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Moerman AM, Korteland S, Dilba K, van Gaalen K, Poot DHJ, van Der Lugt A, Verhagen HJM, Wentzel JJ, van Der Steen AFW, Gijsen FJH, Van der Heiden K. The Correlation Between Wall Shear Stress and Plaque Composition in Advanced Human Carotid Atherosclerosis. Front Bioeng Biotechnol 2022; 9:828577. [PMID: 35155418 PMCID: PMC8831262 DOI: 10.3389/fbioe.2021.828577] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
The role of wall shear stress (WSS) in atherosclerotic plaque development is evident, but the relation between WSS and plaque composition in advanced atherosclerosis, potentially resulting in plaque destabilization, is a topic of discussion. Using our previously developed image registration pipeline, we investigated the relation between two WSS metrics, time-averaged WSS (TAWSS) and the oscillatory shear index (OSI), and the local histologically determined plaque composition in a set of advanced human carotid plaques. Our dataset of 11 carotid endarterectomy samples yielded 87 histological cross-sections, which yielded 511 radial bins for analysis. Both TAWSS and OSI values were subdivided into patient-specific low, mid, and high tertiles. This cross-sectional study shows that necrotic core (NC) size and macrophage area are significantly larger in areas exposed to high TAWSS or low OSI. Local TAWSS and OSI tertile values were generally inversely related, as described in the literature, but other combinations were also found. Investigating the relation between plaque vulnerability features and different combinations of TAWSS and OSI tertile values revealed a significantly larger cap thickness in areas exposed to both low TAWSS and low OSI. In conclusion, our study confirmed previous findings, correlating high TAWSS to larger macrophage areas and necrotic core sizes. In addition, our study demonstrated new relations, correlating low OSI to larger macrophage areas, and a combination of low TAWSS and low OSI to larger cap thickness.
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Affiliation(s)
- A. M. Moerman
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
| | - S. Korteland
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
| | - K. Dilba
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
| | - K. van Gaalen
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
| | - D. H. J. Poot
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | - A. van Der Lugt
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
| | | | - J. J. Wentzel
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
| | | | - F. J. H. Gijsen
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
- Department of Biomedical Engineering, Delft University of Technology, Delft, Netherlands
| | - K. Van der Heiden
- Department of Biomedical Engineering, Thorax Center, Erasmus MC, Rotterdam, Netherlands
- *Correspondence: K. Van der Heiden,
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Ultrasound Based Computational Fluid Dynamics Assessment of Brachial Artery Wall Shear Stress in Preeclamptic Pregnancy. Cardiovasc Eng Technol 2020; 11:760-768. [PMID: 33025370 DOI: 10.1007/s13239-020-00488-6] [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: 03/18/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Preeclampsia (PE) is a pregnancy complication of abnormally elevated blood pressure and organ damage where endothelial function is impaired. Wall shear stress (WSS) strongly effects endothelial cell morphology and function but in PE the WSS values are unknown. WSS calculations from ultrasound inaccurately assume cylindrical arteries and patient specific computational fluid dynamics (CFD) typically require time-consuming 3D imaging such as CT or MRI. METHODS Two-dimensional (2D) B-mode ultrasound images were lofted together to create simplified three-dimensional (3D) geometries of the brachial artery (BA) that incorporate artery curvature and non-circular cross sections. This process was efficient and on average took 120 ± 10 s. Patient specific CFD was then performed to quantify BA WSS for a small cohort of PE (n = 5) and normotensive pregnant patients (n = 5) and compared against WSS calculations assuming a cylindrical artery. RESULTS For several WSS metrics (time averaged WSS (TAWSS), peak systolic WSS, oscillatory shear index (OSI), OSI/TAWSS and relative residence time) CFD on the simplified arterial geometries calculated large spatial differences in WSS that assuming a cylindrical artery cannot calculate. Bland-Altman and intra-class correlation (ICC) analyses found assuming a cylindrical artery both underestimated (p < 0.05) and had poor agreement (ICC < 0.5) with the maximum WSS values from CFD. WSS values that were abnormal compared to the normotensive patients (OSI = 0.014 ± 0.026) appear related to the pregnancy complications fetal growth restriction (n = 2, OSI = 0.14, 0.25) and gestational diabetes (n = 1, OSI = 0.23). CONCLUSION Creating 3D artery geometries from 2D ultrasound images can be used for CFD simulations to calculate WSS from ultrasound without assuming cylindrical arteries. This approach requires minimal time for both medical imaging and CFD analysis.
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Arabul MU, Heres M, Rutten MCM, van Sambeek MR, van de Vosse FN, Lopata RGP. Toward the detection of intraplaque hemorrhage in carotid artery lesions using photoacoustic imaging. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:41010. [PMID: 28008447 DOI: 10.1117/1.jbo.22.4.041010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/01/2016] [Indexed: 05/06/2023]
Abstract
Photoacoustic imaging (PAI) may have the ability to reveal the composition and the anatomical structure of carotid plaques, which determines its mechanical properties and vulnerability. We used PAI and plane wave ultrasound (PUS) imaging to obtain three-dimensional (3-D) images of endarterectomy samples ex vivo and compared the results with histology to investigate the potential of PAI-based identification of intraplaque hemorrhage. Seven carotid plaque samples were obtained from patients undergoing carotid endarterectomy and imaged with a fully integrated hand-held photoacoustic (PA) probe, consisting of a pulsed diode laser ( t pulse = 130 ?? ns , E pulse = 1 ?? mJ , ? = 808 ?? nm ) and a linear array transducer ( f c = 7.5 ?? MHz ). The samples were rotated 360 deg with 10 deg steps, and data were spatially compounded to obtain complete 3-D images of the plaques. Areas of high absorption in the 3-D datasets were identified and compared to histological data of the plaques. Data in six out of seven endarterectomy samples revealed the presence of intraplaque hemorrhages that were not visible in the PUS images. Due to the noninvasive nature of PAI, this ex vivo study may elucidate preclinical studies toward the in vivo, noninvasive, vulnerability assessment of the atherosclerotic carotid plaque.
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Affiliation(s)
- Mustafa Umit Arabul
- Eindhoven University of Technology, Department of Biomedical Engineering, Cardiovascular Biomechanics Group, De Zaale, Eindhoven 5612 AJ, The Netherlands
| | - Maarten Heres
- Eindhoven University of Technology, Department of Biomedical Engineering, Cardiovascular Biomechanics Group, De Zaale, Eindhoven 5612 AJ, The Netherlands
| | - Marcel C M Rutten
- Eindhoven University of Technology, Department of Biomedical Engineering, Cardiovascular Biomechanics Group, De Zaale, Eindhoven 5612 AJ, The Netherlands
| | - Marc R van Sambeek
- Catharina Hospital Eindhoven, Department of Vascular Surgery, Michelangelolaan 2, Eindhoven 5623 EJ, The Netherlands
| | - Frans N van de Vosse
- Eindhoven University of Technology, Department of Biomedical Engineering, Cardiovascular Biomechanics Group, De Zaale, Eindhoven 5612 AJ, The Netherlands
| | - Richard G P Lopata
- Eindhoven University of Technology, Department of Biomedical Engineering, Cardiovascular Biomechanics Group, De Zaale, Eindhoven 5612 AJ, The Netherlands
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Boekhoven RW, Peters MFJ, Rutten MCM, van Sambeek MR, van de Vosse FN, Lopata RGP. Inflation and Bi-Axial Tensile Testing of Healthy Porcine Carotid Arteries. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:574-585. [PMID: 26598396 DOI: 10.1016/j.ultrasmedbio.2015.09.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 09/16/2015] [Accepted: 09/16/2015] [Indexed: 06/05/2023]
Abstract
Knowledge of the intrinsic material properties of healthy and diseased arterial tissue components is of great importance in diagnostics. This study describes an in vitro comparison of 13 porcine carotid arteries using inflation testing combined with functional ultrasound and bi-axial tensile testing. The measured tissue behavior was described using both a linear, but geometrically non-linear, one-parameter (neo-Hookean) model and a two-parameter non-linear (Demiray) model. The shear modulus estimated using the linear model resulted in good agreement between the ultrasound and tensile testing methods, GUS = 25 ± 5.7 kPa and GTT = 23 ± 5.4 kPa. No significant correspondence was observed for the non-linear model aUS = 1.0 ± 2.7 kPa vs. aTT = 17 ± 8.8 kPa, p ∼ 0); however, the exponential parameters were in correspondence (bUS = 12 ± 4.2 vs. bTT = 10 ± 1.7, p > 0.05). Estimation of more complex models in vivo is cumbersome considering the sensitivity of the model parameters to small changes in measurement data and the absence of intraluminal pressure data, endorsing the use of a simple, linear model in vivo.
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Affiliation(s)
- Renate W Boekhoven
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Mathijs F J Peters
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marcel C M Rutten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marc R van Sambeek
- Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Frans N van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Richard G P Lopata
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
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Lechareas S, Yanni AE, Golemati S, Chatziioannou A, Perrea D. Ultrasound and Biochemical Diagnostic Tools for the Characterization of Vulnerable Carotid Atherosclerotic Plaque. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:31-43. [PMID: 26493239 DOI: 10.1016/j.ultrasmedbio.2015.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 08/10/2015] [Accepted: 09/04/2015] [Indexed: 06/05/2023]
Abstract
Stroke is a leading cause of morbidity and mortality worldwide, and characterization of vulnerable carotid plaque remains the spearhead of scientific research. Plaque destabilization, the key factor that induces the series of events leading to the clinical symptoms of carotid artery disease, is a consequence of complex mechanical, structural and biochemical processes. Novel imaging and molecular markers have been studied as predictors of disease outcome with promising results. The aim of this review is to present the current state of research on the association between ultrasound-derived echogenicity indices and blood parameters indicative of carotid plaque stability and activity. Bibliographic research revealed that there are limited available data. Among the biomarkers studied, those related to oxidative stress, lipoproteins and diabetes/insulin resistance are associated with echolucent plaques, whereas adipokines are associated with echogenic plaques. Biomarkers of inflammation and coagulation have not exhibited any conclusive relationship with plaque echogenicity, and it is not possible to come to any conclusion regarding calcification-, apoptosis- and neo-angiogenesis-related parameters because of the extremely limited bibliographic data.
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Affiliation(s)
- Simeon Lechareas
- Laboratory for Experimental Surgery and Surgery Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Amalia E Yanni
- Laboratory for Experimental Surgery and Surgery Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Nutrition and Dietetics, Harokopio University of Athens, Athens, Greece.
| | - Spyretta Golemati
- Intensive Care Unit, Evangelismos Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Achilles Chatziioannou
- Department of Interventional Radiology, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Despoina Perrea
- Laboratory for Experimental Surgery and Surgery Research, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Boekhoven RW, Rutten MCM, van Sambeek MR, van de Vosse FN, Lopata RGP. Echo-computed tomography strain imaging of healthy and diseased carotid specimens. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1329-1342. [PMID: 24613555 DOI: 10.1016/j.ultrasmedbio.2013.11.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 11/14/2013] [Accepted: 11/18/2013] [Indexed: 06/03/2023]
Abstract
To improve our understanding of the mechanical behavior of human atherosclerotic plaque tissue, fully 3-D geometrical, morphological and dynamical information is essential. For this purpose, four-dimensional (3-D+t) strain imaging using an ultrasound tomography approach (echo-computed tomography) was performed in carotid arteries in vitro. The method was applied to a carotid phantom (CPh), a porcine carotid artery (PC) and human carotid atherosclerotic plaque samples (HC, n = 5). Each sample was subjected to an intraluminal pressure, after which 2-D longitudinal ultrasound images were obtained for 36 angles along the circumferential direction. Local deformations were estimated using a 2-D strain algorithm, and 3-D radial strain data were reconstructed. At systole, median luminal strains of 15% (CPh) and 18% (PC) were found, which is in agreement with the stiffness of the material and applied pressure pulse. The elastographic signal-to-noise ratio was consistent in all directions and ranged from 16 to 36 dB. Furthermore, realistic but more complex strain patterns were found for the HC, with 99th percentile systolic strain values ranging from 0.1% to 18%.
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Affiliation(s)
- Renate W Boekhoven
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Marcel C M Rutten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Marc R van Sambeek
- Vascular Surgery, Catharina Hospital Eindhoven, Eindhoven, The Netherlands
| | - Frans N van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Richard G P Lopata
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Towards mechanical characterization of intact endarterectomy samples of carotid arteries during inflation using Echo-CT. J Biomech 2014; 47:805-14. [DOI: 10.1016/j.jbiomech.2014.01.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2014] [Indexed: 11/18/2022]
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