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van de Velde L, Groot Jebbink E, Jain K, Versluis M, Reijnen MMPJ. Lesion Eccentricity Plays a Key Role in Determining the Pressure Gradient of Serial Stenotic Lesions: Results from a Computational Hemodynamics Study. Cardiovasc Intervent Radiol 2024; 47:533-542. [PMID: 38565717 DOI: 10.1007/s00270-024-03708-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE In arterial disease, the presence of two or more serial stenotic lesions is common. For mild lesions, it is difficult to predict whether their combined effect is hemodynamically significant. This study assessed the hemodynamic significance of idealized serial stenotic lesions by simulating their hemodynamic interaction in a computational flow model. MATERIALS AND METHODS Flow was simulated with SimVascular software in 34 serial lesions, using moderate (15 mL/s) and high (30 mL/s) flow rates. Combinations of one concentric and two eccentric lesions, all 50% area reduction, were designed with variations in interstenotic distance and in relative direction of eccentricity. Fluid and fluid-structure simulations were performed to quantify the combined pressure gradient. RESULTS At a moderate flow rate, the combined pressure gradient of two lesions ranged from 3.8 to 7.7 mmHg, which increased to a range of 12.5-24.3 mmHg for a high flow rate. Eccentricity caused an up to two-fold increase in pressure gradient relative to concentric lesions. At a high flow rate, the combined pressure gradient for serial eccentric lesions often exceeded the sum of the individual lesions. The relative direction of eccentricity altered the pressure gradient by 15-25%. The impact of flow pulsatility and wall deformability was minor. CONCLUSION This flow simulation study revealed that lesion eccentricity is an adverse factor in the hemodynamic significance of isolated stenotic lesions and in serial stenotic lesions. Two 50% lesions that are individually non-significant can combine more often than thought to hemodynamic significance in hyperemic conditions.
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Affiliation(s)
- L van de Velde
- Multi-Modality Medical Imaging M3i Group, TechMed Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands.
- Department of Surgery, Rijnstate, Arnhem, The Netherlands.
- Physics of Fluids Group, TechMed Centre, University of Twente, Enschede, The Netherlands.
| | - E Groot Jebbink
- Multi-Modality Medical Imaging M3i Group, TechMed Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
- Physics of Fluids Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - K Jain
- Department of Thermal and Fluid Engineering, University of Twente, Enschede, The Netherlands
| | - M Versluis
- Physics of Fluids Group, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - M M P J Reijnen
- Multi-Modality Medical Imaging M3i Group, TechMed Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands
- Department of Surgery, Rijnstate, Arnhem, The Netherlands
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Sonmez F, Karagoz S, Yildirim O, Firat I. Experimental and numerical investigation of the stenosed coronary artery taken from the clinical setting and modeled in terms of hemodynamics. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3793. [PMID: 37975163 DOI: 10.1002/cnm.3793] [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: 04/03/2023] [Revised: 10/31/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
The study was carried out to investigate the effect of the artery with different pulse values and stenosis rates on the pressure drop, the peristaltic pump outlet pressure, fractional flow reserve (FFR) and most importantly the amount of power consumed by the peristaltic pump. For this purpose, images taken from the clinical environment were produced as models (10 mm inlet diameter) with 0% and 70% percent areal stenosis rates (PSR) on a three-dimensional (3D) printer. In the experimental system, pure water was used as the fluid at 54, 84, 114, 132, and 168 bpm pulse values. In addition, computational fluid dynamics (CFD) analyzes of the test region were performed using experimental boundary conditions with the help of ANSYS-Fluent software. The findings showed that as PSR increases in the arteries, the pressure drop in the stenosis region increases and this amount increases dramatically with increasing effort. An increase of approximately 40% was observed in the pump outlet pressure value from 54 bpm to 168 bpm in the PSR 0% model and 51% increase in the PSR 70% model. It has been observed that the pump does more work to overcome the increased pressure difference due to increased pulse rate and PSR. With the effect of contraction, the power consumption of the pump increased from 9.2% for 54 bpm to 13.8% for 168 bpm. In both models, the Wall Shear Stress (WSS) increased significantly. WSS increased abruptly in the stenosis and arcuate regions, while sudden decreases were observed in the flow separation region.
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Affiliation(s)
- Fatin Sonmez
- Artvin Vocational School, Artvin Coruh University, Artvin, Turkey
| | - Sendogan Karagoz
- Department of Mechanical Engineering, Ataturk University, Erzurum, Turkey
| | - Orhan Yildirim
- Department of Mechanical Engineering, Ataturk University, Erzurum, Turkey
| | - Ilker Firat
- Ilic Dursun Yildirim Vocational School, Erzincan Binali Yildirim University, Erzincan, Turkey
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Wall Shear Stress Alteration: a Local Risk Factor of Atherosclerosis. Curr Atheroscler Rep 2022; 24:143-151. [PMID: 35080718 DOI: 10.1007/s11883-022-00993-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Wall shear stress describes the mechanical influence of blood flow on the arterial wall. In this review, we discuss the role of the wall shear stress in the development of atherosclerosis and its complications. RECENT FINDINGS Areas with chronically low, oscillating wall shear stress are most prone to plaque development and include outer bifurcation walls and inner walls of arches. In some diseases, patients have lower wall shear stress even in straight arterial segments; also, these findings were associated with atherosclerosis. High wall shear stress develops in the distal part (shoulder) of a stenosis and contributes to plaque destabilization. Wall shear stress changes are involved in the development of atherosclerosis. They are not fully understood yet and act in concert with tangential wall stress.
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Gong X, Liang Z, Wang Y, Zhang C, Xie S, Fan Y. Comparative study on hemodynamic environments around patient-specific carotid atherosclerotic plaques with different symmetrical features. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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de Bont C, Malik J. Vascular access ultrasonography: The risk of simplification. J Vasc Access 2021:11297298211039655. [PMID: 34396832 DOI: 10.1177/11297298211039655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Cora de Bont
- Vascular Laboratory, Bravis Hospital, Bergen op Zoom, The Netherlands
| | - Jan Malik
- Center for Vascular Access, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
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Malik J, Lomonte C, Meola M, de Bont C, Shahverdyan R, Rotmans JI, Saucy F, Jemcov T, Ibeas J. The role of Doppler ultrasonography in vascular access surveillance-controversies continue. J Vasc Access 2021; 22:63-70. [PMID: 34281410 PMCID: PMC8619723 DOI: 10.1177/1129729820928174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Chronic hemodialysis therapy required regular entry into the patient’s blood stream with adequate flow. The use of arteriovenous fistulas and grafts is linked with lower morbidity and mortality than the use of catheters. However, these types of accesses are frequently affected by stenoses, which decrease the flow and lead to both inadequate dialysis and access thrombosis. The idea of duplex Doppler ultrasound surveillance is based on the presumption that in-time diagnosis of an asymptomatic significant stenosis and its treatment prolongs access patency. Details of performed trials are conflicting, and current guidelines do not support ultrasound surveillance. This review article summarizes the trials performed and focuses on the reasons of conflicting results. We stress the need of precise standardized criteria of significant access stenosis and the weakness of the metaanalyses performed.
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Affiliation(s)
- Jan Malik
- Center for Vascular Access, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic.,3rd Department of Internal Medicine, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Carlo Lomonte
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| | - Mario Meola
- Institute of Life Sciences, Sant'Anna of Advanced Studies and Department of Internal Medicine, Pisa University, Pisa, Italy
| | - Cora de Bont
- Vascular Laboratory, Bravis Hospital, Bergen op Zoom, The Netherlands
| | | | - Joris I Rotmans
- Department of Internal Medicine, Leiden University Medical Center, The Netherlands
| | - Francois Saucy
- Service of Vascular Surgery, Department of Heart and Vessels, University Hospital, Lausanne, Switzerland
| | - Tamara Jemcov
- Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jose Ibeas
- Nephrology Department, Parc Taulí University Hospital, Parc Taulí Research and Innovation Institute (I3PT), Autonomous University of Barcelona, Barcelona, Spain
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The relationship between coronary lesion characteristics and pathologic shear in human coronary arteries. Clin Biomech (Bristol, Avon) 2018; 60:177-184. [PMID: 30384262 DOI: 10.1016/j.clinbiomech.2018.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/06/2018] [Accepted: 10/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pathological shear stress is associated with distinct pathogenic biological pathways relevant to coronary thrombosis and atherogenesis. Although the individual effects of lesion characteristics including stenosis severity, eccentricity and lesion length on coronary haemodynamics is known, their relative importance remains poorly understood. METHODS Computational fluid dynamics (CFD) was implemented for haemodynamic analysis of 104 coronary arteries. For each coronary artery, maximum shear stress at the site of maximal stenosis, average shear stress over the sites of maximal stenosis segment, average shear stress in the proximal segments and average shear stress in the distal segments were determined. In addition, the area of low wall shear stress (ALWSS) sites in post-stenotic regions were quantified as a proportion of the vessel segment. RESULTS With increasing stenosis severity, eccentricity and lesion length, maximal and average shear stress over the sites of maximal stenosis and ALWSS increased whereas average shear stress in the proximal segments decreased. Two-way ANCOVA analysis revealed that stenosis severity and lesion length were both independent predictors of maximum shear at the site of maximal stenosis [F (1, 104) = 10.94, P = 0.001 for diameter stenosis and F (1, 104) = 6.21, P = 0.014 for lesion length] and ALWSS [F (1, 104) = 66.10, P = 0.001 for diameter stenosis and F (1, 104) = 4.23, P = 0.047 for lesion length]. CONCLUSION Our findings demonstrate that although all lesion characteristics correlate with abnormal shear stress, only stenosis severity and lesion length are independent predictors of pathogenic physiological processes.
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GOVINDARAJU KALIMUTHU, VISWANATHAN GIRISHN, BADRUDDIN IRFANANJUM, WELDEMARIAM SIRAKAREGAWI, GEBREHIWOT WOLDUZINA, KAMANGAR SARFARAZ. THE MECHANICAL FACTORS INFLUENCING THE ASSESSMENT OF INTERMEDIATE STENOSIS SEVERITY EXPLAINED THROUGH FRACTIONAL FLOW RESERVE. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417300010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Assessment of intermediate coronary lesions with diameter stenosis of 40% to 70% severity is being a challenge for cardiologist to identify potentially ischemic stenosis for revascularization and nonculprit stenosis which can be deferred from stenting. An invasive coronary angiography and intravascular ultrasound provide anatomic information of stenosis severity whereas an invasive fractional flow reserve index (FFR) provides the functional significance of the stenosis severity. The measurement of functional significance of stenosis severity minimizes the procedural complications such as coronary dissection, in stent restenosis etc. rather than anatomical significance measure. The FFR cutoff value of [Formula: see text]0.8 is used to distinguish ischemic and nonischemic stenosis. The FFR is clinically well validated even though it is influenced by the mechanical factors such as hyperemic flow and guide wire insertion. In recent times, noninvasive coronary computed tomography (CCTA) modality has become popular in the diagnosis of coronary artery disease. The CCTA permits the assessment of cross-sectional parameters such as minimum lumen area and lumen diameter, lesion length and plaque morphology. However, the CCTA provides limited information on the functional significance of stenotic lesions as compared to FFR. The purpose of this review is to discuss the mechanical factors influencing the invasive FFR while assessing the functional significance of intermediate stenosis severity. In addition, the hidden mechanical factors influencing the noninvasive CCTA assessment of stenosis severity will be discussed from the critical information obtained from FFR which could be beneficial for the clinician particularly in the assessment of intermediate stenosis severity.
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Affiliation(s)
- KALIMUTHU GOVINDARAJU
- Ethiopian Institute of Technology, School of Mechanical and Industrial Engineering, Mekelle University, Mekelle, Ethiopia
| | | | | | - SIRAK AREGAWI WELDEMARIAM
- Ethiopian Institute of Technology, School of Mechanical and Industrial Engineering, Mekelle University, Mekelle, Ethiopia
| | - WOLDU ZINA GEBREHIWOT
- Ethiopian Institute of Technology, School of Mechanical and Industrial Engineering, Mekelle University, Mekelle, Ethiopia
| | - SARFARAZ KAMANGAR
- Department of Mechanical Engineering, University of Malaya, Malaysia
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