1
|
Belsheva M, Safonova L, Shkarubo A. Sensitivity of Frequency Domain Near Infrared Spectroscopy for Neurovascular Structure Detection in Biotissue Volume: Numerical Modeling Results. JOURNAL OF BIOPHOTONICS 2024:e202400291. [PMID: 39257224 DOI: 10.1002/jbio.202400291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/16/2024] [Accepted: 08/20/2024] [Indexed: 09/12/2024]
Abstract
Through numerical modeling, it has been determined that near infrared spectroscopy with a frequency domain approach can detect neurovascular structures with diameters from 0.5 mm at source-detector distances of 5-8 mm, depending on optical parameters and technical implementation of the method. Among the five classical machine learning methods considered, quadratic discriminant analysis is the most effective for detection. Furthermore, it has been demonstrated that the use of a photomultiplier tube and the registration of both amplitude and phase signal components exhibit the highest sensitivity. Spectroscopy can rival modern ultrasound for detecting arterial vessels. A cross-shaped probe configuration improves sensitivity, and the ratio of reduced scattering coefficient values at different wavelengths is informative for blood-filled vessel detection. These findings are consistent with and significantly extend previous experimental in vivo and in situ studies and could be valuable for intraoperative diagnostic tasks, particularly in neurosurgery.
Collapse
Affiliation(s)
- Mariia Belsheva
- Department of Biomedical Engineering, Bauman Moscow State Technical University, Moscow, Russia
| | - Larisa Safonova
- Department of Biomedical Engineering, Bauman Moscow State Technical University, Moscow, Russia
| | - Alexey Shkarubo
- Federal State Autonomous Institution "N. N. Burdenko National Medical Research Center of Neurosurgery" of the Ministry of Health of the Russian Federation, Moscow, Russia
| |
Collapse
|
2
|
Lv H, Fu K, Liu W, He Z, Li Z. Numerical study on the cerebral blood flow regulation in the circle of Willis with the vascular absence and internal carotid artery stenosis. Front Bioeng Biotechnol 2024; 12:1467257. [PMID: 39239254 PMCID: PMC11374663 DOI: 10.3389/fbioe.2024.1467257] [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: 07/19/2024] [Accepted: 08/12/2024] [Indexed: 09/07/2024] Open
Abstract
Objectives This study explores how vascular stenosis and absence affect the regulation of cerebral blood flow in the Circle of Willis (CoW) and the hemodynamic changes downstream of the stenosis. Materials and Methods Forty idealized CoW models were simulated to analyze the impact of vascular absence and internal carotid artery (ICA) stenosis on hemodynamics. Inlet conditions were set using a physiological pressure waveform, and outflow boundaries were modeled using three-element Windkessel models. Results The absence of vessels such as RP1, LP1, RA1, or LA1 had a comparable effect on total blood flow to a 40% stenosis of the left internal carotid artery (LICA) across the entire CoW. Specifically, when LP1 and RA1 were absent with a 50% LICA stenosis, the total blood flow closely resembled that of a complete CoW with 75% LICA stenosis. In cases of proximal ICA stenosis, downstream regions showed elevated oscillatory shear index (OSI >0.2) and reduced time-averaged wall shear stress (TAWSS <1 Pa). With increasing stenosis severity, areas of high OSI shifted, and regions of low TAWSS expanded notably. At 75% stenosis, the area with TAWSS <1 Pa downstream significantly increased. Until complete occlusion, the area of low TAWSS and high OSI were maximized. Conclusion This study underscores how anatomical variations in the CoW, combined with ICA stenosis, impact both total cerebral blood flow and its distribution among different outlets. Moreover, it highlights the potential for increased atherosclerosis development in affected areas. Particularly notable is the finding the absence of LP1 and RA1 vessels alongside 50% LICA stenosis results in blood flow patterns similar to those seen with 75% LICA stenosis in a complete CoW, emphasizing clinical implications for the patient. Hemodynamic changes, including TAWSS and OSI, are most pronounced downstream of the stenosis especially when the stenosis rate exceeds 75%.
Collapse
Affiliation(s)
- Hong Lv
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China
- Development and Related Diseases of Women and Children Key Laboratory of Sichuan Province, Chengdu, China
| | - Kailei Fu
- Stroke Center, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wei Liu
- School of Energy and Power Engineering, Dalian University of Technology, Dalian, China
| | - Zhiyi He
- Department of Neurology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhiqing Li
- Stroke Center, The First Affiliated Hospital of China Medical University, Shenyang, China
| |
Collapse
|
3
|
Dogra S, Wang X, Gupta A, Veraart J, Ishida K, Qiu D, Dehkharghani S. Acetazolamide-augmented BOLD MRI to Assess Whole-Brain Cerebrovascular Reactivity in Chronic Steno-occlusive Disease Using Principal Component Analysis. Radiology 2023; 307:e221473. [PMID: 36916889 PMCID: PMC10140639 DOI: 10.1148/radiol.221473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/12/2023] [Accepted: 02/10/2023] [Indexed: 03/16/2023]
Abstract
Background Exhaustion of cerebrovascular reactivity (CVR) portends increased stroke risk. Acetazolamide-augmented blood oxygenation level-dependent (BOLD) MRI has been used to estimate CVR, but low signal-to-noise conditions relegate its use to terminal CVR (CVRend) measurements that neglect dynamic features of CVR. Purpose To demonstrate comprehensive characterization of acetazolamide-augmented BOLD MRI response in chronic steno-occlusive disease using a computational framework to precondition signal time courses for dynamic whole-brain CVR analysis. Materials and Methods This study focused on retrospective analysis of consecutive patients with unilateral chronic steno-occlusive disease who underwent acetazolamide-augmented BOLD imaging for recurrent minor stroke or transient ischemic attack at an academic medical center between May 2017 and October 2020. A custom principal component analysis-based denoising pipeline was used to correct spatially varying non-signal-bearing contributions obtained by a local principal component analysis of the MRI time series. Standard voxelwise CVRend maps representing terminal responses were produced and compared with maximal CVR (CVRmax) as isolated from binned (per-repetition time) denoised BOLD time course. A linear mixed-effects model was used to compare CVRmax and CVRend in healthy and diseased hemispheres. Results A total of 23 patients (median age, 51 years; IQR, 42-61, 13 men) who underwent 32 BOLD examinations were included. Processed MRI data showed twofold improvement in signal-to-noise ratio, allowing improved isolation of dynamic characteristics in signal time course for sliding window CVRmax analysis to the level of each BOLD repetition time (approximately 2 seconds). Mean CVRmax was significantly higher than mean CVRend in diseased (5.2% vs 3.8%, P < .01) and healthy (5.5% vs 4.0%, P < .01) hemispheres. Several distinct time-signal signatures were observed, including nonresponsive; delayed/blunted; brisk; and occasionally nonmonotonic time courses with paradoxical features in normal and abnormal tissues (ie, steal and reverse-steal patterns). Conclusion A principal component analysis-based computational framework for analysis of acetazolamide-augmented BOLD imaging can be used to measure unsustained CVRmax through twofold improvements in signal-to-noise ratio. © RSNA, 2023 Supplemental material is available for this article.
Collapse
Affiliation(s)
- Siddhant Dogra
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
| | - Xiuyuan Wang
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
| | - Alejandro Gupta
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
| | - Jelle Veraart
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
| | - Koto Ishida
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
| | - Deqiang Qiu
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
| | - Seena Dehkharghani
- From the Departments of Radiology (S. Dogra, A.G., J.V., S. Dehkharghani) and Neurology (K.I., S. Dehkharghani), New York University Langone Health, 660 First Ave, New York, NY 10016; Department of Radiology, Weill Cornell Medical College, New York, NY (X.W.); and Department of Radiology and Imaging Sciences, Emory University, Atlanta, Ga (D.Q.)
| |
Collapse
|
4
|
Zang J, Tang X, Su X, Zhang T, Lu D, Xu A. Systematic Analysis of RNA Expression Profiles in Different Ischemic Cortices in MCAO Mice. Cell Mol Neurobiol 2023; 43:859-878. [PMID: 35449428 DOI: 10.1007/s10571-022-01220-9] [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: 12/24/2021] [Accepted: 03/29/2022] [Indexed: 11/03/2022]
Abstract
The prognosis of ischemic stroke patients is highly associated with the collateral circulation. And the competing endogenous RNAs (ceRNAs) generated from different compensatory supply regions may also involve in the regulation of ischemic tissues prognosis. In this study, we found the apoptosis progress of ischemic neurons in posterior circulation-supplied regions (close to PCA, cortex2) was much slower than that in anterior circulation-supplied territory (close to ACA, cortex1) in MCAO-3-h mice. Using the RNA sequencing and functional enrichment analysis, we analyzed the difference between RNA expression profile in cortex1 and cortex2 and the related biological processes. The results indicated that the differential expressed ceRNAs in cortex1 were involved in cell process under acute injury, while the differential expressed ceRNAs in cortex2 was more likely to participate in long-term injury and repair process. Besides, by establishing the miRNA-ceRNA interaction network we further sorted out two specifically distributed miRNAs, namely mmu-miR446i-3p (in cortex1) and mmu-miR3473d (in cortex2). And the specifically increased mmu-miR3473d in cortex2 mainly involved the angiogenesis and cell proliferation after ischemic stroke, which may be the critical reason for the longer therapeutic time window in cortex2. In conclusion, the present study reported the specific changes of ceRNAs in distinct compensatory regions potentially involved in the evolution of cerebral ischemic tissues and the unbalance prognosis after stroke. It provided more evidence for the collateral compensatory effects on patients' prognosis and carried out the new targets for the ischemic stroke therapy.
Collapse
Affiliation(s)
- Jiankun Zang
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 West Huangpu Ave, Guangzhou, 510632, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xionglin Tang
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 West Huangpu Ave, Guangzhou, 510632, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xuanlin Su
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 West Huangpu Ave, Guangzhou, 510632, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tianyuan Zhang
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 West Huangpu Ave, Guangzhou, 510632, China.,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Dan Lu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 West Huangpu Ave, Guangzhou, 510632, China. .,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China.
| | - Anding Xu
- Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, 613 West Huangpu Ave, Guangzhou, 510632, China. .,Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, China.
| |
Collapse
|
5
|
Raj KV, Nabeel PM, Sivaprakasam M, Joseph J. Time-warping for robust automated arterial wall-recognition and tracking from single-scan-line ultrasound signals. ULTRASONICS 2022; 126:106828. [PMID: 36031705 DOI: 10.1016/j.ultras.2022.106828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 05/26/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Current ultrasound methods for recognition and motion-tracking of arterial walls are suited for image-based B-mode or M-mode scans but not adequately robust for single-line image-free scans. We introduce a time-warping-based technique to address this need. Its performance was validated through simulations and in-vivo trials on 21 subjects. The method recognized wall locations with 100 % precision for simulated frames (SNR > 10 dB). Clustering detections for multiple frames achieved sensitivity >98 %, while it was ∼90 % without clustering. The absence of arterial walls was predicted with 100 % specificity. In-vivo results corroborated the performance outcomes yielding a sensitivity ≥94 %, precision ≥98 %, and specificity ≥98 % using the clustering scheme. Further, excellent frame-to-frame tracking accuracy (absolute error <3 %, RMSE <2 μm) was demonstrated. Image-free measurements of peak arterial distension agreed with the image-based ones, within an error of 1.08 ± 3.65 % and RMSE of 38 μm. The method discerned the presence of arterial walls in A-mode frames, robustly localized, and tracked them even when they were proximal to hyperechoic regions or slow-moving tissue structures. Unification of delineation techniques with the proposed methods facilitates a complete image-free framework for measuring arterial dynamics and the development of reliable A-mode devices.
Collapse
Affiliation(s)
- Kiran V Raj
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India.
| | - P M Nabeel
- Healthcare Technology Innovation Centre, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Mohanasankar Sivaprakasam
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India; Healthcare Technology Innovation Centre, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| | - Jayaraj Joseph
- Department of Electrical Engineering, Indian Institute of Technology Madras, Chennai, Tamil Nadu, India
| |
Collapse
|
6
|
Cao T, Jiang Z, Zhao H, Zhang KQ, Meng K. Numerical simulation to study the impact of compliance mismatch between artificial and host blood vessel on hemodynamics. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
7
|
On non-Kolmogorov turbulence in blood flow and its possible role in mechanobiological stimulation. Sci Rep 2022; 12:13166. [PMID: 35915207 PMCID: PMC9343407 DOI: 10.1038/s41598-022-16079-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/04/2022] [Indexed: 01/09/2023] Open
Abstract
The study of turbulence in physiologic blood flow is important due to its strong relevance to endothelial mechanobiology and vascular disease. Recently, Saqr et al. (Sci Rep 10, 15,492, 2020) discovered non-Kolmogorov turbulence in physiologic blood flow in vivo, traced its origins to the Navier–Stokes equation and demonstrated some of its properties using chaos and hydrodynamic-stability theories. The present work extends these findings and investigates some inherent characteristics of non-Kolmogorov turbulence in monoharmonic and multiharmonic pulsatile flow under ideal physiologic conditions. The purpose of this work is to propose a conjecture for the origins for picoNewton forces that are known to regulate endothelial cells’ functions. The new conjecture relates these forces to physiologic momentum-viscous interactions in the near-wall region of the flow. Here, we used high-resolution large eddy simulation (HRLES) to study pulsatile incompressible flow in a straight pipe of \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$L/D=20$$\end{document}L/D=20. The simulations presented Newtonian and Carreau–Yasuda fluid flows, at \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$$R{e}_{m}\approx 250$$\end{document}Rem≈250, each represented by one, two and three boundary harmonics. Comparison was established based on maintaining constant time-averaged mass flow rate in all simulations. First, we report the effect of primary harmonics on the global power budget using primitive variables in phase space. Second, we describe the non-Kolmogorov turbulence in frequency domain. Third, we investigate the near-wall coherent structures in time and space domains. Finally, we propose a new conjecture for the role of turbulence in endothelial cells’ mechanobiology. The proposed conjecture correlates near-wall turbulence to a force field of picoNewton scale, suggesting possible relevance to endothelial cells mechanobiology.
Collapse
|
8
|
Investigation of Flow Changes in Intracranial Vascular Disease Models Constructed with MRA Images. SENSORS 2022; 22:s22062302. [PMID: 35336474 PMCID: PMC8949996 DOI: 10.3390/s22062302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023]
Abstract
This study aimed to develop a magnetic resonance imaging (MRI)-compatible flow delivery system and individualized models of circle of Willis (CoW), which include 50% and 100% blockage in internal carotid artery (ICA50 and ICA100), and 100% blockage in vertebral artery (VA100). Images were obtained using 3D time-of-flight and phase-contrast magnetic resonance angiography (MRA) sequences, and changes in velocity and flow direction at CoW models were analyzed. For the ICA50 and VA100 models, the flow was similar to that of the normal model. For the ICA 50 model, it was found that 50% blockage did not affect cerebral blood flow. For the VA100 model, decreased flow in the posterior cerebral artery and a change to the flow direction in the posterior communicating artery were found. For the ICA100 model, particularly, decreased flow in the ipsilateral middle and anterior cerebral arteries and a change to the flow direction in the ipsilateral anterior cerebral artery of the CoW were found. These results demonstrated that the flow system with various CoW disease models tailored to individual characteristics could be used to predict stroke onset more quickly. For the ICA50 and VA100 models, the possibility of cerebral infarction was significantly lower. On the other hand, for the ICA100 model, there was a high possibility of decreased flow, which could lead to cerebral infarction.
Collapse
|
9
|
Dmytriw AA, Bickford S, Pezeshkpour P, Ha W, Amirabadi A, Dibas M, Kitamura LA, Vidarsson L, Pulcine E, Muthusami P. Rotational Vertebrobasilar Insufficiency: Is There a Physiological Spectrum? Phase-Contrast Magnetic Resonance Imaging Quantification in Healthy Volunteers. Pediatr Neurol 2022; 128:58-64. [PMID: 35101804 DOI: 10.1016/j.pediatrneurol.2021.12.005] [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: 09/16/2021] [Revised: 12/07/2021] [Accepted: 12/11/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Some cases of cerebral ischemia have been attributed to dynamic flow limitation in neck vessels. It however remains unknown whether this represents the extreme end of a physiological response. METHODS Eighteen healthy volunteers were recruited to this prospective study. Cervical blood flow (ml/min/m2) was assessed using phase-contrast MRI, and cerebral perfusion ratios were assessed using arterial spin labeling perfusion at neutral position, predefined head rotations, as well as flexion and extension. Inter-reader agreements were assessed using intraclass correlation coefficient. RESULTS The mean age was 38.6 ± 10.8 (range = 22-56) years, for five male participants and 13 females. The means for height and weight were 168 cm and 73.2 kg, respectively. There were no significant differences in individual arterial blood flow with change in head position (P > 0.05). Similarly, the repeated-measures analysis of variance test demonstrated no significant difference in perfusion ratios in relation to head position movement (P > 0.05). Inter-reader agreement was excellent (intraclass correlation coefficient = 0.97). CONCLUSIONS There is neither significant change in either individual cervical arterial blood flow nor cerebral perfusion within the normal physiological/anatomical range of motion in healthy individuals. It is therefore reasonable to conclude that any such hemodynamic change identified in a patient with ischemic stroke be considered causative.
Collapse
Affiliation(s)
- Adam A Dmytriw
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada.
| | - Suzanne Bickford
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Parneyan Pezeshkpour
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Winston Ha
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Afsaneh Amirabadi
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Mahmoud Dibas
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Lee Ann Kitamura
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Logi Vidarsson
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Pulcine
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Prakash Muthusami
- Divisions of Neuroradiology and Image Guided Therapy, Department of Diagnostic Imaging, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Zimelewicz Oberman D, Perez Akly MS, Rabelo NN, Elizondo C, Amorim Correa JL, Ajler P, Baccanelli MM. Morphologic Variations in the Circle of Willis as a Risk Factor for Aneurysm Rupture in the Anterior and Posterior Communicating Arteries. World Neurosurg 2021; 154:e155-e162. [PMID: 34273549 DOI: 10.1016/j.wneu.2021.06.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Intracranial aneurysms are acquired abnormal vascular dilations. The most dangerous complication of a cerebral aneurysm is its rupture, with a high rate of mortality. This study aimed to determine whether there is an association between anatomic variations in the circle of Willis and ruptured aneurysms in the anterior and posterior communicating arteries. METHODS A cross-sectional study of adult patients with a diagnosis of intracranial aneurysm was carried out between March 2015 and March 2019. The patients were divided into groups of ruptured or unruptured aneurysm in the anterior and posterior communicating arteries. RESULTS A total of 132 patients with anterior and posterior communicating artery aneurysms were included. The presence of anatomic variation in the circle of Willis presented a statistically significant association with ruptured aneurysms (odds ratio [OR], 2.28; 95% confidence interval [CI], 1.11-4.65; P = 0.024). There was a statistically significant difference between the presence of nonspherical aneurysm and rupture (OR, 6.9; 95% CI, 3.12-15.48; P < 0.0001). Multivariate logistic regression observed smoking (OR, 2.4; 95% CI, 1.01-5.9; P = 0.4), anterior complex variations (OR, 2.68; 95% CI, 1.01-7.18; P < 0.04), and nonspherical morphology (OR, 4.7; 95% CI, 1.93-11.45; P = 0.001) presented a statistically significant association with the rupture. CONCLUSIONS Our results suggest that the studied variations of the circle of Willis and nonspherical morphology, in addition to playing a role in the development of cerebral aneurysms, may contribute to their rupture.
Collapse
Affiliation(s)
| | | | | | - Cristina Elizondo
- Department of Internal Medicine Research Area, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Pablo Ajler
- Department of Neurosurgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | |
Collapse
|
11
|
Abdi M, NavidBakhsh M. Collateral flow at circle of Willis in healthy condition. Perfusion 2021; 37:293-305. [PMID: 33594933 DOI: 10.1177/0267659120987550] [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: 11/17/2022]
Abstract
Experimental simulation of cerebrovascular system would be very beneficial tool to evaluate millions of human body cascade sequence. The Circle of Willis (CoW) recently named Cerebral Arterial Circle (CAC) is a main loop structure of cerebral circulatory system which positioned at the cranium base. In this research, we investigate cerebral artery flow pattern in cerebral arteries including afferent, Willisian, and efferent arteries of CAC emphasizing on communicating and connecting arteries which are main routes in CAC and as a risky sites when autoregulation is occurred in terminal parts of middle cerebral arteries (MCAs) by PMMA (Polymethyl methacrylate) chip and high quality camera which depict Sequential images. This novelty study analyze flow pattern in CAC that have been challenging subject area for many years which have investigated by scientists yet, because flow pattern in CAC indicate complication progression. This research tries to construct new platform in cerebral circulation analyzing method by reliable experimental in-vitro approach. The outcomes of this study demonstrate that communicating arteries especially anterior communicating artery (ACoA) is main artery in CAC flow distribution.
Collapse
Affiliation(s)
- Mohsen Abdi
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran.,Tissue Engineering and Biological Systems Research Laboratory, School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Mahdi NavidBakhsh
- School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran.,Tissue Engineering and Biological Systems Research Laboratory, School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| |
Collapse
|
12
|
Phan TG, Ma H, Goyal M, Hilton J, Sinnott M, Srikanth V, Beare R. Computer Modeling of Clot Retrieval-Circle of Willis. Front Neurol 2020; 11:773. [PMID: 32849226 PMCID: PMC7427049 DOI: 10.3389/fneur.2020.00773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/24/2020] [Indexed: 12/22/2022] Open
Abstract
Endovascular clot retrieval, often referred to as mechanical thrombectomy, has transformed the treatment of patients with ischemic stroke based on an underlying large cerebral vessel occlusion, ranging from the extracranial internal carotid artery (ICA) to the M1 (proximal) segment of the middle cerebral artery (MCA). The aim of this study was to evaluate the effect of a progressive occlusion of the extracranial portion of the ICA on the cerebral blood flow either with a conventional guiding catheter or a balloon-guiding catheter, which enables the operator to completely occlude the parent artery by inflating the balloon around the tip of this type of guiding catheter. We evaluated the impact of flow reduction in the ICA in the setting of ipsilateral MCA occlusion given the different configurations of the circle of Willis (CoW). The computer model of cerebral arteries was based on anatomical works by Rhoton (1) and van der Eecken (2). The interactive experimental results are available on the web at https://gntem3.shinyapps.io/ecrsim. In the setting of left MCA occlusion, compensation from the anterior and posterior communicating artery preserved the flow in the left anterior cerebral artery (ACA) but not the left MCA branches. Under selected CoW configurations, such as classic, missing Acom, or missing A1 segment of the ACA and concurrent right ICA occlusion, there was a progressive decrease of flow in the left ACA to a minimum of 78% when the simulated catheter fully occluded the left ICA. Flow collapsed (<10%) in the left ACA and MCA branches under CoW configurations, such as bilateral fetal PCA. In summary, compensatory flow collapsed under certain clot retrieval scenarios and unusual configurations of CoW.
Collapse
Affiliation(s)
- Thanh G Phan
- Stroke and Aging Research Group, Clinical Trials, Imaging and Informatics Division, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Monash Health, Melbourne, VIC, Australia
| | - Henry Ma
- Stroke and Aging Research Group, Clinical Trials, Imaging and Informatics Division, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Monash Health, Melbourne, VIC, Australia
| | - Mayank Goyal
- Departments of Clinical Neuroscience and Radiology, Cummings School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - James Hilton
- Data 61, CSIRO, Innovation Hub, Docklands, VIC, Australia
| | | | - Velandai Srikanth
- Department of Medicine, Peninsula Clinical School, Central Clinical School, Frankston Hospital, Monash University, Melbourne, VIC, Australia
| | - Richard Beare
- Departments of Clinical Neuroscience and Radiology, Cummings School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| |
Collapse
|
13
|
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}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$${Re}=300$$\end{document}Re=300, \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\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}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\begin{document}$${Re}=500$$\end{document}Re=500 is around 8% higher than that under \documentclass[12pt]{minimal}
\usepackage{amsmath}
\usepackage{wasysym}
\usepackage{amsfonts}
\usepackage{amssymb}
\usepackage{amsbsy}
\usepackage{mathrsfs}
\usepackage{upgreek}
\setlength{\oddsidemargin}{-69pt}
\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.
Collapse
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
| |
Collapse
|
14
|
Association between Circle of Willis Configuration and Rupture of Cerebral Aneurysms. MEDICINA-LITHUANIA 2019; 55:medicina55070338. [PMID: 31277348 PMCID: PMC6681035 DOI: 10.3390/medicina55070338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/29/2019] [Accepted: 07/01/2019] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Intracranial hemorrhage caused by the rupture of brain aneurysms occurs in almost 10 per 100,000 people whereas the incidence of such aneurysms is significantly higher, accounting for 4–9%. Linking certain factors to cerebral aneurysm rupture could help in explaining the significantly lower incidence of their rupture compared to their presence. The aim of this study is to determine the association between the corresponding circle of Willis configurations and rupture of cerebral aneurysms. Materials and Methods: A group of 114 patients treated operatively for aruptured cerebral aneurysm and a group of 56 autopsied subjects were involved in the study. Four basic types of the circle of Willis configurations were formed—two symmetric types A and C, and two asymmetric types B and D. Results: A statistically significantly higher presence of asymmetry of the circle of Willis was determined in the group of surgically-treated subjects (p = 0.001),witha significant presence of asymmetric Type B in this group (p < 0.001). The changeson the A1 segment in the group of surgically-treated subjects showed a statistically significant presence compared to the group of autopsied subjects (p = 0.001). Analyzing the presence of symmetry of the circle of Willis between the two groups, that is, the total presence of symmetric types A and C, indicated their statistically significant presence in the group of autopsied patients (p < 0.001). Conclusions: Changes such as hypoplasia or aplasia of A1 and the resulting asymmetry of the circle of Willis directly affect the possibility of the rupture of cerebral aneurysms. Detection of the corresponding types of the circle of Willis after diagnostic examination can be the basis for the development of a protocol for monitoring such patients.
Collapse
|
15
|
Kim YY, Chao JR, Kim C, Jung H, Kim B, Kang TC, Chang J, Park HS, Suh JG, Lee JH. Comparing the Superficial Vasculature of the Central Nervous System in Six Laboratory Animals: A Hypothesis About the Role of the "Circle of Willis". Anat Rec (Hoboken) 2019; 302:2049-2061. [PMID: 31087813 DOI: 10.1002/ar.24146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 03/05/2019] [Accepted: 03/23/2019] [Indexed: 11/08/2022]
Abstract
We provide images of the entire central nervous system vasculature, and compare the anatomical findings in six different laboratory animals. A detailed understanding of the specific anatomy for each is important in the design of experimental modeling and for understanding the specific function of each target organ. Six different types of animals, the Korean wild mouse, C57BL/6J mouse, F344 rat, mongolian gerbil, Syrian hamsters, and guinea pigs, were included. To stain the blood vessels in each of the animals, Alcian blue reagent was used to perfuse each species. The bifurcation and anastomotic patterns of the anterior cerebral arteries differed in each species. The vascular supply to the olfactory nerve was visualized as a single artery supplying both olfactory nerves, and arteries supplying the lateral portion of the olfactory nerves originating from the olfactory bulb area. The posterior communicating arteries of the six animals demonstrated unique morphologies. The shape of the hypophyseal portal system varied by species. Most animals used in this study had a hexagonal Circle of Willis, except for the Korean wild mouse. Using this approach, we successfully mapped the brain vascular system in six different species of animals. This information and the images created can guide other researchers as they design research studies and create experimental models for new surgical procedures and approaches. Anat Rec, 2019. © 2019 Wiley Periodicals, Inc. Anat Rec, 302:2049-2061, 2019. © 2019 American Association for Anatomy.
Collapse
Affiliation(s)
- Yoo Yeon Kim
- Department of Medical Genetics, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Janet Ren Chao
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut
| | - Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon, Republic of Korea
| | - Harry Jung
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Boyoung Kim
- Department of Medical Genetics, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Tae-Cheon Kang
- Department of Anatomy and Neurobiology, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Jiwon Chang
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Hae Sang Park
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Jun-Gyo Suh
- Department of Medical Genetics, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Jun Ho Lee
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Republic of Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| |
Collapse
|
16
|
Genetic and Environmental Contributions to Variation in the Posterior Communicating Collaterals of the Circle of Willis. Transl Stroke Res 2019; 10:189-203. [PMID: 29589286 DOI: 10.1007/s12975-018-0626-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/14/2018] [Accepted: 03/16/2018] [Indexed: 02/07/2023]
Abstract
Variation in blood flow mediated by the posterior communicating collateral arteries (PComs) contributes to variation in the severity of tissue injury in obstructive disease. Evidence in animals and humans indicates that differences in the extent of PComs, i.e., their anatomic lumen diameter and whether they are present bilaterally, unilaterally, or absent, are a major factor. These differences arise during development since they are present at birth. However, the causal mechanisms are unknown. We used angiography after maximal dilation to examine involvement of genetic, environmental, and stochastic factors. The extent of PComs varied widely among seven genetically diverse strains of mice. Like pial collaterals in the microcirculation, aging and hypertension reduced PCom diameter, while in contrast, obesity, hyperlipidemia, metabolic syndrome, and diabetes mellitus had no effect. Naturally occurring intrauterine growth restriction had no effect on extent of PCom or pial collaterals in the adult. The number and diameter of PComs evidenced much larger apparent stochastic-dependent variation than pial collaterals. In addition, both PComs underwent flow-mediated outward remodeling after unilateral permanent MCA occlusion that varied with genetic background and was greater on the ipsilesional side. These findings indicate that variation in the number and diameter of PCom collateral arteries arises from stochastic factors and naturally occurring genetic variants that differ from those that cause variation in pial collateral arterioles. Environmental factors also contribute: aging and hypertension reduce PCom diameter. Our results suggest possible sources of variation of PComs in humans and provide information relevant when studying mouse models of occlusive cerebrovascular disease.
Collapse
|
17
|
Smith T, Jafrancesco G, Surace G, Morshuis WJ, Tromp SC, Heijmen RH. A functional assessment of the circle of Willis before aortic arch surgery using transcranial Doppler. J Thorac Cardiovasc Surg 2019; 158:1298-1304. [PMID: 30803779 DOI: 10.1016/j.jtcvs.2019.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 10/31/2018] [Accepted: 01/03/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Antegrade selective cerebral perfusion (ASCP) with systemic moderate hypothermia is routinely used as brain protection during aortic arch surgery. Whether ASCP should be delivered unilaterally (u-ASCP) or bilaterally (bi-ASCP) remains controversial. METHODS We routinely studied the functional anatomy of the circle of Willis (CoW in all patients scheduled for arch surgery using transcranial color-coded Doppler over a decade. On the basis of these data, we classified observed functional variants as being "safe," "moderately safe," or "unsafe" for u-ASCP. RESULTS From January 2005 to June 2015, 1119 patients underwent aortic arch surgery in our institution. Of these, 636 patients had elective surgery performed with ASCP. Preoperative full functional assessment of the CoW was possible in 61% of patients. A functionally complete CoW was found in only 27%. Of all variants, 72% were classified as being safe for u-ASCP, whereas 18% were moderately safe for u-ASCP, and 10% unsafe. Unsafe variants for bi-ASCP were observed in 0.5% of patients. CONCLUSIONS The risk of ischemic brain damage due to malperfusion is estimated to be substantially higher during right u-ASCP than during bi-ASCP. Bi-ASCP is therefore highly preferable over u-ASCP if the function of the CoW is unknown. We propose a tailored approach using this full functional assessment preoperatively by applying u-ASCP via the right subclavian artery when considered safely possible, and bi-ASCP when considered a necessity to prevent cerebral malperfusion, and thus thereby try to reduce the embolic stroke risk of ostial instrumentation in bi-ASCP.
Collapse
Affiliation(s)
- Tim Smith
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Giuliano Jafrancesco
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Giusy Surace
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Wim J Morshuis
- Department of Cardiothoracic Surgery, University Medical Center St Radboud, Nijmegen, The Netherlands
| | - Selma C Tromp
- Department of Clinical Neurophysiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiothoracic Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
| |
Collapse
|
18
|
Li J, Hua Y, Needleman L, Forsberg F, Eisenbray JR, Li Z, Liu R, Tian X, Jiao L, Liu JB. Arterial occlusions increase the risk of in-stent restenosis after vertebral artery ostium stenting. J Neurointerv Surg 2018; 11:574-578. [PMID: 30337379 DOI: 10.1136/neurintsurg-2018-014243] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/19/2018] [Accepted: 09/23/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The study was designed to investigate if vascular occlusion in the internal carotid artery (ICA) or the contralateral vertebral artery (VA) contribute to developing in-stent restenosis (ISR) in patients with vertebral artery ostium stenosis (VAOS). METHODS 420 consecutive patients treated with VAOS stents (from a population of 8145 patients with VAOS) from January 2013 to December 2014 were analyzed in this retrospective study; 216 with drug eluted stents and 204 with bare metal stents. Based on pre-stent DSA findings, patients were divided into four groups: both carotid and vertebral arteries patent (PAT), ICA occlusion (ICA-OCC), contralateral VA occlusion (CVA-OCC), and combined occlusions (C-OCC). The incidence of ISR (stenosis >50%) was compared between groups using Cox regression analysis. RESULTS Of the 420 patients, the mean incidence of ISR was 36.4%, with a median 12 months of follow-up (IQR 3-12). Logistic regression analysis showed that drug eluting stent had less ISR than bare metal stent (OR=0.38, 95% CI 0.19 to 0.75, P=0.01). Cox regression analysis showed that CVA-OCC (HR=1.63, P=0.02) and C-OCC (HR=3.30, P=0.001) were risk factors for ISR but not ICA-OCC (P=0.31). In the CVA-OCC and C-OCC groups, in-stent peak systolic velocity (PSV) ≥140 cm/s, 1 day after successful stenting, was associated with subsequent development of ISR (OR=2.81, 95% CI 1.06 to 7.43, P=0.04). CONCLUSION Contralateral VA occlusion at the time of stenting increased the risk of ISR, especially if stent PSV on day 1 was >140 cm/s. Bare metal stents had more ISR than drug eluting stents.
Collapse
Affiliation(s)
- Jingzhi Li
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yang Hua
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Laurence Needleman
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - John R Eisenbray
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Zhaojun Li
- Department of Ultrasound, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ran Liu
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Tian
- Department of Vascular Ultrasonography, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ji-Bin Liu
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| |
Collapse
|
19
|
Bozkurt S. Effect of Cerebral Flow Autoregulation Function on Cerebral Flow Rate Under Continuous Flow Left Ventricular Assist Device Support. Artif Organs 2018; 42:800-813. [DOI: 10.1111/aor.13148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/13/2018] [Accepted: 02/20/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Selim Bozkurt
- University College London - Institute of Cardiovascular Science; London United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
20
|
Švigelj V, Šinkovec M, Avbelj V, Trobec R, Gaspar L, Petrovič D, Kruzliak P. Cardiovagal and adrenergic function tests in unilateral carotid artery stenosis patients-a Valsalva manoeuvre tool to show an autonomic dysfunction? Wien Klin Wochenschr 2016; 128:504-12. [PMID: 26980215 DOI: 10.1007/s00508-016-0980-2] [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: 07/26/2015] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The stability of an arterial baroreflex depends also upon the integrity of the afferent limb. For its quantification, we can use a noninvasive test such as baroreceptor sensitivity estimation during Valsalva manoeuvre. The aim of this study was to evaluate potential autonomic dysfunction in patients with unilateral severe carotid disease and compare the results to the results obtained from an age and gender matched group of healthy volunteers. METHODS We evaluated dynamic changes during Valsalva manoeuvre (Valsalva ratio, cardiovagal and adrenergic baroreceptor sensitivity, sympathetic indexes and its dynamic ranges) in 41 patients (29 males; 62.9 ± 7.4 years) and compared the results to results obtained from volunteers (62.8 ± 7.0 years). RESULTS Valsalva ratio between the patients and control group revealed no significant difference, as well as cardiovagal and adrenergic baroreceptor sensitivity. Sympathetic indexes, except for sympathetic index 2, reflecting the sympathetic vasoconstrictor baroreceptor response in late phase 2 of Valsalva manoeuvre (7.1 ± 13.1 mmHg in patients vs. 11.4 ± 10.2 mmHg in control group; p = 0.012) showed no significant differences between the studied groups. The most prominent dynamic range between the groups was within the sympathetic index 2. CONCLUSION With some Valsalva manoeuvre test results, we were not able to show severe autonomic dysfunction in unilateral severe carotid stenosis patients except for lower vasoconstriction response within the late phase 2 of the manoeuvre.
Collapse
Affiliation(s)
- Viktor Švigelj
- Division of Neurology, Department of Vascular Neurology and Neurological Intensive Care, Neurological Intensive Care Unit, University Medical Centre Ljubljana, Zaloška 2, 1525, Ljubljana, Slovenia.
| | - Matjaž Šinkovec
- Division of Internal Medicine, Department of Cardiology, University Medical Centre Ljubljana, Zaloška 2, 1525 Ljubljana, Slovenia
| | - Viktor Avbelj
- Department of Communication Systems, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia
| | - Roman Trobec
- Department of Communication Systems, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia
| | - Ludovit Gaspar
- 2nd Department of Internal Medicine, Faculty of Medicine, Comenius University and University Hospital, Mickiewiczova 13, 813 69, Bratislava, Slovak Republic
| | - Daniel Petrovič
- Institute of Histology and Embryology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia
| | - Peter Kruzliak
- 2nd Department of Internal Medicine, Faculty of Medicine, Masaryk University, Pekarska 53, 656 91, Brno, Czech Republic.,Laboratory of Structural Biology and Proteomics, Faculty of Pharmacy, University of Veterinary Medicine and Pharmaceutical Sciences, Brno, Czech Republic
| |
Collapse
|
21
|
Zhu G, Yuan Q, Yang J, Yeo JH. The role of the circle of Willis in internal carotid artery stenosis and anatomical variations: a computational study based on a patient-specific three-dimensional model. Biomed Eng Online 2015; 14:107. [PMID: 26608827 PMCID: PMC4659208 DOI: 10.1186/s12938-015-0105-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 11/18/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study is to provide better insights into the cerebral perfusion patterns and collateral mechanism of the circle of Willis (CoW) under anatomical and pathological variations. METHODS In the current study, a patient-specific three-dimensional computational model of the CoW was reconstructed based on the computed tomography (CT) images. The Carreau model was applied to simulate the non-Newtonian property of blood. Flow distributions in five common anatomical variations coexisting with different degrees of stenosis in the right internal carotid artery (RICA) were investigated to obtain detailed flow information. RESULTS With the development of stenosis in unilateral internal carotid artery (ICA), the cerebral blood supply decreased when the degree of stenosis increased. The blood supply of the ipsilateral middle cerebral artery (MCA) was most affected by the stenosis of ICA. The anterior communicating artery (ACoA) and ipsilateral posterior communicating artery (PCoA) functioned as the important collateral circulation channels when unilateral stenosis occurred. The blood flow of the anterior circulation and the total cerebral blood flow (CBF) reached to the minimum in the configuration of the contralateral proximal anterior cerebral artery (A1) absence coexisting with unilateral ICA stenosis. CONCLUSIONS Communicating arteries provided important collateral channels in the complete CoW when stenosis in unilateral ICA occurred. The cross-flow in the ACoA is a sensitive indicator of the morphological change of the ICA. The collateral function of the PCoA on the affected side will not be fully activated until a severe stenosis occurred in unilateral ICA. The absence of unilateral A1 coexisting with the stenosis in the contralateral ICA could be the most dangerous configuration in terms of the total cerebral blood supply. The findings of this study would enhance the understanding of the collateral mechanism of the CoW under different anatomical variations.
Collapse
Affiliation(s)
- Guangyu Zhu
- School of Energy and Power Engineering, Xi'an Jiaotong University, 28 Xian Ning West Rd, Xi'an, 710049, Shaanxi, China.
| | - Qi Yuan
- School of Energy and Power Engineering, Xi'an Jiaotong University, 28 Xian Ning West Rd, Xi'an, 710049, Shaanxi, China.
| | - Jian Yang
- Department of Radiology and Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, Shaanxi, China.
| | - Joon Hock Yeo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Ave, Singapore, 639798, Singapore.
| |
Collapse
|
22
|
Tang D, Li ZY, Gijsen F, Giddens DP. Cardiovascular diseases and vulnerable plaques: data, modeling, predictions and clinical applications. Biomed Eng Online 2015; 14 Suppl 1:S1. [PMID: 25602945 PMCID: PMC4306097 DOI: 10.1186/1475-925x-14-s1-s1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
|