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Daemen MJ, Gijsen FJH, Heiden KVD, Hoogendoorn A. Animal models for plaque rupture: a biomechanical assessment. Thromb Haemost 2018; 115:501-8. [DOI: 10.1160/th15-07-0614] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 10/22/2015] [Indexed: 11/05/2022]
Abstract
SummaryRupture of atherosclerotic plaques is the main cause of acute cardiovascular events. Animal models of plaque rupture are rare but essential for testing new imaging modalities to enable diagnosis of the patient at risk. Moreover, they enable the design of new treatment strategies to prevent plaque rupture. Several animal models for the study of atherosclerosis are available. Plaque rupture in these models only occurs following severe surgical or pharmaceutical intervention. In the process of plaque rupture, composition, biology and mechanics each play a role, but the latter has been disregarded in many animal studies. The biomechanical environment for atherosclerotic plaques is comprised of two parts, the pressure-induced stress distribution, mainly - but not exclusively – influenced by plaque composition, and the strength distribution throughout the plaque, largely determined by the inflammatory state. This environment differs considerably between humans and most animals, resulting in suboptimal conditions for plaque rupture. In this review we describe the role of the biomechanical environment in plaque rupture and assess this environment in animal models that present with plaque rupture.
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Carotid Artery Plaque Vulnerability Assessment Using Noninvasive Ultrasound Elastography: Validation With MRI. AJR Am J Roentgenol 2017. [PMID: 28639927 DOI: 10.2214/ajr.16.17176] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Vulnerable and nonvulnerable carotid artery plaques have different tissue morphology and composition that may affect plaque biomechanics. The objective of this study is to evaluate plaque vulnerability with the use of ultrasound noninvasive vascular elastography (NIVE). MATERIALS AND METHODS Thirty-one patients (mean [± SD] age, 69 ± 7 years) with stenosis of the internal carotid artery of 50% or greater were enrolled in this cross-sectional study. Elastography parameters quantifying axial strain, shear strain, and translation motion were used to characterize carotid artery plaques as nonvulnerable, neovascularized, and vulnerable. Maximum axial strain, cumulated axial strain, mean shear strain, cumulated shear strain, cumulated axial translation, and cumulated lateral translations were measured. Cumulated measurements were summed over a cardiac cycle. The ratio of cumulated axial strain to cumulated axial translation was also evaluated. The reference method used to characterize plaques was high-resolution MRI. RESULTS According to MRI, seven plaques were vulnerable, 12 were nonvulnerable without neovascularity, and 12 were nonvulnerable with neovascularity (a precursor of vulnerability). The two parameters cumulated axial translation and the ratio of cumulated axial strain to cumulated axial translation could discriminate between nonvulnerable plaques and vulnerable plaques or determine the presence of neovascularity in nonvulnerable plaques (which was also possible with the mean shear strain parameter). All parameters differed between the non-vulnerable plaque group and the group that combined vulnerable plaques and plaques with neovascularity. The most discriminating parameter for the detection of vulnerable neovascularized plaques was the ratio of cumulated axial strain to cumulated axial translation (expressed as percentage per millimeter) (mean ratio, 39.30%/mm ± 12.80%/mm for nonvulnerable plaques without neovascularity vs 63.79%/mm ± 17.59%/mm for vulnerable plaques and nonvulnerable plaques with neovascularity, p = 0.002), giving an AUC value of 0.886. CONCLUSION The imaging parameters cumulated axial translation and the ratio of cumulated axial strain to cumulated axial translation, as computed using NIVE, were able to discriminate vulnerable carotid artery plaques characterized by MRI from nonvulnerable carotid artery plaques. Consideration of neovascularized plaques improved the performance of NIVE. NIVE may be a valuable alternative to MRI for carotid artery plaque assessment.
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Winkel LC, Hoogendoorn A, Xing R, Wentzel JJ, Van der Heiden K. Animal models of surgically manipulated flow velocities to study shear stress-induced atherosclerosis. Atherosclerosis 2015; 241:100-10. [PMID: 25969893 DOI: 10.1016/j.atherosclerosis.2015.04.796] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 04/12/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
Abstract
Atherosclerosis is a chronic inflammatory disease of the arterial tree that develops at predisposed sites, coinciding with locations that are exposed to low or oscillating shear stress. Manipulating flow velocity, and concomitantly shear stress, has proven adequate to promote endothelial activation and subsequent plaque formation in animals. In this article, we will give an overview of the animal models that have been designed to study the causal relationship between shear stress and atherosclerosis by surgically manipulating blood flow velocity profiles. These surgically manipulated models include arteriovenous fistulas, vascular grafts, arterial ligation, and perivascular devices. We review these models of manipulated blood flow velocity from an engineering and biological perspective, focusing on the shear stress profiles they induce and the vascular pathology that is observed.
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Affiliation(s)
- Leah C Winkel
- Department of Biomedical Engineering, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Ayla Hoogendoorn
- Department of Biomedical Engineering, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Ruoyu Xing
- Department of Biomedical Engineering, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Jolanda J Wentzel
- Department of Biomedical Engineering, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Kim Van der Heiden
- Department of Biomedical Engineering, Erasmus Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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Keshavarz-Motamed Z, Saijo Y, Majdouline Y, Riou L, Ohayon J, Cloutier G. Coronary artery atherectomy reduces plaque shear strains: An endovascular elastography imaging study. Atherosclerosis 2014; 235:140-9. [DOI: 10.1016/j.atherosclerosis.2014.04.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 04/16/2014] [Accepted: 04/16/2014] [Indexed: 01/26/2023]
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Zuo CH, Qiu XX, Ouyang YZ, Zhang DI, Xiao H, Mo SC, Tan CQ, Tang M, Zhu HZ. Mesohepatectomy for the treatment of patients with centrally located hepatocellular carcinoma. Mol Clin Oncol 2014; 2:833-838. [PMID: 25054054 DOI: 10.3892/mco.2014.309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 05/27/2014] [Indexed: 01/11/2023] Open
Abstract
Mesohepatectomy is considered a feasible option for patients with centrally located hepatocellular carcinoma (HCC). However, mesohepatectomy is a technically demanding and less frequently used procedure. In this study, we summarized the surgical experience and evaluated the clinical outcomes of mesohepatectomy in 24 patients with centrally located HCC. Of these patients, 9 were treated with hepatectomy of Couinaud's segments IV, V and VIII with concurrent cholecystectomy; 8 underwent resection of segments IVb, V and VIII, including 7 patients who also received a cholecystectomy; 4 underwent hepatectomy of segments IVa, V and VIII; and 3 patients were treated with hepatectomy of segments I, IV, V and VIII, with concurrent cholecystectomy. The Pringle maneuver was used on 17 patients during hepatectomy. Total hepatic vascular exclusion (HVE) was performed on 3 patients and HVE was not used on 4 patients. The average mesohepatectomy operative time was 238 min and the average intraoperative blood loss was 480 ml (200-2,200 ml). There was no intraoperative mortality and the postoperative morbidity rate was 25% (6/24). The 1- and 3-year overall survival rates were 76 and 46%, respectively. Therefore, mesohepatectomy is a safe and effective surgical procedure for the treatment of centrally located HCC and HVE during mesohepatectomy for centrally located HCC is crucial to the success of the operation and postoperative patient recovery.
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Affiliation(s)
- Chao-Hui Zuo
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, P.R. China ; Liver Cancer Translational Medicine Center of Hunan University and Hunan Provincial Tumor Hospital, Changsha, Hunan 410082, P.R. China
| | - Xiao-Xin Qiu
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, P.R. China ; Liver Cancer Translational Medicine Center of Hunan University and Hunan Provincial Tumor Hospital, Changsha, Hunan 410082, P.R. China
| | - Yong-Zhong Ouyang
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, P.R. China ; Liver Cancer Translational Medicine Center of Hunan University and Hunan Provincial Tumor Hospital, Changsha, Hunan 410082, P.R. China
| | - DI Zhang
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, P.R. China ; Liver Cancer Translational Medicine Center of Hunan University and Hunan Provincial Tumor Hospital, Changsha, Hunan 410082, P.R. China
| | - Hua Xiao
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, P.R. China ; Liver Cancer Translational Medicine Center of Hunan University and Hunan Provincial Tumor Hospital, Changsha, Hunan 410082, P.R. China
| | - Sheng-Chuan Mo
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, P.R. China ; Liver Cancer Translational Medicine Center of Hunan University and Hunan Provincial Tumor Hospital, Changsha, Hunan 410082, P.R. China
| | - Chun-Qi Tan
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, P.R. China ; Liver Cancer Translational Medicine Center of Hunan University and Hunan Provincial Tumor Hospital, Changsha, Hunan 410082, P.R. China
| | - Ming Tang
- Department of Gastroduodenal and Pancreatic Surgery, Hunan Provincial Tumor Hospital and Affiliated Tumor Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan 410013, P.R. China ; Liver Cancer Translational Medicine Center of Hunan University and Hunan Provincial Tumor Hospital, Changsha, Hunan 410082, P.R. China
| | - Hai-Zhen Zhu
- Liver Cancer Translational Medicine Center of Hunan University and Hunan Provincial Tumor Hospital, Changsha, Hunan 410082, P.R. China
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Majdouline Y, Ohayon J, Keshavarz-Motamed Z, Roy Cardinal MH, Garcia D, Allard L, Lerouge S, Arsenault F, Soulez G, Cloutier G. Endovascular shear strain elastography for the detection and characterization of the severity of atherosclerotic plaques: in vitro validation and in vivo evaluation. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:890-903. [PMID: 24495438 DOI: 10.1016/j.ultrasmedbio.2013.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 12/04/2013] [Accepted: 12/06/2013] [Indexed: 06/03/2023]
Abstract
This work explores the potential of shear strain elastograms to identify vulnerable atherosclerotic plaques. The Lagrangian speckle model estimator (LSME) elasticity imaging method was further developed to estimate shear strain elasticity (SSE). Three polyvinyl alcohol cryogel vessel phantoms were imaged with an intravascular ultrasound (IVUS) scanner. The estimated SSE maps were validated against finite-element results. Atherosclerosis was induced in carotid arteries of eight Sinclair mini-pigs using a combination of surgical techniques, diabetes and a high-fat diet. IVUS images were acquired in vivo in 14 plaques before euthanasia and histology. All plaques were characterized by high magnitudes in SSE maps that correlated with American Heart Association atherosclerosis stage classifications (r = 0.97, p < 0.001): the worse the plaque condition the higher was the absolute value of SSE, i.e. |SSE| (e.g., mean |SSE| was 3.70 ± 0.40% in Type V plaques, whereas it was reduced to 0.11 ± 0.01% in normal walls). This study indicates the feasibility of using SSE to highlight atherosclerotic plaque vulnerability characteristics.
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Affiliation(s)
- Younes Majdouline
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada
| | - Jacques Ohayon
- Laboratory TIMC-IMAG/DyCTiM, University Joseph-Fourier, CNRS UMR 5525, Grenoble, France; University of Savoie, Polytech Annecy-Chambery, Le Bourget du Lac, France
| | - Zahra Keshavarz-Motamed
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada
| | - Marie-Hélène Roy Cardinal
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada
| | - Damien Garcia
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada; Research Unit of Biomechanics and Imaging in Cardiology, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada; Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada
| | - Louise Allard
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada
| | - Sophie Lerouge
- Laboratory of Endovascular Biomaterials, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada; Department of Mechanical Engineering, École de technologie supérieure, Montréal, Québec, Canada
| | - Frédéric Arsenault
- Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada; Department of Radiology, University of Montreal Hospital (CHUM), Montréal, Québec, Canada
| | - Gilles Soulez
- Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada; Department of Radiology, University of Montreal Hospital (CHUM), Montréal, Québec, Canada
| | - Guy Cloutier
- Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montréal, Québec, Canada; Department of Radiology, Radio-Oncology and Nuclear Medicine, and Institute of Biomedical Engineering, University of Montreal, Montréal, Québec, Canada.
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