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Zhang Z, Ai X, Xu Y, Wang Y, Zhang S, Zhao Y, Zhou R, Tang R, Wang L, Liu Y. Impact of craniocervical junction abnormality on vertebral artery hemodynamics: based on computational fluid dynamics analysis. Front Neurol 2024; 14:1244327. [PMID: 38249746 PMCID: PMC10796803 DOI: 10.3389/fneur.2023.1244327] [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: 06/22/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Background and purpose A three-dimensional reconstruction and data analysis of the vertebral artery (VA) with craniocervical junction abnormality (CJA) was performed by computational fluid dynamics (CFD) based on images to assess the impact of CJA on vertebral artery hemodynamics. Methods Retrospective analysis of combined head and neck computed tomography angiography (CTA) images of 60 patients with CJA and 60 normal patients admitted to our department from January 2018 to June 2022. The VA was reconstructed in three dimensions using CFD-related software, and the results were visualized to derive vertebral artery lumen diameter (D), peak systolic velocity (PSV), mean blood flow velocity (MV), wall pressure (P), wall shear stress (WSS), normalized WSS (NWSS), etc. Statistical analysis was used to analyze whether the data related to hemodynamics in the CJA group and the control group were statistically significant. Results The lumen diameter of the vertebral artery in the CJA group were less than the control group, and the difference was statistically significant (3.354 ± 0.562 vs. 3.744 ± 0.520, p < 0.05); the PSV, MV, P, WSS, and NWSS of the CJA group were increased compared with the control group, and the difference was statistically significant (1.235 ± 0.182 vs. 1.104 ± 0.145, 0.339 ± 0.063 vs. 0.307 ± 0.042, 24576.980 ± 7095.836 vs. 20824.281 ± 6718.438, 34.863 ± 6.816 vs. 31.080 ± 5.438, 0.272 ± 0.075 vs. 0.237 ± 0.067, p < 0.05). Conclusion In the complex CJA, the possibility of hemodynamic variation in the VAs is higher than in the normal population. The hemodynamic aspects of the vertebral artery in patients with CJA, such as diameter, flow velocity, flow, wall pressure and shear force, differ from those in the normal population and may lead to the occurrence of clinical symptoms, such as dizziness, so preoperative examinations such as combined head and neck CTA should be performed to clarify the vascular abnormalities.
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Affiliation(s)
- Zeyuan Zhang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xin Ai
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuanzhi Xu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuqiang Wang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuhao Zhang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yao Zhao
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruifang Zhou
- School of Mathematics and Information Sciences, Zhongyuan University of Technology, Zhengzhou, China
| | - Rui Tang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Limin Wang
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yilin Liu
- Department of Orthopedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Effects of the Vertebral Artery Ostium/Subclavian Artery Angle on In-Stent Restenosis after Vertebral Artery Ostium Stenting. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5527988. [PMID: 33996998 PMCID: PMC8101481 DOI: 10.1155/2021/5527988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/10/2021] [Accepted: 04/22/2021] [Indexed: 11/17/2022]
Abstract
Methods Between January 2016 and October 2018, sixty-four consecutive patients who underwent a total of 66 stenting procedures were screened for symptomatic and asymptomatic atherosclerotic VAOS. Of these patients, 57 had complete follow-up data. The baseline patient demographics and morphological features of the VAO were recorded. Potential factors influencing ISR, including conventional cerebrovascular disease risk factors, were assessed, together with outcome events including recurrent transient ischemic attack (TIA), stroke, and vascular-related mortality. Results The average follow-up period was 13.2 ± 4.6 months. Technical success was achieved in all interventions. The degree of stenosis was reduced from 77.2 ± 6.1% to 13.7 ± 8.9% after the procedure. ISR was detected in eight treated vessels (14.0%) and occlusion in two (5.3%) arteries. Of the 57 patients, one had an ischemic stroke and 5 had TIAs. The angle of the VAO at the subclavian artery was associated with the risk of restenosis (preoperative, P = 0.04; postoperative, P = 0.02). Conclusions Stenting is a feasible and effective treatment for VAOS. The angle of the VAO at the subclavian artery may contribute to the development of ISR.
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He S, Liu W, Qu K, Yin T, Qiu J, Li Y, Yuan K, Zhang H, Wang G. Effects of different positions of intravascular stent implantation in stenosed vessels on in-stent restenosis: An experimental and numerical simulation study. J Biomech 2020; 113:110089. [PMID: 33181394 DOI: 10.1016/j.jbiomech.2020.110089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 09/08/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Abstract
Percutaneous coronary intervention (PCI) has been widely used in the treatment of atherosclerosis, while in-stent restenosis (ISR) has not been completely resolved. Studies have shown that changes in intravascular mechanical environment are related to ISR. Hence, an in-depth understanding of the effects of stent intervention on vascular mechanics is important for clinically optimizing stent implantation and relieving ISR. Nine rabbits with stenotic carotid artery were collected by balloon injury. Intravascular stents were implanted into different longitudinal positions (proximal, middle and distal relative to the stenotic area) of the stenotic vessels for numerical simulations. Optical coherence tomography (OCT) scanning was performed to reconstruct the three-dimensional configuration of the stented carotid artery and blood flow velocity waveforms were collected by Doppler ultrasound. The numerical simulations were performed through direct solution of Naiver-Stokes equation in ANSYS. Results showed that the distributions of time-averaged wall shear stress (TAWSS), oscillating shear index (OSI) and relative residual time (RRT) in near-end segment were distinctively different from other regions of the stent which considered to promote restenosis for all three models. Spearman rank-correlation analysis showed a significant correlation between hemodynamic descriptors and the stent longitudinal positions (rTAWSS = -0.718, rOSI = 0.898, rRRT = 0.818, p < 0.01). Histology results of the near-end segment showed neointima thickening deepened with the longitudinal positions of stent which was consistent with the numerical simulations. The results suggest that stent implantation can promote restenosis at the near-end segment. As the stenting position moves to distal end, the impact on ISR is more significant.
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Affiliation(s)
- Shicheng He
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China; State Key Laboratory of Bioelectronics, School of Biological Science and Medical Engineering, Southeast University, Nanjing 210096, PR China
| | - Wanling Liu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China
| | - Kai Qu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China
| | - Tieying Yin
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China
| | - Juhui Qiu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China.
| | - Yan Li
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China
| | - Kunshan Yuan
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, Shandong 251100, PR China
| | - Haijun Zhang
- National United Engineering Laboratory for Biomedical Material Modification, Dezhou, Shandong 251100, PR China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing 400030, PR China.
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Cheng D, Zhuang Y, Kou Q, Zhang M, Zhao Y, Han C, Li J, Wang Y, Xu K, Mo F, Zhang J. Numerical simulation of hemodynamics in membranous obstruction of the suprahepatic inferior vena cava based on a subject-specific Budd-Chiari syndrome model. Clin Biomech (Bristol, Avon) 2018; 52:20-24. [PMID: 29316476 DOI: 10.1016/j.clinbiomech.2017.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 12/26/2017] [Accepted: 12/29/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study was performed to determine the hemodynamic changes of Budd-Chiari syndrome when the inferior vena vein membrane is developing. METHODS A patient-specific Budd-Chiari syndrome vascular model was reconstructed based on magnetic resonance images using Mimics software and different degrees (16%, 37%, and 54%) of idealized membrane were built based on the Budd-Chiari syndrome vascular model using Geomagic software. Three membrane obstruction Budd-Chiari syndrome vascular models were established successfully and fluent software was used to simulate hemodynamic parameters, including blood velocity and wall shear stress. FINDINGS The simulation results showed that there is low velocity and a low wall shear stress region at the junction of the inferior vena cava and the branches of the hepatic veins, and swirl may occur in this area. As the membrane develops, the size of the low velocity and low wall shear stress regions enlarged and the wall shear stress was increased at the membrane region. There was a significant difference in the mean values of wall shear stress between the different obstruction membrane models (P<0.05). INTERPRETATION Hemodynamic parameters play an important role in vascular disease and there may be a correlation between inferior vena cava wall shear force changes and the slow development process of the inferior vena cava membrane.
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Affiliation(s)
- Deqiang Cheng
- School of Information and Control Engineering, China University of Mining and Technology, Xuzhou 221116, China
| | - Yinping Zhuang
- School of Information and Control Engineering, China University of Mining and Technology, Xuzhou 221116, China; School of Medical Imaging, Xuzhou Medical University, 84West Huai-hai Road, Xuzhou 221004, China.
| | - Qiqi Kou
- School of Information and Control Engineering, China University of Mining and Technology, Xuzhou 221116, China
| | - Min Zhang
- School of Medical Imaging, Xuzhou Medical University, 84West Huai-hai Road, Xuzhou 221004, China
| | - Yinghong Zhao
- School of Medical Imaging, Xuzhou Medical University, 84West Huai-hai Road, Xuzhou 221004, China
| | - Cuiping Han
- School of Medical Imaging, Xuzhou Medical University, 84West Huai-hai Road, Xuzhou 221004, China
| | - Jingjing Li
- School of Medical Imaging, Xuzhou Medical University, 84West Huai-hai Road, Xuzhou 221004, China
| | - Yong Wang
- School of Medical Imaging, Xuzhou Medical University, 84West Huai-hai Road, Xuzhou 221004, China
| | - Kai Xu
- School of Medical Imaging, Xuzhou Medical University, 84West Huai-hai Road, Xuzhou 221004, China
| | - Fei Mo
- School of Medical Imaging, Xuzhou Medical University, 84West Huai-hai Road, Xuzhou 221004, China
| | - Jiawei Zhang
- School of Medical Imaging, Xuzhou Medical University, 84West Huai-hai Road, Xuzhou 221004, China
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SUN ZHENG, JI SIWEN. AN INTERACTIVE VIRTUAL INTRACORONARY STENTING SYSTEM BASED ON INTRAVASCULAR ULTRASOUND. J MECH MED BIOL 2017. [DOI: 10.1142/s021951941740019x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Percutaneous transluminal coronary angioplasty (PTCA) is a minimally invasive surgery in the clinical treatment of coronary artery diseases. The successful operation highly depends on the size and accurate placement of the stent. In this study, a virtual stenting (VS) system was designed and implemented to facilitate the planning of PTCA. A three-dimensional (3D) vessel model was reconstructed through fusing intravascular ultrasound (IVUS) sequential images and simultaneously recorded X-ray angiograms during cardiac intervention. The user is allowed to intuitively explore the vessel in an endoscopic manner by creating/updating a fly-through trajectory in the lumen. A virtual stent library including a better variety of commercially available bare metal heart stents was built. The user is allowed to select a proper stent according to the morphology of the vessel and lesion and to move it to the lesion. Also, the user can visually observe the stent expansion/apposition and flexibly adjust its position. The system is used to assist visual diagnosis of the vascular diseases, evaluation of interventional treatment and training of the medical personnel.
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Affiliation(s)
- ZHENG SUN
- Department of Electronic and Communication Engineering, North China Electric Power University, Baoding 071003, P. R. China
| | - SIWEN JI
- Department of Electronic and Communication Engineering, North China Electric Power University, Baoding 071003, P. R. China
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Wang HY, Liu LS, Cao HM, Li J, Deng RH, Fu Q, Zhang HX, Fei JG, Wang CX. Hemodynamics in Transplant Renal Artery Stenosis and its Alteration after Stent Implantation Based on a Patient-specific Computational Fluid Dynamics Model. Chin Med J (Engl) 2017; 130:23-31. [PMID: 28051019 PMCID: PMC5221107 DOI: 10.4103/0366-6999.196569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Accumulating studies on computational fluid dynamics (CFD) support the involvement of hemodynamic factors in artery stenosis. Based on a patient-specific CFD model, the present study aimed to investigate the hemodynamic characteristics of transplant renal artery stenosis (TRAS) and its alteration after stent treatment. Methods: Computed tomography angiography (CTA) data of kidney transplant recipients in a single transplant center from April 2013 to November 2014 were reviewed. The three-dimensional geometry of transplant renal artery (TRA) was reconstructed from the qualified CTA images and categorized into three groups: the normal, stenotic, and stented groups. Hemodynamic parameters including pressure distribution, velocity, wall shear stress (WSS), and mass flow rate (MFR) were extracted. The data of hemodynamic parameters were expressed as median (interquartile range), and Mann–Whitney U-test was used for analysis. Results: Totally, 6 normal, 12 stenotic, and 6 stented TRAs were included in the analysis. TRAS presented nonuniform pressure distribution, adverse pressure gradient across stenosis throat, flow vortex, and a separation zone at downstream stenosis. Stenotic arteries had higher maximal velocity and maximal WSS (2.94 [2.14, 3.30] vs. 1.06 [0.89, 1.15] m/s, 256.5 [149.8, 349.4] vs. 41.7 [37.8, 45.3] Pa at end diastole, P = 0.001; 3.25 [2.67, 3.56] vs. 1.65 [1.18, 1.72] m/s, 281.3 [184.3, 364.7] vs. 65.8 [61.2, 71.9] Pa at peak systole, P = 0.001) and lower minimal WSS and MFRs (0.07 [0.03, 0.13] vs. 0.52 [0.45, 0.67] Pa, 1.5 [1.0, 3.0] vs. 11.0 [8.0, 11.3] g/s at end diastole, P = 0.001; 0.08 [0.03, 0.19] vs. 0.70 [0.60, 0.81] Pa, 2.0 [1.3, 3.3] vs. 16.5 [13.0, 20.3] g/s at peak systole, P = 0.001) as compared to normal arteries. Stent implantation ameliorated all the alterations of the above hemodynamic factors except low WSS. Conclusions: Hemodynamic factors were significantly changed in severe TRAS. Stent implantation can restore or ameliorate deleterious change of hemodynamic factors except low WSS at stent regions.
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Affiliation(s)
- Hong-Yang Wang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Long-Shan Liu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Hai-Ming Cao
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Jun Li
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Rong-Hai Deng
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Qian Fu
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Huan-Xi Zhang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Ji-Guang Fei
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Chang-Xi Wang
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510080; Guangdong Provincial Key Laboratory on Organ Donation and Transplant Immunology, Guangzhou, Guangdong 510080, China
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