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Pan F, Mori N, Mugikura S, Ohta M, Anzai H. The influence of blood velocity and vessel geometric parameters on wall shear stress. Med Eng Phys 2024; 124:104112. [PMID: 38418022 DOI: 10.1016/j.medengphy.2024.104112] [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: 04/21/2023] [Revised: 11/16/2023] [Accepted: 01/18/2024] [Indexed: 03/01/2024]
Abstract
Vascular geometry was proposed to be one risk factor of atherosclerosis (AS). When developing this hypothesis, the discussion of geometry-wall shear stress (WSS) has often been included. However, further exploration on how various geometric parameters were affecting WSS was needed. The purpose of this study was to investigate the influence degree of vessel geometric parameters and blood velocity on WSS. A computational fluid dynamics (CFD) analyses of the vertebral and basilar arteries (VA and BA, respectively) was used. Twenty patients with no plaques or vessel wall thickening at the VA and BA were included. CFD analyses using both specific vessel models and flow conditions measured by ultrasound Doppler were performed. Subsequently, CFD results were post-processed with multiple linear regression to investigate numerical correlations between geometrical and flow parameters and WSS. The results of the multiple linear regression analysis further demonstrated that the BA proximal velocity was the most influential factor positively influencing BA WSS. The lower the WSS was, the stronger the influence brought by BA average diameter would be. The regression demonstrated that the contributions brought by average diameter and proximal velocity in lower WSS regions were lower than that in higher WSS regions. Tortuosity was only positively correlated with 97.5th WSS percentile, and vessel length and curvature showed no correlation with WSS. This study quantified the influence degree of BA morphology and flow velocity on WSS, which may have practical implications for predicting hemodynamic risks.
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Affiliation(s)
- Fangjia Pan
- Graduate school of Biomedical Engineering, Tohoku University, Sendai, Japan; Institute of Fluid Science, Tohoku University, Sendai, Japan
| | - Naoko Mori
- Department of Radiology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shunji Mugikura
- Department of Diagnostic Radiology, Graduate School of Medicine, Tohoku University, Sendai, Japan; Division of Image Statistics, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Makoto Ohta
- Institute of Fluid Science, Tohoku University, Sendai, Japan; ELyTMaX IRL3757, CNRS, Univ Lyon, INSA Lyon, Centrale Lyon, Tohoku University, Université Claude Bernard Lyon 1, Sendai, Japan
| | - Hitomi Anzai
- Institute of Fluid Science, Tohoku University, Sendai, Japan.
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Psiuk-Maksymowicz K, Borys D, Melka B, Gracka M, Adamczyk WP, Rojczyk M, Wasilewski J, Głowacki J, Kruk M, Nowak M, Ostrowski Z, Bialecki RA. Methodology of generation of CFD meshes and 4D shape reconstruction of coronary arteries from patient-specific dynamic CT. Sci Rep 2024; 14:2201. [PMID: 38273032 PMCID: PMC10811335 DOI: 10.1038/s41598-024-52398-5] [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: 10/05/2023] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Due to the difficulties in retrieving both the time-dependent shapes of the vessels and the generation of numerical meshes for such cases, most of the simulations of blood flow in the cardiac arteries use static geometry. The article describes a methodology for generating a sequence of time-dependent 3D shapes based on images of different resolutions and qualities acquired from ECG-gated coronary artery CT angiography. The precision of the shape restoration method has been validated using an independent technique. The original proposed approach also generates for each of the retrieved vessel shapes a numerical mesh of the same topology (connectivity matrix), greatly simplifying the CFD blood flow simulations. This feature is of significant importance in practical CFD simulations, as it gives the possibility of using the mesh-morphing utility, minimizing the computation time and the need of interpolation between boundary meshes at subsequent time instants. The developed technique can be applied to generate numerical meshes in arteries and other organs whose shapes change over time. It is applicable to medical images produced by other than angio-CT modalities.
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Affiliation(s)
- Krzysztof Psiuk-Maksymowicz
- Department of Systems Biology and Engineering, Silesian University of Technology, 44-100, Gliwice, Poland
- Biotechnology Centre, Silesian University of Technology, 44-100, Gliwice, Poland
| | - Damian Borys
- Department of Systems Biology and Engineering, Silesian University of Technology, 44-100, Gliwice, Poland.
- Biotechnology Centre, Silesian University of Technology, 44-100, Gliwice, Poland.
| | - Bartlomiej Melka
- Biomedical Engineering Lab, Department of Thermal Technology, Silesian University of Technology, 44-100, Gliwice, Poland
| | - Maria Gracka
- Biomedical Engineering Lab, Department of Thermal Technology, Silesian University of Technology, 44-100, Gliwice, Poland
| | - Wojciech P Adamczyk
- Biomedical Engineering Lab, Department of Thermal Technology, Silesian University of Technology, 44-100, Gliwice, Poland
| | - Marek Rojczyk
- Biomedical Engineering Lab, Department of Thermal Technology, Silesian University of Technology, 44-100, Gliwice, Poland
| | - Jaroslaw Wasilewski
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 41-800, Zabrze, Poland
- Silesian Centre for Heart Diseases, 41-800, Zabrze, Poland
| | - Jan Głowacki
- Silesian Centre for Heart Diseases, 41-800, Zabrze, Poland
- Department of Radiology and Radiodiagnostics, Medical University of Silesia, 41-800, Zabrze, Poland
| | - Mariusz Kruk
- Department of Coronary and Structural Heart Diseases, National Institute of Cardiology, 04-628, Warsaw, Poland
| | - Marcin Nowak
- Department of Mechanics of Materials and Structures, Gdańsk University of Technology, 80-233, Gdańsk, Poland
| | - Ziemowit Ostrowski
- Biomedical Engineering Lab, Department of Thermal Technology, Silesian University of Technology, 44-100, Gliwice, Poland.
| | - Ryszard A Bialecki
- Biomedical Engineering Lab, Department of Thermal Technology, Silesian University of Technology, 44-100, Gliwice, Poland
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Huang R, Gao F, Mo D, Yang M, Hou Z, Liu Y, Cui R, Kang K, Gu W, Miao Z, Ma N. High-Resolution Magnetic Resonance Imaging in Endovascular Treatment of Vertebrobasilar Junction Stenosis. Neurologist 2023; 28:413-418. [PMID: 37027180 PMCID: PMC10627536 DOI: 10.1097/nrl.0000000000000494] [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: 04/08/2023]
Abstract
INTRODUCTION Vertebrobasilar junction (VBJ) stenosis is a challenge in endovascular treatment due to structural variants and complexities. The role of high-resolution magnetic resonance imaging (HRMRI) in endovascular treatment for patients with severe VBJ stenosis is uncertain. CASE REPORT Four patients with symptomatic VBJ stenosis underwent HRMRI of the vessel wall before endovascular treatment. In 3 patients, the VBJ could not be visualized on luminal imaging. One of them had a hypoplastic artery and 2 of them had severe stenotic arteries on HRMRI. HRMRI showed an artery with a negative remodeling in a patient with a hypoplastic vertebral artery. One patient had intraplaque hemorrhage and calcification, and 2 patients had calcification in VBJ lesions. Endovascular treatment was performed utilizing HRMRI findings to guide the decision-making process. CONCLUSION HRMRI provides additional information about the structure and angle of the VBJ, the characteristics and vulnerability of the plaques, and the lesion size, thus helping to improve the operation process and reduce the risk of complications.
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Affiliation(s)
- Rui Huang
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
- Department of Neurology, Taizhou Central Hospital (Taizhou University Hospital), Zhejiang, China
| | - Feng Gao
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Dapeng Mo
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Ming Yang
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Zhikai Hou
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Yifan Liu
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Rongrong Cui
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Kaijiang Kang
- Department of Neurology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Weibin Gu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Zhongrong Miao
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
| | - Ning Ma
- Department of Interventional Neuroradiology
- China National Clinical Research Center for Neurological Disease, Beijing
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Qu M, Liu P, Tao T, Chen Y, Mao L, He X. Association between vertebrobasilar artery geometry and vertebrobasilar stenosis, recurrence, and death in posterior circulation stroke and transient ischemic attack. J Stroke Cerebrovasc Dis 2023; 32:107306. [PMID: 37598548 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107306] [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: 07/03/2023] [Revised: 08/08/2023] [Accepted: 08/12/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Intracranial atherosclerosis is one of the primary causes of posterior circulation stroke and transient ischemic attack (TIA), particularly in people of South and East Asian heritage. Focal vessel geometry may play a role in atherosclerosis progression. Thus, we investigated the relevance of vertebrobasilar artery (VBA) geometry and vertebrobasilar atherosclerotic stenosis, recurrence, and death in posterior circulation stroke and TIA. METHODS Four hundred and twenty patients with posterior circulation ischemic stroke or TIA were included. The VBA geometric features, comprising the geometric configurations (Tuning fork, Walking, Lambda, and No confluence), vascular bends (multi-bending and oligo-bending), and VBA stenosis degrees, were defined based on computed tomography angiography (CTA) images. Recurrence of stroke or TIA and death were assessed through a 1-year follow-up. Additionally, the relationship between VBA geometric features, VBA stenosis, and prognosis were analyzed. RESULTS Walking type and vascular multi-bending showed significant associations with more severe VBA stenosis and distribution, and these were also more frequently observed in patients with large-artery atherosclerosis (LAA) stroke (all P < 0.05). Sixty-four patients exhibited recurrent stroke or TIA, and 31 died during the 1-year follow-up. In the binary logistic regression analysis, Walking type (P = 0.018), Lambda type (P = 0.021), and multi-bending type (P = 0.004) were found to be independently associated with stroke recurrence, while No confluence type was independently associated with death (P = 0.010). CONCLUSIONS The geometric characteristics of the VBA are associated with vertebrobasilar stenosis, LAA stroke, 1-year recurrence, and death in posterior circulation stroke and TIA. VBA geometry may be used to stratify the risk of stroke and TIA in the posterior circulation.
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Affiliation(s)
- Man Qu
- Department of Neurology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou Univerisity, Taizhou, Zhejiang 318000, China
| | - Peng Liu
- Department of Neurology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou Univerisity, Taizhou, Zhejiang 318000, China
| | - Taotao Tao
- Department of Neurology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou Univerisity, Taizhou, Zhejiang 318000, China
| | - Yun Chen
- Department of Neurology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou Univerisity, Taizhou, Zhejiang 318000, China
| | - Lingqun Mao
- Department of Neurology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou Univerisity, Taizhou, Zhejiang 318000, China
| | - Xinwei He
- Department of Neurology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou Univerisity, Taizhou, Zhejiang 318000, China.
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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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Lee SJ, Lee TK, Moon JE. Vertebral artery foraminal segment doppler sonography to detect vertebral and basilar artery stenosis or occlusion. J Neuroimaging 2023; 33:852-859. [PMID: 37296498 DOI: 10.1111/jon.13131] [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: 01/09/2023] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND AND PURPOSE The diagnostic value of vertebral artery foraminal segment (V2) ultrasonography remains unclear. This study aimed to estimate the predictive value of V2 Doppler imaging for the detection of vertebrobasilar stenosis or occlusion. METHODS Three hundred sixty-four vertebral arteries from 182 patients were investigated. Abnormal Doppler spectra were categorized as high-resistance flow (resistive index ≥0.9), low-resistance flow (resistive index ≤0.5), increased flow velocity (peak systolic velocity ≥137.5 cm/second), or no flow signal. On MR angiography, stenosis and occlusion were defined as >50% narrowing and absent flow signals, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS Sixty of 364 vertebral arteries (16.5%) had V2 Doppler abnormalities, while 89 vertebrobasilar arteries (24.5%) had a stenosis or occlusion. The Doppler abnormalities predicted any stenosis or occlusion in the vertebrobasilar artery with a sensitivity of 56.2% and specificity of 96.4% (PPV, 83.3%; NPV, 87.2%). The hypoplastic vertebral artery (lumen diameter ≤2.7 mm) was more frequently associated with vertebrobasilar stenosis or occlusion, and with abnormal Doppler spectra (mostly high-resistance flow), even when it was nonstenotic, than the normal-diameter vertebral artery (p < .001, chi-square test). CONCLUSIONS The low sensitivity seems to be due to the high prevalence of non-V2 lesions not detected on V2 Doppler imaging, suggesting the necessity for a more extensive sonographic examination beyond V2. However, PPV and NPV ≥80% may suggest its usefulness in clinical practice.
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Affiliation(s)
- Seung-Jae Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Tae-Kyeong Lee
- Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
| | - Ji Eun Moon
- Department of Biostatistics, Clinical Trial Center, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
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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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Huang R, Yang B, Gao F, Mo D, Yang M, Hou Z, Liu Y, Cui R, Kang K, Gu W, He J, Lou X, Miao Z, Ma N. Association between basilar artery stenosis features, vertebral artery stenosis and perforator stroke after stenting. Interv Neuroradiol 2023:15910199231164840. [PMID: 36987683 DOI: 10.1177/15910199231164840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND AND PURPOSE We investigated the relationship between basilar artery (BA) atherosclerotic stenosis features and vertebral artery (VA) stenosis and explored whether BA stenosis features are associated with perforator stroke after stenting. METHODS Patients with BA stenosis who underwent HRMRI and DSA were recruited. Patients were divided into proximal BA stenosis and middle-or-distal BA stenosis groups, and then subgroup analyses were performed based on whether they had VA stenosis. BA plaque features were evaluated by HRMRI. Artery stenosis was measured by DSA. The incidence of perforator stroke after BA stenting was recorded, and the potential association between BA stenosis features and perforator stroke was analyzed. RESULTS One hundred and seventy-four patients were consecutively enrolled. Patients with proximal BA stenosis had a higher proportion of severe stenosis than those with middle-or-distal BA stenosis (P = 0.027). In the subgroup analysis, this difference mainly existed in patients complicated with VA stenosis (P = 0.023). Patients with proximal BA stenosis had a higher proportion of strong plaque enhancement than those with middle-or-distal BA stenosis (P < 0.001), especially in those with vertebrobasilar junction (VBJ) stenosis (P < 0.001). Perforator stroke after BA stenting occurred in five patients, of whom four had lateral wall BA plaques, four had plaque enhancement and four had proximal BA stenosis. CONCLUSION Patients with proximal BA stenosis had a higher proportion of severe stenosis and strong plaque enhancement, particularly in patients complicated with VA stenosis and VBJ stenosis. Perforator stroke after BA stenting may be related to distribution, burden and characteristics of BA lesions.
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Affiliation(s)
- Rui Huang
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Taizhou Central Hospital (Taizhou University Hospital), Zhejiang, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Bo Yang
- Department of Neurology, 626035Beijing Jiangong Hospital, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Ming Yang
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Zhikai Hou
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Yifan Liu
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Rongrong Cui
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Kaijiang Kang
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Weibin Gu
- China National Clinical Research Center for Neurological Disease, Beijing, China
- Department of Radiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianfeng He
- Department of Radiology, 104607Chinese PLA General Hospital, Beijing, China
| | - Xin Lou
- Department of Radiology, 104607Chinese PLA General Hospital, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, 105738Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Disease, Beijing, China
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Chung TD, Linville RM, Guo Z, Ye R, Jha R, Grifno GN, Searson PC. Effects of acute and chronic oxidative stress on the blood-brain barrier in 2D and 3D in vitro models. Fluids Barriers CNS 2022; 19:33. [PMID: 35551622 PMCID: PMC9097350 DOI: 10.1186/s12987-022-00327-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/04/2022] [Indexed: 12/12/2022] Open
Abstract
Oxidative stress is a shared pathology of neurodegenerative disease and brain injuries, and is derived from perturbations to normal cell processes by aging or environmental factors such as UV exposure and air pollution. As oxidative cues are often present in systemic circulation, the blood-brain barrier (BBB) plays a key role in mediating the effect of these cues on brain dysfunction. Therefore, oxidative damage and disruption of the BBB is an emergent focus of neurodegenerative disease etiology and progression. We assessed barrier dysfunction in response to chronic and acute oxidative stress in 2D and 3D in vitro models of the BBB with human iPSC-derived brain microvascular endothelial-like cells (iBMECs). We first established doses of hydrogen peroxide to induce chronic damage (modeling aging and neurodegenerative disease) and acute damage (modeling the response to traumatic brain injury) by assessing barrier function via transendothelial electrical resistance in 2D iBMEC monolayers and permeability and monolayer integrity in 3D tissue-engineered iBMEC microvessels. Following application of these chronic and acute doses in our in vitro models, we found local, discrete structural changes were the most prevalent responses (rather than global barrier loss). Additionally, we validated unique functional changes in response to oxidative stress, including dysfunctional cell turnover dynamics and immune cell adhesion that were consistent with changes in gene expression.
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Affiliation(s)
- Tracy D Chung
- Institute for Nanobiotechnology, Johns Hopkins University, 100 Croft Hall, 3400 North Charles Street, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Raleigh M Linville
- Institute for Nanobiotechnology, Johns Hopkins University, 100 Croft Hall, 3400 North Charles Street, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Zhaobin Guo
- Institute for Nanobiotechnology, Johns Hopkins University, 100 Croft Hall, 3400 North Charles Street, Baltimore, MD, USA
| | - Robert Ye
- Institute for Nanobiotechnology, Johns Hopkins University, 100 Croft Hall, 3400 North Charles Street, Baltimore, MD, USA
- Department of Applied Mathematics and Statistics, Johns Hopkins University, Baltimore, MD, USA
| | - Ria Jha
- Institute for Nanobiotechnology, Johns Hopkins University, 100 Croft Hall, 3400 North Charles Street, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Gabrielle N Grifno
- Institute for Nanobiotechnology, Johns Hopkins University, 100 Croft Hall, 3400 North Charles Street, Baltimore, MD, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Peter C Searson
- Institute for Nanobiotechnology, Johns Hopkins University, 100 Croft Hall, 3400 North Charles Street, Baltimore, MD, USA.
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Department of Materials Science and Engineering, Johns Hopkins University, Baltimore, MD, USA.
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Luan Y, Liu H, Luan Y, Yang Y, Yang J, Ren KD. New Insight in HDACs: Potential Therapeutic Targets for the Treatment of Atherosclerosis. Front Pharmacol 2022; 13:863677. [PMID: 35529430 PMCID: PMC9068932 DOI: 10.3389/fphar.2022.863677] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/21/2022] [Indexed: 12/13/2022] Open
Abstract
Atherosclerosis (AS) features include progressive hardening and reduced elasticity of arteries. AS is the leading cause of morbidity and mortality. An increasing amount of evidence showed that epigenetic modifications on genes serve are a main cause of several diseases, including AS. Histone deacetylases (HDACs) promote the deacetylation at lysine residues, thereby condensing the chromatin structures and further inhibiting the transcription of downstream genes. HDACs widely affect various physiological and pathological processes through transcriptional regulation or deacetylation of other non-histone proteins. In recent years, the role of HDACs in vascular systems has been revealed, and their effects on atherosclerosis have been widely reported. In this review, we discuss the members of HDACs in vascular systems, determine the diverse roles of HDACs in AS, and reveal the effects of HDAC inhibitors on AS progression. We provide new insights into the potential of HDAC inhibitors as drugs for AS treatment.
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Affiliation(s)
- Yi Luan
- Research Center for Clinical System Biology, Translational Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hui Liu
- School of Laboratory Medicine, Xinxiang Medical University, Xinxiang, China
| | - Ying Luan
- Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
| | - Yang Yang
- Research Center for Clinical System Biology, Translational Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yang Yang, ; Jing Yang, ; Kai-Di Ren,
| | - Jing Yang
- Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yang Yang, ; Jing Yang, ; Kai-Di Ren,
| | - Kai-Di Ren
- Henan Key Laboratory of Precision Clinical Pharmacy, Zhengzhou University, Zhengzhou, China
- Department of Pharmacy, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yang Yang, ; Jing Yang, ; Kai-Di Ren,
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11
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Li J, Yang WJ, Zheng L, Du H, Chu WCW, Leung TWH, Chen XY. Vertebrobasilar Junction Angle Over 90°: A Potential Imaging Marker Associated With Vertebrobasilar Atherosclerosis. Front Neurosci 2022; 15:789852. [PMID: 35069103 PMCID: PMC8766791 DOI: 10.3389/fnins.2021.789852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/23/2021] [Indexed: 11/22/2022] Open
Abstract
Objective: Whether the cerebral vascular variations play an important role in the progression of intracranial atherosclerosis is yet largely unclear. We aimed to investigate the relationship between the magnitude of the vertebrobasilar junction (VBJ) angle and the imaging features of vertebrobasilar artery atherosclerosis. Methods: Adult patients with acute ischemic stroke or transient ischemic attack undergoing a 3.0-tesla vessel wall magnetic resonance imaging (VW-MRI) scanning were consecutively included. Imaging features of vertebrobasilar artery atherosclerosis were assessed on the reconstructed short axis of VW-MRI at the most stenotic site. The VBJ angle degree was measured on magnetic resonance angiography and classified into the angle ≥90° or <90°. Results: Among 68 patients (mean age = 63.5 ± 9.4 years old; 63.2% were male) with vertebrobasilar atherosclerosis, 33 had a VBJ angle ≥90° and 35 had a VBJ angle <90°. Compared to the vertebrobasilar plaques with VBJ angle <90°, those with VBJ angle ≥90° had a heavier plaque burden (84.35 vs. 70.58%, p < 0.001) and higher prevalence of intraplaque hemorrhage (17.1 vs. 3.3%, p = 0.01). In the regression analyses, the VBJ angle ≥90° was also robustly associated with plaque burden (odds ratio, 1.11; 95% confidential interval, 1.043–1.18; p = 0.001) and intraplaque hemorrhage (odds ratio, 5.776; 95% confidential interval, 1.095–30.46; p = 0.039) of vertebrobasilar atherosclerosis. Conclusion: The VBJ angle over 90° might aggravate the vessel wall condition of the atherosclerotic vertebrobasilar arteries, which might serve as a potential risk factor for vertebrobasilar atherosclerosis.
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Affiliation(s)
- Jia Li
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Wen-Jie Yang
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland, Baltimore, Baltimore, MD, United States
| | - Lu Zheng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Heng Du
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Winnie Chiu-Wing Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Thomas Wai-Hong Leung
- Division of Neurology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Xiang-Yan Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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12
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Tang H, Wang Q, Xu F, Zhang X, Zeng Z, Yan Y, Lu Z, Xue G, Zuo Q, Luo Y, Liu J, Huang Q. Underlying mechanism of hemodynamics and intracranial aneurysm. Chin Neurosurg J 2021; 7:44. [PMID: 34847937 PMCID: PMC8638472 DOI: 10.1186/s41016-021-00260-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/17/2021] [Indexed: 12/13/2022] Open
Abstract
In modern society, subarachnoid hemorrhage, mostly caused by intracranial aneurysm rupture, is accompanied by high disability and mortality rate, which has become a major threat to human health. Till now, the etiology of intracranial aneurysm has not been entirely clarified. In recent years, more and more studies focus on the relationship between hemodynamics and intracranial aneurysm. Under the physiological condition, the mechanical force produced by the stable blood flow in the blood vessels keeps balance with the structure of the blood vessels. When the blood vessels are stimulated by the continuous abnormal blood flow, the functional structure of the blood vessels changes, which becomes the pathophysiological basis of the inflammation and atherosclerosis of the blood vessels and further promotes the occurrence and development of the intracranial aneurysm. This review will focus on the relationship between hemodynamics and intracranial aneurysms, will discuss the mechanism of occurrence and development of intracranial aneurysms, and will provide a new perspective for the research and treatment of intracranial aneurysms.
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Affiliation(s)
- Haishuang Tang
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.,Naval Medical Center of PLA, Naval Military Medical University, Shanghai, 200050, People's Republic of China
| | - Qingsong Wang
- Department of Cardiology, the First Medical Centre, Chinese PLA General Hospital, Beijing, 100853, People's Republic of China
| | - Fengfeng Xu
- Naval Medical Center of PLA, Naval Military Medical University, Shanghai, 200050, People's Republic of China
| | - Xiaoxi Zhang
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Zhangwei Zeng
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Yazhou Yan
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Zhiwen Lu
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Gaici Xue
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Qiao Zuo
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Yin Luo
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Jianmin Liu
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
| | - Qinghai Huang
- Department of Neurosurgery, Changhai Hospital, Naval Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
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13
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Dinç Y, Özpar R, Emir B, Hakyemez B, Bakar M. Vertebral artery hypoplasia as an independent risk factor of posterior circulation atherosclerosis and ischemic stroke. Medicine (Baltimore) 2021; 100:e27280. [PMID: 34559134 PMCID: PMC8462547 DOI: 10.1097/md.0000000000027280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 08/11/2021] [Accepted: 09/01/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Vertebral artery hypoplasia (VAH) is a frequent anatomical variation of vertebral arteries, with emerging evidence suggesting that it contributes to posterior circulation ischemia. However, the relationship between VAH and ischemic stroke remains unknown. Hence, this study aimed to determine the prevalence of VAH in patients diagnosed with acute ischemic stroke who were followed up in a neurology clinic and to determine if it can potentially be a risk factor for atherosclerotic stenosis in vertebrobasilar circulation.This retrospective study included 609 patients diagnosed with acute ischemic stroke between January 1, 2019 and January 1, 2020. Demographic of patients, risk factors, radiological and clinical characteristics were evaluated.Posterior circulation was very common in patients with VAH, and the most common locations of atherosclerotic stenosis were V1 and V4 segments of the vertebral artery and the middle segment of basilar artery. Analysis of the risk factors for atherosclerotic stenosis in patients with posterior circulation acute ischemic stroke suggested that VAH was an independent risk factor.Findings of the study suggest that VAH pre-disposes atherosclerotic stenosis in vertebrobasilar circulation, although its mechanism remains unknown. Hemodynamic parameters associated with atherosclerosis could not be measured in vivo. Thus, to better understand the underlying mechanism, conducting studies that examine blood flow parameters with high-resolution magnetic resonance angiography in patients diagnosed with acute cerebral ischemia patients with VAH is warranted.
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Affiliation(s)
- Yasemin Dinç
- Uludağ University Medicine Faculty, Department of Neurology, Turkey
| | - Rifat Özpar
- Uludağ University Medicine Faculty, Department of Radiology, Turkey
| | - Büşra Emir
- Izmir Katip Celebi University, Department of Biostatistic, Turkey
| | | | - Mustafa Bakar
- Uludağ University Medicine Faculty, Department of Neurology, Turkey
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14
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Gaddam DS, Crews G, Chryssikos T, Gandhi D, Morales R, Zhuo J, Almardawi R, Raghavan P. Circumferential segmental vessel-wall enhancement on black blood MRI in patients referred for the evaluation of vasculopathy. Clin Imaging 2021; 80:67-71. [PMID: 34246832 DOI: 10.1016/j.clinimag.2021.05.024] [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: 12/20/2020] [Revised: 04/26/2021] [Accepted: 05/26/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND High resolution intracranial vessel wall magnetic resonance imaging, or black blood MRI, has recently gained traction as an adjunct to computed tomography angiography, magnetic resonance angiography, and digital subtraction angiography in the characterization of atherosclerosis, vasculitides, and inflammatory changes in the aneurysm wall. However, the occurrence of uniform circumferential segmental arterial vessel wall enhancement (CSWE) in patients without these diagnoses has not previously been studied. The purpose of this study is twofold: 1) to evaluate the prevalence of CSWE in the major intracranial arteries in patients without vasculitides, symptomatic atherosclerosis, or aneurysmal subarachnoid hemorrhage and 2) to determine the association, if any, between such enhancement and risk factors for cerebrovascular atherosclerotic disease. MATERIALS & METHODS A retrospective study of vessel wall magnetic resonance imaging examinations was performed to evaluate for CSWE in 26 patients without known vessel wall pathology such as aneurysms or vasculitides and intracranial hemorrhage. Further evaluation of CSWE association with major intracranial atherosclerotic disease risk factors including hypertension, hyperlipidemia, diabetes mellitus and cigarette smoking was performed. RESULTS AND CONCLUSION 46% of the cohort of patients demonstrated CSWE. Among the patients with CSWE, there was increased prevalence of CSWE in the posterior circulation vasculature with particular predilection to the V4 vertebral artery segments (92%), although there was greater association of anterior circulation CSWE with risk factors for atherosclerosis. Patients with anterior circulation CSWE also demonstrated the most number of segments with CSWE. We therefore propose that CSWE, particularly in the anterior circulation, may portend early atherosclerosis.
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Affiliation(s)
- Durga Sivacharan Gaddam
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA.
| | - Gordon Crews
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
| | - Timothy Chryssikos
- Department of Neurosurgery, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
| | - Dheeraj Gandhi
- Department of Neurointerventional Radiology, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
| | - Robert Morales
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
| | - Jiachen Zhuo
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
| | - Ranyah Almardawi
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
| | - Prashant Raghavan
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, 655 W. Baltimore St., Baltimore, MD 21201, USA
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15
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Zheng J, Sun B, Lin R, Teng Y, Zhao X, Xue Y. Association between the vertebrobasilar artery geometry and basilar artery plaques determined by high-resolution magnetic resonance imaging. BMC Neurosci 2021; 22:20. [PMID: 33765922 PMCID: PMC7992992 DOI: 10.1186/s12868-021-00624-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
Background Atherosclerotic plaques are often present in regions of arteries with complicated flow patterns. Vascular morphology plays important role in hemodynamics. In this study, we investigated the relationship between the geometry of the vertebrobasilar artery system and presence of basilar artery (BA) plaque. Methods We enrolled 290 patients with posterior circulation ischemic stroke. We distinguished four configurations of the vertebrobasilar artery: Walking, Tuning Fork, Lambda, and No Confluence. Patients were divided into multi-bending (≥ 3 bends) and oligo-bending (< 3 bends) VA groups. The diameter of the vertebral artery (VA) and the number of bends in the intracranial VA segment were assessed using three-dimensional time-of-flight magnetic resonance angiography. High-resolution magnetic resonance imaging was used to evaluate BA plaques. Logistic regression models were used to determine the relationship between the geometry type and BA plaque prevalence. Results After adjusting for sex, age, body mass index ≥ 28, hypertension, and diabetes mellitus, the Walking, Lambda, and No Confluence geometries were associated with the presence of BA plaque (all p < 0.05). Patients with multi-bending VAs in both the Walking (20/28, 71.43% vs. 6/21, 28.57%, p = 0.003) and Lambda group (19/47, 40.43% vs. 21/97, 21.65%, p = 0.018) had more plaques compared to patients with oligo-bending VAs in these groups. In the Lambda group, the difference in diameter of bilateral VAs was larger in patients with BA plaques than that in patients without BA plaques (1.4 mm [IQR: 0.9–1.6 mm] vs. 0.9 mm [IQR: 0.6–1.3 mm], p < 0.001). Conclusions The Walking, Lambda, and No Confluence geometry, ≥ 3 bends in the VAs, and a large diameter difference between bilateral VAs are associated with the presence of BA plaque. Supplementary Information The online version contains supplementary material available at 10.1186/s12868-021-00624-5.
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Affiliation(s)
- Jinmei Zheng
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Bin Sun
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Ruolan Lin
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Yongqi Teng
- Department of Radiology, Changle District Hospital of Fuzhou, Fuzhou, 350299, Fujian, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, 100084, China
| | - Yunjing Xue
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China.
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16
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Characteristics of basilar artery atherosclerotic plaques in pontine infarctions: A high-resolution magnetic resonance imaging study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 2:100005. [PMID: 36324728 PMCID: PMC9616278 DOI: 10.1016/j.cccb.2021.100005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/26/2021] [Accepted: 01/31/2021] [Indexed: 11/24/2022]
Abstract
This study used a 3.0T high-resolution magnetic resonance imaging to explore basilar artery plaque characteristics in patients suffering from acute isolated pontine infarction. The study also used plaque analysis software to calculate the properties of the plaques and to fully analyze and compare the differences between two types of pontine infarction. The result may account for the different prognosis associated with these two types of pontine infarction.
Objective This study used a 3.0T high-resolution magnetic resonance imaging approach to explore basilar artery plaque characteristics in patients suffering from acute isolated pontine infarction. Materials and methods 30 consecutive patients suffering from acute isolated pontine infarction were enrolled in this study and underwent examinations including high-resolution MRI assessment of the basilar artery within 7 days following infarction. Results The basilar artery plaque burden of 16 patients with paramedian pontine infarction was 0.26±0.085, while the reconstruction index and enhancement rate index values in these patients were 1.097±0.133 and 1.750±0.447, respectively. In the 14 patients suffering from deep pontine infarction, these three values were 0.21±0.055, 0.896±0.223, and 1.285±0.611, respectively.These values differed significantly when comparing patients suffering from paramedian pontine infarction to those suffering from deep pontine infarction. Conclusion This study suggests that the characteristics of basilar artery plaques differ between the two subtypes of pontine infarctions, which may account for the differences in prognosis associated with these two infarct subtypes.
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17
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Xu Z, Li M, Hou Z, Lyu J, Zhang N, Lou X, Miao Z, Ma N. Association between basilar artery configuration and Vessel Wall features: a prospective high-resolution magnetic resonance imaging study. BMC Med Imaging 2019; 19:99. [PMID: 31878890 PMCID: PMC6933671 DOI: 10.1186/s12880-019-0388-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The relationship between intracranial vessel configuration and wall features remains poorly investigated. Therefore, we aimed to investigate the relationship between the distal and proximal anatomical configuration of basilar artery (BA) and BA vessel wall features on high-resolution magnetic resonance imaging (HRMRI). METHODS From September 2014 to January 2017, patients with suspected symptomatic intracranial arterial stenosis underwent HRMRI. Patients with severe BA stenosis were selected for this prospective study and divided into two groups corresponding to complete and incomplete BA configuration based on characteristics of the bilateral vertebral arteries and posterior cerebral arteries. Culprit blood vessel wall features on HRMRI included plaque enhancement, intraplaque hemorrhage, remodeling patterns, and plaque distribution. Culprit vessel wall features were compared between patients in the complete and incomplete BA configuration groups. RESULTS Among the 298 consecutively enrolled patients, 34 had severe BA stenosis. Twenty patients had complete anatomical BA configuration and another 14 of them displayed incomplete configuration. There were no significant differences in vessel wall features between the complete and incomplete configuration patient groups. However, the proximal configuration of BA was associated with intraplaque hemorrhage (p = 0.002) while the distal configuration of BA correlated with strong enhancement of BA plaque (p = 0.041). CONCLUSIONS No association was found between the complete and incomplete BA configuration groups and blood vessel wall features. The proximal configuration of BA was related with intraplaque hemorrhage and the distal configuration of BA was associated with strong plaque enhancement. Further studies are warranted to confirm these findings. TRIAL REGISTRATION URL: Unique identifier: NCT02705599 (March 10, 2016).
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Affiliation(s)
- Ziqi Xu
- Department of Neurology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Mingyao Li
- Department of Interventional, Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Zhikai Hou
- Department of Interventional, Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Jinhao Lyu
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Na Zhang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Zhongrong Miao
- Department of Interventional, Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China
| | - Ning Ma
- Department of Neurology, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China.
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Zhu G, Wei Y, Yuan Q, Yang J, Yeo JH. PIV investigation of the flow fields in subject-specific vertebro-basilar (VA-BA) junction. Biomed Eng Online 2019; 18:93. [PMID: 31492145 PMCID: PMC6731569 DOI: 10.1186/s12938-019-0711-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022] Open
Abstract
Background As the only arterial structure of which two main arteries merged into one, the vertebro-basilar (VA-BA) system is one of the favorite sites of cerebral atherosclerotic plaques. The aim of this study was to investigate the detailed hemodynamics characteristics in the VA-BA system. Methods A scale-up subject-specific flow phantom of VA-BA system was fabricated based on the computed tomography angiography (CTA) scanning images of a healthy adult. Flow fields in eight axial planes and six radial planes were measured and analyzed by using particle image velocimetry (PIV) under steady flow conditions of \documentclass[12pt]{minimal}
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\begin{document}$${Re}=300$$\end{document}Re=300, \documentclass[12pt]{minimal}
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\begin{document}$${Re}=500$$\end{document}Re=500. A water–glycerin mixture was used as the working fluid. Results The flow in the current model exhibited highly three-dimensional characteristics. The confluence of VAs flow formed bimodal velocity distribution near the confluence apex. Due to the asymmetrical structural configuration, the bimodal velocity profile skewed towards left, and sharper peaks were observed under higher Reynolds condition. Secondary flow characterized by two vortices formed in the radial planes where 10 mm downstream the confluence apex and persists along the BA under both Reynolds numbers. The strength of secondary flow under \documentclass[12pt]{minimal}
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\begin{document}$${Re}=500$$\end{document}Re=500 is around 8% higher than that under \documentclass[12pt]{minimal}
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\begin{document}$${Re}=300$$\end{document}Re=300, and decayed nonlinearly along the flow direction. In addition, a low momentum recirculation region induced by boundary layer separation was observed near the confluence apex. The wall shear stress (WSS) in the recirculation area was found to be lower than 0.4 Pa. This region coincides well with the preferential site of vascular lesions in the VA-BA system. Conclusions This preliminary study verified that the subject-specific in-vitro experiment is capable of reflecting the detailed flow features in the VA-BA system. The findings from this study may help to expand the understanding of the hemodynamics in the VA-BA system, and further clarifying the mechanism that underlying the localization of vascular lesions.
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Affiliation(s)
- Guangyu Zhu
- School of Energy and Power Engineering, Xi'an Jiaotong University, No. 28 Xian Ning West Road, Xi'an, 710049, China
| | - Yuan Wei
- School of Energy and Power Engineering, Xi'an Jiaotong University, No. 28 Xian Ning West Road, Xi'an, 710049, China
| | - Qi Yuan
- School of Energy and Power Engineering, Xi'an Jiaotong University, No. 28 Xian Ning West Road, Xi'an, 710049, China.
| | - Jian Yang
- Department of Radiology and Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Weest Road, Xi'an, 710061, China
| | - Joon Hock Yeo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
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Tucker T. Fluid dynamics of thoracic cavity venous flow in multiple sclerosis. Med Hypotheses 2019; 131:109236. [PMID: 31443776 DOI: 10.1016/j.mehy.2019.109236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
This paper hypothesizes, based on fluid dynamics principles, that in multiple sclerosis (MS) non-laminar, vortex blood flow occurs in the superior vena cava (SVC) and brachiocephalic veins (BVs), particularly at junctions with their tributary veins. The physics-based analysis demonstrates that the morphology and physical attributes of the major thoracic veins, and their tributary confluent veins, together with the attributes of the flowing blood, predict transition from laminar to non-laminar flow, primarily vortex flow, at select vein curvatures and junctions. Non-laminar, vortex flow results in the development of immobile stenotic valves and intraluminal flow obstructions, particularly in the internal jugular veins (IJVs) and in the azygos vein (AV) at their confluences with the SVC or BVs. Clinical trials' observations of vascular flow show that regions of low and reversing flow are associated with endothelial malformation. The physics-based analysis predicts the growth of intraluminal flaps and septa at segments of vein curvature and flow confluences. The analysis demonstrates positive correlations between predicted and clinically observed elongation of valve leaflets and between the predicted and observed prevalence of immobile valves at various venous flow confluences. The analysis predicts the formation of sclerotic plaques at venous junctions and curvatures, in locations that are analogous to plaques in atherosclerosis. The analysis predicts that increasing venous compliance increases the laminarity of venous flow and reduces the prevalence and severity of vein malformations and plaques, a potentially significant clinical result. An over-arching observation is that the correlations between predicted phenomena and clinically observed phenomena are sufficiently positive that the physics-based approach represents a new means for understanding the relationships between venous flow in MS and clinically observed venous malformations.
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Ramalho LS, Silveira LAMD, Fonseca BC, Félix JER, Morais LJ, Soares MH, Ferraz MLF, Teixeira VDPA, Pereira SAL. Width of sulcus and thickness of gyrus in patients with cerebral atherosclerosis: a new tool for the prevention of vascular cognitive impairment. ACTA ACUST UNITED AC 2019; 64:684-691. [PMID: 30673038 DOI: 10.1590/1806-9282.64.08.684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/24/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND PURPOSE Cerebral atherosclerosis is the main cause of lesions that contribute to vascular cognitive impairment and vascular dementia, followed by arteriosclerosis of small vessels and cerebral amyloid angiopathy. The purpose of this study was to compare the post-mortem radiological alterations of autopsied adults with the macroscopic alterations in the posterior region of these brains in order to establish a relationship between the two forms of analysis and to discuss the relevance of the prevention of vascular cognitive impairment in patients with encephalic atherosclerosis. MATERIALS AND METHODS Thirteen brains were analysed macroscopically to assess the degree of atherosclerosis of the basilar and the posterior cerebral arteries. The patients were autopsied in the Subject of General Pathology at General Hospital of Triângulo Mineiro Federal University in Uberaba, state of Minas Gerais, Brazil. The qualitative analysis of atherosclerosis was performed with classification into mild, moderate or severe. In the posterior region of the brains, width of sulcus and thickness of gyrus were measured by macroscopic analysis and by tomographic analysis. RESULTS AND CONCLUSIONS There was a decrease in calcarine sulcus width and an increase in medial temporal occipital gyrus thickness in patients with a higher degree of atherosclerosis, macroscopically and in tomography, respectively. Low oxygenation caused by atherosclerosis probably leads to an encephalic parenchyma inflammation that causes microglial cells hypertrophy provoking increase in the gyrus thickness and decrease in the sulcus width, as observed in the present study.
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Affiliation(s)
- Luciana Santos Ramalho
- . PhD in Pathology, Student of Postgraduate Course Health Sciences, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba (MG), Brasil
| | - Luciano Alves Matias da Silveira
- . MS in Pathology, Anesthesiologist, Professor of Anesthesiology, Department of Surgery, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba (MG), Brasil
| | - Bárbara Cecílio Fonseca
- . Medical Student at UFTM, Scientific Initiation Grant from UFTM (BIC/Fapemig), Uberaba (MG), Brasil
| | - José Eduardo Reis Félix
- . Department of Radiology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba (MG), Brasil
| | - Lourimar José Morais
- . MS in Pathology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba (MG), Brasil
| | - Maria Helena Soares
- . MS in Pathology, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba (MG), Brasil
| | - Mara Lúcia Fonseca Ferraz
- . PhD in Pathology, Professor of Postgraduate Course Health Sciences, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba (MG), Brasil
| | - Vicente de Paula Antunes Teixeira
- . Pathologist, Professor of General Pathology, Institute of Biological and Natural Sciences, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba (MG), Brasil
| | - Sanívia Aparecida Lima Pereira
- . PhD in Pathology, Professor of Postgraduate Course Health Sciences, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba (MG), Brasil
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Yu J, Zhang S, Li ML, Ma Y, Dong YR, Lou M, Feng F, Gao S, Wu SW, Xu WH. Relationship between the geometry patterns of vertebrobasilar artery and atherosclerosis. BMC Neurol 2018; 18:83. [PMID: 29895279 PMCID: PMC5996488 DOI: 10.1186/s12883-018-1084-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/30/2018] [Indexed: 12/20/2022] Open
Abstract
Background The plaques at the dorsal or lateral wall of basilar artery (BA) are associated with pontine infarcts. We sought to explore the correlations between vertebrobasilar artery geometry and BA plaque locations. Methods We retrospectively analyzed the imaging and clinical data of 84 patients with BA atherosclerosis. On three-dimensional time-of-flight images, a side to side diameter difference of bilateral vertebral artery (VA) and BA bending were assessed. The vertebrobasilar artery geometry was qualitatively classified into four basic configurations: Walking, Tuning Fork, Dominant-Lambda, and Hypoplasia-Lambda. On high-resolution magnetic resonance imaging, the plaques were categorized based on the involvement of the ventral, dorsal, or lateral sides of BA wall. The relationships between vertebrobasilar artery geometry parameters and plaque locations were analyzed. Results Left VA dominance was identified in 28(33%) patients, and right VA dominance in 22(26%) patients. BA bending were detected in 49 patients. There were no significant correlations between the diameter difference/ratio of VA diameters and plaque locations, or between BA bending and plaque locations. BA plaques were evenly distributed in the vertebrobasilar arteries with Tuning Fork and Dominant-Lambda configurations. In Hypoplasia-Lambda group, however, plaques were more frequently located at the dorsal wall (58.57%) than at the ventral (14.43%) and lateral wall (26.71%; P = 0.001). In Walking group, the plaques more likely occurred at the lateral (49.79%) and dorsal (35.07%) wall than at the ventral wall (14.86%, P = 0.02). Conclusions The geometric configurations of vertebrobasilar artery strongly influence the BA plaque locations. Further prospective studies are warranted to testify whether Hypoplasia-Lambda and Walking configurations are independent risk factors for pontine infarcts. Electronic supplementary material The online version of this article (10.1186/s12883-018-1084-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jin Yu
- Department of Neurology and Radiology, General Hospital of Chinese People's Armed Police Forces, 69 Yongding road, Haidian District, Beijing, 100039, China
| | - Shu Zhang
- Department of Neurology and Radiology, General Hospital of Chinese People's Armed Police Forces, 69 Yongding road, Haidian District, Beijing, 100039, China
| | - Ming-Li Li
- Department of Neurology and Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Yi Ma
- Department of Neurology and Radiology, General Hospital of Chinese People's Armed Police Forces, 69 Yongding road, Haidian District, Beijing, 100039, China
| | - Yu-Ru Dong
- Department of Neurology and Radiology, General Hospital of Chinese People's Armed Police Forces, 69 Yongding road, Haidian District, Beijing, 100039, China
| | - Min Lou
- Department of Neurology, Zhejiang University 2nd Affiliate Hospital, Hangzhou, Zhejiang Province, China
| | - Feng Feng
- Department of Neurology and Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Shan Gao
- Department of Neurology and Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China
| | - Shi-Wen Wu
- Department of Neurology and Radiology, General Hospital of Chinese People's Armed Police Forces, 69 Yongding road, Haidian District, Beijing, 100039, China.
| | - Wei-Hai Xu
- Department of Neurology and Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan 1, Dongcheng District, Beijing, 100730, China.
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Morbiducci U, Kok AM, Kwak BR, Stone PH, Steinman DA, Wentzel JJ. Atherosclerosis at arterial bifurcations: evidence for the role of haemodynamics and geometry. Thromb Haemost 2018; 115:484-92. [DOI: 10.1160/th15-07-0597] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/13/2015] [Indexed: 11/05/2022]
Abstract
SummaryAtherosclerotic plaques are found at distinct locations in the arterial system, despite the exposure to systemic risk factors of the entire vascular tree. From the study of arterial bifurcation regions, emerges ample evidence that haemodynamics are involved in the local onset and progression of the atherosclerotic disease. This observed co-localisation of disturbed flow regions and lesion prevalence at geometrically predisposed districts such as arterial bifurcations has led to the formulation of a ‘haemodynamic hypothesis’, that in this review is grounded to the most current research concerning localising factors of vascular disease. In particular, this review focuses on carotid and coronary bifurcations because of their primary relevance to stroke and heart attack. We highlight reported relationships between atherosclerotic plaque location, progression and composition, and fluid forces at vessel’s wall, in particular shear stress and its ‘easier-tomeasure’ surrogates, i.e. vascular geometric attributes (because geometry shapes the flow) and intravascular flow features (because they mediate disturbed shear stress), in order to give more insight in plaque initiation and destabilisation. Analogous to Virchow’s triad for thrombosis, atherosclerosis must be thought of as subject to a triad of, and especially interactions among, haemodynamic forces, systemic risk factors, and the biological response of the wall.
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23
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Incremental Value of Plaque Enhancement in Patients with Moderate or Severe Basilar Artery Stenosis: 3.0 T High-Resolution Magnetic Resonance Study. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4281629. [PMID: 29075645 PMCID: PMC5623789 DOI: 10.1155/2017/4281629] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/07/2017] [Accepted: 07/16/2017] [Indexed: 11/22/2022]
Abstract
Aim To investigate the clinical relevance of plaque's morphological characteristics and distribution pattern using 3.0 T high-resolution magnetic resonance imaging (HRMRI) in patients with moderate or severe basilar artery (BA) atherosclerosis stenosis. Materials and Methods Fifty-seven patients (33 symptomatic patients and 24 asymptomatic patients) were recruited for 3.0 T HRMRI scan; all of them had >50% stenosis on the BA. The intraplaque hemorrhage (IPH), contrast-enhancement pattern, and distribution of BA plaques were compared between the symptomatic and asymptomatic groups. Factors potentially associated with posterior ischemic stroke were calculated by multivariate analyses. Results Enhancement of BA plaque was more frequently observed in symptomatic than in asymptomatic patients (27/33, 81.8% versus 11/24, 45.8%; p < 0.01). In multivariate regression analysis, plaque enhancement (OR = 7.193; 95% CI: 1.880–27.517; p = 0.004) and smoking (OR = 4.402; 95% CI: 2.218–15.909; p = 0.024) were found to be independent risk factors of posterior ischemic events in patients with BA stenosis >50%. Plaques were mainly distributed at the ventral site (39.3%) or involved more than two arcs (21.2%) in the symptomatic group but were mainly distributed at left (33.3%) and right (25.0%) sites in the asymptomatic group.
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24
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Roth W, Morgello S, Goldman J, Mohr JP, Elkind MSV, Marshall RS, Gutierrez J. Histopathological Differences Between the Anterior and Posterior Brain Arteries as a Function of Aging. Stroke 2017; 48:638-644. [PMID: 28196941 DOI: 10.1161/strokeaha.116.015630] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/15/2016] [Accepted: 12/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE We tested the hypothesis that posterior brain arteries differ pathologically from anterior brain arteries and that this difference varies with age. METHODS Brain large arteries from 194 autopsied individuals (mean age 56±17 years, 63% men, 25% nonwhite, 17% with brain infarcts) were analyzed to obtain the areas of arterial layers and lumen as well as the relative content of elastin, collagen, and amyloid. Visual rating was used to determine the prevalence of atheroma, calcification, vasa vasorum, pattern of intima thickening, and internal elastic lamina gaps. We used multilevel models adjusting for age, sex, ethnicity, vascular risk factors, artery type and location, and multiple comparisons. RESULTS Of 1362 large artery segments, 5% had vasa vasorum, 5% had calcifications, 15% had concentric intimal thickening, and 11% had atheromas. Posterior brain arteries had thinner walls, less elastin, and more concentric intima thickening than anterior brain arteries. Compared to anterior brain arteries, the basilar artery had higher arterial area encircled by the internal elastic lamina, whereas the vertebral arteries had higher prevalence of elastin loss, concentric intima thickening, and nonatherosclerotic stenosis. In younger individuals, vertebral artery calcifications were more likely than calcification in anterior brain arteries, but this difference attenuated with age. CONCLUSIONS Posterior brain arteries differ pathologically from anterior brain arteries in the degree of wall thickening, elastin loss, and concentric intimal thickening.
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Affiliation(s)
- William Roth
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Susan Morgello
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - James Goldman
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Jay P Mohr
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Mitchell S V Elkind
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Randolph S Marshall
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.)
| | - Jose Gutierrez
- From the Department of Neurology, College of Physicians and Surgeons (W.R., J.P.M., M.S.V.E., R.S.M., J. Gutierrez), Department of Pathology and Cell Biology (J. Goldman), and Department of Epidemiology, Mailman School of Public Health (M.S.V.E.), Columbia University Medical Center, New York, NY; and Departments of Neurology, Neuroscience, and Pathology, Icahn School of Medicine at Mount Sinai, New York, NY (S.M.).
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Li LJ, Kramer M, Tapp RJ, Man REK, Lek N, Cai S, Yap F, Gluckman P, Tan KH, Chong YS, Koh JY, Saw SM, Cheung YB, Wong TY. Gestational diabetes mellitus and retinal microvasculature. BMC Ophthalmol 2017; 17:4. [PMID: 28100181 PMCID: PMC5241913 DOI: 10.1186/s12886-016-0398-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/16/2016] [Indexed: 12/17/2022] Open
Abstract
Background Small-vessel dysfunction may be an important consequence of chronic hyperglycemia. We examined the association between gestational diabetes mellitus (GDM), a state of transient hyperglycemia during pregnancy, and retinal microvascular changes in pregnant women at 26–28 weeks of pregnancy. Methods A total of 1136 pregnant women with singleton pregnancies were recruited during their first trimester at two major Singapore maternity hospitals in an on-going birth cohort study. Participants underwent an oral glucose tolerance test and retinal imaging at 26–28 weeks gestation (n = 542). We used the 1999 World Health Organization (WHO) criteria to define GDM: ≥7.0 mmol/L for fasting glucose and/or ≥7.8 mmol/L for 2-h post-glucose. Retinal microvasculature was measured using computer software (Singapore I Vessel Analyzer, SIVA version 3.0, Singapore Eye Research Institute, Singapore) from the retinal photographs. Results In a multiple linear regression model adjusting for age, ethnicity and maternal education, mothers with GDM had narrower arteriolar caliber (−1.6 μm; 95% Confidence Interval [CI]: −3.1 μm, −0.2 μm), reduced arteriolar fractal dimension (−0.01 Df; 95% CI: −0.02 Df, −0.001 Df;), and larger arteriolar branching angle (1.8°; 95% CI: 0.3°, 3.3°) than mothers without GDM. After further adjusting for traditional risks of GDM, arteriolar branching angle remained significantly larger in mothers with GDM than those without GDM (2.0°; 95% CI: 0.5°, 3.6°). Conclusions GDM was associated with a series of retinal arteriolar abnormalities, including narrower caliber, reduced fractal dimension and larger branching angle, suggesting that transient hyperglycemia during pregnancy may cause small-vessel dysfunction.
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Affiliation(s)
- Ling-Jun Li
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.,Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Michael Kramer
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Departments of Pediatrics and of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Canada
| | - Robyn J Tapp
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Ryan E K Man
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Ngee Lek
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.,KK Women's and Children's Hospital, Singapore, Singapore
| | - Shirong Cai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Fabian Yap
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Peter Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore
| | - Kok Hian Tan
- KK Women's and Children's Hospital, Singapore, Singapore
| | - Yap Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore, Singapore.,Singapore Institute for Clinical Sciences, Growth, Development & Metabolism, Singapore, Singapore
| | - Jia Yu Koh
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore
| | - Seang Mei Saw
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Yin Bun Cheung
- Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore. .,Department for International Health, University of Tampere, Tampere, Finland.
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, 11 Third Hospital Ave, Singapore, 168751, Singapore. .,Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore.
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26
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Interplay of Proximal Flow Confluence and Distal Flow Divergence in Patient-Specific Vertebrobasilar System. PLoS One 2016; 11:e0159836. [PMID: 27467755 PMCID: PMC4965217 DOI: 10.1371/journal.pone.0159836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 07/08/2016] [Indexed: 11/19/2022] Open
Abstract
Approximately one-quarter of ischemic strokes involve the vertebrobasilar arterial system that includes the upstream flow confluence and downstream flow divergence. A patient-specific hemodynamic analysis is needed to understand the posterior circulation. The objective of this study is to determine the distribution of hemodynamic parameters in the vertebrobasilar system, based on computer tomography angiography images. Here, the interplay of upstream flow confluence and downstream flow divergence was hypothesized to be a determinant factor for the hemodynamic distribution in the vertebrobasilar system. A computational fluid dynamics model was used to compute the flow fields in patient-specific vertebrobasilar models (n = 6). The inlet and outlet boundary conditions were the aortic pressure waveform and flow resistances, respectively. A 50% reduction of total outlet area was found to induce a ten-fold increase in surface area ratio of low time-averaged wall shear stress (i.e., TAWSS ≤ 4 dynes/cm2). This study enhances our understanding of the posterior circulation associated with the incidence of atherosclerotic plaques.
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27
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Chen Z, Liu AF, Chen H, Yuan C, He L, Zhu Y, Guan M, Jiang WJ, Zhao X. Evaluation of basilar artery atherosclerotic plaque distribution by 3D MR vessel wall imaging. J Magn Reson Imaging 2016; 44:1592-1599. [PMID: 27249041 DOI: 10.1002/jmri.25296] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Basilar artery (BA) atherosclerosis is an important cause of perforator stroke in the brainstem due to plaque involvement of the perforator ostia in BA dorsal or lateral walls. Therefore, to acquire information on plaque distribution is important to better understand and prevent the perforator stroke. This study aimed to comprehensively evaluate BA plaque distribution with 3D magnetic resonance imaging (MRI) vessel wall imaging. MATERIALS AND METHODS Consecutive patients with cerebrovascular symptoms and stenosis or irregular luminal surface of BA were recruited and underwent BA 3D proton density-weighted volume isotropic turbo spin echo acquisition (VISTA) imaging at 3T. The cross-sectional and longitudinal distribution of BA plaque were analyzed with a custom-developed tool. RESULTS In all, 85 BA plaques were detected in 61 recruited patients. For cross-sectional distribution, the prevalence of plaque involvement in the ventral, left, dorsal, and right quadrant of BA wall was 74.1%, 70.6%, 67.1%, and 62.4%, respectively. Of the 85 plaques, 17.7% involved one quadrant and 82.3% involved two or more quadrants. The most severe plaque region was more commonly situated at lateral walls (66.1%) as compared to ventral (23.2%, P < 0.001) and dorsal walls (10.6%, P < 0.001). Longitudinally, plaques were more frequently found to occur at BA segment distal than proximal to anterior inferior cerebellar artery (AICA) (63.5% vs. 36.5%). CONCLUSION Taking advantage of 3D MR vessel wall imaging, BA plaques were found to more likely affect lateral walls and form in BA distal to AICA, where most perforators originate, suggesting that it might be useful to characterize BA plaque distribution before aggressive treatment for prevention of perforator stroke. J. Magn. Reson. Imaging 2016;44:1592-1599.
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Affiliation(s)
- Zhensen Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Ao-Fei Liu
- New Era Stroke Care and Research Institute, General Hospital of the PLA Rocket Force, Beijing, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Chun Yuan
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China.,Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Le He
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Yandong Zhu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Maobin Guan
- Department of Radiology, Yangzhou First People's Hospital, Yangzhou, China
| | - Wei-Jian Jiang
- New Era Stroke Care and Research Institute, General Hospital of the PLA Rocket Force, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
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28
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Kim C, Sohn JH, Jang MU, Hong SK, Lee JS, Kim HJ, Choi HC, Lee JH. Ischemia as a potential etiologic factor in idiopathic unilateral sudden sensorineural hearing loss: Analysis of posterior circulation arteries. Hear Res 2015; 331:144-51. [PMID: 26368028 DOI: 10.1016/j.heares.2015.09.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 08/04/2015] [Accepted: 09/02/2015] [Indexed: 02/08/2023]
Abstract
The association between idiopathic sudden sensorineural hearing loss (ISSNHL) and the radiologic characteristics of the vertebrobasilar artery is unclear. We hypothesized that the degree and direction of vertebrobasilar artery curvature in the posterior circulation contribute to the occurrence of ISSNHL. We consecutively enrolled patients diagnosed with unilateral ISSNHL in two tertiary hospitals. Magnetic resonance images were performed in all patients to exclude specific causes of ISSNHL, such as vestibular schwannoma, chronic mastoiditis, and anterior inferior cerebellar artery infarct. We measured the following parameters of posterior circulation: vertebral and basilar artery diameter, the degree of basilar artery curvature (modified smoker criteria), and vertebral artery dominance. Pure tone audiometries were performed at admission and again 1 week and 3 months later. A total of 121 ISSNHL patients (mean age, 46.0 ± 17.3 years; 48.8% male) were included in these analyses. The proportion of patients with the left side hearing loss was larger than the proportion with the right side hearing loss (left, 57.9%; right, 42.1%). The majority of patients were characterized by a left dominant vertebral artery and right-sided basilar artery curvature. The direction of the basilar artery curvature was significantly associated with hearing loss lateralization (p = 0.036). Age and sex matched multivariable analyses revealed the absence of diabetes and right-sided basilar artery curvature as significant predictors for left sided hearing loss. There was no statistical difference between atherosclerotic cardiovascular risk score (high versus low) and hearing outcomes at 3 months. In ISSNHL, the laterality of hearing loss was inversely associated with the direction of basilar artery curvature. Our results, therefore, indicate the importance of vascular assessment when evaluating ISSNHL.
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Affiliation(s)
- Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, South Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, South Korea
| | - Min Uk Jang
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, South Korea
| | - Sung-Kwang Hong
- Department of Otorhinolaryngology and Head and Neck Surgery, Hallym University Medical Center, Chuncheon, South Korea
| | - Joong-Seob Lee
- Department of Otorhinolaryngology and Head and Neck Surgery, Hallym University Medical Center, Chuncheon, South Korea
| | - Hyung-Jong Kim
- Department of Otorhinolaryngology and Head and Neck Surgery, Hallym University Medical Center, Chuncheon, South Korea
| | - Hui-Chul Choi
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, South Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology and Head and Neck Surgery, Hallym University Medical Center, Chuncheon, South Korea.
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Aristokleous N, Seimenis I, Georgiou GC, Nicolaides A, Anayiotos AS. The Effect of Head Rotation on the Geometry and Hemodynamics of Healthy Vertebral Arteries. Ann Biomed Eng 2015; 43:1287-97. [DOI: 10.1007/s10439-015-1340-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/13/2015] [Indexed: 12/30/2022]
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Tütüncü F, Schimansky S, Baharoglu MI, Gao B, Calnan D, Hippelheuser J, Safain MG, Lauric A, Malek AM. Widening of the basilar bifurcation angle: association with presence of intracranial aneurysm, age, and female sex. J Neurosurg 2014; 121:1401-10. [DOI: 10.3171/2014.8.jns1447] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Arterial bifurcations represent preferred locations for aneurysm formation, especially when they are associated with variations in divider geometry. The authors hypothesized a link between basilar apex aneurysms and basilar bifurcation (α) and vertebrobasilar junction (VBJ) angles.
Methods
The α and VBJ angles were measured in 3D MR and rotational angiographic volumes using a coplanar 3-point technique. Angle α was compared between age-matched cohorts in 45 patients with basilar artery (BA) aneurysms, 65 patients with aneurysms in other locations (non-BA), and 103 nonaneurysmal controls. Additional analysis was performed in 273 nonaneurysmal controls. Computational fluid dynamics (CFD) simulations were performed on parametric BA models with increasing angles.
Results
Angle α was significantly wider in patients with BA aneurysms (146.7° ± 20.5°) than in those with non-BA aneurysms (111.7° ± 18°) and in controls (103° ± 20.6°) (p < 0.0001), whereas no difference was observed for the VBJ angle. A wider angle α correlated with BA aneurysm neck width but not dome size, which is consistent with CFD results showing a widening of the impingement zone at the bifurcation apex. BA bifurcations hosting even small aneurysms (< 5 mm) had a significantly larger α angle compared with matched controls (p < 0.0001). In nonaneurysmal controls, α increased with age (p < 0.0001), with a threshold effect above 35 years of age and a steeper dependence in females (p = 0.002) than males (p = 0.04).
Conclusions
The α angle widens with age during adulthood, especially in females. This angular widening is associated with basilar bifurcation aneurysms and may predispose individuals to aneurysm initiation by diffusing the flow impingement zone away from the protective medial band region of the flow divider.
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Li X, Yang Q, Wang Z, Wei D. Shear Stress in Atherosclerotic Plaque Determination. DNA Cell Biol 2014; 33:830-8. [DOI: 10.1089/dna.2014.2480] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Xiaohong Li
- Institute of Cardiovascular Disease, Key Laboratory for Atherosclerology of Hunan Province, University of South China, Hengyang, China
| | - Qin Yang
- Institute of Cardiovascular Disease, Key Laboratory for Atherosclerology of Hunan Province, University of South China, Hengyang, China
| | - Zuo Wang
- Institute of Cardiovascular Disease, Key Laboratory for Atherosclerology of Hunan Province, University of South China, Hengyang, China
| | - Dangheng Wei
- Institute of Cardiovascular Disease, Key Laboratory for Atherosclerology of Hunan Province, University of South China, Hengyang, China
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Ha H, Hwang D, Choi WR, Baek J, Lee SJ. Fluid-dynamic optimal design of helical vascular graft for stenotic disturbed flow. PLoS One 2014; 9:e111047. [PMID: 25360705 PMCID: PMC4215892 DOI: 10.1371/journal.pone.0111047] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 09/22/2014] [Indexed: 11/18/2022] Open
Abstract
Although a helical configuration of a prosthetic vascular graft appears to be clinically beneficial in suppressing thrombosis and intimal hyperplasia, an optimization of a helical design has yet to be achieved because of the lack of a detailed understanding on hemodynamic features in helical grafts and their fluid dynamic influences. In the present study, the swirling flow in a helical graft was hypothesized to have beneficial influences on a disturbed flow structure such as stenotic flow. The characteristics of swirling flows generated by helical tubes with various helical pitches and curvatures were investigated to prove the hypothesis. The fluid dynamic influences of these helical tubes on stenotic flow were quantitatively analysed by using a particle image velocimetry technique. Results showed that the swirling intensity and helicity of the swirling flow have a linear relation with a modified Germano number (Gn*) of the helical pipe. In addition, the swirling flow generated a beneficial flow structure at the stenosis by reducing the size of the recirculation flow under steady and pulsatile flow conditions. Therefore, the beneficial effects of a helical graft on the flow field can be estimated by using the magnitude of Gn*. Finally, an optimized helical design with a maximum Gn* was suggested for the future design of a vascular graft.
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Affiliation(s)
- Hojin Ha
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Gyeongbuk, Republic of Korea
| | - Dongha Hwang
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Gyeongbuk, Republic of Korea
| | - Woo-Rak Choi
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Gyeongbuk, Republic of Korea
| | - Jehyun Baek
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Gyeongbuk, Republic of Korea
| | - Sang Joon Lee
- Department of Mechanical Engineering, Pohang University of Science and Technology (POSTECH), Pohang, Gyeongbuk, Republic of Korea
- Center for Biofluid and Biomimic Research, Pohang University of Science and Technology (POSTECH), Pohang, Gyeongbuk, Republic of Korea
- * E-mail:
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Firasat S, Hecker M, Binder L, Asif AR. Advances in endothelial shear stress proteomics. Expert Rev Proteomics 2014; 11:611-9. [DOI: 10.1586/14789450.2014.933673] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Effects of Swedish massage therapy on blood pressure, heart rate, and inflammatory markers in hypertensive women. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:171852. [PMID: 24023571 PMCID: PMC3759268 DOI: 10.1155/2013/171852] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 07/21/2013] [Indexed: 11/18/2022]
Abstract
Swedish Massage Therapy (SMT) is known for its therapeutic relaxation effects. Hypertension is associated with stress and elevated endothelial inflammatory markers. This randomized control trial measured the effects of whole body SMT (massage group) or resting (control group) an hour weekly for four weeks on hypertensive women. Blood pressure (BP) and heart rate (HR) were measured before and after each intervention and endothelial inflammatory markers: vascular endothelial adhesion molecules 1 (VCAM-1) and intracellular adhesion molecules 1 (ICAM-1) were measured at baseline and after the last intervention. Massage group (n=8) showed significant systolic BP (SBP) reduction of 12 mmHg (P=0.01) and diastolic BP (DBP) reduction of 5 mmHg (P=0.01) after four sessions with no significant difference between groups. Reductions in HR were also seen in massage group after sessions 1, 3, and 4 with significant difference between groups. VCAM-1 showed significant reduction after four sessions: the massage group showed reduction of 998.05 ng/mL (P=0.03) and the control group of 375.70 ng/mL (P=0.01) with no significant differences between groups. There were no changes in ICAM-1. In conclusion, SMT or resting an hour weekly has effects on reducing BP, HR, and VCAM-1 in hypertensive women.
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35
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Haemodynamic analysis of the effect of different types of plaques in the left coronary artery. Comput Med Imaging Graph 2013; 37:197-206. [DOI: 10.1016/j.compmedimag.2013.02.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 01/08/2013] [Accepted: 02/27/2013] [Indexed: 11/18/2022]
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36
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Wake-Buck AK, Gatenby JC, Gore JC. Hemodynamic characteristics of the vertebrobasilar system analyzed using MRI-based models. PLoS One 2012; 7:e51346. [PMID: 23251503 PMCID: PMC3519605 DOI: 10.1371/journal.pone.0051346] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 11/05/2012] [Indexed: 11/25/2022] Open
Abstract
The vertebrobasilar system (VBS) is unique in human anatomy in that two arteries merge into a single vessel, and it is especially important because it supplies the posterior circulation of the brain. Atherosclerosis develops in this region, and atherosclerotic plaques in the vertebrobasilar confluence can progress with catastrophic consequences, including artery occlusion. Quantitative assessments of the flow characteristics in the VBS could elucidate the factors that influence flow patterns in this confluence, and deviations from normal patterns might then be used to predict locations to monitor for potential pathological changes, to detect early signs of disease, and to evaluate treatment options and efficacy. In this study, high-field MRI was used in conjunction with computational fluid dynamics (CFD) modeling to investigate the hemodynamics of subject-specific confluence models (n = 5) and to identify different geometrical classes of vertebrobasilar systems (n = 12) of healthy adult subjects. The curvature of the vessels and their mutual orientation significantly affected flow parameters in the VBS. The basilar artery geometry strongly influenced both skewing of the velocity profiles and the wall shear stress distributions in the VBS. All five subjects modeled possessed varying degrees of vertebral asymmetry, and helical flow was observed in four cases, suggesting that factors other than vertebral asymmetry influence mixing of the vertebral artery flow contributions. These preliminary studies verify that quantitative, MR imaging techniques in conjunction with subject-specific CFD models of healthy adult subjects may be used to characterize VBS hemodynamics and to predict flow features that have been related to the initiation and development of atherosclerosis in large arteries. This work represents an important first step towards applying this approach to study disease initiation and progression in the VBS.
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Affiliation(s)
- Amanda K Wake-Buck
- Department of Radiology and Radiological Sciences, Vanderbilt University, Nashville, TN, USA.
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37
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Lee SH, Hur N, Jeong SK. Geometric analysis and blood flow simulation of basilar artery. J Atheroscler Thromb 2012; 19:397-401. [PMID: 22240909 DOI: 10.5551/jat.10694] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The aim of this study was to find a region of low wall shear stress (WSS) in a basilar artery using 3-dimensional (3D) geometric analysis and blood flow simulation. METHODS A 61-year-old patient who underwent follow-up time-of-flight magnetic resonance angiography (TOF-MRA) of the brain was recruited as the subject of the present study. In the basilar artery, the angle of the directional vector was calculated for the region of low WSS. The subject's 3D arterial geometry and blood flow velocity from a transcranial Doppler examination were used for a blood flow simulation study. The regions of low WSS identified by both geometric analysis and blood flow simulation were compared, and these methods were repeated for the basilar arteries of various geometries from other patients. RESULTS Two distinct arterial angulations along the basilar artery were identified: lateral and anterior angulations on the anteroposterior and lateral TOF-MR views, respectively. A low WSS region was observed in the distal portion along the inner curvatures of both angulations in the basilar artery. The directional vectors of the region of low WSS calculated by geometric analysis and blood flow simulation were very similar (correlation coefficient= 0.996, p < 0.001). Follow-up MRA confirmed the progression of plaque in the region of low WSS. CONCLUSION Detailed geometric analysis and blood flow simulation of the basilar artery identified lateral and anterior angulations which determined the low WSS region in the distal portion along the inner curvatures of the angulations.
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Affiliation(s)
- Sang Hyuk Lee
- Department of Mechanical Engineering, Sogang University, Seoul, South Korea
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38
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Dorfmüller P, Chaumais MC, Giannakouli M, Durand-Gasselin I, Raymond N, Fadel E, Mercier O, Charlotte F, Montani D, Simonneau G, Humbert M, Perros F. Increased oxidative stress and severe arterial remodeling induced by permanent high-flow challenge in experimental pulmonary hypertension. Respir Res 2011; 12:119. [PMID: 21906276 PMCID: PMC3189121 DOI: 10.1186/1465-9921-12-119] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 09/09/2011] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Involvement of inflammation in pulmonary hypertension (PH) has previously been demonstrated and recently, immune-modulating dendritic cells (DCs) infiltrating arterial lesions in patients suffering from idiopathic pulmonary arterial hypertension (IPAH) and in experimental monocrotaline-induced PH have been reported. Occurrence of perivascular inflammatory cells could be linked to local increase of oxidative stress (OS), as it has been shown for systemic atherosclerosis. The impact of OS on vascular remodeling in PH is still to be determined. We hypothesized, that augmented blood-flow could increase OS and might thereby contribute to DC/inflammatory cell-recruitment and smooth-muscle-cell-proliferation. METHODS We applied a monocrotaline-induced PH-model and combined it with permanent flow-challenge. Thirty Sprague-Dawley rats were assigned to following groups: control, monocrotaline-exposure (MCT), monocrotaline-exposure/pneumonectomy (MCT/PE). RESULTS Hemodynamic exploration demonstrated most severe effects in MCT/PE, corresponding in histology to exuberant medial and adventitial remodeling of pulmonary muscular arteries, and intimal remodeling of smaller arterioles; lung-tissue PCR evidenced increased expression of DCs-specific fascin, CD68, proinflammatory cytokines (IL-6, RANTES, fractalkine) in MCT/PE and to a lesser extent in MCT. Major OS enzyme NOX-4 was maximal in MCT/PE. Antioxidative stress enzymes Mn-SOD and glutathion-peroxidase-1 were significantly elevated, while HO-1 showed maximal expression in MCT with significant decrease in MCT/PE. Catalase was decreased in MCT and MCT/PE. Expression of NOX-4, but also of MN-SOD in MCT/PE was mainly attributed to a highly increased number of interstitial and perivascular CXCR4/SDF1 pathway-recruited mast-cells. Stress markers malonedialdehyde and nitrotyrosine were produced in endothelial cells, medial smooth muscle and perivascular leucocytes of hypertensive vasculature. Immunolabeling for OX62, CD68 and actin revealed adventitial and medial DC- and monocyte-infiltration; in MCT/PE, medial smooth muscle cells were admixed with CD68+/vimentin+ cells. CONCLUSION Our experimental findings support a new concept of immunologic responses to increased OS in MCT/PE-induced PAH, possibly linking recruitment of dendritic cells and OS-producing mast-cells to characteristic vasculopathy.
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Affiliation(s)
- Peter Dorfmüller
- Université Paris-Sud, Faculté de médecine, Kremlin-Bicêtre, F-94276, France.
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39
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Cecchi E, Giglioli C, Valente S, Lazzeri C, Gensini GF, Abbate R, Mannini L. Role of hemodynamic shear stress in cardiovascular disease. Atherosclerosis 2010; 214:249-56. [PMID: 20970139 DOI: 10.1016/j.atherosclerosis.2010.09.008] [Citation(s) in RCA: 235] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 09/09/2010] [Accepted: 09/10/2010] [Indexed: 12/29/2022]
Abstract
Atherosclerosis is the main cause of morbidity and mortality in the Western world. Inflammation and blood flow alterations are new markers emerging as possible determinants for the development of atherosclerotic lesions. In particular, blood flow exerts a shear stress on vessel walls that alters cell physiology. Shear stress arises from the friction between two virtual layers of a fluid and is induced by the difference in motion and viscosity between these layers. Regions of the arterial tree with uniform geometry are exposed to a unidirectional and constant flow, which determines a physiologic shear stress, while arches and bifurcations are exposed to an oscillatory and disturbed flow, which determines a low shear stress. Atherosclerotic lesions develop mainly in areas of low shear stress, while those exposed to a physiologic shear stress are protected. The presence of areas of the arterial tree with different wall shear stress may explain, in part, the different localization of atherosclerotic lesions in both coronary and extracoronary arteries. The measurement of this parameter may help in identifying atherosclerotic plaques at higher risk as well as in evaluating the efficacy of different pharmacological interventions. Moreover, an altered shear stress is associated with the occurrence of both aortic and intracranial aneurysms, possibly leading to their growth and rupture. Finally, the evaluation of shear stress may be useful for predicting the risk of developing restenosis after coronary and peripheral angioplasty and for devising a coronary stent with a strut design less thrombogenic and more conducive to endothelization.
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Affiliation(s)
- Emanuele Cecchi
- Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Firenze, Italy.
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40
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Nixon AM, Gunel M, Sumpio BE. The critical role of hemodynamics in the development of cerebral vascular disease. J Neurosurg 2010; 112:1240-53. [DOI: 10.3171/2009.10.jns09759] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atherosclerosis and intracranial saccular aneurysms predictably localize in areas with complex arterial geometries such as bifurcations and curvatures. These sites are characterized by unique hemodynamic conditions that possibly influence the risk for these disorders. One hemodynamic parameter in particular has emerged as a key regulator of vascular biology—wall shear stress (WSS). Variations in geometry can change the distribution and magnitude of WSS, thus influencing the risk for vascular disorders. Computer simulations conducted using patient-specific data have suggested that departures from normal levels of WSS lead to aneurysm formation and progression. In addition, multiple studies indicate that disturbed flow and low WSS predispose patients to extracranial atherosclerosis, and particularly to carotid artery disease. Conversely, in the case of intracranial atherosclerosis, more studies are needed to provide a firm link between hemodynamics and atherogenesis. The recognition of WSS as an important factor in cerebral vascular disease may help to identify individuals at risk and guide treatment options.
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Affiliation(s)
| | - Murat Gunel
- 2Neurosurgery, Yale University School of Medicine, New Haven, Connecticut
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41
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Computational study of pulsatile blood flow in prototype vessel geometries of coronary segments. Phys Med 2010; 26:140-56. [PMID: 20400349 DOI: 10.1016/j.ejmp.2009.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 01/26/2009] [Accepted: 03/17/2009] [Indexed: 02/02/2023] Open
Abstract
The spatial and temporal distributions of wall shear stress (WSS) in prototype vessel geometries of coronary segments are investigated via numerical simulation, and the potential association with vascular disease and specifically atherosclerosis and plaque rupture is discussed. In particular, simulation results of WSS spatio-temporal distributions are presented for pulsatile, non-Newtonian blood flow conditions for: (a) curved pipes with different curvatures, and (b) bifurcating pipes with different branching angles and flow division. The effects of non-Newtonian flow on WSS (compared to Newtonian flow) are found to be small at Reynolds numbers representative of blood flow in coronary arteries. Specific preferential sites of average low WSS (and likely atherogenesis) were found at the outer regions of the bifurcating branches just after the bifurcation, and at the outer-entry and inner-exit flow regions of the curved vessel segment. The drop in WSS was more dramatic at the bifurcating vessel sites (less than 5% of the pre-bifurcation value). These sites were also near rapid gradients of WSS changes in space and time - a fact that increases the risk of rupture of plaque likely to develop at these sites. The time variation of the WSS spatial distributions was very rapid around the start and end of the systolic phase of the cardiac cycle, when strong fluctuations of intravascular pressure were also observed. These rapid and strong changes of WSS and pressure coincide temporally with the greatest flexion and mechanical stresses induced in the vessel wall by myocardial motion (ventricular contraction). The combination of these factors may increase the risk of plaque rupture and thrombus formation at these sites.
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42
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Coronary Arteries Simplified with 3D Cylinders to Assess True Bifurcation Angles in Atherosclerotic Patients. ACTA ACUST UNITED AC 2009; 9:127-33. [DOI: 10.1007/s10558-009-9084-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2009] [Accepted: 09/17/2009] [Indexed: 10/20/2022]
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Hong JM, Chung CS, Bang OY, Yong SW, Joo IS, Huh K. Vertebral artery dominance contributes to basilar artery curvature and peri-vertebrobasilar junctional infarcts. J Neurol Neurosurg Psychiatry 2009; 80:1087-92. [PMID: 19414436 PMCID: PMC2735647 DOI: 10.1136/jnnp.2008.169805] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The diameters of the vertebral arteries (VAs) are very often unequal. Therefore, this study investigated if unequal VA flow contributes to the development of basilar artery (BA) curvature and if it is a link to the laterality of pontine or cerebellar infarcts occurring around the vertebrobasilar junction. METHODS Radiological factors were analysed (infarct laterality, VA dominance, BA curvature and their directional relationships) in 91 patients with acute unilateral pontine or posterior inferior cerebellar artery (PICA) territory infarcts. The "dominant" VA side was defined as either that the VA was larger in diameter or the VA was connected with the BA in more of a straight line, if both VAs looked similar in diameter on CT angiography. Multiple regression analysis was performed to predict moderate to severe BA curvature. RESULTS The dominant VA was more frequent on the left side (p<0.01). Most patients had an opposite directional relationship between the dominant VA and BA curvature (p<0.01). Pontine infarcts were opposite to the side of BA curvature (p<0.01) and PICA infarcts were on the same side as the non-dominant VA side (p<0.01). The difference in VA diameters was the single independent predictor for moderate to severe BA curvature (OR per 1 mm, 2.70; 95% CI 1.22 to 5.98). CONCLUSIONS Unequal VA flow is an important haemodynamic contributor of BA curvature and development of peri-vertebrobasilar junctional infarcts.
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Affiliation(s)
- J M Hong
- Department of Neurology, Ajou University Medical Centre, Ajou University School of Medicine, Yongtong-Gu, Suwon-Si, Kyunggi-Do, South Korea.
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Kim YD, Choi HY, Jung YH, Nam CM, Yang JH, Cho HJ, Nam HS, Lee KY, Heo JH. Mirror pattern of cerebral artery atherosclerosis in patients with ischaemic stroke. Eur J Neurol 2009; 16:1159-64. [DOI: 10.1111/j.1468-1331.2009.02690.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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45
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Tsuei YS, Matsumoto Y, Ohta M, Nakayama T, Ezura M, Takahashi A. Vertebrobasilar junction fenestration with dumbbell-shaped aneurysms formation: computational fluid dynamics analysis. ACTA ACUST UNITED AC 2009; 72 Suppl 2:S11-9. [PMID: 19664810 DOI: 10.1016/j.surneu.2009.05.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We report 8 rare cases of paired ANs involving fenestrated vertebrobasilar junction and demonstrate the flow patterns of the paired ANs by qualitative CFD analysis in 5 cases. METHODS Two-dimensional and 3-dimensional angiographic features of 8 cases were reviewed. Nine patient-specific geometries of CFD models in 5 cases were created for flow analysis. RESULTS All 8 cases had 2 ANs, one large and the other small, projecting to the opposite sides at the proximal end of fenestrated vertebrobasilar junction. The different angiographic findings between right VA and left VA suggested the different hemodynamic characteristics of the respective VAs. Computational fluid dynamics analysis also demonstrated that the inflows of these paired ANs were different between right VA and left VA. Flow simulations by CFD were consistent with angiographic findings. CONCLUSION Intrinsic wall defects at fenestrated vertebrobasilar junction and specific hemodynamic stresses from 2 inflows may contribute to the formation of a pair of dumbbell-shaped ANs.
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Affiliation(s)
- Yuang-Seng Tsuei
- Department of Neuroendovascular Therapy, Tohoku University, Japan.
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Pantos I, Patatoukas G, Efstathopoulos EP, Katritsis D. In vivo wall shear stress measurements using phase-contrast MRI. Expert Rev Cardiovasc Ther 2008; 5:927-38. [PMID: 17867922 DOI: 10.1586/14779072.5.5.927] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is growing evidence to suggest that endothelial biology and atherosclerosis depend on arterial wall shear stress (WSS). We review the existing literature on in vivo measurements of WSS in healthy individuals using phase-contrast MRI, which is a promising, noninvasive technique for determining various blood flow characteristics. WSS data exist for the following arteries: carotid, brachial, aorta and femoral. Measured values indicate that WSS is site specific, a finding which opposes the notion that physiological WSS values are maintained at a constant magnitude in all parts of the arterial system. Among the WSS values obtained at the same site by different investigators there is qualitative agreement; however, differences exist in absolute values mainly due to the dependence on the method used to obtain WSS values from velocity data.
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Affiliation(s)
- Ioannis Pantos
- Athens Euroclinic, Department of Cardiology, 9 Athanassiadou St, Athens 11521, Greece.
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47
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Variations in the intracranial vertebrobasilar system. Surg Radiol Anat 2008; 30:257-64. [DOI: 10.1007/s00276-008-0309-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Accepted: 01/17/2008] [Indexed: 10/22/2022]
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48
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McKinney VZ, Rinker KD, Truskey GA. Normal and shear stresses influence the spatial distribution of intracellular adhesion molecule-1 expression in human umbilical vein endothelial cells exposed to sudden expansion flow. J Biomech 2006; 39:806-17. [PMID: 16488220 DOI: 10.1016/j.jbiomech.2005.02.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2004] [Accepted: 02/07/2005] [Indexed: 10/25/2022]
Abstract
Patterns in cell adhesion molecule expression by endothelial cells may play a role in atherogenesis. Previous studies have shown dependence of intracellular adhesion molecule-1 (ICAM-1) expression in human umbilical vein endothelial cells (HUVEC) on shear stress and have indirectly linked ICAM-1 expression to spatial gradients in shear stress. The spatial distribution of ICAM-1 in HUVEC pre-exposed to flow for 8h was determined using fluorescence microscopy and a sudden expansion flow chamber with a 2.66 expansion ratio to simulate gradients in wall shear stress found near arterial branches in vivo. When ICAM-1 expression in the disturbed flow region was compared to theoretical stress distributions obtained from a computational model of sudden expansion flow, a modest trend (R2 = 0.327, p < 0.01)was observed between ICAM-1 and shear stress but the correlation between ICAM-1 and shear stress gradient was insignificant. In contrast, a moderately strong trend (R2 = 0.873, p < 0.01) was evident between ICAM-1 expression and the component of normal stress induced by the expansion. Thus, in this in vitro model, normal stress arising from sudden expansion flow modulates the effect of shear stress on ICAM-1 expression.
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Affiliation(s)
- V Z McKinney
- Department of Biomedical Engineering, Duke University, Box 90281, Durham, NC 27708-0281, USA
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49
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Cagnie B, Barbaix E, Vinck E, D'Herde K, Cambier D. Atherosclerosis in the vertebral artery: an intrinsic risk factor in the use of spinal manipulation? Surg Radiol Anat 2006; 28:129-34. [PMID: 16557345 DOI: 10.1007/s00276-005-0060-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Accepted: 11/07/2005] [Indexed: 10/24/2022]
Abstract
The presence of atherosclerotic plaques and their influence on the vertebral artery is of clinical importance within the scope of spinal manipulation. Manipulation may stimulate the development of atherosclerotic plaques, could detach an embolus with ensuing infarction, injure the endothelium or may directly cause a dissection in the presence of atherosclerotic plaques. In order to identify the sites and frequency of atherosclerotic plaques and to determine its relation to the tortuous course of the vertebral artery, a cadaveric study was performed. The vertebral arteries of 57 human cadavers were studied. The vertebral artery was virtually divided into four segments: the pre-vertebral (V1), the vertebral (V2), the atlanto-axial (V3), and the intracranial segment (V4). Abnormalities in the origin and course of the vertebral artery were noted, along with any associated osseous, or cartilaginous anomalies in the neck. After dissection, the artery was opened and macroscopically screened for the presence of atherosclerotic plaques. In 22.8% of the cases, no atherosclerotic plaques were present. In 35.1% of the cases, the atherosclerotic plaques were unilateral, of which 60.0% was on the left side, 40.0% on the right side, and in 42.1%, the occurrence was bilateral. Atherosclerotic plaques were significantly more present in the V3 segment than in the V1 (0.007) and V2 segment (0.049). In the V1 (P=0.008) and V2 segment (P=0.002), there was a correlation between a tortuous course of the vessel and the occurrence of atherosclerotic plaques. In individuals with marked atherosclerotic disease, stretching and compression effects of rotational manipulative techniques on atherosclerotic vessels impose a further risk factor for vertebrobasilar insufficiency. As direct evidence of atherosclerotic plaques are rarely available, therapists should avoid manipulative techniques at all levels of the cervical spine in the presence of any indirect sign of atherosclerotic disease or in the presence of calcified arterial walls or tortuosities of the vessels visible on routinely available X-ray images of the cervical or thoracic spine. It is strongly recommended, that if any doubt exists about the nature of a clinical presentation, vigorous manual procedures should be avoided until either the diagnosis is definitive or gentle manual therapy has proven effective.
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Affiliation(s)
- Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, De Pintelaan 185, 6K3, 9000, Ghent, Belgium.
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Argyriou AA, Tsolakis I, Papadoulas S, Polychronopoulos P, Gourzis P, Chroni E. Sympathetic skin response in patients with peripheral arterial occlusive disease. Clin Neurophysiol 2006; 117:414-9. [PMID: 16414001 DOI: 10.1016/j.clinph.2005.10.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2005] [Revised: 10/24/2005] [Accepted: 10/30/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The current study aimed to assess the viability of sympathetic sudomotor fibers in patients suffering from mild peripheral arterial occlusive disease (PAD). METHODS Sympathetic skin response (SSR) from the hand (electrical stimulation) and sole (electrical and magnetic stimulation) of 25 patients with PAD (19 males and 6 females with mean age 62.7 +/- 10.2 years) was recorded unilaterally depending on the side of the affected limb (18 right side, 7 left side). Electrophysiological data were also collected and correlated with the SSR results. Twenty-five, age- and gender-matched healthy volunteers served as controls. RESULTS No evidence of nerve conduction abnormalities was recorded from the group of patients. Intact SSR recordings were obtained from the upper limb of patients. Nine patients (36%) had absent SSR in the lower limb following electrical stimulation, whilst the same 9 patients had absent SSR following magnetic stimulation. Significant differences occurred between groups in the SSR latency scores recorded from the lower limb. Following electrical stimulation the mean SSR latency in patients was significantly prolonged, compared to that of controls (P = 0.000), whilst the same applied following magnetic stimulation (P = 0.000). There was no correlation between SSR abnormalities and nerve conduction measurements. The manifestation of intermittent claudication at a walking distance of 250 m was strongly correlated with absent lower limb SSR (r = 0.71, P = 0.035). CONCLUSIONS SSR abnormalities appeared to be an early and independent finding of neural impairment in our patients. SIGNIFICANCE SSR study, performed at an early stage of PAD may prove useful in differentiating PAD-induced neuropathy from other neuropathic processes.
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Affiliation(s)
- Andreas A Argyriou
- Laboratory of Clinical Neurophysiology, Department of Neurology, University of Patras Medical School, P.O. Box 1045, 26504 Rion-Patras, Greece
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