Hemodynamic parameters distribution of upstream,stenosis center,and downstream sides of plaques in carotid artery with different stenosis: a MRI and CFD study

Abstract

Background

Histopathological studies have shown significant differences in plaque components and surface conditions between upstream and downstream of the stenosis. It can be deduced that the flow status near the plaques is different from the flow status at the upstream side, stenosis center, or downstream side of the plaque.

Purpose

To study the hemodynamic parameter distribution in different locations near atherosclerotic plaques in the carotid arteries with different stenosis degrees.

Material and Methods

Eleven patients were recruited in this study. CE-MRA was performed to obtain the carotid three-dimensional surface data and the stenosis degrees were calculated. The hemodynamic parameters including wall shear stress (WSS), pressure, and velocity near the plaques were obtained by computational fluid dynamic (CFD) method. Local hemodynamics parameters were analyzed and compared between different stenosis degree groups, and between upstream, stenosis center, and downstream sides of plaques. Relative ratio of velocity, WSS, and pressure values in different locations was calculated and compared.

Results

Fourteen carotid arteries (with 4 mild, 6 moderate, and 4 severe stenosis) were analyzed. Significant differences were found in Pressure max (P = 0.025), Pressure mean (P = 0.020), and Pressure min (P = 0.026) between three stenosis groups. It showed significant differences in Vmin (P < 0.001) and WSSmin (P < 0.001) between three different locations. It showed upstream to downstream ratio of WSSmax (P = 0.034) and WSSmean value (P = 0.042) was significantly different between mild and moderate/severe groups. Significant differences were found in upstream to stenosis center ratio of Pressure max value (P = 0.018), Pressure mean value (P = 0.029), and Pressure min value (P = 0.026), as well as in stenosis center to downstream ratio of Pressure min value (P = 0.042).

Conclusion

Velocity, WSS, pressure, and relative ratio of these parameters have certain trends in distribution around the plaques in the carotid arteries.

Keywords

Carotid artery hemodynamic atherosclerotic plaques magnetic resonance imaging computational fluid dynamics

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References

Rosamond

Flegal

Friday

. Heart disease and stroke statistics–2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007; 115: e69–e171.

Yusuf

Reddy

Ounpuu

. Global burden of cardiovascular diseases: part I: general considerations, the epidemiologic transition, risk factors, and impact of urbanization. Circulation 2001; 104: 2746–2753.

DeMarco

Ota

Underhill

. MR carotid plaque imaging and contrast-enhanced MR angiography identifies lesions associated with recent ipsilateral thromboembolic symptoms: an in vivo study at 3T. Am J Neuroradiol 2010; 31: 1395–1402.

Takaya

Yuan

Chu

. Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI–initial results. Stroke 2006; 37: 818–823.

Zhao

Liu

. Association of carotid atherosclerotic plaque features with acute ischemic stroke: a magnetic resonance imaging study. Eur J Radiol 2013; 82: e465–e470.

Glagov

Zarins

Giddens

. Hemodynamics and atherosclerosis. Insights and perspectives gained from studies of human arteries. Arch Pathol Lab Med 1988; 112: 1018–1031.

Zarins

Giddens

Bharadvaj

. Carotid bifurcation atherosclerosis. Quantitative correlation of plaque localization with flow velocity profiles and wall shear stress. Circ Res 1983; 53: 502–514.

Gimbrone

Jr Garcia-Cardena

. Vascular endothelium, hemodynamics, and the pathobiology of atherosclerosis. Cardiovasc Pathol 2013; 22: 9–15.

Samady

Eshtehardi

McDaniel

. Coronary artery wall shear stress is associated with progression and transformation of atherosclerotic plaque and arterial remodeling in patients with coronary artery disease. Circulation 2011; 124: 779–788.

10.

Makris

Nicolaides

. Introduction to the biomechanics of carotid plaque pathogenesis and rupture: review of the clinical evidence. Br J Radiol 2010; 83: 729–735.

11.

Dhawan

Avati Nanjundappa

Branch

. Shear stress and plaque development. Expert Rev Cardiovasc Ther 2010; 8: 545–556.

12.

Helderman

Segers

de Crom

. Effect of shear stress on vascular inflammation and plaque development. Curr Opin Lipidol 2007; 18: 527–533.

13.

Huang

Teng

Canton

. Intraplaque hemorrhage is associated with higher structural stresses in human atherosclerotic plaques: an in vivo MRI-based 3D fluid-structure interaction study. Biomed Eng Online 2010; 9: 86–86.

14.

Tang

Teng

Canton

. Local critical stress correlates better than global maximum stress with plaque morphological features linked to atherosclerotic plaque vulnerability: an in vivo multi-patient study. Biomed Eng Online 2009; 8: 15–15.

15.

Groen

Gijsen

van der Lugt

. Plaque rupture in the carotid artery is localized at the high shear stress region: a case report. Stroke 2007; 38: 2379–2381.

16.

Fagerberg

Ryndel

Kjelldahl

. Differences in lesion severity and cellular composition between in vivo assessed upstream and downstream sides of human symptomatic carotid atherosclerotic plaques. J Vasc Res 2010; 47: 221–230.

17.

Cicha

Worner

Urschel

. Carotid plaque vulnerability: a positive feedback between hemodynamic and biochemical mechanisms. Stroke 2011; 42: 3502–3510.

18.

Jing

Gao

Lin

. Distribution of wall shear stress in carotid plaques using magnetic resonance imaging and computational fluid dynamics analysis: a preliminary study. Chin Med J (Engl) 2011; 124: 1465–1469.

19.

Collaborators. NASCET. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325: 445–453.

20.

Antiga

Piccinelli

Botti

. An image-based modeling framework for patient-specific computational hemodynamics. Med Biol Eng Comput 2008; 46: 1097–1112.

21.

Xue

Gao

Lin

. Preliminary study of hemodynamics in human carotid bifurcation by computational fluid dynamics combined with magnetic resonance angiography. Acta Radiol 2007; 48: 788–797.

22.

Xue

Gao

Duan

. Preliminary study of hemodynamic distribution in patient-specific stenotic carotid bifurcation by image-based computational fluid dynamics. Acta Radiol 2008; 49: 558–565.

23.

Feldman

Stone

. Intravascular hemodynamic factors responsible for progression of coronary atherosclerosis and development of vulnerable plaque. Curr Opin Cardiol 2000; 15: 430–440.

24.

Taviani

Tang

. The mechanical triggers of plaque rupture: shear stress vs pressure gradient. Br J Radiol 2009; 82: S39–S45.

25.

Teng

Sadat

Huang

. In vivo MRI-based 3D mechanical stress-strain profiles of carotid plaques with juxtaluminal plaque haemorrhage: an exploratory study for the mechanism of subsequent cerebrovascular events. Eur J Vasc Endovasc Surg 2010; 42: 427–433.