Contribution of atherosclerotic plaque location and severity to the near-wall hemodynamics of the carotid bifurcation: an experimental study and FSI modeling

Atherosclerosis is initiated by endothelial injury that is related to abnormal values of hemodynamic parameters such as wall shear stress (WSS), oscillatory shear index (OSI) and stress phase angle (SPA), which are more common in arterial bifurcations due to the complex structure. An experimental model of human carotid bifurcation with accurate geometrical and mechanical features was set up, and using realistic pulsatile flow rates, the inlet and outlet pressure pulses were measured for normal and stenosed models with 40% and 80% severities at common carotid (CCA), internal carotid (ICA) and external carotid (ECA) arteries. Based on the obtained experimental data, fluid-structure models were developed to obtain WSS, OSI, and SPA and evaluate pathological consequences at different locations. Mild severity had minor impact, however, inducing severe 80% stenosis in each branch led to considerable localized changes of hemodynamic parameters both in the stenosis site and other locations. This included sharp increases in WSS values accompanied by very low values close to zero before and after the peaks. Severe stenosis not only caused significant changes in the local artery, but also in other branches. OSI and SPA were less sensitive to stenosis, although high peaks were observed on bifurcation site for the stenosis at ECA. The interconnection of arteries at carotid bifurcation results in altered pressure/flow patterns in all branches when a stenosis is applied in any site. Such effect confirms pathological findings that atherosclerotic plaques are observed simultaneously in different carotid branches, although with different degrees of plaque growth and severity.

The Interaction between Fluid Wall Shear Stress and Solid Circumferential Strain Affects Endothelial Gene Expression

Endothelial cells lining the walls of blood vessels are exposed simultaneously to wall shear stress (WSS) and circumferential stress (CS) that can be characterized by the temporal phase angle between WSS and CS (stress phase angle - SPA). Regions of the circulation with highly asynchronous hemodynamics (SPA close to -180°) such as coronary arteries are associated with the development of pathological conditions such as atherosclerosis and intimal hyperplasia whereas more synchronous regions (SPA closer to 0°) are spared of disease. The present study evaluates endothelial cell gene expression of 42 atherosclerosis-related genes under asynchronous hemodynamics (SPA=-180 °) and synchronous hemodynamics (SPA=0 °). This study used a novel bioreactor to investigate the cellular response of bovine aortic endothelial cells (BAECS) exposed to a combination of pulsatile WSS and CS at SPA=0 or SPA=-180. Using a PCR array of 42 genes, we determined that BAECS exposed to non-reversing sinusoidal WSS (10±10 dyne/cm2) and CS (4 ± 4%) over a 7 hour testing period displayed 17 genes that were up regulated by SPA = -180 °, most of them pro-atherogenic, including NFκB and other NFκB target genes. The up regulation of NFκB p50/p105 and p65 by SPA =-180° was confirmed by Western blots and immunofluorescence staining demonstrating the nuclear translocation of NFκB p50/p105 and p65. These data suggest that asynchronous hemodynamics (SPA=-180 °) can elicit proatherogenic responses in endothelial cells compared to synchronous hemodynamics without shear stress reversal, indicating that SPA may be an important parameter characterizing arterial susceptibility to disease.

AN IMPROVED MODEL FOR REDUCED-ORDER PHYSIOLOGICAL FLUID FLOWS

An improved one-dimensional mathematical model based on the Pulsed Flow Equations (PFE) is derived by integrating the axial component of the momentum equation over the transient Womersley velocity profile, providing a dynamic momentum equation whose coefficients are smoothly varying functions of the spatial variable. The resulting momentum equation along with the continuity equation and pressure-area relation form our reduced-order model for physiological fluid flows in one dimension and are aimed at providing accurate and fast-to-compute global models for physiological systems represented as networks of quasi one-dimensional fluid flows. The consequent nonlinear coupled system of equations is solved by the Lax-Wendroff scheme and is then applied to an open model arterial network of the human vascular system containing the largest 55 arteries. The proposed model with functional coefficients is compared with current classical one-dimensional theories which assume steady state Hagen-Poiseuille velocity profiles, either parabolic or plug-like, throughout the whole arterial tree. The effects of the nonlinear term in the momentum equation and different strategies for bifurcation points in the network, as well as the various lumped parameter outflow boundary conditions for distal terminal points are also analyzed. The results show that the proposed model can be used as an efficient tool for investigating the dynamics of reduced-order models of flows in physiological systems and would, in particular, be a good candidate for the one-dimensional, system-level component of geometric multiscale models of physiological systems.

The effects of stenosis severity on the hemodynamic parameters-assessment of the correlation between stress phase angle and wall shear stress

To study the effects of increase in the degree of stenosis severity and subsequent complexity of hemodynamic patterns on hemodynamic parameters, experimental investigations and numerical simulations were performed. The correlations between the large negative Stress Phase Angle (SPA), the low mean Wall Shear Stress (WSS) and high Oscillatory Shear Index (OSI) were investigated at the distal shoulder and post-stenotic regions as the outcomes of elevated stenosis severity. Models included non-Newtonian fluid flow in stenotic arteries with 30-80% symmetrical stenoses. To study the interactions between pulsatile WSS and pulsatile wall circumferential stress (WCS) acting on endothelial cells, SPA as the phase difference between WSS and WCS waves was used. Moreover, the distribution of SPA on the lumen axis was compared to the distributions of the mean WSS and OSI that have been regarded until now as the determinants of atherosclerosis-prone regions. Results indicate that an increase in stenosis severity, not only affects the mean WSS, mean WCS and pulse amplitudes, but also influences the phase difference between them. The SPA is large negative on the distal shoulder and post-stenotic areas where atherosclerotic plaque develops. The increasing stenosis severity and the subsequent increasing complexity of hemodynamic patterns affect the correlation between any of the low mean WSS and high OSI with large negative SPA, such that it not only leads to create and develop some regions where the correlation between any of the low mean WSS and high OSI with large negative SPA is well but also leads to create and develop other regions where such correlations fail.

Effects of cyclic stretch waveform on endothelial cell morphology using fractal analysis

Endothelial cells are remodeled when subjected to cyclic loading. Previous in vitro studies have indicated that frequency, strain amplitude, and duration are determinants of endothelial cell morphology, when cells are subjected to cyclic strain. In addition to those parameters, the current study investigated the effects of strain waveform on morphology of cultured endothelial cells quantified by fractal and topological analyses. Cultured endothelial cells were subjected to cyclic stretch by a designed device, and cellular images before and after tests were obtained. Fractal and topological parameters were calculated by development of an image-processing code. Tests were performed for different load waveforms. Results indicated cellular alignment by application of cyclic stretch. By alteration of load waveform, statistically significant differences between cell morphology of test groups were observed. Such differences are more prominent when load cycles are elevated. The endothelial cell remodeling was optimized when the applied cyclic load waveform was similar to blood pressure waveform. Effects of load waveform on cell morphology are influenced by alterations in load amplitude and frequency. It is concluded that load waveform is a determinant of endothelial morphology in addition to amplitude and frequency, and such effect is elevated by increase of load cycles. Due to high correlation between fractal and topological analyses, it is recommended that fractal analysis can be used as a proper method for evaluation of alteration in cell morphology and tissue structure caused by application of external stimuli such as mechanical loading.