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Rakibuzzaman M, Kim HH, Suh SH, Lee BK, Kwon HM, Zhou L. Simulation of stress in a blood vessel due to plaque sediments in coronary artery disease. Biomed Phys Eng Express 2024; 10:045036. [PMID: 38806008 DOI: 10.1088/2057-1976/ad50da] [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: 10/30/2023] [Accepted: 05/28/2024] [Indexed: 05/30/2024]
Abstract
Atherosclerosis is a cardiovascular disease mainly caused by plaque deposition in blood vessels. Plaque comprises components such as thrombosis, fibrin, collagen, and lipid core. It plays an essential role in inducing rupture in a blood vessel. Generally, Plaque could be described as three kinds of elastic models: cellular Plaque, hypocellular Plaque, and calcified Plaque. The present study aimed to investigate the behavior of atherosclerotic plaque rupture according to different lipid cores using Fluid-Structure Interaction (FSI). The blood vessel was also varied with different thicknesses (0.05, 0.25, and 0.5 mm). In this study, FSI simulation with a cellular plaque model with various thicknesses was investigated to obtain information on plaque rupture. Results revealed that the blood vessel with Plaque having a lipid core represents higher stresses than those without a lipid core. Blood vessels' thin thickness, like a thin cap, results in more considerable than Von Mises stress. The result also suggests that even at low fracture stress, the risk of rupture due to platelet decomposition at the gap was more significant for cellular plaques.
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Affiliation(s)
- Md Rakibuzzaman
- Research Center of Fluid Machinery Engineering and Technology, Jiangsu University, Zhenjiang, 212013, People's Republic of China
- Department of Mechanical Engineering, International University of Business Agriculture and Technology, Dhaka, 1230, Bangladesh
| | - Hyoung-Ho Kim
- School of Mechanical Material Convergence Engineering, Gyeongsang National University, Jinju, 52725, Republic of Korea
| | - Sang-Ho Suh
- School of Mechanical Engineering, Soongsil University, Seoul, 06978, Republic of Korea
| | - Byoung-Kwon Lee
- Department of Internal Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-Gu, Seoul, 06273, Republic of Korea
| | - Hyuck Moon Kwon
- Department of Internal Medicine, Gangnam Severance Hospital, 211 Eonju-ro, Gangnam-Gu, Seoul, 06273, Republic of Korea
| | - Ling Zhou
- Research Center of Fluid Machinery Engineering and Technology, Jiangsu University, Zhenjiang, 212013, People's Republic of China
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Abhilash HN, Yanagita Y, Pai R, Zuber M, Tamagawa M, K P, Kamath S G, R P, Barboza ABV, Rao VRK, Khader SMA. Effect of vascular geometry on haemodynamic changes in a carotid artery bifurcation using numerical simulation. Clin Neurol Neurosurg 2024; 237:108153. [PMID: 38350174 DOI: 10.1016/j.clineuro.2024.108153] [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: 11/22/2023] [Revised: 01/28/2024] [Accepted: 01/30/2024] [Indexed: 02/15/2024]
Abstract
OBJECTIVES The geometry of carotid bifurcation is a crucial contributing factor to the localization of atherosclerotic lesions. Currently, studies on carotid bifurcation geometry are limited to the region near to bifurcation. This study aimed to determine the influence of carotid bifurcation geometry on the blood flow using numerical simulations considering magnitude of haemodynamic parameters in the extended regions of carotid artery. METHODS In the present study, haemodynamic analysis is carried out using the non-Newtonian viscosity model for patient-specific geometries consisting of both Left and Right carotid arteries. A 3D patient-specific geometric model is generated using MIMICS, and a numerical model is created using ANSYS. RESULTS The results obtained from patient-specific cases are compared. The influence of geometric features such as lumen diameter, bifurcation angle, and tortuosity on the haemodynamics parameters such as velocity, WSS, pressure, Oscillatory Shear Index (OSI), and Time-Averaged Wall Shear Stress (TAWSS) are compared. CONCLUSION The results demonstrate significant changes in the flow regime due to the geometric shape of the carotid artery. It is observed that the lower value of TAWSS occurs near the bifurcation region and carotid bulb region. In addition, the higher value of the (OSI) is observed in the Internal Carotid Artery (ICA) and the tortuous carotid artery region. However, it is also observed that apart from the bifurcation angle, other factors, such as tortuosity and area ratio, play a significant role in the flow dynamics of the carotid artery.
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Affiliation(s)
- H N Abhilash
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India
| | - Yoshiki Yanagita
- Department of Biological Functions Engineering, Graduate School of Life Sciences and System Engineering, Kyushu Institute of Technology, Kitakyushu, Fukuoka 808-0196, Japan
| | - Raghuvir Pai
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India
| | - Mohammad Zuber
- Department of Aeronautical and Automobile Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India
| | - Masaaki Tamagawa
- Department of Biological Functions Engineering, Graduate School of Life Sciences and System Engineering, Kyushu Institute of Technology, Kitakyushu, Fukuoka 808-0196, Japan
| | - Prakashini K
- Department of Radiology and Imaging, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India
| | - Ganesh Kamath S
- Department of Cardio-Vascular and Thoracic Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India
| | - Padmakumar R
- Department of Cardiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal 576104, India
| | - A B V Barboza
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India
| | - V R K Rao
- Department of Radiodiagnosis, Krishna Institute of Medical Sciences, Secunderabad 500004, India
| | - S M Abdul Khader
- Department of Mechanical and Industrial Engineering, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal 576104, India.
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Kalita J, Show S, Biswas N, Datta A. Atherosclerosis risk assessment in human carotid artery with variation in sinus length: a numerical approach. Comput Methods Biomech Biomed Engin 2023:1-15. [PMID: 37950444 DOI: 10.1080/10255842.2023.2275546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
The mortality rates due to cardiovascular diseases are on a rise globally. One of the major cardiovascular diseases is stroke which occurs due to atherosclerotic plaques build-up in the carotid artery. The common carotid artery (CCA) bifurcates into the internal carotid artery (ICA) and external carotid artery (ECA). Sinus present at ICA is an ellipsoidal-shaped dilated region acting as a pressure receptor and blood flow regulator. Dimensions of the sinus vary from person to person, affecting the hemodynamics of the carotid artery. The current numerical study manifests a 3D flow analysis by varying the sinus length to investigate its local and global effects on the hemodynamics of the carotid artery using various biomechanical risk analysis parameters of atherosclerosis. User-defined function (UDF) dictates the pulsatile flow velocity profile imposed at the inlet. Near the outer wall (OW) of the sinus, the blood flow velocities are lower and recirculation zones are more. Though the recirculation zones for shorter sinus will be close to the inner wall (IW), interestingly, with an increase in the sinus length, the recirculation zones shift toward the OW with higher strength. These significantly decrease the x-wall shear stress (x-WSS) and time-averaged wall shear stress (TAWSS) values on the OW of the longer sinus. The other risk analysis parameters, like oscillatory shear index (OSI) and relative residence time (RRT), support the described consequences. These results reveal that sinus of increased length is more prone to developing atherosclerotic plaque.
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Affiliation(s)
- Jinmay Kalita
- Department of Mechanical Engineering, NIT Durgapur, Durgapur, India
| | - Subham Show
- Department of Mechanical Engineering, NIT Durgapur, Durgapur, India
| | - Nirmalendu Biswas
- Department of Power Engineering, Jadavpur University, Kolkata, India
| | - Aparesh Datta
- Department of Mechanical Engineering, NIT Durgapur, Durgapur, India
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Li R, Zhang Y, Zheng S, Zhang W, Du K, He W, Zhang W. Biomechanical characteristics in the carotid artery: Noninvasive assessment using subharmonic emissions from microbubbles. Med Phys 2023; 50:6857-6863. [PMID: 37337456 DOI: 10.1002/mp.16542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/03/2023] [Accepted: 05/08/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Stroke is closely related to carotid atherosclerotic plaques, which tend to occur in specific parts of the arteries, especially at the bifurcations, and are considered to be caused by biomechanical factors. Quantitative analysis of hemodynamic stress characteristics of the carotid sinus in vivo provides a mechanical basis for the development of atherosclerotic plaque in the carotid sinus. Previous studies found that ultrasound (US) contrast agent microbubbles would vibrate nonlinearly under the excitation of sound pressure, generating subharmonics (transmission fundamental frequency, i.e., f0 and subharmonic frequency at f0 /2), which have the highest sensitivity to pressure changes and exhibit an inverse linear relationship with environmental pressure. PURPOSE This study employed subharmonic aided pressure estimation (SHAPE) technology to reflect carotid artery hydrodynamic characteristics in the carotid lumen. METHODS From May 2021 to December 2021, this prospective study reviewed a total of 26 normal carotid arteries of 13 participants, all of whom received bilateral carotid artery routine US and SHAPE US examinations. During this study, the lumen of the bilateral distal segment of the common carotid artery (Distal-CCA), carotid artery bifurcation (CAB), and carotid bulb (CB) were scanned section by section from bottom to top in longitudinal and transverse sections. Subsequently, the subharmonic amplitudes in the lumen of normal carotid arteries were collected and analyzed. RESULTS This study found that the amplitude of subharmonic amplitude in the carotid was distributed unevenly, with the amplitudes of subharmonic at the CAB being higher. Specifically, the subharmonic gradient of the carotid artery bifurcation apex plane was maximum (9.72 ± 4.31 dB), while the average subharmonic amplitude of the outer lateral layer of the carotid artery was higher (-56.40 ± 6.31 dB) (p < 0.001). CONCLUSION The SHAPE technique is capable of indirectly reflecting the pressure changes of vascular system tissues, which may provide a new monitoring method for evaluating mechanical characteristics obviating invasion.
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Affiliation(s)
- Rui Li
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yukang Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Zheng
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wenkai Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kai Du
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen He
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wei Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Takai H, Matsubara S, Minami-Ogawa Y, Hirai S, Shikata E, Yagi K, Oyama N, Yagita Y, Uno M. Association between Carotid Bifurcation Angle and Vulnerable Plaque Volume Using Black Blood Magnetic Resonance Imaging. Neurol Med Chir (Tokyo) 2023; 63:437-442. [PMID: 37495520 PMCID: PMC10687671 DOI: 10.2176/jns-nmc.2023-0034] [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: 03/09/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023] Open
Abstract
The morphology of the internal carotid artery (ICA) bifurcation is increasingly being recognized as the cause of atherosclerosis and vulnerable plaque leading to cerebral infarction. In this study, we investigated the relationship between carotid bifurcation angle and carotid plaque volume evaluated using black blood magnetic resonance imaging (BB-MRI). Among the 90 patients who underwent revascularization for atherosclerotic symptomatic carotid stenosis between April 2016 and October 2022 using BB-MRI, carotid plaque was evaluated in 57 patients. Relative overall signal intensity (roSI) was defined as the signal intensity of the plaque on T1-weighted images relative to the signal intensity of the sternocleidomastoid muscle in the same slice as the common carotid bifurcation. Regions showing roSI ≥ 1.0 were defined as plaque, and the plaque volume and relative plaque volume were measured from roSI ≥1.0 to ≥2.0 in 0.1 increments. We calculated the angles between the common carotid artery (CCA) and the ICA and between the CCA and the external carotid artery (ECA) on magnetic resonance angiography. We classified two groups according to carotid bifurcation angles based on the ICA angle: Group A = <35° and Group B = ≥35°. Compared with Group A (n = 42), Group B (n = 15) showed a greater relative plaque volume between roSI ≥ 1.3 and roSI ≥ 1.5. A significant correlation was identified between relative plaque volume with roSI ≥ 1.4 and ICA angle (p = 0.049). Vulnerable plaque was significantly more frequent in the group with an ICA angle of ≥35. Moreover, the ICA angle was significantly greater in patients with a roSI of ≥1.4.
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Affiliation(s)
- Hiroki Takai
- Department of Neurosurgery, Kawasaki Medical School
| | | | | | | | - Eiji Shikata
- Department of Neurosurgery, Kawasaki Medical School
| | - Kenji Yagi
- Department of Neurosurgery, Kawasaki Medical School
| | - Naoki Oyama
- Department of Stroke Medicine, Kawasaki Medical School
| | | | - Masaaki Uno
- Department of Neurosurgery, Kawasaki Medical School
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Wild NC, Bulusu KV, Plesniak MW. Vortical Structures Promote Atheroprotective Wall Shear Stress Distributions in a Carotid Artery Bifurcation Model. Bioengineering (Basel) 2023; 10:1036. [PMID: 37760138 PMCID: PMC10525770 DOI: 10.3390/bioengineering10091036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023] Open
Abstract
Carotid artery diseases, such as atherosclerosis, are a major cause of death in the United States. Wall shear stresses are known to prompt plaque formation, but there is limited understanding of the complex flow structures underlying these stresses and how they differ in a pre-disposed high-risk patient cohort. A 'healthy' and a novel 'pre-disposed' carotid artery bifurcation model was determined based on patient-averaged clinical data, where the 'pre-disposed' model represents a pathological anatomy. Computational fluid dynamic simulations were performed using a physiological flow based on healthy human subjects. A main hairpin vortical structure in the internal carotid artery sinus was observed, which locally increased instantaneous wall shear stress. In the pre-disposed geometry, this vortical structure starts at an earlier instance in the cardiac flow cycle and persists over a much shorter period, where the second half of the cardiac cycle is dominated by perturbed secondary flow structures and vortices. This coincides with weaker favorable axial pressure gradient peaks over the sinus for the 'pre-disposed' geometry. The findings reveal a strong correlation between vortical structures and wall shear stress and imply that an intact internal carotid artery sinus hairpin vortical structure has a physiologically beneficial role by increasing local wall shear stresses. The deterioration of this beneficial vortical structure is expected to play a significant role in atherosclerotic plaque formation.
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Affiliation(s)
- Nora C. Wild
- Department of Mechanical and Aerospace Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, USA; (N.C.W.); (K.V.B.)
| | - Kartik V. Bulusu
- Department of Mechanical and Aerospace Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, USA; (N.C.W.); (K.V.B.)
| | - Michael W. Plesniak
- Department of Mechanical and Aerospace Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, USA; (N.C.W.); (K.V.B.)
- Department of Biomedical Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, USA
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Liu Y, Jiang G, Wang X, An X, Wang F. The relationship between geometry and hemodynamics of the stenotic carotid artery based on computational fluid dynamics. Clin Neurol Neurosurg 2023; 231:107860. [PMID: 37390570 DOI: 10.1016/j.clineuro.2023.107860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/17/2023] [Accepted: 06/24/2023] [Indexed: 07/02/2023]
Abstract
OBJECTIVE The purpose of this work was to investigate the relationship between the geometric factors and the hemodynamics of the stenotic carotid artery. METHODS We retrospectively reviewed data of patients with carotid stenosis (40%-95%). The Navier-Stokes equations were solved using ANSYS CFX 18.0. Correlation analysis was based on Spearman's test. Geometric variables (p < 0.1 in the univariate analysis) were entered into the logistical regression. A receiver-operating characteristics analysis was used to detect hemodynamically significant lesions. RESULTS 81 patients (96 arteries) were evaluated. The logistic regression analysis revealed that the translesional pressure ratio was significantly correlated with the stenosis degree (OR = 1.147, p < 0.001) and the angle between internal carotid artery and external carotid artery (angle γ) (OR = 0.933, p = 0.01). The translesional wall shear stress ratio was significantly correlated with stenosis degree (OR = 1.094, p < 0.001), lesion length (OR = 0.873, p = 0.01), lumen area of internal carotid artery (OR = 0.867, p = 0.002), and lumen area of common carotid artery (OR = 1.058, p = 0.01). For predicting low translesional pressure ratio, the AUC was 0.71 (p < 0.001) for angle γ, and was 0.87 (p < 0.001) for stenosis degree. For predicting high translesional wall shear stress ratio, the AUC was 0.62 (p = 0.04) for lumen area of internal carotid artery, and was 0.77 (p < 0.001) for stenosis degree. CONCLUSIONS Apart from stenosis degree, other geometric characteristics of lesions may also have an influence on hemodynamics of the stenotic carotid artery.
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Affiliation(s)
- Yongsheng Liu
- Department of Interventional Neuroradiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Guinan Jiang
- Department of Interventional Neuroradiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xuwen Wang
- Department of Interventional Neuroradiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Xiangbo An
- Department of Interventional Neuroradiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Feng Wang
- Department of Interventional Neuroradiology, First Affiliated Hospital of Dalian Medical University, Dalian, China.
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Zalud NC, Bulusu KV, Plesniak MW. Shear stress metrics associated with pro-atherogenic high-risk anatomical features in a carotid artery bifurcation model. Clin Biomech (Bristol, Avon) 2023; 105:105956. [PMID: 37098301 DOI: 10.1016/j.clinbiomech.2023.105956] [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: 11/13/2022] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Diseases associated with atherosclerotic plaques in the carotid artery are a major cause of deaths in the United States. Blood-flow-induced shear-stresses are known to trigger plaque formation. Prior literature suggests that the internal carotid artery sinus is prone to atherosclerosis, but there is limited understanding of why only certain patients are predisposed towards plaque formation. METHODS We computationally investigate the effect of vessel geometry on wall-shear-stress distribution by comparing flowfields and wall-shear-stress-metrics between a low-risk and a novel predisposed high-risk carotid artery bifurcation anatomy. Both models were developed based on clinical risk estimations and patient-averaged anatomical features. The high-risk geometry has a larger internal carotid artery branching angle and a lower internal-to-carotid-artery-diameter-ratio. A patient-averaged physiological carotid artery inflow waveform is used. FINDINGS The high-risk geometry experiences stronger flow separation in the sinus. Furthermore, it experiences a more equal flow split at the bifurcation, thereby reducing internal carotid artery flowrate and increasing atherosclerosis-prone low-velocity areas. Lowest time-averaged-wall-shear-stresses are present at the sinus outer wall, where plaques are often found, for both geometries. The high-risk geometry has significantly high, unfavorable oscillatory-shear-index values not found in the low-risk geometry. High oscillatory-shear-index areas are located at the vessels outside walls distal to the bifurcation and on the sinus wall. INTERPRETATION These results highlight the effectiveness of oscillatory-shear-index, to augment classical time-averaged-wall-shear-stress, in evaluating pro-atherogenic geometry features. Furthermore, the flow split at the bifurcation is a promising clinical indicator for atherosclerosis risk as it can be directly accessed using clinical imaging, whereas shear-stress-metrics cannot.
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Affiliation(s)
- Nora C Zalud
- Department of Mechanical and Aerospace Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, United States
| | - Kartik V Bulusu
- Department of Mechanical and Aerospace Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, United States
| | - Michael W Plesniak
- Department of Mechanical and Aerospace Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 3000, Washington, DC 20052, United States; Department of Biomedical Engineering, The George Washington University, 800 22nd Street NW, Science & Engineering Hall, Suite 5000, Washington, DC 20052, United States.
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Han N, Ma Y, Li Y, Zheng Y, Wu C, Gan T, Li M, Ma L, Zhang J. Imaging and Hemodynamic Characteristics of Vulnerable Carotid Plaques and Artificial Intelligence Applications in Plaque Classification and Segmentation. Brain Sci 2023; 13:brainsci13010143. [PMID: 36672124 PMCID: PMC9856903 DOI: 10.3390/brainsci13010143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/24/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023] Open
Abstract
Stroke is a massive public health problem. The rupture of vulnerable carotid atherosclerotic plaques is the most common cause of acute ischemic stroke (AIS) across the world. Currently, vessel wall high-resolution magnetic resonance imaging (VW-HRMRI) is the most appropriate and cost-effective imaging technique to characterize carotid plaque vulnerability and plays an important role in promoting early diagnosis and guiding aggressive clinical therapy to reduce the risk of plaque rupture and AIS. In recent years, great progress has been made in imaging research on vulnerable carotid plaques. This review summarizes developments in the imaging and hemodynamic characteristics of vulnerable carotid plaques on the basis of VW-HRMRI and four-dimensional (4D) flow MRI, and it discusses the relationship between these characteristics and ischemic stroke. In addition, the applications of artificial intelligence in plaque classification and segmentation are reviewed.
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Affiliation(s)
- Na Han
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
| | - Yurong Ma
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Yan Li
- School of Mathematics and Statistics, Lanzhou University, Lanzhou 730030, China
| | - Yu Zheng
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
| | - Chuang Wu
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Tiejun Gan
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Min Li
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Laiyang Ma
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
| | - Jing Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
- Correspondence: ; Tel.: +86-139-1999-2479
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Ma W, Cheng Z, Chen X, Huang C, Yu G, Chen G. Multiphase Flow Hemodynamic Evaluation of Vertebral Artery Stenosis Lesions and Plaque Stability. Biomed Mater Eng 2023; 34:247-260. [PMID: 36245366 DOI: 10.3233/bme-221436] [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] [Indexed: 11/15/2022]
Abstract
BACKGROUND Atherosclerosis is one of the main causes of vertebral artery stenosis, which reduces blood supply to the posterior circulation, resulting in cerebral infarction or death. OBJECTIVE To investigate stenosis rates and locations on the development of vertebral artery plaques. METHODS Stenosis models with varying degrees and positions of stenosis were established. The stenosis area was comprehensively analyzed using multiphase flow numerical simulation. Wall shear stress (WSS), blood flow velocity, and red blood cell (RBC) volume fraction were calculated. RESULTS Blood flow velocity in 30-70% stenosis of each segment tended to increase significantly higher than normal. Downstream of 50% stenosis exhibited turbulent flow; downstream of 70% displayed reflux. Severe stenosis increases the WSS and distribution area. The mixed area of high and low WSS appeared downstream of the stenosis. The RBC volume fraction at the stenosis increased (maximum value: 0.487 at 70% stenosis in the V4), which was 1.08 times the normal volume fraction. Turbulent and backflow regions exhibited complex RBC volume fraction distributions. CONCLUSION Flow velocity, WSS, and RBC volume fraction at the stenosis increase with stenosis severity, increasing plaque shedding. Narrow downstream spoiler and reflux areas possess low WSS and high erythrocyte volume fractions, accelerating plaque growth.
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Affiliation(s)
- Wei Ma
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Zhiguo Cheng
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Xiaoqin Chen
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Chengdu Huang
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Guanghao Yu
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
| | - Guangxin Chen
- Mudanjiang Medical University, Heilongjiang, Mudanjiang, China
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Takami Y, Norikane T, Yamamoto Y, Fujimoto K, Mitamura K, Okauchi M, Kawanishi M, Nishiyama Y. A preliminary study of relationship among the degree of internal carotid artery stenosis, wall shear stress on MR angiography and 18F-FDG uptake on PET/CT. J Nucl Cardiol 2022; 29:569-577. [PMID: 32743752 DOI: 10.1007/s12350-020-02300-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/18/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND This preliminary study was undertaken to evaluate relationship among the degree of internal carotid artery (ICA) stenosis, wall shear stress (WSS) by computational fluid dynamics (CFD) on magnetic resonance angiography (MRA) and 18F-FDG uptake of ICA on PET/CT. METHODS A total of 40 carotid arteries in 20 patients with carotid atherosclerotic disease were examined with MRA and 18F-FDG PET/CT. Atherosclerotic risk factors were assessed in all patients. Degree of ICA stenosis was calculated according to NASCET method. CFD analysis was performed and maximum WSS (WSSmax) was measured. 18F-FDG uptake in ICA was quantified using maximum target-to-blood pool ratio (TBRmax). RESULTS Atherosclerotic risk factors did not affect imaging findings. There were significant correlations between WSSmax and degree of ICA stenosis (ρ = .81, P < .001), WSSmax and TBRmax (ρ = .64, P < .001), and TBRmax and degree of ICA stenosis (ρ = .50, P = .001). CONCLUSIONS These preliminary results indicate that there may be significant correlations among the degree of ICA stenosis, WSSmax and TBRmax in patients with carotid artery stenosis.
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Affiliation(s)
- Yasukage Takami
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Takashi Norikane
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yuka Yamamoto
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Kengo Fujimoto
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Katsuya Mitamura
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Masanobu Okauchi
- Department of Neurological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Masahiko Kawanishi
- Department of Neurological Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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Cai Y, Li Z. Mathematical modeling of plaque progression and associated microenvironment: How far from predicting the fate of atherosclerosis? COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 211:106435. [PMID: 34619601 DOI: 10.1016/j.cmpb.2021.106435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 09/16/2021] [Indexed: 06/13/2023]
Abstract
Mathematical modeling contributes to pathophysiological research of atherosclerosis by helping to elucidate mechanisms and by providing quantitative predictions that can be validated. In turn, the complexity of atherosclerosis is well suited to quantitative approaches as it provides challenges and opportunities for new developments of modeling. In this review, we summarize the current 'state of the art' on the mathematical modeling of the effects of biomechanical factors and microenvironmental factors on the plaque progression, and its potential help in prediction of plaque development. We begin with models that describe the biomechanical environment inside and outside the plaque and its influence on its growth and rupture. We then discuss mathematical models that describe the dynamic evolution of plaque microenvironmental factors, such as lipid deposition, inflammation, smooth muscle cells migration and intraplaque hemorrhage, followed by studies on plaque growth and progression using these modelling approaches. Moreover, we present several key questions for future research. Mathematical models can complement experimental and clinical studies, but also challenge current paradigms, redefine our understanding of mechanisms driving plaque vulnerability and propose future potential direction in therapy for cardiovascular disease.
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Affiliation(s)
- Yan Cai
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing 210096, China.
| | - Zhiyong Li
- School of Biological Sciences and Medical Engineering, Southeast University, Nanjing 210096, China; School of Mechanical, Medical and Process Engineering, Queensland University of Technology, Brisbane, QLD 4001, Australia
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Tian S, Pan W, Peng J, Wang H, Deng B, Liang Y, Li X, Liu H, Wang Y, Luo B, Du J. Hemodynamic Responses in Carotid Bifurcation Induced by Enhanced External Counterpulsation Stimulation in Healthy Controls and Patients With Neurological Disorders. Front Physiol 2021; 12:717080. [PMID: 34531762 PMCID: PMC8438206 DOI: 10.3389/fphys.2021.717080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/21/2021] [Indexed: 12/25/2022] Open
Abstract
Enhanced external counterpulsation is a Food and Drug Administration–approved, non-invasive, assisted circulation therapy for ischemic cardiovascular and cerebrovascular diseases. Previous studies have confirmed that EECP stimulation induces largely different cerebral hemodynamic responses in patients with ischemic stroke and healthy controls. However, the underlying mechanisms remain uncertain. We hypothesize that different blood redistributions at the carotid bifurcation may play a key role. Ten subjects were enrolled in this study, namely, five patients with neurological disorders and five young healthy volunteers as controls. Magnetic resonance angiography (MRA) was performed on the carotid artery. All the subjects received a single session of EECP treatment, with external cuff pressures ranging from 20 to 40 kPa. Vascular ultrasound measurements were taken in the common carotid artery (CCA), external carotid artery (ECA) and internal carotid artery (ICA). Three-dimensional patient-specific numerical models were developed to calculate the WSS-derived hemodynamic factors. The results indicated that EECP increased CCA and ECA blood flow in both groups. The ICA blood flow in the patient group exhibited a mean increase of 6.67% during EECP treatment compared with the pre-EECP condition; a mean decrease of 9.2% was observed in the healthy control group. EECP increased the averaged wall shear stress (AWSS) throughout the carotid bifurcation in the patient group; the ICA AWSS of the healthy group decreased during EECP. In both groups, the oscillatory shear index (OSI) in the ICA increased proportionally with external cuff pressure. In addition, the relative resident time (RRT) was constant or slightly decreased in the CCA and ECA in both groups but increased in the ICA. We suggest that the benefits of EECP to patients with neurological disorders may partly result from blood flow promotion in the ICA and increase in WSS at the carotid bifurcation. In the healthy subjects, the ICA blood flow remained constant during EECP, although the CCA blood flow increased significantly. A relatively low external cuff pressure (20 kPa) is recommended as the optimal treatment pressure for better hemodynamic effects. This study may play an important role in the translation of physiological benefits of EECP treatment in populations with or without neurological disorders.
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Affiliation(s)
- Shuai Tian
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, China
| | - Wei Pan
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, China
| | - Junping Peng
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hui Wang
- Department of Ultrasound, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Bin Deng
- Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, China
| | - Yi Liang
- Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, China
| | - Xinghua Li
- Medical Imaging Center, Chongming Medical Technology Company, Shenzhen, China
| | - Huahui Liu
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yujia Wang
- Department of Ultrasound, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Bin Luo
- Department of Neurosurgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jianhang Du
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Sun Yat-sen University, Shenzhen, China.,National Health Commission Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
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Qian S, Ma T, Zhang N, Liu X, Zhao P, Li X, Chen D, Hu L, Chang L, Xu L, Deng X, Fan Y. Spatiotemporal transfer of nitric oxide in patient-specific atherosclerotic carotid artery bifurcations with MRI and computational fluid dynamics modeling. Comput Biol Med 2020; 125:104015. [DOI: 10.1016/j.compbiomed.2020.104015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/17/2020] [Accepted: 09/17/2020] [Indexed: 12/29/2022]
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Blood flow simulations in patient-specific geometries of the carotid artery: A systematic review. J Biomech 2020; 111:110019. [PMID: 32905972 DOI: 10.1016/j.jbiomech.2020.110019] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/07/2020] [Accepted: 08/26/2020] [Indexed: 12/21/2022]
Abstract
Computational Fluid Dynamics (CFD) and Fluid-Structure Interaction (FSI) are currently widely applied in the study of blood flow parameters and their alterations under pathological conditions, which are important indicators for diagnosis of atherosclerosis. In this manuscript, a systematic review of the published literature was conducted, according to the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, on the simulation studies of blood flow in patient-specific geometries of the carotid artery bifurcation. Scopus, PubMed and ScienceDirect databases were used in the literature search, which was completed on the 3rd of August 2020. Forty-nine articles were included after the selection process and were organized in two distinct categories: the CFD studies (36/49 articles), which comprise only the fluid analysis and the FSI studies (13/49 articles), which includes both fluid and Fluid-Structure domain in the analysis. The data of the research works was structured in different categories (Geometry, Viscosity models, Type of Flow, Boundary Conditions, Flow Parameters, Type of Solver and Validation). The aim of this systematic review is to demonstrate the methodology in the modelling, simulation and analysis of carotid blood flow and also identify potential gaps and challenges in this research field.
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Hemodynamic Changes in the Carotid Artery after Infusion of Normal Saline Using Computational Fluid Dynamics. Diagnostics (Basel) 2020; 10:diagnostics10070473. [PMID: 32664658 PMCID: PMC7400695 DOI: 10.3390/diagnostics10070473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/26/2020] [Accepted: 07/09/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose: To study the effect of the infusion of normal saline on hemodynamic changes in healthy volunteers using computational fluid dynamics (CFD) simulation. Methods: Eight healthy subjects participated and 16 carotid arteries were used for the CFD analysis. A one-liter intravenous infusion of normal saline was applied to the participants to observe the hemodynamic variations. Blood viscosity was measured before and after the injection of normal saline to apply the blood properties on the CFD modeling. Blood viscosity, shear rate, and wall shear stress were visually and quantitatively shown for the comparison between before and after the infusion of normal saline. Statistical analyses were performed to confirm the difference between the before and after groups. Results: After the infusion of normal saline, decreased blood viscosity was observed in the whole carotid artery. At the internal carotid artery, the recirculation zone with low intensity was found after the injection of normal saline. Increased shear rate and reduced wall shear stress was observed at the carotid bifurcation and internal carotid artery. The hemodynamic differences between before and after groups were statistically significant. Conclusions: The infusion of normal saline affected not only the overall changes of blood flow in the carotid artery but also the decrease of blood viscosity.
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Age and anatomical location related hemodynamic changes assessed by 4D flow MRI in the carotid arteries of healthy adults. Eur J Radiol 2020; 128:109035. [DOI: 10.1016/j.ejrad.2020.109035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/14/2020] [Accepted: 04/26/2020] [Indexed: 01/01/2023]
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