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Early Diagnosis of Intracranial Internal Carotid Artery Stenosis Using Extracranial Hemodynamic Indices from Carotid Doppler Ultrasound. Bioengineering (Basel) 2022; 9:bioengineering9090422. [PMID: 36134968 PMCID: PMC9495671 DOI: 10.3390/bioengineering9090422] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Atherosclerotic intracranial internal carotid artery stenosis (IICAS) is a leading cause of strokes. Due to the limitations of major cerebral imaging techniques, the early diagnosis of IICAS remains challenging. Clinical studies have revealed that arterial stenosis may have complicated effects on the blood flow’s velocity from a distance. Therefore, based on a patient-specific one-dimensional hemodynamic model, we quantitatively investigated the effects of IICAS on extracranial internal carotid artery (ICA) flow velocity waveforms to identify sensitive hemodynamic indices for IICAS diagnoses. Classical hemodynamic indices, including the peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI), were calculated on the basis of simulations with and without IICAS. In addition, the first harmonic ratio (FHR), which is defined as the ratio between the first harmonic amplitude and the sum of the amplitudes of the 1st−20th order harmonics, was proposed to evaluate flow waveform patterns. To investigate the diagnostic performance of the indices, we included 52 patients with mild-to-moderate IICAS (<70%) in a case−control study and considered 24 patients without stenosis as controls. The simulation analyses revealed that the existence of IICAS dramatically increased the FHR and decreased the PSV and EDV in the same patient. Statistical analyses showed that the average PSV, EDV, and RI were lower in the stenosis group than in the control group; however, there were no significant differences (p > 0.05) between the two groups, except for the PSV of the right ICA (p = 0.011). The FHR was significantly higher in the stenosis group than in the control group (p < 0.001), with superior diagnostic performance. Taken together, the FHR is a promising index for the early diagnosis of IICAS using carotid Doppler ultrasound methods.
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Ventre J, Politi MT, Fernández JM, Ghigo AR, Gaudric J, Wray SA, Lagaert JB, Armentano R, Capurro C, Fullana JM, Lagrée PY. Parameter estimation to study the immediate impact of aortic cross-clamping using reduced order models. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3261. [PMID: 31617333 DOI: 10.1002/cnm.3261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 09/01/2019] [Indexed: 06/10/2023]
Abstract
Aortic cross-clamping is a common strategy during vascular surgery, however, its instantaneous impact on hemodynamics is unknown. We, therefore, developed two numerical models to estimate the immediate impact of aortic clamping on the vascular properties. To assess the validity of the models, we recorded continuous invasive pressure signals during abdominal aneurysm repair surgery, immediately before and after clamping. The first model is a zero-dimensional (0D) three-element Windkessel model, which we coupled to a gradient-based parameter estimation algorithm to identify patient-specific parameters such as vascular resistance and compliance. We found a 10% increase in the total resistance and a 20% decrease in the total compliance after clamping. The second model is a nine-artery network corresponding to an average human body in which we solved the one-dimensional (1D) blood flow equations. With a similar parameter estimation method and using the results from the 0D model, we identified the resistance boundary conditions of the 1D network. Determining the patient-specific total resistance and the distribution of peripheral resistances through the parameter estimation process was sufficient for the 1D model to accurately reproduce the impact of clamping on the pressure waveform. Both models gave an accurate description of the pressure wave and had a high correlation (R2 > .95) with experimental blood pressure data.
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Affiliation(s)
- Jeanne Ventre
- Sorbonne Université, CNRS, Institut Jean Le Rond d'Alembert, Paris, France
| | - M Teresa Politi
- Universidad de Buenos Aires, Facultad de Medicina. Departamento de Ciencias Fisiológicas, Laboratorio de Biomembranas, Buenos Aires, Argentina
- CONICET-Universidad de Buenos Aires, Instituto de Fisiologíay Biofísica "Bernardo Houssay", Buenos Aires, Argentina
| | - Juan M Fernández
- Universidad de Buenos Aires, Facultad de Medicina. Departamento de Ciencias Fisiológicas, Laboratorio de Biomembranas, Buenos Aires, Argentina
- CONICET-Universidad de Buenos Aires, Instituto de Fisiologíay Biofísica "Bernardo Houssay", Buenos Aires, Argentina
| | - Arthur R Ghigo
- Institut de Mécanique des Fluides de Toulouse (IMFT), Université de Toulouse, CNRS, INPT, UPS
| | - Julien Gaudric
- Sorbonne Université, CNRS, Institut Jean Le Rond d'Alembert, Paris, France
- Service de Chirurgie Vasculaire, Hôpitaux Universitaires La Pitié-Salpêtriêre, Paris, France
| | - Sandra A Wray
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería, Universidad Favaloro-CONICET, Buenos Aires, Argentina
| | | | - Ricardo Armentano
- Departamento de Ingeniería Biológica, Universidad de la República, Montevideo, Uruguay
| | - Claudia Capurro
- Universidad de Buenos Aires, Facultad de Medicina. Departamento de Ciencias Fisiológicas, Laboratorio de Biomembranas, Buenos Aires, Argentina
- CONICET-Universidad de Buenos Aires, Instituto de Fisiologíay Biofísica "Bernardo Houssay", Buenos Aires, Argentina
| | - José Maria Fullana
- Sorbonne Université, CNRS, Institut Jean Le Rond d'Alembert, Paris, France
| | - Pierre-Yves Lagrée
- Sorbonne Université, CNRS, Institut Jean Le Rond d'Alembert, Paris, France
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Ventre J, Abou Taam S, Fullana JM, Lagrée PY. Distribution of Flow in an Arteriovenous Fistula Using Reduced-Order Models. J Biomech Eng 2021; 143:101010. [PMID: 34041533 DOI: 10.1115/1.4051282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Indexed: 11/08/2022]
Abstract
The creation of a communication between an artery and a vein (arteriovenous fistula or AVF), to speed up the blood purification during hemodialysis of patients with renal insufficiency, induces significant rheological and mechanical modifications of the vascular network. In this study, we investigated the impact of the creation of an AVF with a zero-dimensional network model of the vascular system of an upper limb and a one-dimensional model around the anastomosis. We compared the simulated distribution of flow rate in this vascular system with Doppler ultrasound measurements. We studied three configurations: before the creation of the AVF, after the creation of the AVF, and after a focal reduction due to a hyper flow rate. The zero-dimensional model predicted the bounds of the diameter of the superficial vein that respects the flow constraints, assuming a high capillary resistance. We indeed highlighted the importance of knowing the capillary resistance as it is a decisive parameter in the models. We also found that the model reproduced the Doppler measurements of flow rate in every configuration and predicted the distribution of flow in cases where the Doppler was not available. The one-dimensional model allowed studying the impact of a venous constriction on the flow distribution, and the capillary resistance was still a crucial parameter.
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Affiliation(s)
- Jeanne Ventre
- Department of Mechanical Engineering, Institut Jean Le Rond d'Alembert, UMR 7190, Sorbonne Université, CNRS, Paris 75005, France
| | - Salam Abou Taam
- Department of Thoracic and Vascular Surgery, Hopital Privé Claude Galien, Quincy-sous-Sénart 91480, France
| | - José Maria Fullana
- Department of Mechanical Engineering, Institut Jean Le Rond d'Alembert, UMR 7190, Sorbonne Université, CNRS, Paris 75005, France
| | - Pierre-Yves Lagrée
- Department of Mechanical Engineering, Institut Jean Le Rond d'Alembert, UMR 7190, Sorbonne Université, CNRS, Paris 75005, France
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Politi MT, Ventre J, Fernández JM, Ghigo A, Gaudric J, Armentano R, Capurro C, Lagrée PY. Effects of Cross-Clamping on Vascular Mechanics: Comparing Waveform Analysis With a Numerical Model. J Surg Res 2019; 244:587-598. [PMID: 31521941 DOI: 10.1016/j.jss.2019.08.009] [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: 02/22/2019] [Revised: 07/30/2019] [Accepted: 08/15/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Immediate changes in vascular mechanics during aortic cross-clamping remain widely unknown. By using a numerical model of the arterial network, vascular compliance and resistance can be estimated and the time constant of pressure waves can be calculated and compared with results from the classic arterial waveform analysis. METHODS Experimental data were registered from continuous invasive radial artery pressure measurements from 11 patients undergoing vascular surgery. A stable set of beats were chosen immediately before and after each clamping event. Through the arterial waveform analysis, the time constant was calculated for each individual beat and for a mean beat of each condition as to compare with numerical simulations. Overall proportional changes in resistance and compliance during clamping and unclamping were calculated using the numerical model. RESULTS Arterial waveform analysis of individual beats indicated a significant 10% median reduction in the time constant after clamping, and a significant 17% median increase in the time constant after unclamping. There was a positive correlation between waveform analysis and numerical values of the time constant, which was moderate (ρ = 0.51; P = 0.01486) during clamping and strong (ρ = 0.77; P ≤ 0.0001) during unclamping. After clamping, there was a significant 16% increase in the mean resistance and a significant 23% decrease in the mean compliance. After unclamping, there was a significant 19% decrease in the mean resistance and a significant 56% increase in the mean compliance. CONCLUSIONS There are significant hemodynamic changes in vascular compliance and resistance during aortic clamping and unclamping. Numerical computer models can add information on the mechanisms of injury due to aortic clamping.
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Affiliation(s)
- María Teresa Politi
- Departamento de Ciencias Fisiológicas, Universidad de Buenos Aires, Facultad de Medicina, Laboratorio de Biomembranas, Buenos Aires, Argentina; CONICET-Universidad de Buenos Aires, Instituto de Fisiología y Biofísica Bernardo Houssay, Buenos Aires, Argentina.
| | - Jeanne Ventre
- Sorbonne Université, Institut Jean Le Rond d'Alembert, CNRS, Paris, France
| | - Juan Manuel Fernández
- Departamento de Ciencias Fisiológicas, Universidad de Buenos Aires, Facultad de Medicina, Laboratorio de Biomembranas, Buenos Aires, Argentina; CONICET-Universidad de Buenos Aires, Instituto de Fisiología y Biofísica Bernardo Houssay, Buenos Aires, Argentina
| | - Arthur Ghigo
- Université de Toulouse, Institut de Mécanique des Fluides de Toulouse (IMFT). CNRS, INPT, UPS, Toulouse, France
| | - Julien Gaudric
- Sorbonne Université, Institut Jean Le Rond d'Alembert, CNRS, Paris, France; Hôpitaux Universitaires La Pitié-Salpêtrière, Service de Chirurgie Vasculaire, Paris, France
| | - Ricardo Armentano
- Departamento de Ingeniería Mecánica, Universidad de Buenos Aires, Facultad de Ingeniería, Buenos Aires, Argentina
| | - Claudia Capurro
- Departamento de Ciencias Fisiológicas, Universidad de Buenos Aires, Facultad de Medicina, Laboratorio de Biomembranas, Buenos Aires, Argentina; CONICET-Universidad de Buenos Aires, Instituto de Fisiología y Biofísica Bernardo Houssay, Buenos Aires, Argentina
| | - Pierre-Yves Lagrée
- Departamento de Ciencias Fisiológicas, Universidad de Buenos Aires, Facultad de Medicina, Laboratorio de Biomembranas, Buenos Aires, Argentina; Sorbonne Université, Institut Jean Le Rond d'Alembert, CNRS, Paris, France
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