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Pei Y, Song P, Zhang K, Dai M, He G, Wen J. Assessing the impact of tear direction in coronary artery dissection on thrombosis development: A hemodynamic computational study. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 249:108144. [PMID: 38569255 DOI: 10.1016/j.cmpb.2024.108144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/11/2024] [Accepted: 03/23/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Iatrogenic coronary artery dissection is a complication of coronary intimal injury and dissection due to improper catheter manipulation. The impact of tear direction on the prognosis of coronary artery dissection (CAD) remains unclear. This study examines the hemodynamic effects of different tear directions (transverse and longitudinal) of CAD and evaluates the risk of thrombosis, rupture and further dilatation of CAD. METHODS Two types of CAD models (Type I: transverse tear, Type II: longitudinal tear) were reconstructed from the aorto-coronary CTA dataset of 8 healthy cases. Four WSS-based indicators were analyzed, including time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and cross flow index (CFI). A thrombus growth model was also introduced to predict the trend of thrombus growth in CAD with two different tear directions. RESULTS For most of the WSS-based indicators, including TAWSS, RRT, and CFI, no statistically significant differences were observed across the CAD models with varying tear directions, except for OSI, where a significant difference was noted (p < 0.05). Meanwhile, in terms of thrombus growth, the thrombus growing at the tear of the Type I (transverse tear) CAD model extended into the true lumen earlier than that of the Type II (longitudinal tear) model. CONCLUSIONS Numerical simulations suggest that: (1) The CAD with transverse tear have a high risk of further tearing of the dissection at the distal end of the tear. (2) The CAD with longitudinal tear create a hemodynamic environment characterized by low TAWSS and high OSI in the false lumen, which may additionally increase the risk of vessel wall injury. (3) The CAD with transverse tear may have a higher risk of thrombosis and coronary obstruction and myocardial ischemia in the early phase of the dissection.
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Affiliation(s)
- Yan Pei
- Department of Computer Science and Technology, Southwest University of Science and Technology, No. 59, middle of Qinglong Avenue, Fucheng District, Mianyang, 621010, China
| | - Pan Song
- Department of Cardiology, Mianyang Central Hospital, Mianyang, 621000, China
| | - Kaiyue Zhang
- Department of Computer Science and Technology, Southwest University of Science and Technology, No. 59, middle of Qinglong Avenue, Fucheng District, Mianyang, 621010, China
| | - Min Dai
- Department of Cardiology, Mianyang Central Hospital, Mianyang, 621000, China
| | - Gang He
- Department of Computer Science and Technology, Southwest University of Science and Technology, No. 59, middle of Qinglong Avenue, Fucheng District, Mianyang, 621010, China
| | - Jun Wen
- Department of Computer Science and Technology, Southwest University of Science and Technology, No. 59, middle of Qinglong Avenue, Fucheng District, Mianyang, 621010, China.
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Wongchadakul P, Lohasammakul S, Rattanadecho P. Comparative analysis of RADAR vs. conventional techniques for AVF maturation in patients with blood viscosity and vessel elasticity-related diseases through fluid-structure interaction modeling: Anemia, hypertension, and diabetes. PLoS One 2024; 19:e0296631. [PMID: 38227602 PMCID: PMC10791008 DOI: 10.1371/journal.pone.0296631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 12/12/2023] [Indexed: 01/18/2024] Open
Abstract
PURPOSE This study aims to compare two surgical techniques, the standard Vein-to-Artery and the newer Artery-to-Vein (Radial Artery Deviation And Reimplantation; RADAR), for enhancing the success of Arterio-Venous Fistula maturation in end-stage renal disease patients. The impact of diseases like anemia, diabetes, hypertension, and chronic kidney disease were considered. The goals are to advance Arterio-Venous Fistula (AVF) surgery, improve patient outcomes, and contribute to evidence-based surgical guidelines. METHODS Fluid-structure interaction modeling was employed to investigate how hemodynamic and mechanical stresses impact arteriovenous fistula maturation, with a particular focus on the role of wall shear stress in determining maturation outcomes. The critical threshold for vessel injury was identified as wall shear stress values exceeding 35 N/m2, while stenosis formation was projected to occur at levels below 1 N/m2. This work introduced a novel approach by considering disease-related factors, including blood viscosity (anemia), and vessel elasticity (diabetes, hypertension, and chronic kidney diseases), which directly influence hemodynamics and the generation of wall shear stress. Furthermore, the model was designed to incorporate varying thicknesses and elasticities for both the vein and artery, accurately representing authentic vascular anatomy. RESULTS The RADAR technique has demonstrated superior performance compared to the standard technique by providing appropriate wall shear stress in critical regions and minimizing the risk of wall damage. Its use of a thicker vessel also reduces the risk of vessel injury, making it particularly effective for patients with Chronic Kidney Disease (CKD), hypertension, anemia, and diabetes, ensuring optimal blood flow and fewer complications. However, there are minor concerns about stenosis formation in hypertension and anemia cases, which could be mitigated by adjusting the anastomosis angle to be lower than 30°. CONCLUSION Diabetes and hypertension have significant physiological effects that increase the risks associated with arteriovenous fistula maturation. The anemic condition resulting from CKD may help reduce vessel injury but raises concerns about potential stenosis formation. Despite these co-morbidities, the RADAR technique has demonstrated its ability to induce more favorable hemodynamic changes, promoting arteriovenous fistula maturation.
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Affiliation(s)
| | - Suphalerk Lohasammakul
- Department of Anatomy, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Phadungsak Rattanadecho
- Center of Excellence in Electromagnetic Energy Utilization in Engineering (C.E.E.E.), Department of Mechanical Engineering, Faculty of Engineering, Thammasat University (Rangsit Campus), Pathumthani, Thailand
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Liu X, Song P, Gao Q, Dai M, Rao J, Wen J. Impact on hemodynamics in carotid arteries with carotid webs at different locations: A Numerical Study Integrating Thrombus Growth Model. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 243:107926. [PMID: 37984097 DOI: 10.1016/j.cmpb.2023.107926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE Carotid webs (CWs), lesions in the carotid arteries, are gaining research interest due to the unclear link to ischemic stroke. Similarity to atherosclerosis in lesion location adds the complexity. The main purpose of study is to investigate the hemodynamic effects of CWs at different locations in carotid arteries. METHODS Three types of models with CWs were reconstructed from the CTA dataset of 8 healthy carotid arteries (Models A: CWs at the common carotid artery; B: at the origin of internal carotid artery; C: at the carotid sinus). Wall shear stress (WSS)-based parameters, including time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and endothelial cell activation potential (ECAP) were analyzed. A thrombus growth model was also incorporated to assess long-term thrombus formation across different carotid webs locations. RESULTS Models A exhibited helical flow, whereas models B and C showed disturbed flow in the carotid sinus. Recirculation in Models A and B was mainly downstream of CWs, while Models C had both upstream and downstream recirculation. In addition, models A had higher overall TAWSS levels, with the smallest region of TAWSS < 0.4 pa (7.78 ± 8.35%). In contrast, Models C had larger areas with TAWSS < 0.4 pa, RRT > 100, and ECAP > 1.5, accounting for 14.18 ± 5.28%, 1.51 ± 1.17%, and 10.36 ± 4.10%, respectively. Noting that thrombus volume was highest in Models C (7.20 ± 3.95%). CONCLUSIONS Numerical simulations indicate that: 1) CWs have less hemodynamic impact when located in the CCA, but may increase flow resistance leading to distal branch ischemia; 2) CWs contribute to thrombus formation, primarily downstream in the common carotid artery and internal carotid artery origin, and both upstream and downstream in the sinus; 3) CWs at the origin of the ICA are more likely to result in disturbed blood flow patterns and thrombus aggregation than the other two locations, which may increase the risk of ischemic stroke in distal cerebral arteries.
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Affiliation(s)
- Xinhui Liu
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Pan Song
- Department of Cardiology, Mianyang Central Hospital, Mianyang 621000, China
| | - Qi Gao
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Min Dai
- Department of Cardiology, Mianyang Central Hospital, Mianyang 621000, China
| | - Junjie Rao
- Office of the Commission for Discipline Inspection, Mianyang Central Hospital, Mianyang 621000, China
| | - Jun Wen
- Department of Computer Science and Technology, Southwest University of Science and Technology, Mianyang 621010, China.
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Wen J, Gao Q, Chen J, Li X, Zhang K, He G, Dai M, Song P. Risk evaluation of adverse aortic events in patients with non-circular aortic annulus after transcatheter aortic valve implantation: a numerical study. Biomech Model Mechanobiol 2023:10.1007/s10237-023-01725-2. [PMID: 37154995 DOI: 10.1007/s10237-023-01725-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/11/2023] [Indexed: 05/10/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is a micro-invasive surgery used to treat patients with aortic stenosis (AS) efficiently. However, the uneven valve expansion can cause a non-circular annulus, which is one of the main factors leading to complications after TAVI. As a preliminary work, the main purpose of this study was to evaluate the risk of adverse aortic events in patients with a non-circular aortic annulus after TAVI. This study numerically investigated the distribution of four wall shear stress (WSS)-based indicators and three helicity-based indicators in eight patient-specific aortas with different annulus including circular, type I elliptical and type II elliptical shapes. Both elliptical annulus features can significantly enhance the intensity of the helicity (h2) in the ascending aorta (p < 0.001). However, for the type I elliptical annulus, the spiral flow structure was changed into low-velocity and disturbed flow pattern close to the inner side of the aortic arch. For the type II elliptical annulus, the spiral flow remained but became skewed in distribution. The elliptical annulus feature could increase the general level WSS-based indicators, especially in the ascending aorta. However, due to the disturbance of spiral flow or second helical flow in ascending aortas, areas with low TAWSS accompanied by high oscillatory shear index (OSI) and cross flow index (CFI) were observed in all the ascending aortas with non-circular annulus. The elliptical annulus feature can change the hemodynamic environment in the aortic arch, especially in the ascending aorta. Although both elliptical annulus features enhanced the strength of helicity, the uniform distribution of the helical flow was disturbed, especially in the ascending aorta, indicating the potential risk of adverse aortic events may increase. Therefore, for the patients without paravalvular leak but elliptical annulus shape after TAVI treatment, surgeons may be needed to consider further dilatation to make the non-circular annulus become circular.
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Affiliation(s)
- Jun Wen
- School of Computer Science and Technology, Southwest University of Science and Technology, Qinglong Road 56, Mianyang, 621010, China
| | - Qi Gao
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang, 621010, China
| | - Jingnan Chen
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang, 621010, China
| | - Xinya Li
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang, 621010, China
| | - Kaiyue Zhang
- School of Computer Science and Technology, Southwest University of Science and Technology, Qinglong Road 56, Mianyang, 621010, China
| | - Gang He
- School of Computer Science and Technology, Southwest University of Science and Technology, Qinglong Road 56, Mianyang, 621010, China.
- NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, Mianyang, 621010, China.
| | - Min Dai
- Department of Cardiology, Mianyang Central Hospital, No. 12, Changjia Lane, Jingzhong Street, Fucheng District, Mianyang, 621000, Sichuan Province, China.
| | - Pan Song
- Department of Cardiology, Mianyang Central Hospital, No. 12, Changjia Lane, Jingzhong Street, Fucheng District, Mianyang, 621000, Sichuan Province, China.
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Wen J, Huang H, Su Z, Jiang L, Gao Q, Chen X, Yan T, Peng L. Predicting the Risk of Type B Aortic Dissection Using Hemodynamic Parameters in Aortic Arches: A Comparative Study between Healthy and Repaired Aortas. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 230:107326. [PMID: 36608431 DOI: 10.1016/j.cmpb.2022.107326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/19/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVE The development of acute aortic dissection (AD) remains unpredictable due to the intricate nature of the AD mechanism and the varied patient-specific aortic anatomy. The aim of this study was to simulate the hemodynamic parameters in the aortas before the onset of TBAD with healthy controls. METHODS This study numerically assessed the effectiveness of hemodynamic indicators in predicting the risk of type B AD (TBAD) by investigating the differences in hemodynamic parameters between healthy and repaired aortas (aortas before TBAD development). Four wall shear stress (WSS)-based indicators and three helicity-based indicators were adopted and analyzed. RESULTS The results showed that more pathological anatomical feathers can be observed in the repaired aortas. For WSS-based indicators, only averaged cross flow index (CFI) and oscillatory shear index OSI (CFI, 1.03 ± 0.07 vs. 0.83 ± 0.10 and OSI, 0.12 ± 0.03 vs. 0.04 ± 0.02) (all p<0.001) were significantly higher in the repaired aortas than those in the healthy aortas. On the other hand, average helicity in the repaired aortas also showed a significant difference compared with that in healthy aortas (h1, 3.88 ± 5.55 vs. -8.03 ± 14.16) (p<0.05). Furthermore, the skewed helical structure and flow disturbance was found in the repaired aortas. CONCLUSION 1) There are marked differences in pathological anatomical features, such as aortic dilation, elongation and tortuosity between the healthy aortas and repaired aortas, and the corresponding hemodynamic indicators also have also been significantly changed. 2) Compared with anatomical characteristics, hemodynamic indicators may be more accurate for predicting the risk and location of TBAD, such as the OSI and CFI index were significantly enhanced in the region where the entry tears have occurred. 3) In clinical practice, anatomical features remain important factors for assessing the risk for development of TBAD; however, hemodynamic analyses with quantitative data and more visualizing characteristics have showed promising potential in this aspect.
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Affiliation(s)
- Jun Wen
- Department of Computer Science and technology, Southwest University of Science and Technology, Mianyang 621010, China
| | - Haodi Huang
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Zhiqiao Su
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Linke Jiang
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Qi Gao
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Xiaoyi Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tingli Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.
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Wen J, Yan T, Su Z, Huang H, Gao Q, Chen X, Wong KKL, Peng L. Risk evaluation of type B aortic dissection based on WSS-based indicators distribution in different types of aortic arch. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106872. [PMID: 35594583 DOI: 10.1016/j.cmpb.2022.106872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/26/2022] [Accepted: 05/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE The underlying mechanism of aortic dissection (AD) remains unclear and the onset of AD is still unpredictable. Although clinical study with statistical analysis has reported that type III aortic arch may have strong correlation with type B AD (TBD), the effects of different arch types on the wall shear stress (WSS) have not been clarified. METHODS As a complementary work, this study numerically investigated the distribution of five WSS-based indicators in thirty aortic arches without AD, which were classified into three groups based on the arch types. RESULTS The distribution of most WSS indicators, such as time averaged WSS (TAWSS), oscillatory shear index (OSI) and relative residence time (RRT) had no significant difference among different types of aortic arches (P>0.05). However, a multidirectional WSS index, namely CFI, was found its maximum value was positively correlated with type III aortic arch in proximal descending aorta (p<0.001, r = 0.65). CONCLUSIONS It can be concluded that the enhancement or oscillation of WSS may not be the main reason of TBD is prevalence in type III arches, while the multidirectional WSS distribution may be an important factor. It can be further referred that the CFI may have a potential to predict the onset of TBD.
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Affiliation(s)
- Jun Wen
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Tingli Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhiqiao Su
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Haodi Huang
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Qi Gao
- Institute of Civil Engineering and Architecture, Southwest University of Science and Technology, Mianyang 621010, China
| | - Xiaoyi Chen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Kelvin K L Wong
- School of Computer Science and Engineering, Central South University, Changsha 410000, China.
| | - Liqing Peng
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, China.
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