Numerical simulation of blood pulsatile flow in a stenosed carotid artery using different rheological models

Artificial intelligence-based prediction of the rheological properties of hydrocolloids for plant-based meat analogues

BACKGROUND

Methylcellulose has been applied as a primary binding agent to control the quality attributes of plant-based meat analogues. H owever, a great deal of effort has been made to search for hydrocolloids to replace methylcellulose because of increasing awareness of clean labels. In this study, a machine learning framework was proposed in order to describe and predict the flow behavior of six hydrocolloid solutions, and the predicted viscosities were correlated with the textural features of their corresponding plant-based meat analogues.

RESULTS

Different shear-thinning and Newtonian behaviors were observed depending on the type of hydrocolloid and the shear rate. Methylcellulose exhibited an increasing viscosity pattern with increasing temperature, compared to the other hydrocolloids. The machine learning algorithms (random forest and multilayer perceptron models) showed a better viscosity fitting performance than the constitutive equations (power law and Cross models). In addition, three hyperparameters of the multilayer perceptron model (optimizer, learning rate, and the number of hidden layers) were tuned using the Bayesian optimization algorithm.

CONCLUSION

The optimized multilayer perceptron model exhibited superior performance in viscosity prediction (R2 = 0.9944-0.9961/RMSE = 0.0545-0.0708). Furthermore, the machine learning-predicted viscosities overall showed similar patterns to the textural parameters of the meat analogues. © 2024 Society of Chemical Industry.

Integrating Computational and Biological Hemodynamic Approaches to Improve Modeling of Atherosclerotic Arteries

Atherosclerosis is the primary cause of cardiovascular disease, resulting in mortality, elevated healthcare costs, diminished productivity, and reduced quality of life for individuals and their communities. This is exacerbated by the limited understanding of its underlying causes and limitations in current therapeutic interventions, highlighting the need for sophisticated models of atherosclerosis. This review critically evaluates the computational and biological models of atherosclerosis, focusing on the study of hemodynamics in atherosclerotic coronary arteries. Computational models account for the geometrical complexities and hemodynamics of the blood vessels and stenoses, but they fail to capture the complex biological processes involved in atherosclerosis. Different in vitro and in vivo biological models can capture aspects of the biological complexity of healthy and stenosed vessels, but rarely mimic the human anatomy and physiological hemodynamics, and require significantly more time, cost, and resources. Therefore, emerging strategies are examined that integrate computational and biological models, and the potential of advances in imaging, biofabrication, and machine learning is explored in developing more effective models of atherosclerosis.

In silico hemodynamical simulations show additional benefits of artery wall softening induced by antihypertensive drugs

BACKGROUND AND OBJECTIVES

Age-related arterial stiffening increases peripheral resistance and decreases arterial distensibility, thus contributing to hypertension, an important risk factor of atherosclerosis. It causes abnormal blood flow, endothelial dysfunction, higher pulse wave velocity, and consequently elevated pressure wave amplitude.

METHODS

This paper presents the influence of these changes via multiscale 3D-0D transient computational fluid dynamics simulations of blood flow in five patient-specific geometries of human carotid bifurcation using archetypal flow waveforms for young and old subjects.

RESULTS

The proposed model shows a significant decrease in the time-averaged wall shear stress (TAWSS) for the old archetypal flow waveform. This is in good agreement with clinical data on a straight segment of common carotid arteries available for young and old subjects. Moreover, our study showed that the decrease of area-averaged TAWSS related to the old flow waveform is much more pronounced (2.5 ÷ 4.5 times higher) at risk areas (areas showing TAWSS below its threshold value of 0.48 Pa) than in straight segments commonly considered in clinical studies.

CONCLUSIONS

Since arterial stiffness can be lowered through long-term usage of any of the five basic groups of antihypertensives, possible benefits of such medical therapy could be not only lowering blood pressure and peripheral resistance but also in increasing the TAWSS and thus attenuating an important mechanism of the atherosclerotic process.

Prediction of Hemodynamic-Related Hemolysis in Carotid Stenosis and Aiding in Treatment Planning and Risk Stratification Using Computational Fluid Dynamics

Atherosclerosis affects human health in many ways, leading to disability or premature death due to ischemic heart disease, stroke, or limb ischemia. Poststenotic blood flow disruption may also play an essential role in artery wall impairment linked with hemolysis related to shear stress. The maximum shear stress in the atherosclerotic plaque area is the main parameter determining hemolysis risk. In our work, a 3D internal carotid artery model was built from CT scans performed on patients qualified for percutaneous angioplasty due to its symptomatic stenosis. The obtained stenosis geometries were used to conduct a series of computer simulations to identify critical parameters corresponding to the increase in shear stress in the arteries. Stenosis shape parameters responsible for the increase in shear stress were determined. The effect of changes in the carotid artery size, length, and degree of narrowing on the change in maximum shear stress was demonstrated. Then, a correlation for the quick initial diagnosis of atherosclerotic stenoses regarding the risk of hemolysis was developed. The developed relationship for rapid hemolysis risk assessment uses information from typical non-invasive tests for treated patients. Practical guidelines have been developed regarding which stenosis shape parameters pose a risk of hemolysis, which may be adapted in medical practice.

Usage of computational method for hemodynamic analysis of intracranial aneurysm rupture risk in different geometrical aspects

The importance of the parent vessel geometrical feature on the risk of cerebral aneurysm rupture is unavoidable. This study presents inclusive details on the hemodynamics of Internal carotid artery (ICA) aneurysms with different parent vessel mean diameters. Different aspects of blood hemodynamics are compared to find a reasonable connection between parent vessel mean diameter and significant hemodynamic factors of wall shear stress (WSS), oscillatory shear index (OSI), and pressure distribution. To access hemodynamic data, computational fluid dynamics is used to model the blood stream inside the cerebral aneurysms. A hemodynamic comparison of the selected cerebral aneurysm shows that the minimum WSS is reduced by about 71% as the parent vessel's mean diameter is increased from 3.18 to 4.48 mm.

Impacts of morphology parameters on the risk of rupture in intracranial aneurysms: statistical and computational analyses

The hemodynamic analysis of the blood stream inside the cerebral aneurysms reveals the risk of the aneurysm rupture. In addition, the high risk region prone to rupture would be determined by the hemodynamic analysis of the blood. In present article, computational fluid dynamic is used for the investigation of the hemodynamic effects on the aneurysm wall and risk of rupture. This study tries to find the connection between the risk of rupture with three geometrical features of aneurysm i.e., Ellipsoid Max semi-axis, Size ratio and Tortuosity. Statistical analysis is done over 30 different ruptured /unruptured ICA aneurysms to find meaningful relation between selected geometrical factors and rupture risk. The hemodynamic analysis is done over four distinct aneurysm models to attain more details on effects of chosen geometrical factors. The results of simulations indicate that the Ellipsoid Max semi-axis have meaningful impacts on the risk of rupture.

Hemolysis of red blood cells in blood vessels modeled via computational fluid dynamics

The research aims to verify the universal relationship between vessel shape and the risk of hemolysis using a rheological model of blood reflecting the physiological processes related to blood for any blood vessel. Blood is a multi-component fluid, the rheology of which depends on many factors, such as the concentration of red blood cells and local shear stress, which significantly affect the process of hemolysis. Blood rheology models used so far cannot be used for all flows and geometries. Therefore, a new rheology model has been introduced suitable for modeling hemolytic flows observed in arteries with atherosclerotic lesions in the in vivo environment. The previously presented model also has advantages in modeling local viscosity in stenosis. Geometries of the blood vessels from computed tomography scans and simplified models of the actual arteries observed during medical procedures were used in the calculations. Population Balance Based Rheology model predicts the concentration of single, deagglomerated red blood cells and the concentration and size of red blood cell agglomerates, which affect blood rheology and hemolysis. Based on the simulations carried out, a correlation was found between the shape of the vessel cavity and the risk of hemolysis. Presented results can be used in the future to create a correlation between the shape of the atherosclerotic lesions and the risk of hemolysis in the blood to make an initial risk assessment for a given patient.

Cerebral multi-autoregulation model based enhanced external counterpulsation treatment planning for cerebral ischemic stroke

Enhanced external counterpulsation (EECP) treatment for cerebral ischemic stroke patients with differing severity of stenosis, is subject to uncertainties due to the varying effects of the cerebral autoregulation mechanism on haemodynamics. The current study reports the development of a cerebral multi-autoregulation (MR) mathematical model, based on cerebral arteriole regulation of neurogenic, vascular smooth muscle reflex and shear stress mechanisms which takes into account the severity of stenosis. The model was evaluated by comparison to authentic clinical measurements of cerebral autoregulatory efficiency. Then it was applied to a 0D/3D geometric multi-scale haemodynamic model of a cerebral artery. Haemodynamic indicators were calculated under different pressurization durations of EECP to evaluate the efficacy for different stenosis lesions. Moderate stenosis of 50% to 60% produced excessive time-averaged wall shear stress in the distal area of the stenosis (>7 Pa) during prolonged pressurization and may result in damage to vascular endothelial cells. However, prolonged pressurization did not result in haemodynamic risk for severe stenosis of 70% to 80%, indicating that the duration of pressurization may be extended with increasing severity of stenosis. The current MR model accurately simulated cerebral blood flow and has relevance to the simulation of cerebral haemodynamics in a clinical setting.

The influence of sac centreline on saccular aneurysm rupture: computational study

The geometric characteristics of a saccular aneurysm play a crucial role in its rupturing. This article thoroughly investigates the impact of the sac centerline on aneurysm rupture, with a focus on identifying significant factors related to rupture at different time intervals. The study employs comprehensive computational simulations of six models of the ICA with varying coiling porosities and blood HCTs, using CFD analysis to examine WSS, OSI, pressure, and velocity within the saccular aneurysm for different sac centerlines. The results indicate that higher blood HCT levels lead to increased WSS and pressure values on the aneurysm wall, while OSI and mean velocity decrease. The study also reveals that coiling techniques can significantly reduce the risk of rupture, as decreasing coil porosity (increasing coil permeability) increases OSI and pressure while decreasing WSS and blood velocity within the aneurysm sac.

Numerical computation of pulsatile hemodynamics and diagnostic concern of coronary bifurcated artery flow for Newtonian and non-Newtonian fluid

Atherosclerotic with the high occurrence of plaque formation due to stenosis has attracted wide attention among researchers. The left coronary artery has been studied in two-dimensional and in three-dimensional (3D) bifurcation as the models of blood flow through Newtonian and non-Newtonian fluids to better understand the physical mechanism. The computational Fluid Dynamics (CFD) technique is incorporated in COMSOL Multiphysics and then it is justified by satisfactory validation. It is found that the Newtonian model shows larger recirculation zones than non-Newtonian does. The present study also focuses on the evaluations of the lesion of diagnostic and the coefficient of pressure drop assessments on the basis of the diagnostic parameter's critical values affected by the rheological model. Nevertheless, the leading concentration of the subsisting investigation works is confined to the change of importance factor (IFc) affected by arterial blockage. But the IFc of non-Newtonian fluid for 3D left coronary artery bifurcation model decreases with increasing bifurcation angle and the time-averaged inlet pressure is the least for smaller bifurcation angles. The current research further concentrates that the flow separation length reduces with developing bifurcation angle in bifurcated geometry. It is significant to mention that non-Newtonian blood flow model incorporating hemodynamic and diagnostic parameters has great impacts on instantaneous flow systems.

A Bayesian approach to blood rheological uncertainties in aortic hemodynamics

Computational hemodynamics has received increasing attention recently. Patient-specific simulations require questionable model assumptions, for example, for geometry, boundary conditions, and material parameters. Consequently, the credibility of these simulations is much doubted, and rightly so. Yet, the matter may be addressed by a rigorous uncertainty quantification. In this contribution, we investigated the impact of blood rheological models on wall shear stress uncertainties in aortic hemodynamics obtained in numerical simulations. Based on shear-rheometric experiments, we compare the non-Newtonian Carreau model to a simple Newtonian model and a Reynolds number-equivalent Newtonian model. Bayesian Probability Theory treats uncertainties consistently and allows to include elusive assumptions such as the comparability of flow regimes. We overcome the prohibitively high computational cost for the simulation with a surrogate model, and account for the uncertainties of the surrogate model itself, too. We have two main findings: (1) The Newtonian models mostly underestimate the uncertainties as compared to the non-Newtonian model. (2) The wall shear stresses of specific persons cannot be distinguished due to largely overlapping uncertainty bands, implying that a more precise determination of person-specific blood rheological properties is necessary for person-specific simulations. While we refrain from a general recommendation for one rheological model, we have quantified the error of the uncertainty quantification associated with these modeling choices.

Influence of stent-induced vessel deformation on hemodynamic feature of bloodstream inside ICA aneurysms

One of the effective treatment options for intracranial aneurysms is stent-assisted coiling. Though, previous works have demonstrated that stent usage would result in the deformation of the local vasculature. The effect of simple stent on the blood hemodynamics is still uncertain. In this work, hemodynamic features of the blood stream on four different ICA aneurysm with/without interventional are investigated. To estimate the relative impacts of vessel deformation, four distinctive ICA aneurysm is simulated by the one-way FSI technique. Four hemodynamic factors of aneurysm blood velocity, wall pressure and WSS are compared in the peak systolic stage to disclose the impact of defamation by the stent in two conditions. The stent usage would decrease almost all of the mentioned parameters, except for OSI. Stenting reduces neck inflow rate, while the effect of interventional was not consistent among the aneurysms. The deformation of an aneurysm has a strong influence on the hemodynamics of an aneurysm. This outcome is ignored by most of the preceding investigations, which focused on the pre-interventional state for studying the relationship between hemodynamics and stents. Present results show that the application of stent without coiling would improve most hemodynamic factors, especially when the deformation of the aneurysm is high enough.

Computational study of blood flow inside MCA aneurysm with/without endovascular coiling

The simulation of blood hemodynamics inside the MCA aneurysm is done to investigate the potential region for rupture and hemorrhage. The main focus of this work is to disclose the impacts of endovascular coiling on blood hemodynamics and the risk of aneurysm rupture. Navier-stokes equations are solved for the computational study of blood flow while it is assumed that flow remains laminar, unsteady, and non-Newtonian. Influences of blood hematocrits and coiling porosity are also examined in this work. Obtained results show that impacts of blood hematocrit on the maximum OSI are limited in the MCA case.

Computational study of the blood hemodynamic inside the cerebral double dome aneurysm filling with endovascular coiling

The rupture of the aneurysm wall is highly associated with the hemodynamic feature of bloodstream as well as the geometrical feature of the aneurysm. Coiling is known as the most conventional technique for the treatment of intracranial cerebral aneurysms (ICA) in which blood stream is obstructed from entering the sac of the aneurysm. In this study, comprehensive efforts are done to disclose the impacts of the coiling technique on the aneurysm progress and risk of rupture. The computational fluid dynamic method is used for the analysis of the blood hemodynamics in the specific ICA. The impacts of the pulsatile blood stream on the high-risk region are also explained. Wall shear Stress (WSS) and Oscillatory shear index (OSI) factors are also compared in different blood viscosities and coiling conditions. According to our study, the hematocrit test (Hct) effect is evident (25% reduction in maximum WSS) in the two first stages (maximum acceleration and peak systolic). Our findings present that reduction of porosity from 0.89 to 0.79 would decrease maximum WSS by about 8% in both HCT conditions.

Hemodynamic analysis of hybrid treatment for thoracoabdominal aortic aneurysm based on Newtonian and non-Newtonian models in a patient-specific model

The accuracy of the Newtonian model used in retrograde visceral revascularization (RVR) of hybrid surgery for thoracoabdominal aortic aneurysm (TAAA) hemodynamic simulation remains unclear. Noting that an appropriate blood viscosity model is a significant factor to capture hemodynamic changes in numerical studies. Therefore, both Newtonian and non-Newtonian blood viscosity models were adopted in this study to investigate the importance of hemodynamics when non-Newtonian blood property was accounted for in a patient-specific RVR simulation. The results revealed that disturbed flow and unfavorable WSS distribution can be observed in the anastomosis region under both blood viscosity models due to the retrograde flow pattern in the RVR model. However, although the non-Newtonian blood model has negligible effect on flow pattern and pressure drop, there were of significance quantitative and qualitative difference of local normalized helicity and wall shear stress distribution under pulsatile flow condition. In particular, the unfavorable WSS indicators distribution was better matched with a patient-specific follow-up report when non-Newtonian blood viscosity was accounted for. To conclude, the use of a Newtonian blood model is a reasonable approximation to obtain the general features of the flow field under steady flow condition. However, to study the hemodynamic parameters within retrograde flow under pulsatile flow condition, a non-Newtonian model may be more appropriate.

Effects of coiling embolism on blood hemodynamic of the MCA aneurysm: a numerical study

One of common endovascular technique for treatment of MCA aneurysm is using coiling gel for limiting of blood stream. In this work, computational fluid dynamic is used for the simulation of the blood hemodynamic inside MCA in existence of coiling gel. This work has tried to visualize the impacts of blood characteristics i.e. hematocrit as a protein related factor on efficiency of coiling fiber inside the aneurysm. Tufts of polyester fibers may be attached to the coil to support thrombosis and platelet aggregation. Blood rheology analysis is done by solving RANS equations and it is assumed that blood stream is non-Newtonian with fluid-solid interaction. OSI and WSS are compared on sac surface area for different stages of blood cycle. Achieved results confirm that the coiling gel substantially decreases the blood circulation inside the aneurysm sac. It is also found that the influence of blood hematocrit decreases when the MCA aneurysm is filled by the coiling gel.

Simulation of LDL permeation into multilayer wall of a coronary bifurcation using WSS-dependent model: effects of hemorheology

Atherosclerosis, due to the permeation of low-density lipoprotein (LDL) particles into the arterial wall, is one of the most common and deadly diseases in today's world. Due to its importance, numerous studies have been conducted on the factors affecting this disease. In this study, using numerical simulation, the effects of Wall Shear Stress (WSS), non-Newtonian behavior of blood, different values of hematocrit and blood pressure on LDL permeation into the arterial wall layers are investigated in a 4-layer wall model of a coronary bifurcation. To obtain the velocity and concentration fields in the fluid domain, the Navier-Stokes, Brinkman, and mass transfer equations are numerically solved in the lumen and wall layers. Results show that it is important to consider the effects of WSS on transport properties of endothelium layer in bifurcations and this leads to completely different concentration profiles compared to the constant properties model. Our computations show that a giant accumulation of LDL in the intima layer of the outer wall of the left anterior descending artery, especially in low WSS regions, may lead to atherosclerosis. It is also, necessary to consider the non-Newtonian behavior of blood in bifurcations due to its direct effect on WSS. A pressure-induced increase in the half-width of leaky junctions may be responsible for the higher risk of atherosclerosis in hypertension. In addition, it is shown that the dominant mechanism in LDL permeation into the wall is convection, and also, hypertension increases the effect of mass transfer by convection mechanism more than the diffusion mechanism. Furthermore, our results are consistent with various clinical studies.

Effects of non-Newtonian viscosity on arterial and venous flow and transport

It is well known that blood exhibits non-Newtonian viscosity, but it is generally modeled as a Newtonian fluid. However, in situations of low shear rate, the validity of the Newtonian assumption is questionable. In this study, we investigated differences between Newtonian and non-Newtonian hemodynamic metrics such as velocity, vorticity, and wall shear stress. In addition, we investigated cardiovascular transport using two different approaches, Eulerian mass transport and Lagrangian particle tracking. Non-Newtonian solutions revealed important differences in both hemodynamic and transport metrics relative to the Newtonian model. Most notably for the hemodynamic metrics, in-plane velocity and vorticity were consistently larger in the Newtonian approximation for both arterial and venous flows. Conversely, wall shear stresses were larger for the non-Newtonian case for both the arterial and venous models. Our results also indicate that for the Lagrangian metrics, the history of accumulated shear was consistently larger for both arterial and venous flows in the Newtonian approximation. Lastly, our results also suggest that the Newtonian model produces larger near wall and luminal mass transport values compared to the non-Newtonian model, likely due to the increased vorticity and recirculation. These findings demonstrate the importance of accounting for non-Newtonian behavior in cardiovascular flows exhibiting significant regions of low shear rate and recirculation.

Influence of the coiling porosity on the risk reduction of the cerebral aneurysm rupture: computational study

The formation and progress of cerebral aneurysm is highly associated with hemodynamic factors and blood flow feature. In this study, comprehensive efforts are done to investigate the blood hemodynamic effects on the creation and growth of the Internal Carotid Artery. The computational fluid dynamic method is used for the visualization of the bloodstream inside the aneurysm. Transitional, non-Newtonian and incompressible conditions are considered for solving the Navier-Stokes equation to achieve the high-risk region on the aneurysm wall. OSI and WSS of the aneurysm wall are compared within different blood flow stages. The effects of blood viscosity and coiling treatment on these factors are presented in this work. Our study shows that in male patients (HCT = 0.45), changing the porosity of coiling from 0.89 with 0.79 would decreases maximum OSI up to 75% (in maximum acceleration). However, this effect is limited to about 45% for female patients (HCT = 0.35).

Transient wall shear stress estimation in coronary bifurcations using convolutional neural networks

BACKGROUND AND OBJECTIVE

Haemodynamic metrics, such as blood flow induced shear stresses at the inner vessel lumen, are associated with the development and progression of coronary artery disease. Understanding these metrics may therefore improve the assessment of an individual's coronary disease risk. However, the calculation of such luminal Wall Shear Stress (WSS) using traditional Computational Fluid Dynamics (CFD) methods is relatively slow and computationally expensive. As a result, CFD based haemodynamic computation is not suitable for integrated and large-scale use in clinical settings.

METHODS

In this work, deep learning techniques are proposed as an alternative method to CFD, whereby luminal WSS magnitude can be predicted in coronary bifurcations throughout the cardiac cycle based on the steady state solution (which takes <120 seconds to calculate including preprocessing), vessel geometry and additional global features. The deep learning model is trained on a dataset of 101 patient-specific and 2626 synthetic left main bifurcation models with 26 separate patient-specific cases used as the test set.

RESULTS

The model showed high fidelity predictions with <5% (normalised against mean WSS magnitude) deviation to CFD derived values as the gold-standard method, while being orders of magnitude faster with on average <2 minutes versus 3 hours computation for transient CFD.

CONCLUSIONS

This method therefore offers a new approach to substantially reduce the computational cost involved in, for example, large-scale population studies of coronary haemodynamic metrics, and may therefore open the pathway for future clinical integration.

A predictive patient-specific computational model of coronary artery bypass grafts for potential use by cardiac surgeons to guide selection of graft configurations

Cardiac surgeons face a significant degree of uncertainty when deciding upon coronary artery bypass graft configurations for patients with coronary artery disease. This leads to significant variation in preferred configuration between different surgeons for a particular patient. Additionally, for the majority of cases, there is no consensus regarding the optimal grafting strategy. This situation results in the tendency for individual surgeons to opt for a “one size fits all” approach and use the same grafting configuration for the majority of their patients neglecting the patient-specific nature of the diseased coronary circulation. Quantitative metrics to assess the adequacy of coronary bypass graft flows have recently been advocated for routine intraoperative use by cardiac surgeons. In this work, a novel patient-specific 1D-0D computational model called “COMCAB” is developed to provide the predictive haemodynamic parameters of functional graft performance that can aid surgeons to avoid configurations with grafts that have poor flow and thus poor patency. This model has significant potential for future expanded applications.

Probing the possibility of lesion formation/progression in vicinity of a primary atherosclerotic plaque: A fluid-solid interaction study and angiographic evidences

It is shown that certain locations in the arterial tree, such as coronary and cerebral arteries, are more prevalent to plaque formation. Endothelial activation and consequent plaque development are attributed to local hemodynamic parameters such as wall shear stress (WSS), oscillatory shear index (OSI), relative residence time (RRT), and stress phase angle. After a certain level of plaque progression, these hemodynamic parameters are disturbed before and after the plaque. In the current study, it is hypothesized that the vicinity of a primary lesion is susceptible for further degeneration and second plaque formation. A fluid-solid interaction (FSI) model of the coronary artery with different levels of asymmetric constriction, is simulated and the trend of hemodynamic parameters were studied in both of the plaque side (PS) and the opposite wall (facing the plaque [PF]). Also, a novel factor is introduced that can identify the high-risk regions associated with WSS oscillations to negative values. Our results indicate that when more than half of the artery is constricted, the downstream of the plaque is highly exposed to endothelial pathogenesis the PS, such that negative WSS, and as well, critical values of OSI and RRT, that is, -1.2 Pa, 0.42 and 6.5 s, respectively arise in this region. PS endothelial cells in this region exposed to the highest risk of atherosclerosis based on the proposed index (3 out of 3). As well, three cases of angiographic images are provided that confirms existence of secondary lesion close to the primary one as predicted by our computational simulations.

Helical Flow in Healthy and Diseased Patient-specific Coronary Bifurcations

Helical flow (HF) exists in healthy and diseased coronary bifurcations and was found to have a protective atherosclerotic vascular effect in other vessels. However, the role of HF in patient-specific human coronary arteries still needs further study, and is therefore the objective of this study in both healthy and diseased bifurcations. Computational studies were conducted on 16 patient-specific coronary bifurcations, including eight healthy and eight identical cases with idealized narrowing to represent disease. In general, higher HF intensity may have a favorable effect as it corelated to the reduction of the percentage vessel area exposed to adverse time averaged wall shear stress (TAWSS%) in both healthy and diseased models. The HF intensity and distribution of each model varies due to the complex shape of patient-specific models. The presence of disease appears to have an important impact on the downstream HF patterns and the TAWSS distributions. Clinical Relevance- By understanding the relationship between HF and hemodynamics, HF may be used as a predictor for the formation and progression of atherosclerotic plaque in coronary arteries instead of near-wall WSS measures, which can be determined with higher accuracy in vivo.

A new and automated risk prediction of coronary artery disease using clinical endpoints and medical imaging-derived patient-specific insights: protocol for the retrospective GeoCAD cohort study

INTRODUCTION

Coronary artery disease (CAD) is the leading cause of death worldwide. More than a quarter of cardiovascular events are unexplained by current absolute cardiovascular disease risk calculators, and individuals without clinical risk factors have been shown to have worse outcomes. The 'anatomy of risk' hypothesis recognises that adverse anatomical features of coronary arteries enhance atherogenic haemodynamics, which in turn mediate the localisation and progression of plaques. We propose a new risk prediction method predicated on CT coronary angiography (CTCA) data and state-of-the-art machine learning methods based on a better understanding of anatomical risk for CAD. This may open new pathways in the early implementation of personalised preventive therapies in susceptible individuals as a potential key in addressing the growing burden of CAD.

METHODS AND ANALYSIS

GeoCAD is a retrospective cohort study in 1000 adult patients who have undergone CTCA for investigation of suspected CAD. It is a proof-of-concept study to test the hypothesis that advanced image-derived patient-specific data can accurately predict long-term cardiovascular events. The objectives are to (1) profile CTCA images with respect to variations in anatomical shape and associated haemodynamic risk expressing, at least in part, an individual's CAD risk, (2) develop a machine-learning algorithm for the rapid assessment of anatomical risk directly from unprocessed CTCA images and (3) to build a novel CAD risk model combining traditional risk factors with these novel anatomical biomarkers to provide a higher accuracy CAD risk prediction tool.

ETHICS AND DISSEMINATION

The study protocol has been approved by the St Vincent's Hospital Human Research Ethics Committee, Sydney-2020/ETH02127 and the NSW Population and Health Service Research Ethics Committee-2021/ETH00990. The project outcomes will be published in peer-reviewed and biomedical journals, scientific conferences and as a higher degree research thesis.

Steady-state solutions of one-dimensional equations of non-Newtonian hemodynamics

This paper is devoted to obtaining and analysis of steady-state solutions of one-dimensional equations for the simulation of blood flow when the non-Newtonian nature of blood is taken into account. The models, based on the rheological relations, widely used for the blood, are considered. The expressions for the nonlinear frictional term are presented. For the Power Law, Simplified Cross, and Quemada models, the exact integrals of the nonlinear ordinary differential equation, obtained from the averaged momentum equation, are obtained. It is demonstrated that several solutions exist for every rheological model, but the physically relevant solutions can be selected by the appropriate value of Mach number. The effects of the velocity profile and the value of hematocrit on the steady-state solutions are analyzed. It is demonstrated that the flattening of the velocity profile, which is typical for the blood, leads to the diminishing of the length of the interval, where the solution exists. The same effect is observed when the hematocrit value is increased.

Wall Shear Stress Alteration: a Local Risk Factor of Atherosclerosis

PURPOSE OF REVIEW

Wall shear stress describes the mechanical influence of blood flow on the arterial wall. In this review, we discuss the role of the wall shear stress in the development of atherosclerosis and its complications.

RECENT FINDINGS

Areas with chronically low, oscillating wall shear stress are most prone to plaque development and include outer bifurcation walls and inner walls of arches. In some diseases, patients have lower wall shear stress even in straight arterial segments; also, these findings were associated with atherosclerosis. High wall shear stress develops in the distal part (shoulder) of a stenosis and contributes to plaque destabilization. Wall shear stress changes are involved in the development of atherosclerosis. They are not fully understood yet and act in concert with tangential wall stress.

Secondary flow in bifurcations - Important effects of curvature, bifurcation angle and stents

Coronary bifurcations have complex flow patterns including secondary flow zones and helical flow, which directly affect pathophysiological mechanisms such as the development of atherosclerosis. The objective of this study was to generate insights into the effects of curvature, bifurcation angle and the presence of stents on flow patterns and resulting haemodynamics in coronary left main bifurcations. The blood flow and associated metrics were modelled in both idealised and patient-specific bifurcations with varying curvature and bifurcation angles with and without stents, resulting in a total of 128 geometries considered. The results showed that larger curvature of bifurcating vessels has a significant influence on secondary flow, especially with distance to the bifurcation region, causing a skew, spin and asymmetry of Dean vortices, an increase in helical flow intensity with symmetry loss, and a decrease in adversely low time-average wall shear stress (TAWSS). Generally, asymmetric flow patterns coincided with adversely low TAWSS regions. In identical stented geometries, the presence of the stents induced local recirculation immediately adjacent to the stent struts, thus generating adversely low TAWSS in these areas, with some effect on the overall secondary flow. Overall, the effect of stents outweighed the effect of curvature and BA. This new knowledge contributes to a better understanding of the joint effects of curvature, bifurcation angle, and stents on flow patterns and haemodynamics in coronary bifurcations.

Comparison of Non-Newtonian Models of One-Dimensional Hemodynamics

The paper is devoted to the comparison of different one-dimensional models of blood flow. In such models, the non-Newtonian property of blood is considered. It is demonstrated that for the large arteries, the small parameter is observed in the models, and the perturbation method can be used for the analytical solution. In the paper, the simplified nonlinear problem for the semi-infinite vessel with constant properties is solved analytically, and the solutions for different models are compared. The effects of the flattening of the velocity profile and hematocrit value on the deviation from the Newtonian model are investigated.

Numerical simulation of pulsatile blood flow characteristics in a multi stenosed coronary artery

BACKGROUND

Coronary artery disease is reported as one of the most common sources of death all over the world. The presence of stenosis (plaque) in the coronary arteries results in the restriction of blood supply, which leads to myocardial infarction.

OBJECTIVE

The aim of this study was to investigate the effect of multi stenosis on hemodynamics parameters in idealized coronary artery models with varying degrees of stenosis and interspace distance between the stenosis.

METHODS

A finite volume-based software package (Ansys CFX version 17.2) was employed to model the blood flow. The hemodynamic stenosis parameters of blood, such as the pressure, velocity, and wall shear stress were obtained.

RESULTS

The computed results showed that the pressure drop is maximum across the 90% area stenosis (AS). The pressure drop is increased as the distance between the proximal and distal stenosis is decreased across the proximal stenosis for the model P70_D70 during the systolic period of the cardiac cycle. A recirculation zone is formed behind the stenosis and is restricted by the occurrence of distal stenosis as the interspacing distance decreases, which could lead to further progression of stenosis in the flow-disturbed area. The wall shear stress was found to increase as the distance between the proximal and distal stenosis is increased across the distal stenosis. The maximum wall shear stress was found at 90% AS.

CONCLUSIONS

In the clinical diagnosis, an overestimation of distal stenosis severity could be possible. Furthermore, the low wall shear stress zone in between the proximal and distal stenosis may help atherosclerotic growth or merge adjacent stenosis.

Simulation of non-Newtonian flow of blood in a modified laparoscopic forceps used in minimally invasive surgery

During surgeries, blood often oozes out of the operated tissue and this has to be sucked out by the S-I device. Blood is more viscous than saline, the cleaning fluid is used in the S-I process. Therefore, for a more comprehensive CFD flow analysis of the improved forceps is simulated in the present work for different driving pressures. The resulting flow rate of blood is compared among the prospective designs and the S-I device currently in use. The new surgical forceps eliminates re-insertion of dissector with suction-irrigator and is reusable, multi-functional, non-toxic, corrosion resistant, toughened, and cost-effective.

Local hemodynamic analysis after coronary stent implantation based on Euler-Lagrange method

Coronary stents are deployed to treat the coronary artery disease (CAD) by reopening stenotic regions in arteries to restore blood flow, but the risk of the in-stent restenosis (ISR) is high after stent implantation. One of the reasons is that stent implantation induces changes in local hemodynamic environment, so it is of vital importance to study the blood flow in stented arteries. Based on regarding the red blood cell (RBC) as a rigid solid particle and regarding the blood (including RBCs and plasma) as particle suspensions, a non-Newtonian particle suspensions model is proposed to simulate the realistic blood flow in this work. It considers the blood's flow pattern and non-Newtonian characteristic, the blood cell-cell interactions, and the additional effects owing to the bi-concave shape and rotation of the RBC. Then, it is compared with other four common hemodynamic models (Newtonian single-phase flow model, Newtonian Eulerian two-phase flow model, non-Newtonian single-phase flow model, non-Newtonian Eulerian two-phase flow model), and the comparison results indicate that the models with the non-Newtonian characteristic are more suitable to describe the realistic blood flow. Afterwards, based on the non-Newtonian particle suspensions model, the local hemodynamic environment in stented arteries is investigated. The result shows that the stent strut protrusion into the flow stream would be likely to produce the flow stagnation zone. And the stent implantation can make the pressure gradient distribution uneven. Besides, the wall shear stress (WSS) of the region adjacent to every stent strut is lower than 0.5 Pa, and along the flow direction, the low-WSS zone near the strut behind is larger than that near the front strut. What's more, in the regions near the struts in the proximal of the stent, the RBC particle stagnation zone is easy to be formed, and the erosion and deposition of RBCs are prone to occur. These hemodynamic analyses illustrate that the risk of ISR is high in the regions adjacent to the struts in the proximal and the distal ends of the stent when compared with struts in other positions of the stent. So the research can provide a suggestion on the stent design, which indicates that the strut structure in these positions of a stent should be optimized further.

Effect of non-Newtonian fluid rheology on an arterial bypass graft: A numerical investigation guided by constructal design

In post-operative scenarios of arterial graft surgeries to bypass coronary artery stenosis, fluid dynamics plays a crucial role. Problems such as intimal hyperplasia have been related to fluid dynamics and wall shear stresses near the graft junction. This study focused on the question of the use of Newtonian and non-Newtonian models to represent blood in this type of problem in order to capture important flow features, as well as an analysis of the performance of geometry from the view of Constructive Theory. The objective of this study was to investigate the effects rheology on the steady-state flow and on the performance of a system consisting of an idealized version of a partially obstructed coronary artery and bypass graft. The Constructal Design Method was employed with two degrees of freedom: the ratio between bypass and artery diameters and the junction angle at the bypass inlet. The flow problem was solved numerically using the Finite Volume Method with blood modeled employing the Carreau equation for viscosity. The Computational Fluid Dynamics model associated with the Sparse Grid method generated eighteen response surfaces, each representing a severe stenosis degree of 75% for specific combinations of rheological parameters, dimensionless viscosity ratio, Carreau number and flow index at two distinct Reynolds numbers of 150 and 250. There was a considerable dependence of the pressure drop on rheological parameters. For the two Reynolds numbers studied, the Newtonian case presented the lowest value of the dimensionless pressure drop, suggesting that the choice of applying Newtonian blood may underestimate the value of pressure drop in the system by about 12.4% (Re =150) and 7.8% (Re = 250). Even so, results demonstrated that non-Newtonian rheological parameters did not influence either the shape of the response surfaces or the optimum bypass geometry, which consisted of a diameter ratio of 1 and junction angle of 30°. However, the viscosity ratio and the flow index had the greatest impact on pressure drop, recirculation zones and wall shear stress. Rheological parameters also affected the recirculation zones downstream of stenosis, where intimal hyperplasia is more prevalent. Newtonian and most non-Newtonian results had similar wall shear stresses, except for the non-Newtonian case with high viscosity ratio. In the view of Constructal Design, the geometry of best performance was independent of the rheological model. However, rheology played an important role on pressure drop and flow dynamics, allowing the prediction of recirculation zones that were not captured by a Newtonian model.

Contribution of atherosclerotic plaque location and severity to the near-wall hemodynamics of the carotid bifurcation: an experimental study and FSI modeling

Atherosclerosis is initiated by endothelial injury that is related to abnormal values of hemodynamic parameters such as wall shear stress (WSS), oscillatory shear index (OSI) and stress phase angle (SPA), which are more common in arterial bifurcations due to the complex structure. An experimental model of human carotid bifurcation with accurate geometrical and mechanical features was set up, and using realistic pulsatile flow rates, the inlet and outlet pressure pulses were measured for normal and stenosed models with 40% and 80% severities at common carotid (CCA), internal carotid (ICA) and external carotid (ECA) arteries. Based on the obtained experimental data, fluid-structure models were developed to obtain WSS, OSI, and SPA and evaluate pathological consequences at different locations. Mild severity had minor impact, however, inducing severe 80% stenosis in each branch led to considerable localized changes of hemodynamic parameters both in the stenosis site and other locations. This included sharp increases in WSS values accompanied by very low values close to zero before and after the peaks. Severe stenosis not only caused significant changes in the local artery, but also in other branches. OSI and SPA were less sensitive to stenosis, although high peaks were observed on bifurcation site for the stenosis at ECA. The interconnection of arteries at carotid bifurcation results in altered pressure/flow patterns in all branches when a stenosis is applied in any site. Such effect confirms pathological findings that atherosclerotic plaques are observed simultaneously in different carotid branches, although with different degrees of plaque growth and severity.

Blood Flow Modeling in Coronary Arteries: A Review

Atherosclerosis is one of the main causes of cardiovascular events, namely, myocardium infarction and cerebral stroke, responsible for a great number of deaths every year worldwide. This pathology is caused by the progressive accumulation of low-density lipoproteins, cholesterol, and other substances on the arterial wall, narrowing its lumen. To date, many hemodynamic studies have been conducted experimentally and/or numerically; however, this disease is not yet fully understood. For this reason, the research of this pathology is still ongoing, mainly, resorting to computational methods. These have been increasingly used in biomedical research of atherosclerosis because of their high-performance hardware and software. Taking into account the attempts that have been made in computational techniques to simulate realistic conditions of blood flow in both diseased and healthy arteries, the present review aims to give an overview of the most recent numerical studies focused on coronary arteries, by addressing the blood viscosity models, and applied physiological flow conditions. In general, regardless of the boundary conditions, numerical studies have been contributed to a better understanding of the development of this disease, its diagnosis, and its treatment.

Hemodynamic study in 3D printed stenotic coronary artery models: experimental validation and transient simulation

Atherosclerosis is a progressive disease that can significantly reduce blood supply to vital organs, being one of the main causes of death worldwide. In this work, a numerical and experimental study in 3D printed stenotic coronary arteries, considering both steady and pulsatile blood flow conditions, is presented. The results revealed that a degree of stenosis superior to 50% creates disturbed flows downstream of the contraction, with an accented increase in the wall shear stress measurements at the stenosis throat. Finally, the multiphase mixture was investigated and compared with a single-phase modelling, and only slight differences were observed right after the stenosis throat.

Computer modeling of pulsatile blood flow in elastic artery using a software program for application in biomedical engineering

BACKGROUND AND OBJECTIVE

Atherosclerosis-a condition in which an artery is constricted-alters blood flow in the artery, that can exacerbate the condition. Focusing on previous studies, it can be seen that the k-ε model has been used in the simulation. Therefore, the reverse flow on the back of stenosis is not well represented. In this study, the simulated results are much closer to clinical results, relying on the use of physiological pulses, and considering elasticity of the vessel wall, and the applying k-ω model. It can therefore be claimed that a much more accurate prediction will be made regarding the formation, development and progression of the disease.

METHODS

Modeling biological systems usually contain many parameters, which cannot be calculated experimentally, or are too costly and time consuming. In addition, it is occasionally required to examine the influence of different physical variables, which, given the complexity of the governing equations, make analytical methods feasible (or very limited). The present study is an attempt to investigate the turbulent pulsatile blood flow in an elastic artery with single and double stenoses using a finite element software program, ADINA 8.8.

RESULTS

According to the results, the k - ω turbulence model predicted a larger reverse flow in the post-stenotic region and between the two stenoses in comparison with the k - ε model. In other words, the k - ω model results suggest that a larger region is prone to atherosclerosis. In addition, that the k - ε model predicted a greater maximum shear stress at the throat and a shorter reverse flow region (Mean WSS < 0) in both stenosis scenarios. In other words, relative to the k - ε model, the k - ω model underestimated the damage to the plaque and the risk of its rupture though it predicted new stenosis developing behind the previous one. It was observed that the presence of a double stenosis causes the upstream pressure to reach the critical value in less time. Velocity profiles revealed that in the stenosis throat, the maximum velocity exceeds the normal biological state, which may cause disorders in the blood circulation.

CONCLUSIONS

The artery wall displacement results are suggestive of the greater difference between the two turbulence models in the case with double stenosis compared with single stenosis. Moreover, the difference between the two turbulence models in double stenosis is minimized in both post-stenotic and pre-stenotic regions.

Hemodynamic effects of blood clots trapped by an inferior vena cava filter

The alteration of blood flow around an OPTEASE inferior vena cava filter with one or two blood clots attached was investigated by means of computational fluid dynamics. We used a patient-specific vein wall geometry, and we generated different clot models with shapes adapted to the filter and vein wall geometries. A total of eight geometries, with one or two clots and a total clot volume of 0.5 or 1 cm³ , were considered. A non-Newtonian model for blood viscosity was adopted and the possible development of turbulence was accounted for by means of a three-equation model. Two blood flow rates were considered for each case, representative for rest and exercise conditions. In exercise conditions, flow unsteadiness and even turbulence was detected in some cases. Pressure and wall shear stress (WSS) distributions were modified in all cases. Clots attached to the filter downstream basket considerably increased averaged WSS values by up to almost 50%. In all the cases a flow recirculation region appeared downstream of the clot. The degree of flow stagnation in these regions, an indicator of propensity to thrombogenesis, was estimated in terms of mean residence times and mean blood viscosity. High levels of flow stagnation were detected in rest conditions in the wake of those clots that were placed upstream from the filter. Our results suggest that one downstream placed big clot, showing a higher tendency to induce flow instabilities and turbulence, might be more harmful than two small clots placed in tandem.

Long-Term Venovenous Connection for Extracorporeal Carbon Dioxide Removal (ECCO2R)-Numerical Investigation of the Connection to the Common Iliac Veins

Purpose

Currently used cannulae for extracorporeal carbon dioxide removal (ECCO₂R) are associated with complications such as thrombosis and distal limb ischemia, especially for long-term use. We hypothesize that the risk of these complications is reducible by attaching hemodynamically optimized grafts to the patient’s vessels. In this study, as a first step towards a long-term stable ECCO₂R connection, we investigated the feasibility of a venovenous connection to the common iliac veins. To ensure its applicability, the drainage of reinfused blood (recirculation) and high wall shear stress (WSS) must be avoided.

Methods

A reference model was selected for computational fluid dynamics, on the basis of the analysis of imaging data. Initially, a sensitivity analysis regarding recirculation was conducted using as variables: blood flow, the distance of drainage and return to the iliocaval junction, as well as the diameter and position of the grafts. Subsequently, the connection was optimized regarding recirculation and the WSS was evaluated. We validated the simulations in a silicone model traversed by dyed fluid.

Results

The simulations were in good agreement with the validation measurements (mean deviation 1.64%). The recirculation ranged from 32.1 to 0%. The maximum WSS did not exceed 5.57 Pa. The position and diameter of the return graft show the highest influence on recirculation. A correlation was ascertained between recirculation and WSS. Overall, an inflow jet directed at a vessel wall entails not only high WSS, but also a flow separation and thereby an increased recirculation. Therefore, return grafts aligned to the vena cava are crucial.

Conclusion

In conclusion, a connection without recirculation could be feasible and therefore provides a promising option for a long-term ECCO₂R connection.

Effects of different non-Newtonian models on unsteady blood flow hemodynamics in patient-specific arterial models with in-vivo validation

The aim of this study is to demonstrate the implications of using different blood rheological models in the simulation of blood flow dynamics in atherosclerotic coronary arteries. Computational fluid dynamics simulation was performed using three-dimensional (3D) patient-specific models of diseased left anterior descending (LAD) coronary arteries with varying degrees of stenosis severity. The three-dimensional arterial models were reconstructed from 3D quantitative coronary angiography, and input flow conditions were prescribed with blood flow conditions measured in-vivo. Different blood viscosity models were used for the simulations, and they include Newtonian and also non-Newtonian models such as Bingham, Carreau, Carreau-Yasuda, Casson, modified Casson, Cross, modified Cross, simplified Cross, Herschel Bulkley, Kuang-Luo (K-L), PowellErying, modified PowellErying, Power-law, Quemada and Walburn-Schneck models. Results from this study show that the time-averaged velocity at the centre of the arteries produced in the CFD simulations that uses the Carreau, modified Casson or Quemada blood viscosity models corresponded exceptionally well with the clinical measurements regardless of stenosis severities and hence, highlights the usefulness of these models to determine the potential determinants of blood vessel wall integrity such as dynamic blood viscosity, blood velocity and wall shear stress.

Computational fluid dynamic simulation of two-fluid non-Newtonian nanohemodynamics through a diseased artery with a stenosis and aneurysm

This article presents a two-dimensional theoretical study of hemodynamics through a diseased permeable artery with a mild stenosis and an aneurysm present. The effect of metallic nanoparticles on the blood flow is considered, motivated by drug delivery (pharmacology) applications. Two different models are adopted to mimic non-Newtonian characteristics of the blood flow; the Casson (viscoplastic) fluid model is deployed in the core region and the Sisko (viscoelastic) fluid model employed in the peripheral (porous) region. The revised Buongiorno two-component nanofluid model is utilized for nanoscale effects. The blood is considered to contain a homogenous suspension of nanoparticles. The governing equations are derived by extending the Navier-Stokes equations with linear Boussinesq approximation (which simulates both heat and mass transfer). Natural (free) double-diffusive convection is considered to simulate the dual influence of thermal and solutal buoyancy forces. The conservation equations are normalised by employing appropriate non-dimensional variables. The transformed equations are solved numerically using the finite element method with the variational formulation scheme available in the FreeFEM++ code. A comprehensive mesh-independence study is included. The effect of selected parameters (thermophoresis, Brownian motion, Grashof number, thermo-solutal buoyancy ratio, Sisko parameter ratio, and permeability parameter) on velocity, temperature, nanoparticle concentration, and hemodynamic pressure have been calculated for two clinically important cases of arteries with stenosis and an aneurysm. Skin-friction coefficient, Nusselt number, volumetric flow rate, and resistance impedance of blood flow are also computed. Colour contours and graphs are employed to visualize the simulated blood flow characteristics. It is observed that by increasing the thermal buoyancy parameter, i.e. Grashof number (Gr), the nanoparticle concentration and temperature decrease, whereas velocity increases with an increment in the Brownian motion parameter (Nb). Furthermore, velocity decreases in the peripheral porous region with elevation in the Sisko material ratio (m) and permeability parameter (k'). The simulations are relevant to transport phenomena in pharmacology and nano-drug targeted delivery in haematology.

Effect of stenosis shape on the sound emitted from a constricted blood vessel

Effect of stenosis shape on the post-stenotic pressure fluctuations and the sound emitted from a constricted blood vessel is studied numerically. Large eddy simulations are performed using OpenFOAM under pulsatile flow conditions with a non-Newtonian fluid model. Findings indicate that the high slope at the stenosis entrance and overlap of more than one stenosis shorten the length of the flow jet, trigger turbulence, and increase vortical activity, turbulent kinetic energy, and magnitude of pressure fluctuations at the post-stenotic region. Also, these morphological parameters strengthen the audible signal especially in the systolic phase of the pulsatile flow. On the other hand, asymmetry of the stenosis creates an opposite effect. Based on the wall pressure data, it is shown that the stenosis shape affects the intensity and the pattern of the murmurs generated. Stenosis shape is found to be an essential factor for the acoustic-based non-invasive diagnosis of stenosis. Graphical abstract Wall pressure content of the elliptic stenosis shape.