiray (Delfino) and classic two-fiber Holzapfel-Gasser-Ogden formulations were better than the Neo-Hookean model for predicting deformations due to limb flexion, but both significantly overestimated principal stresses compared to the FPA or Neo-Hookean models.

Three-dimensional vascular smooth muscle orientation as quantitatively assessed by multiphoton microscopy: mouse carotid arteries do show a helix

Smooth muscle cells (SMCs) play a pivotal role in regulating vascular tone in arteries, and are therefore an essential part of constitutive models of the artery wall. In the present study, we developed a method to quantify in 3D the orientation of SMCs in the intact artery wall. We stained cell nuclei in excised mouse carotid arteries mounted between micropipettes and imaged these in 3D using two-photon laser scanning microscopy. A clustering method was used to identify individual nuclei. Orientations of these nuclei (as a representative of the SMC orientations) were found by calculating the inertia matrix eigenvectors. Subsequently, SMC locations and orientations were converted to cylindrical and spherical coordinate systems, respectively. We found SMCs to be arranged in two distinct layers. For each of these layers, SMC orientations were described by a Bingham distribution. Distributions showed a statistically significant helical and transversal angular component in both inner and outer layers. In conclusion, this study demonstrates that SMC orientation can be quantified in 3D, and shows a distinct helical as well as transversal orientation. The acquired distribution data are essential to improve current constitutive models of the artery wall, by describing physiological SMC orientation and dispersion.

A method for three-dimensional quantification of vascular smooth muscle orientation: application in viable murine carotid arteries

When studying in vivo arterial mechanical behaviour using constitutive models, smooth muscle cells (SMCs) should be considered, while they play an important role in regulating arterial vessel tone. Current constitutive models assume a strictly circumferential SMC orientation, without any dispersion. We hypothesised that SMC orientation would show considerable dispersion in three dimensions and that helical dispersion would be greater than transversal dispersion. To test these hypotheses, we developed a method to quantify the 3D orientation of arterial SMCs. Fluorescently labelled SMC nuclei of left and right carotid arteries of ten mice were imaged using two-photon laser scanning microscopy. Arteries were imaged at a range of luminal pressures. 3D image processing was used to identify individual nuclei and their orientations. SMCs showed to be arranged in two distinct layers. Orientations were quantified by fitting a Bingham distribution to the observed orientations. As hypothesised, orientation dispersion was much larger helically than transversally. With increasing luminal pressure, transversal dispersion decreased significantly, whereas helical dispersion remained unaltered. Additionally, SMC orientations showed a statistically significant (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$p < 0.05$$\end{document}p<0.05) mean right-handed helix angle in both left and right arteries and in both layers, which is a relevant finding from a developmental biology perspective. In conclusion, vascular SMC orientation (1) can be quantified in 3D; (2) shows considerable dispersion, predominantly in the helical direction; and (3) has a distinct right-handed helical component in both left and right carotid arteries. The obtained quantitative distribution data are instrumental for constitutive modelling of the artery wall and illustrate the merit of our method.

The structural factor of hypertension: large and small artery alterations

Pathophysiological studies have extensively investigated the structural factor in hypertension, including large and small artery remodeling and functional changes. Here, we review the recent literature on the alterations in small and large arteries in hypertension. We discuss the possible mechanisms underlying these abnormalities and we explain how they accompany and often precede hypertension. Finally, we propose an integrated pathophysiological approach to better understand how the cross-talk between large and small artery changes interacts in pressure wave transmission, exaggerates cardiac, brain and kidney damage, and lead to cardiovascular and renal complications. We focus on patients with essential hypertension because this is the most prevalent form of hypertension, and describe other forms of hypertension only for contrasting their characteristics with those of uncomplicated essential hypertension.

A constitutive modeling interpretation of the relationship among carotid artery stiffness, blood pressure, and age in hypertensive subjects

Aging has a profound influence on arterial wall structure and function. We have previously reported the relationship among pulse wave velocity, age, and blood pressure in hypertensive subjects. In the present study, we aimed for a quantitative interpretation of the observed changes in wall behavior with age using a constitutive modeling approach. We implemented a model of arterial wall biomechanics and fitted this to the group-averaged pressure-area ( P-A) relationship of the “young” subgroup of our study population. Using this model as our take-off point, we assessed which parameters had to be changed to let the model describe the “old” subgroup’s P-A relationship. We allowed elastin stiffness and collagen recruitment parameters to vary and adjusted residual stress parameters according to published age-related changes. We required wall stress to be homogeneously distributed over the arterial wall and assumed wall stress normalization with age by keeping average “old” wall stress at the “young” level. Additionally, we required axial force to remain constant over the cardiac cycle. Our simulations showed an age-related shift in pressure-load bearing from elastin to collagen, caused by a decrease in elastin stiffness and a considerable increase in collagen recruitment. Correspondingly, simulated diameter and wall thickness increased by about 20 and 17%, respectively. The latter compared well with a measured thickness increase of 21%. We conclude that the physiologically realistic changes in constitutive properties we found under physiological constraints with respect to wall stress could well explain the influence of aging in the stiffness-pressure-age pattern observed.

Nonlinear mechanical behavior of the human common, external, and internal carotid arteries in vivo

BACKGROUND

The mechanical environment and properties of the carotid artery play an important role in the formation and progression of atherosclerosis in the carotid bifurcation. The purpose of this work was to measure and compare the range and variation of circumferential stress and tangent elastic moduli in the human common (CCA), external (ECA), and internal (ICA) carotid arteries over the cardiac cycle in vivo.

METHODS

Measurements were performed in the surgically exposed proximal cervical CCA, distal ECA, and distal ICA of normotensive patients (n = 16) undergoing carotid endarterectomy. All measurements were completed in vivo over the cardiac cycle in the repaired carotid bifurcation after the atherosclerotic plaque was successfully removed. B-mode Duplex ultrasonography was used for measurement of arterial diameter and wall thickness, and an angiocatheter placed in the CCA was used for concurrent measurement of blood pressure. A semiautomatic segmentation algorithm was used to track changes in arterial diameter and wall thickness in response to blood pressure. These measurements were then used to calculate the variation of circumferential (hoop) stresses, tangent elastic moduli (the slope of the stress-strain curve at specified stresses), and strain-induced stiffness of the arterial wall (stiffening in response to the increase of intraluminal blood pressure) for each patient.

RESULTS

The diameter and wall thickness of the segments (CCA, ECA, and ICA) of the carotid bifurcation were found to decrease and strain-induced stiffness to increase from proximal CCA to distal ECA and ICA. The circumferential stress from end-diastole (minimum pressure) to peak-systole (maximum pressure) varied nonlinearly from 25 ± 7 to 63 ± 23 kPa (CCA), from 22 ± 7 to 57 ± 19 kPa (ECA), and from 28 ± 8 to 67 ± 23 kPa (ICA). Tangent elastic moduli also varied nonlinearly from end-diastole to peak-systole as follows: from 0.40 ± 0.25 to 1.50 ± 2.05 MPa (CCA), from 0.49 ± 0.34 to 1.14 ± 0.52 MPa (ECA), and from 0.68 ± 0.31 to 1.51 ± 0.69 MPa (ICA). The strain-induced stiffness of CCA and ECA increased more than 3-fold and the stiffness of ICA increased more than 2.5-fold at peak-systole compared with end-diastole.

CONCLUSIONS

The in vivo mechanical behavior of the three segments of the carotid bifurcation was qualitatively similar, but quantitatively different. All three arteries--CCA, ECA and ICA--exhibited nonlinear variations of circumferential stress and tangent elastic moduli within the normal pressure range. The variability in the properties of the three segments of the carotid bifurcation indicates a need for development of carotid models that match the in vivo properties of the carotid segments. Finally, the observed nonlinear behavior of the artery points to the need for future vascular mechanical studies to evaluate the mechanical factors of the arterial wall over the entire cardiac cycle.