Coronary artery disease is reported as one of the most common sources of death all over the world. The presence of stenosis (plaque) in the coronary arteries results in the restriction of blood supply, which leads to myocardial infarction.
OBJECTIVE:
The aim of this study was to investigate the effect of multi stenosis on hemodynamics parameters in idealized coronary artery models with varying degrees of stenosis and interspace distance between the stenosis.
METHODS:
A finite volume-based software package (Ansys CFX version 17.2) was employed to model the blood flow. The hemodynamic stenosis parameters of blood, such as the pressure, velocity, and wall shear stress were obtained.
RESULTS:
The computed results showed that the pressure drop is maximum across the 90% area stenosis (AS). The pressure drop is increased as the distance between the proximal and distal stenosis is decreased across the proximal stenosis for the model P70_D70 during the systolic period of the cardiac cycle. A recirculation zone is formed behind the stenosis and is restricted by the occurrence of distal stenosis as the interspacing distance decreases, which could lead to further progression of stenosis in the flow-disturbed area. The wall shear stress was found to increase as the distance between the proximal and distal stenosis is increased across the distal stenosis. The maximum wall shear stress was found at 90% AS.
CONCLUSIONS:
In the clinical diagnosis, an overestimation of distal stenosis severity could be possible. Furthermore, the low wall shear stress zone in between the proximal and distal stenosis may help atherosclerotic growth or merge adjacent stenosis.
AsakuraT. and KarinoT., Flow patterns and spatial distribution of atherosclerotic lesions in human coronary arteries, Circ. Res.66(4) (1990), 1045–1066.
2.
ChaichanaT.SunZ. and JewkesJ., Computation of hemodynamics in the left coronary artery with variable angulations, J. Biomech. Eng.44(10) (2011), 1869–1878.
3.
FusterV., Lewis A. Conner Memorial Lecture. Mechanisms leading to myocardial infarction: Insights from studies of vascular biology, Circulation90(4) (1994), 2126–2146.
4.
El-GhobashyN.El-GarfK. and AbdoM., Arterial aneurysms in Behçet’s disease patients: Frequency, clinical characteristics and long-term outcome, Egypt. Rheumatol.41(4) (2019), 309–312.
5.
ZarinsC.K.GiddensD.P.BharadvajB.K.SottiuraiV.S.MabonR.F. and GlagovS., Carotid bifurcation atherosclerosis. Quantitative correlation of plaque localization with flow velocity profiles and wall shear stress, Circ. Res.53(4) (1983), 502–514.
6.
ChaichanaT.SunZ. and JewkesJ., Computational fluid dynamics analysis of the effect of plaques in the left coronary artery, Comput. Math. Meth. Med.2012 (2012).
7.
ShanmugavelayudamS.K.RubensteinD.A. and YinW., Effect of geometrical assumptions on numerical modeling of coronary blood flow under normal and disease conditions, J. Biomech. Eng.132(6) (2010), 061004.
8.
FazliS.ShiraniE. and SadeghiM.R., Numerical simulation of LDL mass transfer in a common carotid artery under pulsatile flows, J. Biomech.44(1) (2011), 68–76.
9.
RazaviA.ShiraniE. and SadeghiM.R., Numerical simulation of blood pulsatile flow in a stenosed carotid artery using different rheological models, J. Biomech.44(11) (2011), 2021–2030.
10.
AhamadN.A.KamangarS. and BadruddinI.A., The influence of curvature wall on the blood flow in stenosed artery: A computational study, Biomed. Mater. Eng.29(3) (2018), 319–332.
11.
ChenJ. and LuX.Y., Numerical investigation of the non-Newtonian pulsatile blood flow in a bifurcation model with a non-planar branch, J. Biomech.39(5) (2006), 818–832.
12.
KamangarS.BadruddinI.A.AhamadN.A.GovindarajuK.Nik-GhazaliN.AhmedN.J., The influence of geometrical shapes of stenosis on the blood flow in stenosed artery, Sains. Malays.46(10) (2017), 1923–1933.
13.
LorenziniG. and CasalenaE., CFD analysis of pulsatile blood flow in an atherosclerotic human artery with eccentric plaques, J. Biomech.41(9) (2008), 1862–1870.
14.
YaoH.AngK.C.YeoJ.H. and SimE.K., Computational modelling of blood flow through curved stenosed arteries, J. Med. Eng. Technol.24(4) (2000), 163–168.
15.
BoutsianisE.DaveH.FrauenfelderT.PoulikakosD.WildermuthS.TurinaM., Computational simulation of intracoronary flow based on real coronary geometry, Eur. J. Cardiothorac. Surg.26(2) (2004), 248–256.
16.
WuJ.LiuG.HuangW.GhistaD.N. and WongK.K., Transient blood flow in elastic coronary arteries with varying degrees of stenosis and dilatations: CFD modelling and parametric study, Comput. Meth. Biomech. Biomed. Eng.18(16) (2015), 1835–1845.
17.
LiM.X.Beech-BrandtJ.J.JohnL.R.HoskinsP.R. and EassonW.J., Numerical analysis of pulsatile blood flow and vessel wall mechanics in different degrees of stenoses, J. Biomech.40(16) (2007), 3715–3724.
18.
MorenoC. and BhaganagarK., Modeling of stenotic coronary artery and implications of plaque morphology on blood flow, Mod. Sim. Eng.2013 (2013), 1–14.
19.
NosovitskyV.A.IlegbusiO.J.JiangJ.StoneP.H. and FeldmanC.L., Effects of curvature and stenosis-like narrowing on wall shear stress in a coronary artery model with phasic flow, Comput. Biomed. Res.30(1) (1997), 61–82.
20.
VargheseS.S. and FrankelS.H., Numerical modeling of pulsatile turbulent flow in stenotic vessels, J. Biomech. Eng.125(4) (2003), 445–460.
21.
BeratlisN.BalarasE.ParvinianB. and KigerK., A numerical and experimental investigation of transitional pulsatile flow in a stenosed channel, J. Biomech. Eng.127(7) (2005), 1147–1157.
22.
CarewE.O. and PedleyT.J., An active membrane model for peristaltic pumping: Part I—Periodic activation waves in an infinite tube, J. Biomech.119(1) (1997), 66–76.
23.
TripR.KuikD.J.WesterweelJ. and PoelmaC., An experimental study of transitional pulsatile pipe flow, Phys. Fluids24(1) (2012), 014103.
24.
ChaichanaT.SunZ. and JewkesJ., Haemodynamic analysis of the effect of different types of plaques in the left coronary artery, Comput. Med. Imag. Graph.37(3) (2013), 197–206.
25.
KamangarS.BadruddinI.A.GovindarajuK.Nik-GhazaliN.BadarudinA.ViswanathanG.N., Patient-specific 3D hemodynamics modelling of left coronary artery under hyperemic conditions, Med. Biol. Eng. Comput.55(8) (2017), 1451–1461.
26.
KarayannacosP.E.TalukderN.NeremR.M.RoshonS. and VaskoJ.S., The role of multiple noncritical arterial stenoses in the pathogenesis of ischemia, J. Thorac. Cardiovasc. Surg.73(3) (1977), 458–469.
27.
Rathish KumarB.V.YamaguchiT.LiuH. and HimenoR., A numerical study of an unsteady laminar flow in a doubly constricted 3D vessel, Int J. Numer. Meth. Fluids38(12) (2002), 1159–1176.
28.
DashR.K.JayaramanG. and MehtaK.N., Flow in a catheterized curved artery with stenosis, J. Biomech.32(1) (1999), 49–61.
29.
KamangarS.KalimuthuG.Anjum BadruddinI.BadarudinA.Salman AhmedN.J. and KhanT.M., Numerical investigation of the effect of stenosis geometry on the coronary diagnostic parameters, Sci. World J.2014 (2014), 354946.
30.
Ansys Inc., Ansys CFX Introduction, 2012.
31.
DowningJ.M. and KuD.N., Effects of frictional losses and pulsatile flow on the collapse of stenotic arteries, J. Biomech. Eng. (1997), 317–324.
32.
TangD.YangC.KobayashiS. and KuD.N., Steady flow and wall compression in stenotic arteries: A three-dimensional thick-wall model with fluid–wall interactions, J. Biomech. Eng.123(6) (2001), 548–557.
33.
CorbanM.T.HungO.Y.EshtehardiP.Rasoul-ArzrumlyE.McDanielM.MekonnenG., Myocardial bridging: Contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies, J. Am. Coll. Cardiol.63(22) (2014), 2346–2355.
34.
LeeM.S. and ChenC.H., Myocardial bridging: An up-to-date review, J. Invasive Cardiol.27(11) (2015), 521.
35.
ZhangQ.GaoB. and ChangY., Helical flow component of left ventricular assist devices (LVADs) outflow improves aortic hemodynamic states, Med. Sci. Mon. Int. Med. J. Exp. Clin. Res.24 (2018), 869.
36.
GijsenF.J.WentzelJ.J.ThuryA.LamersB.SchuurbiersJ.C.SerruysP.W., A new imaging technique to study 3-D plaque and shear stress distribution in human coronary artery bifurcations in vivo, J. Biomech.40(11) (2007), 2349–2357.
37.
MyersJ.G.MooreJ.A.OjhaM.JohnstonK.W. and EthierC.R., Factors influencing blood flow patterns in the human right coronary artery, Ann. Biomed. Eng.29(2) (2001), 109–120.
38.
JahangiriM.SaghafianM. and SadeghiM.R., Numerical simulation of hemodynamic parameters of turbulent and pulsatile blood flow in flexible artery with single and double stenoses, J. Mech. Sci. Technol.29(8) (2015), 3549–3560.
39.
GawazM., Role of platelets in coronary thrombosis and reperfusion of ischemic myocardium, Cardiovasc. Res.61(3) (2004), 498–511.
40.
SadeghiM.R., Numerical simulation of blood flow in vessels with arterial stenosis considering fluid structure interaction (Doctoral dissertation, Ph.D. Dissertation), Graduate School of Mechanical Engineering, Isfahan University of Technology, Iran.
41.
BanerjeeR.K.BackL.H.BackM.R. and ChoY.I., Physiological flow analysis in significant human coronary artery stenoses, Biorheology40(4) (2003), 451–476.
42.
GovindarajuK.ViswanathanG.N.BadruddinI.A.KamangarS.AhmedN.S. and Al-RashedA.A., A parametric study of the effect of arterial wall curvature on non-invasive assessment of stenosis severity: Computational foluid dynamics study, Curr. Sci. (2016), 483–491.
43.
KonalaB.C.DasA. and BanerjeeR.K., Influence of arterial wall-stenosis compliance on the coronary diagnostic parameters, J. Biomech.44(5) (2011), 842–847.
