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Tziotziou A, Hartman E, Korteland SA, van der Lugt A, van der Steen AFW, Daemen J, Bos D, Wentzel J, Akyildiz AC. Mechanical wall stress and wall shear stress are associated with atherosclerosis development in non-calcified coronary segments. Atherosclerosis 2023; 387:117387. [PMID: 38029610 DOI: 10.1016/j.atherosclerosis.2023.117387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 11/09/2023] [Accepted: 11/10/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND AND AIMS Atherosclerotic plaque onset and progression are known to be affected by local biomechanical factors. While the role of wall shear stress (WSS) has been studied, the impact of another biomechanical factor, namely mechanical wall stress (MWS), remains poorly understood. In this study, we investigated the association of MWS, independently and combined with WSS, towards atherosclerosis in coronary arteries. METHODS Thirty-four human coronary arteries were analyzed using near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) and optical coherence tomography (OCT) at baseline and after 12 months. Baseline WSS and MWS were calculated using computational models, and wall thickness (ΔWT) and lipid-rich necrotic core size (ΔLRNC) change were measured in non-calcified coronary segments. The arteries were further divided into 1.5 mm/45° sectors and categorized as plaque-free or plaque sectors. For each category, associations between biomechanical factors (WSS & MWS) and changes in coronary wall (ΔWT & ΔLRNC) were studied using linear mixed models. RESULTS In plaque-free sectors, higher MWS (p < 0.001) was associated with greater vessel wall growth. Plaque sectors demonstrated wall thickness reduction over time, likely due to medical therapy, where higher levels of WSS and WMS, individually and combined, (p < 0.05) were associated with a greater reduction. Sectors with low MWS combined with high WSS demonstrated the highest LRNC increase (p < 0.01). CONCLUSIONS In this study, we investigated the association of the (largely-overlooked) biomechanical factor MWS with coronary atherosclerosis, individually and combined with WSS. Our results demonstrated that both MWS and WSS significantly correlate with atherosclerotic plaque initiation and development.
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Affiliation(s)
- Aikaterini Tziotziou
- Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eline Hartman
- Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Suze-Anne Korteland
- Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Aad van der Lugt
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Joost Daemen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Daniel Bos
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jolanda Wentzel
- Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ali C Akyildiz
- Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, the Netherlands.
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In Vivo Intravascular Optical Coherence Tomography (IVOCT) Structural and Blood Flow Imaging Based Mechanical Simulation Analysis of a Blood Vessel. Cardiovasc Eng Technol 2022; 13:685-698. [PMID: 35112317 DOI: 10.1007/s13239-022-00608-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/04/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Computer modelling of blood vessels based on biomedical imaging provides important hemodynamic and biomechanical information for vascular disease studies and diagnosis. However due to lacking well-defined physiological blood flow profiles, the accuracy of the simulation results is often not guaranteed. Flow velocity profiles of a specific cross section of a blood vessel were obtained by in vivo Doppler intravascular optical coherence tomography (IVOCT) lately. However due to the influence of the catheter, the velocity profile imaged by IVOCT can't be applied to simulation directly. METHODS A simulation-experiment combined method to determine the inlet flow boundary based on in vivo porcine carotid Doppler IVOCT imaging is proposed. A single conduit carotid model was created from the 3D IVOCT structural images using an image processing-computer aided design combined method. RESULTS With both high- resolution arterial model and near physiological blood flow profile, stress analysis by fluid-structure interaction and computational fluid dynamics were performed. The influence of the catheter to the wall shear stress, the hemodynamics and the stresses of the carotid wall under the measured inlet flow and various outlet pressure boundary conditions, are analyzed. CONCLUSION This study provides a solution to the difficulty of getting inlet flow boundary for numerical simulation of arteries. It paves the way for developing IVOCT based vascular stress analysis and imaging methods for the studies and diagnosis of vascular diseases.
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Crombag G, Aizaz M, Schreuder F, Benali F, van Dam-Nolen D, Liem M, Lucci C, van der Steen A, Daemen M, Mess W, van der Lugt A, Nederkoorn P, Hendrikse J, Hofman P, van Oostenbrugge R, Wildberger J, Kooi M. Proximal Region of Carotid Atherosclerotic Plaque Shows More Intraplaque Hemorrhage: The Plaque at Risk Study. AJNR Am J Neuroradiol 2022; 43:265-271. [PMID: 35121587 PMCID: PMC8985675 DOI: 10.3174/ajnr.a7384] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE Intraplaque hemorrhage contributes to lipid core enlargement and plaque progression, leading to plaque destabilization and stroke. The mechanisms that contribute to the development of intraplaque hemorrhage are not completely understood. A higher incidence of intraplaque hemorrhage and thin/ruptured fibrous cap (upstream of the maximum stenosis in patients with severe [≥70%] carotid stenosis) has been reported. We aimed to noninvasively study the distribution of intraplaque hemorrhage and a thin/ruptured fibrous cap in patients with mild-to-moderate carotid stenosis. MATERIALS AND METHODS Eighty-eight symptomatic patients with stroke (<70% carotid stenosis included in the Plaque at Risk study) demonstrated intraplaque hemorrhage on MR imaging in the carotid artery plaque ipsilateral to the side of TIA/stroke. The intraplaque hemorrhage area percentage was calculated. A thin/ruptured fibrous cap was scored by comparing pre- and postcontrast black-blood TSE images. Differences in mean intraplaque hemorrhage percentages between the proximal and distal regions were compared using a paired-samples t test. The McNemar test was used to reveal differences in proportions of a thin/ruptured fibrous cap. RESULTS We found significantly larger areas of intraplaque hemorrhage in the proximal part of the plaque at 2, 4, and 6 mm from the maximal luminal narrowing, respectively: 14.4% versus 9.6% (P = .04), 14.7% versus 5.4% (P < .001), and 11.1% versus 2.2% (P = .001). Additionally, we found an increased proximal prevalence of a thin/ruptured fibrous cap on MR imaging at 2, 4, 6, and 8 mm from the MR imaging section with the maximal luminal narrowing, respectively: 33.7% versus 18.1%, P = .007; 36.1% versus 7.2%, P < .001; 33.7% versus 2.4%, P = .001; and 30.1% versus 3.6%, P = .022. CONCLUSIONS We demonstrated that intraplaque hemorrhage and a thin/ruptured fibrous cap are more prevalent on the proximal side of the plaque compared with the distal side in patients with mild-to-moderate carotid stenosis.
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Affiliation(s)
- G.A.J.C. Crombag
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - M. Aizaz
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - F.H.B.M. Schreuder
- Department of Neurology & Donders Institute for Brain Cognition & Behaviour (F.H.B.M.S.), Radboud University Medical Center, Nijmegen, the Netherlands
| | - F. Benali
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.)
| | | | - M.I. Liem
- Departments of Neurology (M.I.L., P.J.N.)
| | - C. Lucci
- Department of Radiology (C.L., J.H.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - A.F. van der Steen
- Biomedical Engineering (A.F.v.d.S.), Erasmus University Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M.J.A.P. Daemen
- Pathology (M.J.A.P.D.), Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | | | - A. van der Lugt
- Departments of Radiology and Nuclear Medicine (D.H.K.v.D.-N., A.v.d.L.)
| | | | - J. Hendrikse
- Department of Radiology (C.L., J.H.), University Medical Center Utrecht, Utrecht, the Netherlands
| | - P.A.M. Hofman
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.)
| | - R.J. van Oostenbrugge
- Neurology (R.J.v.O.), Maastricht University Medical Center, Maastricht, the Netherlands,CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - J.E. Wildberger
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
| | - M.E. Kooi
- From the Departments of Radiology and Nuclear Medicine (G.A.J.C.C., M.A., F.B., P.A.M.H., J.E.W., M.E.K.),CARIM School for Cardiovascular Diseases (G.A.J.C.C., M.A., R.J.v.O., J.E.W., M.E.K.), Maastricht University, Maastricht, the Netherlands
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Yu H, Kang D, Whang M, Kim T, Kim J. A Microfluidic Model Artery for Studying the Mechanobiology of Endothelial Cells. Adv Healthc Mater 2021; 10:e2100508. [PMID: 34297476 DOI: 10.1002/adhm.202100508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/25/2021] [Indexed: 11/07/2022]
Abstract
Recent vascular mechanobiology studies find that endothelial cells (ECs) convert multiple mechanical forces into functional responses in a nonadditive way, suggesting that signaling pathways such as those regulating cytoskeleton may be shared among the processes of converting individual forces. However, previous in vitro EC-culture platforms are inherent with extraneous mechanical components, which may saturate or insufficiently activate the shared signaling pathways and accordingly, may misguide EC mechanobiological responses being investigated. Here, a more physiologically relevant model artery is reported that accurately reproduces most of the mechanical forces found in vivo, which can be individually varied in any combination to pathological levels to achieve diseased states. Arterial geometries of normal and diseased states are also realized. By mimicking mechanical microenvironments of early-stage atherosclerosis, it is demonstrated that the elevated levels of the different types of stress experienced by ECs strongly correlate with the disruption of barrier integrity, suggesting that boundaries of an initial lesion could be sites for efficient disease progression.
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Affiliation(s)
- Hyeonji Yu
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul, 04107, Republic of Korea
| | - Dongwon Kang
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul, 04107, Republic of Korea
| | - Minji Whang
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul, 04107, Republic of Korea
| | - Taeyoung Kim
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul, 04107, Republic of Korea
| | - Jungwook Kim
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul, 04107, Republic of Korea
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Rupture Risk Assessment of Cervical Spinal Manipulations on Carotid Atherosclerotic Plaque by a 3D Fluid-Structure Interaction Model. BIOMED RESEARCH INTERNATIONAL 2021; 2021:8239326. [PMID: 33490277 PMCID: PMC7801070 DOI: 10.1155/2021/8239326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 12/12/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022]
Abstract
Method The FSI model, based on MRI data of an atherosclerosis patient, was used to simulate the deformations of the plaque and lumen during the process of two kinds of typical cSMT (the high-speed, low-amplitude spinal manipulation and the cervical rotatory manipulation). The biomechanical parameters were recorded, such as the highest wall shear stress (WSS), the maximum plaque wall stress (PWS), the wall tensile stress (Von mises stress, VWTS), and the strain. Result The max_WSS was 33.77 kPa in the most extensive deformation. The highest WSS region on the plaque surface was also the highest PWS region. The max_PWS in a 12% stretch was 55.11 kPa, which was lower than the rupture threshold. The max_VWTS of the cap in 12% stretch which approached the fracture stress level was 116.75 kPa. Moreover, the vessel's max_VWTS values in 10% and 12% stretch were 554.21 and 855.19 kPa. They were higher than the fracture threshold, which might cause media fracture. Meanwhile, the 7% stretched strain was 0.29, closed to the smallest experimental green strains at rupture. Conclusion The carotid arteries' higher stretch generated the higher stress level of the plaque. Cervical rotatory manipulation might cause plaque at a high risk of rupture in deformation after 12% stretch and more. Lower deformation of the plaque and artery caused by the high-speed, low-amplitude spinal manipulation might be safer.
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Wang Q, Tang D, Wang L, Canton G, Wu Z, Hatsukami TS, Billiar KL, Yuan C. Combining morphological and biomechanical factors for optimal carotid plaque progression prediction: An MRI-based follow-up study using 3D thin-layer models. Int J Cardiol 2019; 293:266-271. [PMID: 31301863 DOI: 10.1016/j.ijcard.2019.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/24/2019] [Accepted: 07/02/2019] [Indexed: 11/24/2022]
Abstract
Plaque progression prediction is of fundamental significance to cardiovascular research and disease diagnosis, prevention, and treatment. Magnetic resonance image (MRI) data of carotid atherosclerotic plaques were acquired from 20 patients with consent obtained. 3D thin-layer models were constructed to calculate plaque stress and strain. Data for ten morphological and biomechanical risk factors were extracted for analysis. Wall thickness increase (WTI), plaque burden increase (PBI) and plaque area increase (PAI) were chosen as three measures for plaque progression. Generalized linear mixed models (GLMM) with 5-fold cross-validation strategy were used to calculate prediction accuracy and identify optimal predictor. The optimal predictor for PBI was the combination of lumen area (LA), plaque area (PA), lipid percent (LP), wall thickness (WT), maximum plaque wall stress (MPWS) and maximum plaque wall strain (MPWSn) with prediction accuracy = 1.4146 (area under the receiver operating characteristic curve (AUC) value is 0.7158), while PA, plaque burden (PB), WT, LP, minimum cap thickness, MPWS and MPWSn was the best for WTI (accuracy = 1.3140, AUC = 0.6552), and a combination of PA, PB, WT, MPWS, MPWSn and average plaque wall strain (APWSn) was the best for PAI with prediction accuracy = 1.3025 (AUC = 0.6657). The combinational predictors improved prediction accuracy by 9.95%, 4.01% and 1.96% over the best single predictors for PAI, PBI and WTI (AUC values improved by 9.78%, 9.45%, and 2.14%), respectively. This suggests that combining both morphological and biomechanical risk factors could lead to better patient screening strategies.
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Affiliation(s)
- Qingyu Wang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
| | - Dalin Tang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China; Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA 01609, USA.
| | - Liang Wang
- School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China.
| | - Gador Canton
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA.
| | - Zheyang Wu
- Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA 01609, USA.
| | - Thomas S Hatsukami
- Division of Vascular Surgery, University of Washington, Seattle, WA 98195, USA.
| | - Kristen L Billiar
- Biomedical Engineering Department, Worcester Polytechnic Institute, Worcester, MA 01609, USA.
| | - Chun Yuan
- Department of Radiology, University of Washington, Seattle, WA 98195, USA.
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Alegre-Martínez C, Choi KS, Tammisola O, McNally D. On the axial distribution of plaque stress: Influence of stenosis severity, lipid core stiffness, lipid core length and fibrous cap stiffness. Med Eng Phys 2019; 68:76-84. [DOI: 10.1016/j.medengphy.2019.02.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 02/12/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
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MRI-based patient-specific human carotid atherosclerotic vessel material property variations in patients, vessel location and long-term follow up. PLoS One 2017; 12:e0180829. [PMID: 28715441 PMCID: PMC5513425 DOI: 10.1371/journal.pone.0180829] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 06/16/2017] [Indexed: 12/15/2022] Open
Abstract
Background Image-based computational models are widely used to determine atherosclerotic plaque stress/strain conditions and investigate their association with plaque progression and rupture. However, patient-specific vessel material properties are in general lacking in those models, limiting the accuracy of their stress/strain measurements. A noninvasive approach of combining in vivo 3D multi-contrast and Cine magnetic resonance imaging (MRI) and computational modeling was introduced to quantify patient-specific carotid plaque material properties for potential plaque model improvements. Vessel material property variation in patients, along vessel segment, and between baseline and follow up were investigated. Methods In vivo 3D multi-contrast and Cine MRI carotid plaque data were acquired from 8 patients with follow-up (18 months) with written informed consent obtained. 3D thin-layer models and an established iterative procedure were used to determine parameter values of the Mooney-Rivlin models for the 81slices from 16 plaque samples. Effective Young’s Modulus (YM) values were calculated for comparison and analysis. Results Average Effective Young’s Modulus (YM) and circumferential shrinkage rate (C-Shrink) value of the 81 slices was 411kPa and 5.62%, respectively. Slice YM value varied from 70 kPa (softest) to 1284 kPa (stiffest), a 1734% difference. Average slice YM values by vessel varied from 109 kPa (softest) to 922 kPa (stiffest), a 746% difference. Location-wise, the maximum slice YM variation rate within a vessel was 311% (149 kPa vs. 613 kPa). The average slice YM variation rate for the 16 vessels was 134%. The average variation of YM values for all patients from baseline to follow up was 61.0%. The range of the variation of YM values was [-28.4%, 215%]. For plaque progression study, YM at follow-up showed negative correlation with plaque progression measured by wall thickness increase (WTI) (r = -0.7764, p = 0.0235). Wall thickness at baseline correlated with WTI negatively, with r = -0.5253 (p = 0.1813). Plaque burden at baseline correlated with YM change between baseline and follow-up, with r = 0.5939 (p = 0.1205). Conclusion In vivo carotid vessel material properties have large variations from patient to patient, along the diseased segment within a patient, and with time. The use of patient-specific, location specific and time-specific material properties in plaque models could potentially improve the accuracy of model stress/strain calculations.
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Douglas GR, Brown AJ, Gillard JH, Bennett MR, Sutcliffe MPF, Teng Z. Impact of Fiber Structure on the Material Stability and Rupture Mechanisms of Coronary Atherosclerotic Plaques. Ann Biomed Eng 2017; 45:1462-1474. [PMID: 28361184 PMCID: PMC5415591 DOI: 10.1007/s10439-017-1827-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 03/22/2017] [Indexed: 12/19/2022]
Abstract
The rupture of an atherosclerotic plaque in the coronary circulation remains the main cause of heart attack. As a fiber-oriented structure, the fiber structure, in particular in the fibrous cap (FC), may affect both loading and material strength in the plaque. However, the role of fiber orientation and dispersion in plaque rupture is unclear. Local orientation and dispersion of fibers were calculated for the shoulder regions, mid FC, and regions with intimal thickening (IT) from histological images of 16 human coronary atherosclerotic lesions. Finite element analysis was performed to assess the effect of these properties on mechanical conditions. Fibers in shoulder regions had markedly reduced alignment (Median [interquartile range] 12.9° [6.6, 18.0], p < 0.05) compared with those in mid FC (6.1° [5.5, 9.0]) and IT regions (6.7° [5.1, 8.6]). Fiber dispersion was highest in shoulders (0.150 [0.121, 0.192]), intermediate in IT (0.119 [0.103, 0.144]), and lowest in mid FC regions (0.093 [0.081, 0.105], p < 0.05). When anisotropic properties were considered, stresses were significantly higher for the mid FC (p = 0.030) and IT regions (p = 0.002) and no difference was found for the shoulder or global regions. Shear (sliding) stress between fibers in each region and their proportion of maximum principal stress were: shoulder (25.8 kPa [17.1, 41.2], 12.4%), mid FC (13.9 kPa [5.8, 29.6], 13.8%), and IT (36.5 kPa [25.9, 47.3], 15.5%). Fiber structure within the FC has a marked effect on principal stresses, resulting in considerable shear stress between fibers. Fiber structure including orientation and dispersion may determine mechanical strength and thus rupture of atherosclerotic plaques.
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Affiliation(s)
- Graeham R Douglas
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, CB2 1PZ, UK
| | - Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Jonathan H Gillard
- Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, UK
| | - Michael P F Sutcliffe
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, CB2 1PZ, UK.
| | - Zhongzhao Teng
- Department of Engineering, University of Cambridge, Trumpington Street, Cambridge, CB2 1PZ, UK. .,Department of Radiology, School of Clinical Medicine, University of Cambridge, Box 218, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK.
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Huang X, Yang C, Zheng J, Bach R, Muccigrosso D, Woodard PK, Tang D. 3D MRI-based multicomponent thin layer structure only plaque models for atherosclerotic plaques. J Biomech 2016; 49:2726-2733. [PMID: 27344199 DOI: 10.1016/j.jbiomech.2016.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/22/2016] [Accepted: 06/01/2016] [Indexed: 01/13/2023]
Abstract
MRI-based fluid-structure interactions (FSI) models for atherosclerotic plaques have been developed to perform mechanical analysis to investigate the association of plaque wall stress (PWS) with cardiovascular disease. However, the time consuming 3D FSI model construction process is a great hinder for its clinical implementations. In this study, a 3D thin-layer structure only (TLS) plaque model was proposed as an approximation with much less computational cost to 3D FSI models for better clinical implementation potential. 192 TLS models were constructed based on 192 ex vivo MRI Images of 12 human coronary atherosclerotic plaques. Plaque stresses were extracted from all lumen nodal points. The maximum value of Plaque wall stress (MPWS) and average value of plaque wall stress (APWS) of each slice were used to compare with those from corresponding FSI models. The relative errors for MPWS and APWS were 9.76% and 9.89%, respectively. Both MPWS and APWS values obtained from TLS models showed very good correlation with those from 3D FSI models. Correlation results from TLS models were in consistent with FSI models. Our results indicated that the proposed 3D TLS plaque models may be used as a good approximation to 3D FSI models with much less computational cost. With further validation, 3D TLS models may be possibly used to replace FSI models to save time and perform mechanical analysis for atherosclerotic plaques for clinical implementation.
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Affiliation(s)
- Xueying Huang
- School of Mathematical Sciences, Xiamen University, Xiamen, Fujian 361005, China; Fujian Provincial Key Laboratory of Mathematical Modeling and High-Performance Scientific Computation, Xiamen University, Xiamen, Fujian 361005 China; Department of Mathematical Sciences, Worcester Polytechnic Institute, MA 01609, USA.
| | - Chun Yang
- Department of Mathematical Sciences, Worcester Polytechnic Institute, MA 01609, USA; Network Technology Research Institute, China United Network Communications Co., Ltd., Beijing, China
| | - Jie Zheng
- Mallinkcrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Richard Bach
- Cardiovascular Division, Washington University, St. Louis, MO 63110, USA
| | - David Muccigrosso
- Mallinkcrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Pamela K Woodard
- Mallinkcrodt Institute of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Dalin Tang
- Department of Mathematical Sciences, Worcester Polytechnic Institute, MA 01609, USA; School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, China
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Raj JR, Rahman SMK, Anand S. An insight into elasticity analysis of common carotid artery using ultrasonography. Proc Inst Mech Eng H 2016; 230:750-60. [DOI: 10.1177/0954411916650220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 04/25/2016] [Indexed: 12/14/2022]
Abstract
Elastance is a distinguished marker in diagnosing various arterial diseases as studies have reported carotid artery–related diseases linked with stiffness index (β) values greater than 5. This study was to estimate elasticity of common carotid artery by measuring the diameter during systolic and diastolic phases using pixel tracing of successive frames and blood pressure. The B-mode ultrasonography video containing arterial wall motion was captured and fragmented into image frames. Each pixel on the greyscale image was converted into RGB intensity values. The diameter of the artery as well as the thickness of the wall was measured by tracing the pixel displacements from successive frames during arterial pulsation. The study was conducted on 19 subjects aged 25–40 years. The systolic and diastolic carotid artery lumen diameters and carotid intima-media thickness were calculated as 7.1 ± 0.7, 6.3 ± 0.6 and 0.5 ± 0.05 mm (mean ± standard deviation), respectively. The mean stiffness index (β), Peterson’s modulus and Young’s modulus of elasticity were 5.2 ± 1.1, 69 ± 15 kPa and 453 ± 99 kPa, respectively. The pixel displacements in tunica intima, tunica media and tunica adventitia were not homogeneous, due to varied macro-constituents such as endothelial tissues, smooth muscle cells, elastin lamina, fibrous tissue and micro-constituents such as collagen, fibroblast and elastin. We found that women have smaller arteries, and the stiffness increased during the systolic phase.
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Affiliation(s)
- Jean Rossario Raj
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - SMK Rahman
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- Biomedical Engineering Unit, All India Institute of Medical Sciences – New Delhi, New Delhi, India
| | - Sneh Anand
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
- Biomedical Engineering Unit, All India Institute of Medical Sciences – New Delhi, New Delhi, India
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Speelman L, Teng Z, Nederveen AJ, van der Lugt A, Gillard JH. MRI-based biomechanical parameters for carotid artery plaque vulnerability assessment. Thromb Haemost 2016; 115:493-500. [PMID: 26791734 DOI: 10.1160/th15-09-0712] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/13/2015] [Indexed: 12/18/2022]
Abstract
Carotid atherosclerotic plaques are a major cause of ischaemic stroke. The biomechanical environment to which the arterial wall and plaque is subjected to plays an important role in the initiation, progression and rupture of carotid plaques. MRI is frequently used to characterize the morphology of a carotid plaque, but new developments in MRI enable more functional assessment of carotid plaques. In this review, MRI based biomechanical parameters are evaluated on their current status, clinical applicability, and future developments. Blood flow related biomechanical parameters, including endothelial wall shear stress and oscillatory shear index, have been shown to be related to plaque formation. Deriving these parameters directly from MRI flow measurements is feasible and has great potential for future carotid plaque development prediction. Blood pressure induced stresses in a plaque may exceed the tissue strength, potentially leading to plaque rupture. Multi-contrast MRI based stress calculations in combination with tissue strength assessment based on MRI inflammation imaging may provide a plaque stress-strength balance that can be used to assess the plaque rupture risk potential. Direct plaque strain analysis based on dynamic MRI is already able to identify local plaque displacement during the cardiac cycle. However, clinical evidence linking MRI strain to plaque vulnerability is still lacking. MRI based biomechanical parameters may lead to improved assessment of carotid plaque development and rupture risk. However, better MRI systems and faster sequences are required to improve the spatial and temporal resolution, as well as increase the image contrast and signal-to-noise ratio.
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Affiliation(s)
- Lambert Speelman
- Dr. Lambert Speelman, Department of Biomedical Engineering, Ee 23.38B, P.O Box 2040, 3000 CA Rotterdam, the Netherlands, Tel.: +31 10 70 44039, Fax: +31 10 70 44720, E-mail:
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13
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Yuan J, Teng Z, Feng J, Zhang Y, Brown AJ, Gillard JH, Jing Z, Lu Q. Influence of material property variability on the mechanical behaviour of carotid atherosclerotic plaques: a 3D fluid-structure interaction analysis. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2015; 31:e02722. [PMID: 25940741 PMCID: PMC4528233 DOI: 10.1002/cnm.2722] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 03/10/2015] [Accepted: 04/27/2015] [Indexed: 06/04/2023]
Abstract
Mechanical analysis has been shown to be complementary to luminal stenosis in assessing atherosclerotic plaque vulnerability. However, patient-specific material properties are not available and the effect of material properties variability has not been fully quantified. Media and fibrous cap (FC) strips from carotid endarterectomy samples were classified into hard, intermediate and soft according to their incremental Young's modulus. Lipid and intraplaque haemorrhage/thrombus strips were classified as hard and soft. Idealised geometry-based 3D fluid-structure interaction analyses were performed to assess the impact of material property variability in predicting maximum principal stress (Stress-P1 ) and stretch (Stretch-P1 ). When FC was thick (1000 or 600 µm), Stress-P1 at the shoulder was insensitive to changes in material stiffness, whereas Stress-P1 at mid FC changed significantly. When FC was thin (200 or 65 µm), high stress concentrations shifted from the shoulder region to mid FC, and Stress-P1 became increasingly sensitive to changes in material properties, in particular at mid FC. Regardless of FC thickness, Stretch-P1 at these locations was sensitive to changes in material properties. Variability in tissue material properties influences both the location and overall stress/stretch value. This variability needs to be accounted for when interpreting the results of mechanical modelling.
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Affiliation(s)
- Jianmin Yuan
- Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Zhongzhao Teng
- Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, UK
- Department of Engineering, University of Cambridge, Cambridge, CB2 1PZ, UK
| | - Jiaxuan Feng
- Department of Vascular Surgery, Changhai Hospital, Changhai Road, Shanghai, 200433, China
| | - Yongxue Zhang
- Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, UK
- Department of Vascular Surgery, Changhai Hospital, Changhai Road, Shanghai, 200433, China
| | - Adam J Brown
- Division of Cardiovascular Medicine, University of Cambridge, Cambridge, CB2 1TN, UK
| | - Jonathan H Gillard
- Department of Radiology, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Changhai Road, Shanghai, 200433, China
| | - Qingsheng Lu
- Department of Vascular Surgery, Changhai Hospital, Changhai Road, Shanghai, 200433, China
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Makris GC, Teng Z, Patterson AJ, Lin JM, Young V, Graves MJ, Gillard JH. Advances in MRI for the evaluation of carotid atherosclerosis. Br J Radiol 2015; 88:20140282. [PMID: 25826233 DOI: 10.1259/bjr.20140282] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Carotid artery atherosclerosis is an important source of mortality and morbidity in the Western world with significant socioeconomic implications. The quest for the early identification of the vulnerable carotid plaque is already in its third decade and traditional measures, such as the sonographic degree of stenosis, are not selective enough to distinguish those who would really benefit from a carotid endarterectomy. MRI of the carotid plaque enables the visualization of plaque composition and specific plaque components that have been linked to a higher risk of subsequent embolic events. Blood suppressed T1 and T2 weighted and proton density-weighted fast spin echo, gradient echo and time-of-flight sequences are typically used to quantify plaque components such as lipid-rich necrotic core, intraplaque haemorrhage, calcification and surface defects including erosion, disruption and ulceration. The purpose of this article is to review the most important recent advances in MRI technology to enable better diagnostic carotid imaging.
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Affiliation(s)
- G C Makris
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - Z Teng
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - A J Patterson
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - J-M Lin
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - V Young
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - M J Graves
- Department of Radiology, University of Cambridge, Cambridge, UK
| | - J H Gillard
- Department of Radiology, University of Cambridge, Cambridge, UK
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The application of ultrasonic velocity vector imaging technique of carotid plaque in predicting large-artery atherosclerotic stroke. J Stroke Cerebrovasc Dis 2015; 24:1351-6. [PMID: 25797431 DOI: 10.1016/j.jstrokecerebrovasdis.2015.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 02/09/2015] [Accepted: 02/11/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Large-artery atherosclerotic stroke (LAAs) is related to carotid plaque, but the mechanical mechanism is unclear. We aimed to use ultrasonic velocity vector imaging (VVI) technique to study the mechanical difference of carotid plaque in patients with LAAs and controls. METHODS We enrolled 43 LAAs patients and 38 controls but all showing plaque on carotid ultrasonography. Ultrasonic VVI technique was used to analyze radial systolic and diastolic peak velocity (R-vs, R-vd), radial and circumferential peak strain (R-s, C-s) and radial displacement (R-dis) of carotid plaque. RESULTS Compared with controls, LAAs patients showed higher pulse pressure (P = .001), pulse pressure index (PPI, P = .006), and greater stress at carotid plaque as manifested by higher absolute value of radial diastolic peak velocity (R-vd, P = .021), radial systolic peak velocity (R-vs, P = .007), radial peak strain (R-s, P = .015), and radial displacement (R-dis, P = .022). PPI was significantly correlated with R-vs (r = -.274, P = .013), R-vd (r = .304, P = .006), and R-dis (r = -.28, P = .011). But there was no correlation between R-s and blood pressure. R-s was screened to be the most predictable parameters for LAAs (odds ratio, 1.118; 95% confidence interval, 1.012∼1.236; P = .029). The area under the curve of R-s was .627. CONCLUSIONS Radial peak strain (R-s) is a predictable parameter for the occurrence of LAAs. We predict using ultrasonic VVI technique to analyze whether the mechanics of carotid plaque is helpful to screen patients with high risks of LAAs.
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Xiong H, Liu X, Tian X, Pu L, Zhang H, Lu M, Huang W, Zhang YT. A numerical study of the effect of varied blood pressure on the stability of carotid atherosclerotic plaque. Biomed Eng Online 2014; 13:152. [PMID: 25413300 PMCID: PMC4277844 DOI: 10.1186/1475-925x-13-152] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/22/2014] [Indexed: 12/18/2022] Open
Abstract
Background Blood pressure (BP) is associated with early atherosclerosis and plaque
rupture because the BP variability can significantly affect the blood flow
velocity and shear stress over the plaque. However, the mechanical response of BP
variability to the plaque remains unclear. Therefore, we investigated the
correlation between different maximum systolic blood pressure (SBP) and the stress
distribution on plaque, as well as the stress over the plaque and blood velocity
around the plaque using different BP variations, which are the BP variability in
different phases during one cardiac cycle and beat-to-beat BP variability. Method We established a two-dimensional artery model with stenosis at the degree of
62.5%. Eight combinations of pulsatile pressure gradients between the inflow and
outflow were implemented at the model. Three levels of fibrous cap thickness were
taken into consideration to investigate the additional effect on the BP
variability. Wall shear stress and stress/strain distribution over the plaque were
derived as well as the oscillation shear index (OSI) to analyze the impact of the
changing rate of BP. Result The stresses at diastole were 2.5% ± 1.8% lower than that at systole under the
same pressure drop during one cycle. It was also found that elevated SBP might
cause the immediate increment of stress in the present cycle (292% ± 72.3%), but
slight reduction in the successive cycle (0.48% ± 0.4%). Conclusion The stress/strain distribution over the plaque is sensitive to the BP
variability during one cardiac cycle, and the beat-to-beat BP variability could
cause considerable impact on the progression of atherosclerosis in
long-term.
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Affiliation(s)
| | | | | | | | - Heye Zhang
- Key Lab of Health Informatics of Chinese Academy of Sciences, Shenzhen, China.
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Abstract
Internal carotid artery (ICA) plaques constitute one major source of retinal and cerebral brain embolism. Current guidelines recommend optimal treatment of cardiovascular risk factors and recanalization based on the degree of ICA stenosis. However, ICA plaque composition, motion, vascularization, and local hemodynamics have only received limited attention as potential and independent risk factors for plaque rupture. The European Carotid Surgery Trial (ECST) showed an increased risk of stroke recurrence even in moderate stenosis if the plaque surface was ulcerated in angiography. Further indicators of plaque instability and thus vulnerability were established by native or contrast-enhanced two-dimensional duplex ultrasound, CT, and MRI. Due to high soft tissue contrast, multi-contrast MRI seems to be ideally suited to identify plaque compositions that are prone to rupture, although data from large clinical trials proving the independent predictive value of plaque morphology are lacking. The role of cardiovascular risk factors for atherosclerosis of the common carotid artery is well established. Nevertheless, little is known concerning the impact of local hemodynamics on plaque development, progression, and rupture. Wall shear stress, the friction force acting on the endothelium of the vessel wall, was shown to be able to induce local atherosclerosis and vulnerable plaques in animal models. Plaque movement and deformation was limited to investigations using ultrasound in order to identify plaques at risk. Similarly, models to calculate tensile plaque stress seem to be able to identify peak mechanical stress acting on plaque surfaces that make such regions susceptible to rupture. In this review, current evidence regarding the correlation of plaque location, composition, and local hemodynamics at the carotid artery bifurcation will be presented. Moreover, the potential benefit of a future comprehensive and individual risk assessment will be discussed.
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Affiliation(s)
- Andreas Harloff
- Department of Neurology, University Hospital Freiburg, Freiburg, Germany
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Huang Y, Teng Z, Sadat U, Graves MJ, Bennett MR, Gillard JH. The influence of computational strategy on prediction of mechanical stress in carotid atherosclerotic plaques: comparison of 2D structure-only, 3D structure-only, one-way and fully coupled fluid-structure interaction analyses. J Biomech 2014; 47:1465-71. [PMID: 24529358 PMCID: PMC3989027 DOI: 10.1016/j.jbiomech.2014.01.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/15/2014] [Accepted: 01/15/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Compositional and morphological features of carotid atherosclerotic plaques provide complementary information to luminal stenosis in predicting clinical presentations. However, they alone cannot predict cerebrovascular risk. Mechanical stress within the plaque induced by cyclical changes in blood pressure has potential to assess plaque vulnerability. Various modeling strategies have been employed to predict stress, including 2D and 3D structure-only, 3D one-way and fully coupled fluid-structure interaction (FSI) simulations. However, differences in stress predictions using different strategies have not been assessed. METHODS Maximum principal stress (Stress-P1) within 8 human carotid atherosclerotic plaques was calculated based on geometry reconstructed from in vivo computerized tomography and high resolution, multi-sequence magnetic resonance images. Stress-P1 within the diseased region predicted by 2D and 3D structure-only, and 3D one-way FSI simulations were compared to 3D fully coupled FSI analysis. RESULTS Compared to 3D fully coupled FSI, 2D structure-only simulation significantly overestimated stress level (94.1 kPa [65.2, 117.3] vs. 85.5 kPa [64.4, 113.6]; median [inter-quartile range], p=0.0004). However, when slices around the bifurcation region were excluded, stresses predicted by 2D structure-only simulations showed a good correlation (R(2)=0.69) with values obtained from 3D fully coupled FSI analysis. 3D structure-only model produced a small yet statistically significant stress overestimation compared to 3D fully coupled FSI (86.8 kPa [66.3, 115.8] vs. 85.5 kPa [64.4, 113.6]; p<0.0001). In contrast, one-way FSI underestimated stress compared to 3D fully coupled FSI (78.8 kPa [61.1, 100.4] vs. 85.5 kPa [64.4, 113.7]; p<0.0001). CONCLUSIONS A 3D structure-only model seems to be a computationally inexpensive yet reasonably accurate approximation for stress within carotid atherosclerotic plaques with mild to moderate luminal stenosis as compared to fully coupled FSI analysis.
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Affiliation(s)
- Yuan Huang
- University Departments of Radiology, University of Cambridge, UK
| | - Zhongzhao Teng
- University Departments of Radiology, University of Cambridge, UK; Department of Engineering, University of Cambridge, UK.
| | - Umar Sadat
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Martin J Graves
- University Departments of Radiology, University of Cambridge, UK
| | - Martin R Bennett
- Division of Cardiovascular Medicine, University of Cambridge, UK
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Huang X, Yang C, Canton G, Ferguson M, Yuan C, Tang D. Quantifying effect of intraplaque hemorrhage on critical plaque wall stress in human atherosclerotic plaques using three-dimensional fluid-structure interaction models. J Biomech Eng 2014; 134:121004. [PMID: 23363206 DOI: 10.1115/1.4007954] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Recent magnetic resonance studies have indicated that intraplaque hemorrhage (IPH) may accelerate plaque progression and play an important role in plaque destabilization. However, the impact of hemorrhage on critical plaque wall stress (CPWS) and strain (CPWSn) has yet to be determined. The objective of this study was to assess the effect of the presence and size of IPH on wall mechanics. The magnetic resonance image (MRI) of one patient with histology-confirmed IPH was used to build eight 3D fluid-structure interaction (FSI) models by altering the dimensions of the existing IPH. As a secondary end point, the combined effect of IPH and fibrous cap thickness (FCT) was assessed. A volume curve fitting method (VCFM) was applied to generate a mesh that would guarantee numerical convergence. Plaque wall stress (PWS), strain (PWSn), and flow shear stress (FSS) were extracted from all nodal points on the lumen surface for analysis. Keeping other conditions unchanged, the presence of intraplaque hemorrhage caused a significant increase (27.5%) in CPWS; reduced FCT caused an increase of 22.6% of CPWS. Similar results were found for CPWSn. Furthermore, combination of IPH presence, reduced FCT, and increased IPH volume caused an 85% and 75% increase in CPWS and CPWSn, respectively. These results show that intraplaque hemorrhage has considerable impact on plaque stress and strain conditions and accurate quantification of IPH could lead to more accurate assessment of plaque vulnerability. Large-scale studies are needed to further validate our findings.
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Affiliation(s)
- Xueying Huang
- School of Mathematical Sciences, Xiamen University, Xiamen, Fujian 361005, PRC.
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20
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Tang D, Kamm RD, Yang C, Zheng J, Canton G, Bach R, Huang X, Hatsukami TS, Zhu J, Ma G, Maehara A, Mintz GS, Yuan C. Image-based modeling for better understanding and assessment of atherosclerotic plaque progression and vulnerability: data, modeling, validation, uncertainty and predictions. J Biomech 2014; 47:834-46. [PMID: 24480706 DOI: 10.1016/j.jbiomech.2014.01.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 01/30/2023]
Abstract
Medical imaging and image-based modeling have made considerable progress in recent years in identifying atherosclerotic plaque morphological and mechanical risk factors which may be used in developing improved patient screening strategies. However, a clear understanding is needed about what we have achieved and what is really needed to translate research to actual clinical practices and bring benefits to public health. Lack of in vivo data and clinical events to serve as gold standard to validate model predictions is a severe limitation. While this perspective paper provides a review of the key steps and findings of our group in image-based models for human carotid and coronary plaques and a limited review of related work by other groups, we also focus on grand challenges and uncertainties facing the researchers in the field to develop more accurate and predictive patient screening tools.
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Affiliation(s)
- Dalin Tang
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing, China; Worcester Polytechnic Institute, Worcester, MA 01609, USA.
| | - Roger D Kamm
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Chun Yang
- Worcester Polytechnic Institute, Worcester, MA 01609, USA; China Information Tech. Designing & Consulting Institute Co., Ltd., Beijing 100048, China
| | - Jie Zheng
- Mallinkcrodt Inst. of Radiology, Washington University, St. Louis, MO 63110, USA
| | - Gador Canton
- Department of Mechanical Engineering, University of Washington, Seattle, WA 98195, USA
| | - Richard Bach
- Cardiovascular Division, Washington University, St. Louis, MO 63110, USA
| | - Xueying Huang
- School of Mathematical Sciences, Xiamen University, Xiamen, Fujian 361005, China
| | - Thomas S Hatsukami
- Division of Vascular Surgery, University of Washington, Seattle, WA, 98195, USA
| | - Jian Zhu
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, Southeast University, Nanjing 210009, China
| | | | - Gary S Mintz
- The Cardiovascular Research Foundation, NY, NY, USA
| | - Chun Yuan
- Deparment of Radiology, University of Washington, Seattle, WA 98195, USA
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Seneviratne A, Hulsmans M, Holvoet P, Monaco C. Biomechanical factors and macrophages in plaque stability. Cardiovasc Res 2013; 99:284-93. [DOI: 10.1093/cvr/cvt097] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Huang Y, Teng Z, Sadat U, He J, Graves MJ, Gillard JH. In vivo MRI-based simulation of fatigue process: a possible trigger for human carotid atherosclerotic plaque rupture. Biomed Eng Online 2013; 12:36. [PMID: 23617791 PMCID: PMC3651387 DOI: 10.1186/1475-925x-12-36] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2013] [Accepted: 04/15/2013] [Indexed: 11/10/2022] Open
Abstract
Background Atherosclerotic plaque is subjected to a repetitive deformation due to arterial pulsatility during each cardiac cycle and damage may be accumulated over a time period causing fibrous cap (FC) fatigue, which may ultimately lead to rupture. In this study, we investigate the fatigue process in human carotid plaques using in vivo carotid magnetic resonance (MR) imaging. Method Twenty seven patients with atherosclerotic carotid artery disease were included in this study. Multi-sequence, high-resolution MR imaging was performed to depict the plaque structure. Twenty patients were found with ruptured FC or ulceration and 7 without. Modified Paris law was used to govern crack propagation and the propagation direction was perpendicular to the maximum principal stress at the element node located at the vulnerable site. Results The predicted crack initiations from 20 patients with FC defect all matched with the locations of the in vivo observed FC defect. Crack length increased rapidly with numerical steps. The natural logarithm of fatigue life decreased linearly with the local FC thickness (R2 = 0.67). Plaques (n=7) without FC defect had a longer fatigue life compared with those with FC defect (p = 0.03). Conclusion Fatigue process seems to explain the development of cracks in FC, which ultimately lead to plaque rupture.
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Affiliation(s)
- Yuan Huang
- University Department of Radiology, University of Cambridge, Level 5, Box 218, Hills Road, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK
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Teng Z, Sadat U, Wang W, Bahaei NS, Chen S, Young VE, Graves MJ, Gillard JH. Intraplaque stretch in carotid atherosclerotic plaque--an effective biomechanical predictor for subsequent cerebrovascular ischemic events. PLoS One 2013; 8:e61522. [PMID: 23626694 PMCID: PMC3634006 DOI: 10.1371/journal.pone.0061522] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 03/11/2013] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Stretch is a mechanical parameter, which has been proposed previously to affect the biological activities in different tissues. This study explored its utility in determining plaque vulnerability. METHODS One hundred and six patients with mild to moderate carotid stenosis were recruited in this study (53 symptomatic and 53 asymptomatic). High resolution, multi-sequence magnetic resonance (MR) imaging was performed to delineate various plaque components. Finite element method was used to predict high stretch concentration within the plaque. RESULTS During a two-year follow-up, 11 patients in symptomatic group and 3 in asymptomatic group experienced recurrent cerebrovascular events. Plaque stretch at systole and stretch variation during one cardiac cycle was greater in symptomatic group than those in the asymptomatic. Within the symptomatic group, a similar trend was observed in patients with recurrent events compared to those without. CONCLUSION Plaques with high stretch concentration and large stretch variation are associated with increased risk of future cerebrovascular events.
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Affiliation(s)
- Zhongzhao Teng
- University Department of Radiology, University of Cambridge, Cambridge, United Kingdom.
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Tang D, Yang C, Zheng J, Canton G, Bach RG, Hatsukami TS, Wang L, Yang D, Billiar KL, Yuan C. Image-based modeling and precision medicine: patient-specific carotid and coronary plaque assessment and predictions. IEEE Trans Biomed Eng 2013; 60:643-51. [PMID: 23362245 DOI: 10.1109/tbme.2013.2242891] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Atherosclerotic plaques may rupture without warning and cause acute cardiovascular events such as heart attack and stroke. Current clinical screening tools are insufficient to identify those patients with risks early and prevent the adverse events from happening. Medical imaging and image-based modeling have made considerable progress in recent years in identifying plaque morphological and mechanical risk factors which may be used in developing improved patient screening strategies. The key steps and factors in image-based models for human carotid and coronary plaques were illustrated, as well as grand challenges facing the researchers in the field to develop more accurate screening tools.
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Affiliation(s)
- Dalin Tang
- Southeast University, Nanjing 210018, China.
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Kerwin WS. Carotid artery disease and stroke: assessing risk with vessel wall MRI. ISRN CARDIOLOGY 2012; 2012:180710. [PMID: 23209940 PMCID: PMC3504380 DOI: 10.5402/2012/180710] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2012] [Accepted: 10/03/2012] [Indexed: 11/23/2022]
Abstract
Although MRI is widely used to diagnose stenotic carotid arteries, it also detects characteristics of the atherosclerotic plaque itself, including its size, composition, and activity. These features are emerging as additional risk factors for stroke that can be feasibly acquired clinically. This paper summarizes the state of evidence for a clinical role for MRI of carotid atherosclerosis.
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Affiliation(s)
- William S Kerwin
- Department of Radiology, University of Washington, Seattle, WA 98109, USA ; VPDiagnostics Incorporation, Seattle, WA 98101, USA
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26
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Magnetic Resonance Imaging of Carotid Atherosclerosis and the Risk of Stroke. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9178-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Belzacq T, Avril S, Leriche E, Delache A. A numerical parametric study of the mechanical action of pulsatile blood flow onto axisymmetric stenosed arteries. Med Eng Phys 2012; 34:1483-95. [PMID: 22464939 DOI: 10.1016/j.medengphy.2012.02.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Revised: 12/24/2011] [Accepted: 02/19/2012] [Indexed: 10/28/2022]
Abstract
In the present paper, a fluid-structure interaction model is developed, questioning how the mechanical action of the blood onto an atheromatous plaque is affected by the length and the severity of the stenosis. An axisymmetric model is considered. The fluid is assumed Newtonian. The plaque is modelled as a heterogeneous hyperelastic anisotropic solid composed of the arterial wall, the lipid core and the fibrous cap. Transient velocity and pressure conditions of actual pulsatile blood flow are prescribed. The simulation is achieved using the Arbitrary Lagrangian Eulerian scheme in the COMSOL commercial Finite Element package. The results reveal different types of behavior in function of the length (denoted L) and severity (denoted S) of the stenosis. Whereas large plaques (L>10 mm) are mostly deformed under the action of the blood pressure, it appears that shorter plaques (L<10 mm) are significantly affected by the shear stresses. The shear stresses tend to deform the plaque by pinching it. This effect is called: "the pinching effect". It has an essential influence on the mechanical response of the plaque. For two plaques having the same radius severity S=45%, the maximum stress in the fibrous cap is 50% larger for the short plaque (L=5 mm) than for a larger plaque (L=10 mm), and the maximum wall shear stress is increased by 100%. Provided that they are confirmed by experimental investigations, these results may offer some new perspectives for understanding the vulnerability of short plaques.
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Affiliation(s)
- Tristan Belzacq
- Ecole Nationale Supérieure des Mines, Centre Ingénierie et Santé, CNRS UMR 5146, Saint-Etienne, France
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Creane A, Kelly DJ, Lally C. Patient Specific Computational Modeling in Cardiovascular Mechanics. PATIENT-SPECIFIC COMPUTATIONAL MODELING 2012. [DOI: 10.1007/978-94-007-4552-0_3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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