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Faideci EM, Alak ME, Güzel S, Bekler Ö, Güven G, Hancıoğlu E, Çolakoğlu Gevher CZ, Özcan S, Dönmez E, Ziyrek M. Could Right Coronary Artery-Aorta Angle be Used to Predict Atherosclerotic Lesion Localization in Critical Site of the Right Coronary Artery in Patients With Right Dominancy? Catheter Cardiovasc Interv 2025. [PMID: 40231446 DOI: 10.1002/ccd.31532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2025] [Accepted: 04/01/2025] [Indexed: 04/16/2025]
Abstract
BACKGROUND This study aimed to evaluate the impact of the aorta-right coronary artery angle (ARA) on lesion localization and its protective effect in the critical osteal region in patients with dominant right coronary artery (RCA). METHODS This cross-sectional study included 294 patients who underwent elective coronary angiography for stable angina pectoris and had a single significant lumen stenosis (50%-95%) before the RCA crux. Patients with tortuous vessels, previous interventions, left-dominant circulation, or insufficient image quality were excluded. ARA, lesion criticality, length, and distance from the aorto-osteal junction were calculated using quantitative coronary analysis. Patients were categorized based on lesion location: osteal, proximal, mid, and distal regions. RESULTS ARA increased significantly as the lesion localization moved distally (osteal: 53.26° ± 5.65°, proximal: 60.79° ± 9.53°, mid: 82.33° ± 9.85°, distal: 93.53° ± 7.46°; p < 0.0001). A strong positive correlation was found between ARA and the distance of the lesion from the aorto-osteal junction (r = 0.759, p < 0.0001). In binary regression, ARA was the only independent risk factor for critical lesion localization in the osteal region (OR = 0.915; 95% CI 0.868-0.965, p < 0.001). ROC analysis showed that an ARA > 73.50° had 83.2% sensitivity and 81.3% specificity for excluding critical lesions in the osteal region (AUC = 0.861; 95% CI 0.815-0.907). CONCLUSION A narrow ARA increases the likelihood of critical lesions in the osteal RCA, while an ARA > 73.50° is protective. These findings suggest ARA could guide risk assessment and treatment planning in coronary interventions.
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Affiliation(s)
- Emre Melik Faideci
- Cardiology Clinic, Bilecik Training and Research Hospital, Pelitözü, Bilecik, Turkey
| | - Mehmet Emin Alak
- Cardiology Clinic, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Sinan Güzel
- Cardiovascular Surgery Clinic, Kayseri State Hospital, Kayseri, Turkey
| | - Özkan Bekler
- Cardiology Department, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Gülden Güven
- Cardiology Clinic, Istanbul Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Emirhan Hancıoğlu
- Cardiology Clinic, Medipol Acıbadem Regional Hospital, Istanbul, Turkey
| | | | - Sevgi Özcan
- Cardiology Clinic, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Esra Dönmez
- Cardiology Clinic, Istanbul Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Murat Ziyrek
- Cardiology Clinic, Konya Farabi Hospital, Konya, Turkey
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Sarkhosh MH, Edrisnia H, Raveshi MR, Sharbatdar M. Prediction of time averaged wall shear stress distribution in coronary arteries' bifurcation varying in morphological features via deep learning. Front Physiol 2025; 16:1518732. [PMID: 40110184 PMCID: PMC11920710 DOI: 10.3389/fphys.2025.1518732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Accepted: 02/04/2025] [Indexed: 03/22/2025] Open
Abstract
Introduction Understanding the hemodynamics of blood circulation is crucial to reveal the processes contributing to stenosis and atherosclerosis development. Method Computational fluid dynamics (CFD) facilitates this understanding by simulating blood flow patterns in coronary arteries. Nevertheless, applying CFD in fast-response scenarios presents challenge due to the high computational costs. To overcome this challenge, we integrate a deep learning (DL) method to improve efficiency and responsiveness. This study presents a DL approach for predicting Time-Averaged Wall Shear Stress (TAWSS) values in coronary arteries' bifurcation. Results To prepare the dataset, 1800 idealized models with varying morphological parameters are created. Afterward, we design a CNN-based U-net architecture to predict TAWSS by the point cloud of the geometries. Moreover, this architecture is implemented using TensorFlow 2.3.0. Our results indicate that the proposed algorithms can generate results in less than one second, showcasing their suitability for applications in terms of computational efficiency. Discussion Furthermore, the DL-based predictions demonstrate strong agreement with results from CFD simulations, with a normalized mean absolute error of only 2.53% across various cases.
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Affiliation(s)
- Mohammad Hossein Sarkhosh
- Faculty of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran
- Faculty of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Hadis Edrisnia
- Faculty of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran
| | | | - Mahkame Sharbatdar
- Faculty of Mechanical Engineering, K. N. Toosi University of Technology, Tehran, Iran
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Colombo A, Chiastra C, Gallo D, Loh PH, Dokos S, Zhang M, Keramati H, Carbonaro D, Migliavacca F, Ray T, Jepson N, Beier S. Advancements in Coronary Bifurcation Stenting Techniques: Insights From Computational and Bench Testing Studies. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2025; 41:e70000. [PMID: 40087854 PMCID: PMC11909422 DOI: 10.1002/cnm.70000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 11/28/2024] [Accepted: 01/11/2025] [Indexed: 03/17/2025]
Abstract
Coronary bifurcation lesions present complex challenges in interventional cardiology, necessitating effective stenting techniques to achieve optimal results. This literature review comprehensively examines the application of computational and bench testing methods in coronary bifurcation stenting, offering insights into procedural aspects, stent design considerations, and patient-specific characteristics. Structural mechanics finite element analysis, computational fluid dynamics, and multi-objective optimization are valuable tools for evaluating stenting strategies, including provisional side branch stenting and two-stenting techniques. We highlight the impact of procedural factors, such as balloon positioning and rewiring techniques, and stent design features on the outcome of percutaneous coronary interventions with stents. We discuss the importance of patient-specific characteristics in deployment strategies, such as bifurcation angle and plaque properties. This understanding informs present and future research and clinical practice on bifurcation stenting. Computational simulations are a continuously maturing advance that has significantly enhanced stenting devices and techniques for coronary bifurcation lesions over the years. However, the accurate account of patient-specific vessel and lesion characteristics, both in terms of anatomical and accurate physiological behavior, and their large variation between patients, remains a significant challenge in the field. In this context, advancements in multi-objective optimization offer significant opportunities for refining stent design and procedural practices.
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Affiliation(s)
- Andrea Colombo
- Sydney Vascular Modelling Group, School of Mechanical and Manufacturing EngineeringUniversity of New South WalesSydneyNew South WalesAustralia
| | - Claudio Chiastra
- PolitoBIOMed Lab, Department of Mechanical and Aerospace EngineeringPolitecnico di TorinoTurinItaly
| | - Diego Gallo
- PolitoBIOMed Lab, Department of Mechanical and Aerospace EngineeringPolitecnico di TorinoTurinItaly
| | - Poay Huan Loh
- Department of Cardiology, National University Heart CentreNational University Health SystemSingaporeSingapore
- Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
| | - Socrates Dokos
- Graduate School of Biomedical EngineeringUniversity of New South WalesSydneyNew South WalesAustralia
| | - Mingzi Zhang
- Sydney Vascular Modelling Group, School of Mechanical and Manufacturing EngineeringUniversity of New South WalesSydneyNew South WalesAustralia
| | - Hamed Keramati
- Sydney Vascular Modelling Group, School of Mechanical and Manufacturing EngineeringUniversity of New South WalesSydneyNew South WalesAustralia
| | - Dario Carbonaro
- PolitoBIOMed Lab, Department of Mechanical and Aerospace EngineeringPolitecnico di TorinoTurinItaly
| | - Francesco Migliavacca
- Department of Chemistry, Material and Chemical EngineeringPolitecnico di MilanoMilanItaly
| | - Tapabrata Ray
- School of Engineering and TechnologyUniversity of New South WalesCanberraAustralian Capital TerritoryAustralia
| | - Nigel Jepson
- Prince of Wales Clinical School of MedicineUniversity of New South WalesSydneyNew South WalesAustralia
- Department of CardiologyPrince of Wales HospitalSydneyNew South WalesAustralia
| | - Susann Beier
- Sydney Vascular Modelling Group, School of Mechanical and Manufacturing EngineeringUniversity of New South WalesSydneyNew South WalesAustralia
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4
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Garcha A, Grande Gutiérrez N. Sensitivity of coronary hemodynamics to vascular structure variations in health and disease. Sci Rep 2025; 15:3325. [PMID: 39865100 PMCID: PMC11770140 DOI: 10.1038/s41598-025-85781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 01/03/2025] [Indexed: 01/28/2025] Open
Abstract
Local hemodynamics play an essential role in the initiation and progression of coronary artery disease. While vascular geometry alters local hemodynamics, the relationship between vascular structure and hemodynamics is poorly understood. Previous computational fluid dynamics (CFD) studies have explored how anatomy influences plaque-promoting hemodynamics. For example, areas exposed to low wall shear stress (ALWSS) can indicate regions of plaque growth. However, small sample sizes, idealized geometries, and simplified boundary conditions have limited their scope. We generated 230 synthetic models of left coronary arteries and simulated coronary hemodynamics with physiologically realistic boundary conditions. We measured the sensitivity of hemodynamic metrics to changes in bifurcation angles, positions, diameter ratios, tortuosity, and plaque topology. Our results suggest that the diameter ratio between left coronary branches plays a substantial role in generating adverse hemodynamic phenotypes and can amplify the effect of other geometric features such as bifurcation position and angle, and vessel tortuosity. Introducing mild plaque in the models did not change correlations between structure and hemodynamics. However, certain vascular structures can induce ALWSS at the trailing edge of the plaque. Our analysis demonstrates that coronary artery vascular structure can provide key insight into the hemodynamic environments conducive to plaque formation and growth.
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Affiliation(s)
- Arnav Garcha
- Mechanical Engineering, Carnegie Mellon University, Pittsburgh, 15213, USA
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Cardona JJ, Samrid R, Kim CY, Tabira Y, Dumont AS, Iwanaga J, Tubbs RS. Angulation of the dural venous sinuses in the posterior cranial fossa: an anatomical study and its implications for venous circulation. Neurosurg Rev 2025; 48:66. [PMID: 39833551 PMCID: PMC11753370 DOI: 10.1007/s10143-025-03195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 11/19/2024] [Accepted: 01/04/2025] [Indexed: 01/22/2025]
Abstract
The purpose of the current study was to determine the angulation of the dural venous sinuses in soft tissue, to evaluate differences between types of tissue, and to discuss the potential influence of these angulations on intracranial venous hemodynamics and related pathologies. Angulations formed in different segments of the transverse, sigmoid, and superior sagittal sinuses were measured in 13 adult human cadaveric heads (26 sides). After the soft tissues were removed, measurements were also taken from the underlying bone. The overall angulation of the transverse sinus was assessed using two reference points, while the lengths and widths of the dural venous sinuses were measured using microcalipers. Statistical analyses were performed considereing sides, sex, and types of tissue. The mean angulation of the superior sagittal sinuses - transverse sinus junction was 116 degrees. The mean angulations of the transverse sinus - sigmoid sinus junction in medial and superior views were 108 degrees and 114 degrees, respectively. The mean angulations of the entire transverse sinus at two different points were 45 degrees and 44 degrees, respectively. There were statistically significant differences in angulation in some variables when they were adjusted for sides and sex, but not types of tissue. Angulation is a paramount factor in venous hemodynamics. Certain angulations of the dural venous sinuses differed significantly between sides and sexes, but not between types of tissue. Future research should investigate the effects of these angulations on intracranial venous circulation and their relevance to related pathologies.
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Affiliation(s)
- Juan J Cardona
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Rarinthorn Samrid
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, USA.
- Department of Anatomy, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Chung Yoh Kim
- Department of Anatomy, Dongguk University School of Medicine, Gyeongju, Republic of Korea
| | - Yoko Tabira
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Aaron S Dumont
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, USA
| | - Joe Iwanaga
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, USA
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
- Department of Neurology, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
- Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - R Shane Tubbs
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurology, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Structural & Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
- Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- University of Queensland, Brisbane, Australia
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Çizgici AY, Güner A, Alizade E, Çetin İ, Serin E, Doğan A, Gökçe K, Serter B, Çiloğlu K, Aktürk İF, Uysal H, Gültekin Güner E, Akman C, Şimşek A, Bedir FF, Tanik VO, Keskin K, Püşüroğlu H, Aydin M, Aydin E, Çörekçioğlu B, Köseoğlu M, Uzun F. The impact of bifurcation angle on clinical outcomes in patients who underwent nano-crush technique: the insight from the multicenter EVOLUTE-CRUSH V study. Coron Artery Dis 2025:00019501-990000000-00343. [PMID: 39831537 DOI: 10.1097/mca.0000000000001507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2025]
Abstract
BACKGROUND This multicenter study aimed to retrospectively assess the relationship between bifurcation angle (BA) and major cardiovascular events (MACEs) in patients undergoing nano-crush technique (NCT) for complex bifurcation lesions (CBLs). METHODS A total of 122 consecutive patients [male: 85 (69.6%), mean age: 61.53 ± 9.03 years] who underwent NCT between January 2019 and January 2024 were included. The primary endpoint was a combined endpoint (MACE) including cardiac death, target vessel myocardial infarction (TVMI), or clinically driven target lesion revascularization (TLR). Patients were classified into two groups: MACE-positive and MACE-negative patients. RESULTS Among the study population, 22 patients (18%) had at least one MACE. The BA (46.89 ± 14.65° vs. 65.23 ± 10.40°, P = 0.001) was notably lower in the MACE-positive group than the MACE-negative group. In multivariable regression analysis, decreased BA was identified as one of the independent predictors of MACE (odds ratio = 0.908; 95% confidence interval: 0.852-0.969; P < 0.001). We divided the study cohort into two subgroups based on historical narrow and wide BAs (<70 vs. ≥70°). The incidence of MACE (25.3 vs. 6.4%, P = 0.008), clinically driven TLR (22.7 vs. 4.3%, P = 0.009), and TVMI (18.7 vs. 0%, P = 0.001) were notably higher in the BA <70° group than in the BA ≥70° group. Kaplan-Meier analysis also revealed that MACE-free survival was significantly lower in the BA <70° group than in the BA ≥70° group under mid-term follow-up (log-rank P = 0.009). CONCLUSION This observational multicenter study showed that the BA significantly affects mid-term outcomes in patients who underwent NCT. In addition, our findings suggest that NCT may not be a viable option in patients with narrow-angle (<70°) CBLs.
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Affiliation(s)
- Ahmet Yaşar Çizgici
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Ahmet Güner
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Elnur Alizade
- Department of Cardiology, Koşuyolu Kartal Heart Training & Research Hospital
| | - İlyas Çetin
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital
| | - Ebru Serin
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul
| | - Abdullah Doğan
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Kaan Gökçe
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Berkay Serter
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Koray Çiloğlu
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - İbrahim Faruk Aktürk
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Hande Uysal
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Ezgi Gültekin Güner
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Cemalettin Akman
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Aybüke Şimşek
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Fatih Furkan Bedir
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | | | - Kudret Keskin
- Department of Cardiology, Şişli Hamidiye Etfal Training and Research Hospital, Istanbul
| | - Hamdi Püşüroğlu
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital
| | - Merve Aydin
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Emre Aydin
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Büşra Çörekçioğlu
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
| | - Mehmet Köseoğlu
- Department of Anesthesia, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Fatih Uzun
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital
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Gharleghi R, Zhang M, Shen C, Webster M, Ellis C, Beier S. Assessing left main bifurcation anatomy and haemodynamics as a potential surrogate for disease risk in suspected coronary artery disease without stenosis. Sci Rep 2025; 15:254. [PMID: 39747107 PMCID: PMC11697190 DOI: 10.1038/s41598-024-73490-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 09/18/2024] [Indexed: 01/04/2025] Open
Abstract
Coronary anatomy governs local haemodynamics associated with atherosclerotic development, progression and ultimately adverse clinical outcomes. However, lack of large sample size studies and methods to link adverse haemodynamics to anatomical information has hindered meaningful insights to date. The Left Main coronary bifurcations of 127 patients with suspected coronary artery disease in the absence of significant stenosis were segmented from CTCA images before computing the local haemodynamics. We correlated 11 coronary anatomical characteristics with the normalised lumen area exposed to adverse haemodynamics linked with atherosclerotic processes. These include mean curvatures and diameters of branches, bifurcation and inflow angles, and Finet's ratio as the anatomical parameters, and low Time-Averaged Endothelial Shear Stress ( lowTAESS < 0.5 Pa), high Oscillatory Shear Index (highOSI > 0.1), high Relative Residence Time (highRRT > 4.17 Pa-1), and mean Topological Shear Variation Index for the haemodynamics consideration. We separately tested if the geometric measures and haemodynamics indicators differed between subgroups (sex, smokers, and those with hypertension). We then use a step-down multiple linear regression model to find the best model for predicting lowTAESS, highOSI, highRRT and meanTSVI. Finet's Ratio (FR) significantly correlated to lowTAESS ( p < 0.001 ). Vessel diameters and curvature correlated to highOSI (both p< 0.001) as well as meanTSVI (p< 0.05). Finet's ratio, vessel diameters and daughter branch curvature independently correlated to RRT (all p< 0.01). Our results indicate that specific anatomical vessel characteristics may be used as a surrogate of adverse haemodynamics environment associated with clinically adverse mechanisms of disease. This is especially powerful with the latest computing resources and may unlock clinical integration via standard imaging modalities as biomarkers without further computationally expensive simulations.
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Affiliation(s)
- R Gharleghi
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney, Australia.
| | - M Zhang
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney, Australia
| | - C Shen
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney, Australia
| | - M Webster
- Auckland City Hospital, Auckland, New Zealand
| | - C Ellis
- Auckland City Hospital, Auckland, New Zealand
| | - S Beier
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney, Australia
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Bao J, Bai M, Zhou M, Fang J, Li Y, Guo J, He L. Morphological Features of the Vertebrobasilar System Predict Ischemic Stroke Risk in Spontaneous Vertebral Artery Dissection. J Cardiovasc Transl Res 2024; 17:1365-1376. [PMID: 38980655 PMCID: PMC11634921 DOI: 10.1007/s12265-024-10534-6] [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: 03/10/2024] [Accepted: 06/07/2024] [Indexed: 07/10/2024]
Abstract
The vertebral artery's morphological characteristics are crucial in spontaneous vertebral artery dissection (sVAD). We aimed to investigate morphologic features related to ischemic stroke (IS) and develop a novel prediction model. Out of 126 patients, 93 were finally analyzed. We constructed 3D models and morphological analyses. Patients were randomly classified into training and validation cohorts (3:1 ratio). Variables selected by LASSO - including five morphological features and five clinical characteristics - were used to develop prediction model in the training cohort. The model exhibited a high area under the curve (AUC) of 0.944 (95%CI, 0.862-0.984), with internal validation confirming its consistency (AUC = 0.818, 95%CI, 0.597-0.948). Decision curve analysis (DCA) indicated clinical usefulness. Morphological features significantly contribute to risk stratification in sVAD patients. Our novel developed model, combining interdisciplinary parameters, is clinically useful for predicting IS risk. Further validation and in-depth research into the hemodynamics related to sVAD are necessary.
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Affiliation(s)
- Jiajia Bao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Mateng Bai
- Key Laboratory of Biomechanics and Mechanobiology (Beihang University), Beijing, China
- Ministry of Education Beijing Advanced Innovation Center for Biomedical Engineering, Beijing, China
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Muke Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinghuan Fang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbo Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Guo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
- Department of Neurology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, 610041, China.
| | - Li He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
- Department of Neurology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, Sichuan, 610041, China.
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9
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Zuin M, Chiastra C, Morbiducci U, Gallo D, Bilato C, Rigatelli G. Carina: A major determinant in the pathophysiology and treatment of coronary bifurcation lesions. Catheter Cardiovasc Interv 2024; 104:1353-1361. [PMID: 39354881 DOI: 10.1002/ccd.31254] [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: 03/10/2024] [Revised: 08/22/2024] [Accepted: 09/23/2024] [Indexed: 10/03/2024]
Abstract
Over the last decade, several in vivo and computational investigations have significantly advanced our understanding of the pathophysiology of coronary bifurcations, contributing to the enhancement of their percutaneous revascularization. The carina of the coronary bifurcations plays a substantial role in generating their main hemodynamic features, including distinctive flow patterns with secondary flows and specific shear stress patterns. These factors play a pivotal role in determining the susceptibility, development, and progression of atherosclerosis. The underlying pathophysiological mechanisms of atherosclerosis in coronary bifurcations are complex and multifactorial. Understanding these mechanisms is fundamental to comprehending lesions at the bifurcation level and informing future treatment strategies. This review aims to present the currently available data regarding the pathophysiological and prognostic role of the carina in coronary bifurcations, offering an interpretation of these findings from the perspective of interventional cardiologists, providing valuable insights for their clinical practice.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Claudio Chiastra
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Diego Gallo
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Claudio Bilato
- Division of Cardiology, West Vicenza Hospital, Arzignano, Italy
| | - Gianluca Rigatelli
- Interventional Cardiology Unit, Department of Cardiology, Madre Teresa Hospital, Padova, Italy
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Ungureanu C, Natalis A, Cocoi M, Dumitrascu S, Noterdaeme T, Gach O, Jossart A, Soetens R, Colletti G. The impact of the bifurcation angle for the Nano-Crush two-stent coronary bifurcation technique on long-term outcomes in a real-world clinical population. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 64:54-59. [PMID: 38494371 DOI: 10.1016/j.carrev.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 03/19/2024]
Abstract
AIM This study aims to assess the direct impact of bifurcation angle (BA) on immediate procedural outcomes and patient prognosis post-Nano-Crush stenting for coronary bifurcation lesions. METHODS A retrospective analysis was conducted for all consecutive patients treated with the Nano-Crush technique across two high-volume interventional centers from January 2020 to October 2022. PRIMARY ENDPOINT comparison of target lesion failure rate in two cohorts based on bifurcation angle (<70° vs. ≥70°), with secondary endpoints including side branch ostium coverage, rate of successful final kissing balloon inflation (FKBI), need for conversion to another technique, and procedure length. RESULTS Baseline demographics included 71 patients in the BA<70° group and 49 in the BA≥70° group, with well-balanced characteristics. Angiographic characteristics revealed similar trends, including anatomic and morphological lesion characteristics (referencing Syntax score, Medina classification, and presence of calcifications). Both groups predominantly had complex coronary disease, with a baseline mean Syntax score of 24.18 ± 8.19 in the BA<70° group and 23.91 ± 7.29 in the BA≥70° group, respectively. A dedicated debulking device for lesion preparation was used in 25.35 % of patients in the first group and in 28.57 % of patients in the second group. The primary endpoint occurred in 5.63 % of patients in the BA<70° group and in 4.08 % of patients in the BA≥70° group (P = 0.7014) after ≥ 2 years of clinical follow-up. Angiographic success was achieved in 100 % of both groups, with procedural time averaging 74.99 ± 25.55 min in the BA≥70° and 76.94 ± 27.81 min in the BA<70° (P = 0.6922). The rate of successful final kissing balloon inflation was 98.59 % in the BA<70° group and 95.91 % in the BA≥70° group (P = 0.3566). The mean contrast volume was 189.54 ± 73.74 ml in BA<70° and 168.9 ± 62.77 ml in BA≥70° (P = 0.1126). Clinical follow-ups at 30 days and 2 years revealed similar outcomes and complications for each group, as summarized in Table 3. CONCLUSIONS Our results demonstrate that the bifurcation angle does not significantly impact long-term clinical outcomes or procedural parameters, such as side branch ostium coverage, conversion to a modified DK Crush technique, FKBI success rate, and procedure length. These findings suggest that the Nano-Crush technique can be a viable option for bifurcation lesions, irrespective of the bifurcation angle, achieving optimal side branch ostium coverage while preventing excessive protrusion into the main vessel.
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Affiliation(s)
| | - Alexandre Natalis
- Cardiovascular Department, Clinique Saint Joseph, Vivalia, Arlon, Belgium
| | - Mihai Cocoi
- Cardiovascular Department, Institutul Inimii, Cluj, Romania
| | | | | | - Olivier Gach
- Cardiovascular Departement, MontLégia, Liège, Belgium
| | | | | | - Giuseppe Colletti
- Cardiovascular Department, Clinique Saint Joseph, Vivalia, Arlon, Belgium
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11
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Suk J, de Haan P, Lippe P, Brune C, Wolterink JM. Mesh neural networks for SE(3)-equivariant hemodynamics estimation on the artery wall. Comput Biol Med 2024; 173:108328. [PMID: 38552282 DOI: 10.1016/j.compbiomed.2024.108328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/29/2024] [Accepted: 03/17/2024] [Indexed: 04/17/2024]
Abstract
Computational fluid dynamics (CFD) is a valuable asset for patient-specific cardiovascular-disease diagnosis and prognosis, but its high computational demands hamper its adoption in practice. Machine-learning methods that estimate blood flow in individual patients could accelerate or replace CFD simulation to overcome these limitations. In this work, we consider the estimation of vector-valued quantities on the wall of three-dimensional geometric artery models. We employ group-equivariant graph convolution in an end-to-end SE(3)-equivariant neural network that operates directly on triangular surface meshes and makes efficient use of training data. We run experiments on a large dataset of synthetic coronary arteries and find that our method estimates directional wall shear stress (WSS) with an approximation error of 7.6% and normalised mean absolute error (NMAE) of 0.4% while up to two orders of magnitude faster than CFD. Furthermore, we show that our method is powerful enough to accurately predict transient, vector-valued WSS over the cardiac cycle while conditioned on a range of different inflow boundary conditions. These results demonstrate the potential of our proposed method as a plugin replacement for CFD in the personalised prediction of hemodynamic vector and scalar fields.
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Affiliation(s)
- Julian Suk
- Department of Applied Mathematics & Technical Medical Center, University of Twente, Enschede, 7522 NB, The Netherlands.
| | - Pim de Haan
- Qualcomm AI Research, Qualcomm Technologies Netherlands B.V., Nijmegen, 6546 AS, The Netherlands; QUVA Lab, University of Amsterdam, Amsterdam, 1012 WX, The Netherlands
| | - Phillip Lippe
- QUVA Lab, University of Amsterdam, Amsterdam, 1012 WX, The Netherlands
| | - Christoph Brune
- Department of Applied Mathematics & Technical Medical Center, University of Twente, Enschede, 7522 NB, The Netherlands
| | - Jelmer M Wolterink
- Department of Applied Mathematics & Technical Medical Center, University of Twente, Enschede, 7522 NB, The Netherlands
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12
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Ashrafee A, Yashfe SMS, Khan NS, Islam MT, Azam MG, Arafat MT. Design of experiment approach to identify the dominant geometrical feature of left coronary artery influencing atherosclerosis. Biomed Phys Eng Express 2024; 10:035008. [PMID: 38430572 DOI: 10.1088/2057-1976/ad2f59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/01/2024] [Indexed: 03/04/2024]
Abstract
Background and Objective. Coronary artery geometry heavily influences local hemodynamics, potentially leading to atherosclerosis. Consequently, the unique geometrical configuration of an individual by birth can be associated with future risk of atherosclerosis. Although current researches focus on exploring the relationship between local hemodynamics and coronary artery geometry, this study aims to identify the order of influence of the geometrical features through systematic experiments, which can reveal the dominant geometrical feature for future risk assessment.Methods. According to Taguchi's method of design of experiment (DoE), the left main stem (LMS) length (lLMS), curvature (kLMS), diameter (dLMS) and the bifurcation angle between left anterior descending (LAD) and left circumflex (LCx) artery (αLAD-LCx) of two reconstructed patient-specific left coronary arteries (LCA) were varied in three levels to create L9 orthogonal array. Computational fluid dynamic (CFD) simulations with physiological boundary conditions were performed on the resulting eighteen LCA models. Average helicity intensity (h2) and relative atheroprone area (RAA) of near-wall hemodynamic descriptors were analyzed.Results. The proximal LAD (LADproximal) was identified to be the most atheroprone region of the left coronary artery due to higherh2,large RAA of time averaged wall shear stress (TAWSS < 0.4 Pa), oscillatory shear index (OSI ∼ 0.5) and relative residence time (RRT > 4.17 Pa-1). In both patient-specific cases, based onh2and TAWSS,dlmsis the dominant geometric parameter while based on OSI and RRT,αLAD-LCxis the dominant one influencing hemodynamic condition in proximal LAD (p< 0.05). Based on RRT, the rank of the geometrical factors is:αLAD-LCx>dLMS>lLMS>kLMS, indicating thatαLAD-LCxis the most dominant geometrical factor affecting hemodynamics at proximal LAD which may influence atherosclerosis.Conclusion. The proposed identification of the rank of geometrical features of LCA and the dominant feature may assist clinicians in predicting the possibility of atherosclerosis, of an individual, long before it will occur. This study can further be translated to be used to rank the influence of several arterial geometrical features at different arterial locations to explore detailed relationships between the arterial geometrical features and local hemodynamics.
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Affiliation(s)
- Adiba Ashrafee
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
| | - Syed Muiz Sadat Yashfe
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
| | - Nusrat S Khan
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, United States of America
| | - Md Tariqul Islam
- Department of Radiology and Imaging, Sheikh Hasina National Institute of Burn & Plastic Surgery, Dhaka - 1205, Bangladesh
| | - M G Azam
- Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka - 1207, Bangladesh
| | - M Tarik Arafat
- Department of Biomedical Engineering, Bangladesh University of Engineering and Technology (BUET), Dhaka - 1205, Bangladesh
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13
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Tahir AM, Mutlu O, Bensaali F, Ward R, Ghareeb AN, Helmy SMHA, Othman KT, Al-Hashemi MA, Abujalala S, Chowdhury MEH, Alnabti ARDMH, Yalcin HC. Latest Developments in Adapting Deep Learning for Assessing TAVR Procedures and Outcomes. J Clin Med 2023; 12:4774. [PMID: 37510889 PMCID: PMC10381346 DOI: 10.3390/jcm12144774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 07/30/2023] Open
Abstract
Aortic valve defects are among the most prevalent clinical conditions. A severely damaged or non-functioning aortic valve is commonly replaced with a bioprosthetic heart valve (BHV) via the transcatheter aortic valve replacement (TAVR) procedure. Accurate pre-operative planning is crucial for a successful TAVR outcome. Assessment of computational fluid dynamics (CFD), finite element analysis (FEA), and fluid-solid interaction (FSI) analysis offer a solution that has been increasingly utilized to evaluate BHV mechanics and dynamics. However, the high computational costs and the complex operation of computational modeling hinder its application. Recent advancements in the deep learning (DL) domain can offer a real-time surrogate that can render hemodynamic parameters in a few seconds, thus guiding clinicians to select the optimal treatment option. Herein, we provide a comprehensive review of classical computational modeling approaches, medical imaging, and DL approaches for planning and outcome assessment of TAVR. Particularly, we focus on DL approaches in previous studies, highlighting the utilized datasets, deployed DL models, and achieved results. We emphasize the critical challenges and recommend several future directions for innovative researchers to tackle. Finally, an end-to-end smart DL framework is outlined for real-time assessment and recommendation of the best BHV design for TAVR. Ultimately, deploying such a framework in future studies will support clinicians in minimizing risks during TAVR therapy planning and will help in improving patient care.
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Affiliation(s)
- Anas M Tahir
- Electrical and Computer Engineering Department, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Biomedical Research Center, Qatar University, Doha 2713, Qatar
| | - Onur Mutlu
- Biomedical Research Center, Qatar University, Doha 2713, Qatar
| | - Faycal Bensaali
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | - Rabab Ward
- Electrical and Computer Engineering Department, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Abdel Naser Ghareeb
- Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
- Faculty of Medicine, Al Azhar University, Cairo 11884, Egypt
| | - Sherif M H A Helmy
- Noninvasive Cardiology Section, Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
| | | | - Mohammed A Al-Hashemi
- Noninvasive Cardiology Section, Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
| | | | | | | | - Huseyin C Yalcin
- Biomedical Research Center, Qatar University, Doha 2713, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
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14
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Gharleghi R, Adikari D, Ellenberger K, Webster M, Ellis C, Sowmya A, Ooi S, Beier S. Annotated computed tomography coronary angiogram images and associated data of normal and diseased arteries. Sci Data 2023; 10:128. [PMID: 36899014 PMCID: PMC10006074 DOI: 10.1038/s41597-023-02016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/14/2023] [Indexed: 03/12/2023] Open
Abstract
Computed Tomography Coronary Angiography (CTCA) is a non-invasive method to evaluate coronary artery anatomy and disease. CTCA is ideal for geometry reconstruction to create virtual models of coronary arteries. To our knowledge there is no public dataset that includes centrelines and segmentation of the full coronary tree. We provide anonymized CTCA images, voxel-wise annotations and associated data in the form of centrelines, calcification scores and meshes of the coronary lumen in 20 normal and 20 diseased cases. Images were obtained along with patient information with informed, written consent as part of the Coronary Atlas. Cases were classified as normal (zero calcium score with no signs of stenosis) or diseased (confirmed coronary artery disease). Manual voxel-wise segmentations by three experts were combined using majority voting to generate the final annotations. Provided data can be used for a variety of research purposes, such as 3D printing patient-specific models, development and validation of segmentation algorithms, education and training of medical personnel and in-silico analyses such as testing of medical devices.
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Affiliation(s)
- R Gharleghi
- Faculty of Engineering, University of New South Wales, Kensington, NSW, 2052, Australia.
| | - D Adikari
- Prince of Wales Clinical School of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - K Ellenberger
- Prince of Wales Clinical School of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - M Webster
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
| | - C Ellis
- Auckland City Hospital, 2 Park Road, Auckland, 1023, New Zealand
| | - A Sowmya
- Faculty of Engineering, University of New South Wales, Kensington, NSW, 2052, Australia
| | - S Ooi
- Prince of Wales Clinical School of Medicine, UNSW Sydney, Sydney, NSW, Australia
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - S Beier
- Faculty of Engineering, University of New South Wales, Kensington, NSW, 2052, Australia
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15
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Gharleghi R, Chen N, Sowmya A, Beier S. Towards automated coronary artery segmentation: A systematic review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107015. [PMID: 35914439 DOI: 10.1016/j.cmpb.2022.107015] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Vessel segmentation is the first processing stage of 3D medical images for both clinical and research use. Current segmentation methods are tedious and time consuming, requiring significant manual correction and hence are infeasible to use in large data sets. METHODS Here, we review and analyse available coronary artery segmentation methods, focusing on fully automated methods capable of handling the rapidly growing medical images available. All manuscripts published since 2010 are systematically reviewed, categorised into different groups based on the approach taken, and characteristics of the different approaches as well as trends over the past decade are explored. RESULTS The manuscripts were divided intro three broad categories, consisting of region growing, voxelwise prediction and partitioning approaches. The most common approach overall was region growing, particularly using active contour models, however these have had a sharp fall in popularity in recent years with convolutional neural networks becoming significantly more popular. CONCLUSIONS The systematic review of current coronary artery segmentation methods shows interesting trends, with rising popularity of machine learning methods, a focus on efficient methods, and falling popularity of computationally expensive processing steps such as vesselness and multiplanar reformation.
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Affiliation(s)
- Ramtin Gharleghi
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney NSW 2053, Australia.
| | - Nanway Chen
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney NSW 2053, Australia
| | - Arcot Sowmya
- School of Computer Science and Engineering, UNSW, Sydney NSW 2053, Australia; Tyree Foundation Institute of Health Engineering (Tyree IHealthE), Sydney, Australia
| | - Susann Beier
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney NSW 2053, Australia
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16
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Gharleghi R, Sowmya A, Beier S. Transient wall shear stress estimation in coronary bifurcations using convolutional neural networks. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 225:107013. [PMID: 35901629 DOI: 10.1016/j.cmpb.2022.107013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Haemodynamic metrics, such as blood flow induced shear stresses at the inner vessel lumen, are associated with the development and progression of coronary artery disease. Understanding these metrics may therefore improve the assessment of an individual's coronary disease risk. However, the calculation of such luminal Wall Shear Stress (WSS) using traditional Computational Fluid Dynamics (CFD) methods is relatively slow and computationally expensive. As a result, CFD based haemodynamic computation is not suitable for integrated and large-scale use in clinical settings. METHODS In this work, deep learning techniques are proposed as an alternative method to CFD, whereby luminal WSS magnitude can be predicted in coronary bifurcations throughout the cardiac cycle based on the steady state solution (which takes <120 seconds to calculate including preprocessing), vessel geometry and additional global features. The deep learning model is trained on a dataset of 101 patient-specific and 2626 synthetic left main bifurcation models with 26 separate patient-specific cases used as the test set. RESULTS The model showed high fidelity predictions with <5% (normalised against mean WSS magnitude) deviation to CFD derived values as the gold-standard method, while being orders of magnitude faster with on average <2 minutes versus 3 hours computation for transient CFD. CONCLUSIONS This method therefore offers a new approach to substantially reduce the computational cost involved in, for example, large-scale population studies of coronary haemodynamic metrics, and may therefore open the pathway for future clinical integration.
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Affiliation(s)
- Ramtin Gharleghi
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney, NSW 2052, Australia.
| | - Arcot Sowmya
- School of Computer Science and Engineering, UNSW, Sydney, NSW 2052, Australia; Tyree Foundation Institute of Health Engineering (Tyree IHealthE), Sydney, Australia
| | - Susann Beier
- School of Mechanical and Manufacturing Engineering, UNSW, Sydney, NSW 2052, Australia
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17
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Karanasiou GE, Loukas VS, Tsompou PI, Karanasiou GS, Kyriakidis S, Antonini L, Poletti G, Pennati G, Papafaklis M, Gergidis LN, Fotiadis DI, Sakellarios AI. A proof-of-concept study for the simulation of blood flow in a post arterial segment for different blood rheology models. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3985-3988. [PMID: 36086124 DOI: 10.1109/embc48229.2022.9871397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Cardiovascular disease (CVD) and especially atherosclerosis are chronic inflammatory diseases which cause the atherosclerotic plaque growth in the arterial vessels and the blood flow reduction. Stents have revolutionized the treatment of this disease to a great extent by restoring the blood flow in the vessel. The present study investigates the performance of the blood flow after stent implantation in patient-specific coronary artery and demonstrates the effect of using Newtonian vs. non-Newtonian blood fluid models in the distribution of endothelial shear stress. In particular, the Navier-Stokes and continuity equations were employed, and three non-Newtonian fluid models were investigated (Carreau, Carreau-Yasuda and the Casson model). Computational finite elements models were used for the simulation of blood flow. The comparison of the results demonstrates that the Newtonian fluid model underestimates the calculation of Endothelial Shear Stress, while the three non-Newtonian fluids present similar distribution of shear stress. Keywords: Blood flow dynamics, stented artery, non-Newtonian fluid. Clinical Relevance- This work demonstrates that when blood flow modeling is performed at stented arteries and predictive models are developed, the non-Newtonian nature of blood must be considered.
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18
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Decroocq M, Lavoue G, Ohta M, Frindel C. A Software to Visualize, Edit, Model and Mesh Vascular Networks. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:2208-2214. [PMID: 36085963 DOI: 10.1109/embc48229.2022.9871365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Computational fluid dynamics (CFD) is a key tool for a wide range of research areas, beyond the computer science community. In particular, CFD is used in medicine to measure blood flow from patient specific models of arteries. In this field, the creation of accurate meshes remains the most challenging step, as it is based on the segmentation of medical images, a time-consuming task which often requires manual intervention by medical doctors. In this context, user-friendly, interactive softwares are valuable. They enable to spread the new advances in numerical treatment to the medical community and enrich them with the expert knowledge (e.g anatomical knowledge) of clinicians. In this work, we present a user interface dedicated to the meshing of vascular networks from centerlines. It allows for the 3D visualization and edition of input centerlines, which constitute a simplified, easy-to-manipulate representation of vascular networks. The surface of the artery can be reconstructed from the modified centerlines by an editable parametric model and then meshed with high quality hexahedral elements. At every step of the process, the network can be confronted with medical images with enhanced visualization. The software will be released publicly. Clinical relevance- This tool facilitates the manual extraction and editing of vascular networks by medical doctors. It opens the generation of hexahedral meshes for computational fluid dynamics studies to non-expert users.
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Adikari D, Gharleghi R, Zhang S, Jorm L, Sowmya A, Moses D, Ooi SY, Beier S. A new and automated risk prediction of coronary artery disease using clinical endpoints and medical imaging-derived patient-specific insights: protocol for the retrospective GeoCAD cohort study. BMJ Open 2022; 12:e054881. [PMID: 35725256 PMCID: PMC9214399 DOI: 10.1136/bmjopen-2021-054881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Coronary artery disease (CAD) is the leading cause of death worldwide. More than a quarter of cardiovascular events are unexplained by current absolute cardiovascular disease risk calculators, and individuals without clinical risk factors have been shown to have worse outcomes. The 'anatomy of risk' hypothesis recognises that adverse anatomical features of coronary arteries enhance atherogenic haemodynamics, which in turn mediate the localisation and progression of plaques. We propose a new risk prediction method predicated on CT coronary angiography (CTCA) data and state-of-the-art machine learning methods based on a better understanding of anatomical risk for CAD. This may open new pathways in the early implementation of personalised preventive therapies in susceptible individuals as a potential key in addressing the growing burden of CAD. METHODS AND ANALYSIS GeoCAD is a retrospective cohort study in 1000 adult patients who have undergone CTCA for investigation of suspected CAD. It is a proof-of-concept study to test the hypothesis that advanced image-derived patient-specific data can accurately predict long-term cardiovascular events. The objectives are to (1) profile CTCA images with respect to variations in anatomical shape and associated haemodynamic risk expressing, at least in part, an individual's CAD risk, (2) develop a machine-learning algorithm for the rapid assessment of anatomical risk directly from unprocessed CTCA images and (3) to build a novel CAD risk model combining traditional risk factors with these novel anatomical biomarkers to provide a higher accuracy CAD risk prediction tool. ETHICS AND DISSEMINATION The study protocol has been approved by the St Vincent's Hospital Human Research Ethics Committee, Sydney-2020/ETH02127 and the NSW Population and Health Service Research Ethics Committee-2021/ETH00990. The project outcomes will be published in peer-reviewed and biomedical journals, scientific conferences and as a higher degree research thesis.
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Affiliation(s)
- Dona Adikari
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Cardiology Department, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Ramtin Gharleghi
- School of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, New South Wales, Australia
| | - Shisheng Zhang
- School of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, The University of New South Wales, Sydney, New South Wales, Australia
| | - Arcot Sowmya
- School of Computer Science and Engineering, The University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel Moses
- School of Computer Science and Engineering, The University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Imaging, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Sze-Yuan Ooi
- Faculty of Medicine, The University of New South Wales, Sydney, New South Wales, Australia
- Cardiology Department, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Susann Beier
- School of Mechanical and Manufacturing Engineering, The University of New South Wales, Sydney, New South Wales, Australia
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Gharleghi R, Adikari D, Ellenberger K, Ooi SY, Ellis C, Chen CM, Gao R, He Y, Hussain R, Lee CY, Li J, Ma J, Nie Z, Oliveira B, Qi Y, Skandarani Y, Wang X, Yang S, Sowmya A, Beier S. Automated Segmentation of Normal and Diseased Coronary Arteries - The ASOCA Challenge. Comput Med Imaging Graph 2022; 97:102049. [DOI: 10.1016/j.compmedimag.2022.102049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 12/19/2022]
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Kashyap V, Gharleghi R, Li DD, McGrath-Cadell L, Graham RM, Ellis C, Webster M, Beier S. Accuracy of vascular tortuosity measures using computational modelling. Sci Rep 2022; 12:865. [PMID: 35039557 PMCID: PMC8764056 DOI: 10.1038/s41598-022-04796-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022] Open
Abstract
Severe coronary tortuosity has previously been linked to low shear stresses at the luminal surface, yet this relationship is not fully understood. Several previous studies considered different tortuosity metrics when exploring its impact of on the wall shear stress (WSS), which has likely contributed to the ambiguous findings in the literature. Here, we aim to analyze different tortuosity metrics to determine a benchmark for the highest correlating metric with low time-averaged WSS (TAWSS). Using Computed Tomography Coronary Angiogram (CTCA) data from 127 patients without coronary artery disease, we applied all previously used tortuosity metrics to the left main coronary artery bifurcation, and to its left anterior descending and left circumflex branches, before modelling their TAWSS using computational fluid dynamics (CFD). The tortuosity measures included tortuosity index, average absolute-curvature, root-mean-squared (RMS) curvature, and average squared-derivative-curvature. Each tortuosity measure was then correlated with the percentage of vessel area that showed a < 0.4 Pa TAWSS, a threshold associated with altered endothelial cell cytoarchitecture and potentially higher disease risk. Our results showed a stronger correlation between curvature-based versus non-curvature-based tortuosity measures and low TAWSS, with the average-absolute-curvature showing the highest coefficient of determination across all left main branches (p < 0.001), followed by the average-squared-derivative-curvature (p = 0.001), and RMS-curvature (p = 0.002). The tortuosity index, the most widely used measure in literature, showed no significant correlation to low TAWSS (p = 0.86). We thus recommend the use of average-absolute-curvature as a tortuosity measure for future studies.
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Affiliation(s)
- Vishesh Kashyap
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, USA
| | - Ramtin Gharleghi
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW, Australia.
| | - Darson D Li
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Lucy McGrath-Cadell
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Robert M Graham
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | | | | | - Susann Beier
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW, Australia
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22
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Shen C, Gharleghi R, Li DD, Stevens M, Dokos S, Beier S. Secondary flow in bifurcations - Important effects of curvature, bifurcation angle and stents. J Biomech 2021; 129:110755. [PMID: 34601214 DOI: 10.1016/j.jbiomech.2021.110755] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 09/01/2021] [Accepted: 09/16/2021] [Indexed: 12/27/2022]
Abstract
Coronary bifurcations have complex flow patterns including secondary flow zones and helical flow, which directly affect pathophysiological mechanisms such as the development of atherosclerosis. The objective of this study was to generate insights into the effects of curvature, bifurcation angle and the presence of stents on flow patterns and resulting haemodynamics in coronary left main bifurcations. The blood flow and associated metrics were modelled in both idealised and patient-specific bifurcations with varying curvature and bifurcation angles with and without stents, resulting in a total of 128 geometries considered. The results showed that larger curvature of bifurcating vessels has a significant influence on secondary flow, especially with distance to the bifurcation region, causing a skew, spin and asymmetry of Dean vortices, an increase in helical flow intensity with symmetry loss, and a decrease in adversely low time-average wall shear stress (TAWSS). Generally, asymmetric flow patterns coincided with adversely low TAWSS regions. In identical stented geometries, the presence of the stents induced local recirculation immediately adjacent to the stent struts, thus generating adversely low TAWSS in these areas, with some effect on the overall secondary flow. Overall, the effect of stents outweighed the effect of curvature and BA. This new knowledge contributes to a better understanding of the joint effects of curvature, bifurcation angle, and stents on flow patterns and haemodynamics in coronary bifurcations.
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Affiliation(s)
- C Shen
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia.
| | - R Gharleghi
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - D D Li
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - M Stevens
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - S Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - S Beier
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia
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23
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Ray S, Bandyopadhyay S, Bhattacharjee P, Mukherjee P, Karmakar S, Bose PK, Mitra S, Dalui A, Ray S. Nano-crush technique in narrow angle (<70˚) bifurcation - bench test, computed tomographic reconstruction, fluid dynamics, and clinical outcomes. Minerva Cardiol Angiol 2021; 70:459-467. [PMID: 34472773 DOI: 10.23736/s2724-5683.21.05834-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Bifurcation stenting techniques are still refining and under testing. Nano-crush is a novel technique which allow minimum protrusion of side branch struts at the ostium. To demonstrate the efficacy of Nano-crush technique in narrow-angle bifurcation (<70˚) using bench test model, 3D reconstruction of the stent structure, computational fluid dynamics study and a clinical follow-up. METHODS This was a retrospective observational single-centre study which included 40 patients who underwent angioplasty using Nano-crush technique for de-novo complex coronary bifurcation lesions with narrow bifurcation angle(<70˚) between April-2016 to March-2019. The in-vitro bench test and computational fluid dynamics analysis were performed using a bifurcation model designed. The clinical primary endpoint was major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, and target lesion revascularization (TLR) at one-year angiographic follow-up. RESULTS The reconstructed results of in-vitro bench test showed minimum length of stent struts moving away from the rounded side branch ostium. The mean age of patients was 62.8 ± 7.98 years (32 male) and presented 100% procedural success. The mean bifurcation angle was 47.3˚ ± 9.2˚. The MACE was reported in 4 (10%) patients which included 1 (2.5%) death and 3 (7.5%) TLR at the mean follow-up of 35.54 ± 12.31 months. No significant correlation between occurrence of MACE and gender, age, comorbidities and bifurcation angle was reported. CONCLUSIONS The Nano-crush technique demonstrated least metal load around carina and abnormal flow dynamics in narrow angle (<70˚) bifurcation lesions and also reported favorable long-term clinical outcomes.
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Affiliation(s)
- Shuvanan Ray
- Department of Cardiology, Fortis Hospital Anandapur, Kolkata, West Bengal, India -
| | | | | | - Priyam Mukherjee
- Department of Cardiology, Fortis Hospital Anandapur, Kolkata, West Bengal, India
| | - Suman Karmakar
- Department of Cardiology, Fortis Hospital Anandapur, Kolkata, West Bengal, India
| | - Pallab K Bose
- Department of Cardiology, Fortis Hospital Anandapur, Kolkata, West Bengal, India
| | - Sabyasachi Mitra
- Department of Cardiology, Fortis Hospital Anandapur, Kolkata, West Bengal, India
| | - Anirban Dalui
- Department of Community Medicine, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Sayak Ray
- Department of Cardiology, Fortis Hospital Anandapur, Kolkata, West Bengal, India
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24
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Rigatelli G, Zuin M. Left main bifurcation stenting: the impact of strut thickness on long-term outcomes. J Geriatr Cardiol 2021; 18:91-93. [PMID: 33747057 PMCID: PMC7940968 DOI: 10.11909/j.issn.1671-5411.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Ferrara, Italy
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25
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Rigatelli G, Zuin M, Lee A. Coronary artery double stenting techniques and their results in complex left main bifurcation disease. Future Cardiol 2020; 16:497-504. [PMID: 32524885 DOI: 10.2217/fca-2019-0081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/18/2020] [Indexed: 11/21/2022] Open
Abstract
Aim: Complex left main (LM) bifurcation disease seems to be better approached by a planned double stent technique. Materials & methods: Medline search for articles including randomized trials, prospective series, large registries and retrospective studies >50 patients has been performed. Results: Double kissing crush demonstrated its superiority over culotte stenting and cross over, while other techniques such as the T-stenting and T-stent and Protrusion have not been extensively reported in LM setting. The nano inverted-T-stenting has provided evidences that the use of ultrathin strut stents and very minimal crush is beneficial for both the physiological and rheological properties. Conclusion: The double stenting techniques used in LM should be evaluated in terms of procedural differences and technical simplicity.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Cardiovascular Diagnosis & Endoluminal Interventions, Rovigo General Hospital, viale Tre Martiri, Rovigo 45100, Italy
| | - Marco Zuin
- Faculty of Medicine, University of Ferrara, via Savonarola 9, Ferrara 44121, Italy
| | - Arthur Lee
- California Northstate University, College of Medicine, 9700 W Taron Dr, Elk Grove, CA 95757, USA
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26
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Feng J, Wang N, Wang Y, Tang X, Yuan J. Haemodynamic mechanism of formation and distribution of coronary atherosclerosis: A lesion-specific model. Proc Inst Mech Eng H 2020; 234:1187-1196. [PMID: 32748686 DOI: 10.1177/0954411920947972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Coronary arterial disease, as the most devastated cardiovascular disease, is caused by the atherosclerosis in the coronary arteries, which blocks the blood flow to the heart, resulting in the deficient supply of oxygen and nutrition to the heart, and eventually leading to heart failure. To date, haemodynamic mechanisms for atherosclerosis development are not fully understood although it is believed that the haemodynamic disturbance at the region of the arterial bifurcation, particular, bifurcation angle, plays an important role in the atherosclerosis development. In this study, two types of computational fluid dynamics models, lesion-specific and idealized models, combined with the computer tomography imaging techniques, are used to explore the mechanism of formation and distribution of the atherosclerosis around the bifurcation of left coronary artery and its association with the bifurcation angle. The lesion-specific model is used to characterize the effect of personalized features on the haemodynamic performance, while the idealized model is focusing on the effect of single factor, bifurcation angle, on the haemodynamic performance. The simulated results from both types of the models, combined with the clinical observation, revealed that the three key areas around the bifurcations are prone to formation of the atherosclerosis. Unlike the idealized models, lesion-specific modelling results did not show the significant correlation between the wall shear stress and bifurcation angle, although the mean value of the wall shear stress in smaller bifurcation angles (less than 90°) is higher than that with larger bifurcation angles (greater than 90°). In conclusion, lesion-specific computational fluid dynamics modelling is an efficient and convenient way to predict the haemodynamic performance around the bifurcation region, allowing the comprehensive information for the clinicians to predict the atherosclerosis development. The idealized models, which only focus on single parameter, may not provide the sufficient and reliable information for the clinical application. A novel multi-parameters modelling technique, therefore, is suggested to be developed in future, allowing the effects of many parameters on the haemodynamic performance to be evaluated.
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Affiliation(s)
- Jiling Feng
- Department of Engineering, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Nannan Wang
- Department of Mechanical Design, College of Mechanical Engineering, Taiyuan University of Technology, Taiyuan, P.R. China
| | - Yiliang Wang
- Department of Mechanical Design, College of Mechanical Engineering, Taiyuan University of Technology, Taiyuan, P.R. China
| | - Xiaoxian Tang
- Radiology Department, Shanxi Provincial People’s Hospital, Taiyuan, P.R. China
| | - Jie Yuan
- Radiology Department, Shanxi Provincial People’s Hospital, Taiyuan, P.R. China
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27
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Lodi Rizzini M, Gallo D, De Nisco G, D'Ascenzo F, Chiastra C, Bocchino PP, Piroli F, De Ferrari GM, Morbiducci U. Does the inflow velocity profile influence physiologically relevant flow patterns in computational hemodynamic models of left anterior descending coronary artery? Med Eng Phys 2020; 82:58-69. [PMID: 32709266 DOI: 10.1016/j.medengphy.2020.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/03/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022]
Abstract
Patient-specific computational fluid dynamics is a powerful tool for investigating the hemodynamic risk in coronary arteries. Proper setting of flow boundary conditions in computational hemodynamic models of coronary arteries is one of the sources of uncertainty weakening the findings of in silico experiments, in consequence of the challenging task of obtaining in vivo 3D flow measurements within the clinical framework. Accordingly, in this study we evaluated the influence of assumptions on inflow velocity profile shape on coronary artery hemodynamics. To do that, (1) ten left anterior descending coronary artery (LAD) geometries were reconstructed from clinical angiography, and (2) eleven velocity profiles with realistic 3D features such as eccentricity and differently shaped (single- and double-vortex) secondary flows were generated analytically and imposed as inflow boundary conditions. Wall shear stress and helicity-based descriptors obtained prescribing the commonly used parabolic velocity profile were compared with those obtained with the other velocity profiles. Our findings indicated that the imposition of idealized velocity profiles as inflow boundary condition is acceptable as long the results of the proximal vessel segment are not considered, in LAD coronary arteries. As a pragmatic rule of thumb, a conservative estimation of the length of influence of the shape of the inflow velocity profile on LAD local hemodynamics can be given by the theoretical entrance length for cylindrical conduits in laminar flow conditions.
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Affiliation(s)
- Maurizio Lodi Rizzini
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Diego Gallo
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Giuseppe De Nisco
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Fabrizio D'Ascenzo
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Claudio Chiastra
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Pier Paolo Bocchino
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Francesco Piroli
- Hemodynamic Laboratory, Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Umberto Morbiducci
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
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28
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Hoque KE, Ferdows M, Sawall S, Tzirtzilakis EE. The effect of hemodynamic parameters in patient-based coronary artery models with serial stenoses: normal and hypertension cases. Comput Methods Biomech Biomed Engin 2020; 23:467-475. [DOI: 10.1080/10255842.2020.1737028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- K. E. Hoque
- Research group of Fluid Flow Modeling and Simulation, Department of Applied Mathematics, University of Dhaka, Dhaka, Bangladesh
- Department of Arts and Sciences, Faculty of Engineering, Ahsanullah University of Science and Technology, Dhaka, Bangladesh
| | - M. Ferdows
- Research group of Fluid Flow Modeling and Simulation, Department of Applied Mathematics, University of Dhaka, Dhaka, Bangladesh
| | - S. Sawall
- X-Ray Imaging and Computed Tomography, German Cancer Research Center, Heidelberg, Germany
| | - E. E. Tzirtzilakis
- Fluid Dynamics & Turbo-machinery Laboratory, Department of Mechanical Engineering, University of the Peloponnese, Patras, Greece
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29
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Zuin M, Rigatelli G, Vassilev D, Ronco F, Rigatelli A, Roncon L. Computational fluid dynamic-derived wall shear stress of non-significant left main bifurcation disease may predict acute vessel thrombosis at 3-year follow-up. Heart Vessels 2020; 35:297-306. [PMID: 31482218 DOI: 10.1007/s00380-019-01494-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023]
Abstract
Wall shear stress (WSS) plays a pivotal role on plaque progression in coronary artery disease. We assess the prognostic role of baseline mean WSS in developing a bifurcation-located myocardial infarction (B-MI) over the following 3 years in angiographically non-significant LM bifurcation disease. For this purpose, we retrospectively reviewed the procedural and medical records of consecutive patients evaluated in our center from 1st January 2014 to 1st January 2019 who had a non-significant LM bifurcation disease as evaluated at coronary computed tomography angiography (CCTA) and confirmed by coronary angiography. Each bifurcation model was reconstructed on the patient-specific geometries derived from the CCTA. The population was divided into two groups: patients with (n = 12) and without B-MI (n = 20) over the following 3 years. Both the mean WSSprox of each branch and the WSSentire_lesion of each vessel, adjusted for the respective mean lesions lengths and 3-dimensional percentage of stenosis (DS%), resulted in independent predictors of 3-year B-MI. Multivariate Cox-regression analysis confirmed that a baseline mean WSSentire_model ≥ 5.05 Pa (HR 1.98, 95% CI 1.83-2.10, p = 0.001) was a predictor of 3-year B-MI independently from the entire mean lesions lengths (HR 1.56. 95% CI 1.43.1.68, p = 0.002) and DS% (HR 1.26, 95% CI 1.18-1.37, p = 0.03). In conclusion, in patients with angiographically non-significant LM bifurcation disease, both the mean WSSprox of each branch and WSSentire_lesion of each stenotic vessel predicted the occurrence of B-MI over the following 3 years. Moreover, the WSSentire_bifurcation ≥ 5.05 Pa seems to be a predictor of 3-year B-MI independently from the DS% and lesions lengths.
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Affiliation(s)
- Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, Faculty of Medicine, University of Ferrara, Ferrara, Italy
- Division of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
| | - Gianluca Rigatelli
- Department of Cardiovascular Diagnosis and Endoluminal Interventions, Santa Maria Della Misericordia Hospital, Viale Tre Martiri, 45100, Rovigo, Italy.
| | - Dobrin Vassilev
- "Alexandrovska" University Hospital, Medical University, Sofia, Bulgaria
| | - Federico Ronco
- Interventional Cardiology, Cardiology Department, Mestre General Hospital, Mestre, Italy
| | - Alberto Rigatelli
- Department of Emergency, Borgo Trento University Hospital, Verona, Italy
| | - Loris Roncon
- Division of Cardiology, Santa Maria Della Misericordia Hospital, Rovigo, Italy
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30
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Computational analysis of the coronary artery hemodynamics with different anatomical variations. INFORMATICS IN MEDICINE UNLOCKED 2020. [DOI: 10.1016/j.imu.2020.100314] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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31
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Shen X, Jiang J, Deng Y, Zhu H, Lu K. Haemodynamics Study of Tapered Stents Intervention to Tapered Arteries. Cardiovasc Eng Technol 2019; 10:583-589. [DOI: 10.1007/s13239-019-00437-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
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32
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Zhu G, Wei Y, Yuan Q, Yang J, Yeo JH. PIV investigation of the flow fields in subject-specific vertebro-basilar (VA-BA) junction. Biomed Eng Online 2019; 18:93. [PMID: 31492145 PMCID: PMC6731569 DOI: 10.1186/s12938-019-0711-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/20/2019] [Indexed: 12/25/2022] Open
Abstract
Background As the only arterial structure of which two main arteries merged into one, the vertebro-basilar (VA-BA) system is one of the favorite sites of cerebral atherosclerotic plaques. The aim of this study was to investigate the detailed hemodynamics characteristics in the VA-BA system. Methods A scale-up subject-specific flow phantom of VA-BA system was fabricated based on the computed tomography angiography (CTA) scanning images of a healthy adult. Flow fields in eight axial planes and six radial planes were measured and analyzed by using particle image velocimetry (PIV) under steady flow conditions of \documentclass[12pt]{minimal}
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\begin{document}$${Re}=300$$\end{document}Re=300, \documentclass[12pt]{minimal}
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\begin{document}$${Re}=500$$\end{document}Re=500. A water–glycerin mixture was used as the working fluid. Results The flow in the current model exhibited highly three-dimensional characteristics. The confluence of VAs flow formed bimodal velocity distribution near the confluence apex. Due to the asymmetrical structural configuration, the bimodal velocity profile skewed towards left, and sharper peaks were observed under higher Reynolds condition. Secondary flow characterized by two vortices formed in the radial planes where 10 mm downstream the confluence apex and persists along the BA under both Reynolds numbers. The strength of secondary flow under \documentclass[12pt]{minimal}
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\begin{document}$${Re}=500$$\end{document}Re=500 is around 8% higher than that under \documentclass[12pt]{minimal}
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\begin{document}$${Re}=300$$\end{document}Re=300, and decayed nonlinearly along the flow direction. In addition, a low momentum recirculation region induced by boundary layer separation was observed near the confluence apex. The wall shear stress (WSS) in the recirculation area was found to be lower than 0.4 Pa. This region coincides well with the preferential site of vascular lesions in the VA-BA system. Conclusions This preliminary study verified that the subject-specific in-vitro experiment is capable of reflecting the detailed flow features in the VA-BA system. The findings from this study may help to expand the understanding of the hemodynamics in the VA-BA system, and further clarifying the mechanism that underlying the localization of vascular lesions.
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Affiliation(s)
- Guangyu Zhu
- School of Energy and Power Engineering, Xi'an Jiaotong University, No. 28 Xian Ning West Road, Xi'an, 710049, China
| | - Yuan Wei
- School of Energy and Power Engineering, Xi'an Jiaotong University, No. 28 Xian Ning West Road, Xi'an, 710049, China
| | - Qi Yuan
- School of Energy and Power Engineering, Xi'an Jiaotong University, No. 28 Xian Ning West Road, Xi'an, 710049, China.
| | - Jian Yang
- Department of Radiology and Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta Weest Road, Xi'an, 710061, China
| | - Joon Hock Yeo
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore, 639798, Singapore
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33
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Daggubati R, Brahmbhatt K, Rigatelli G. Don't Touch My POT! Korean Circ J 2019; 49:495-497. [PMID: 31074222 PMCID: PMC6554591 DOI: 10.4070/kcj.2019.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ramesh Daggubati
- Department of Cardiology, NYU Winthrop Hospital, Mineola, NY, USA.
| | - Kunal Brahmbhatt
- Department of Cardiology, NYU Winthrop Hospital, Mineola, NY, USA
| | - Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
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34
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Razavi SE, Farhangmehr V, Babaie Z. Numerical investigation of hemodynamic performance of a stent in the main branch of a coronary artery bifurcation. ACTA ACUST UNITED AC 2019; 9:97-103. [PMID: 31334041 PMCID: PMC6637217 DOI: 10.15171/bi.2019.13] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 12/11/2018] [Accepted: 12/26/2018] [Indexed: 01/09/2023]
Abstract
Introduction: The effect of a bare-metal stent on the hemodynamics in the main branch of a coronary artery bifurcation with a particular type of stenosis was numerically investigated by the computational fluid dynamics (CFD). Methods: Three-dimensional idealized geometry of bifurcation was constructed in Catia modelling commercial software package. The Newtonian blood flow was assumed to be incompressible and laminar. CFD was utilized to calculate the shear stress and blood pressure distributions on the wall of main branch. In order to do the numerical simulations, a commercial software package named as COMSOL Multiphysics 5.3 was employed. Two types of stent , namely, one-part stent and two-part stent were applied to prevent the build-up and progression of the atherosclerotic plaques in the main branch. Results: A particular type of stenosis in the main branch was considered in this research. It occurred before and after the side branch. Moreover, it was found that the main branch with an inserted one-part stent had the smallest region with the wall shear stress (WSS) below 0.5 Pa which was the minimum WSS in the main branch without the stenosis. Conclusion: The use of a one-part stent in the main branch of a coronary artery bifurcation for the aforementioned type of stenosis is recommended.
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Affiliation(s)
| | - Vahid Farhangmehr
- Department of Mechanical Engineering, University of Bonab, Bonab 5551761167, Iran
| | - Zahra Babaie
- Department of Mechanical Engineering, University of Tabriz, Tabriz, Iran
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35
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Rigatelli G, Zuin M, Dash D. Thin and crush: The new mantra in left main stenting? World J Cardiol 2018; 10:191-195. [PMID: 30510635 PMCID: PMC6259027 DOI: 10.4330/wjc.v10.i11.191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/23/2018] [Accepted: 10/09/2018] [Indexed: 02/06/2023] Open
Abstract
Complex bifurcations have been suggested to be better approached by a planned double stent technique; however, recent randomized trials have shown better outcomes of provisional compared to planned two-stent strategy, in terms of both short-term efficacy and safety. In left main (LM) bifurcations, double kissing (DK)-Crush has demonstrated its superiority over Culotte and provisional-T in terms of restenosis and stent thrombosis, gaining respect as one of the most performant techniques for bifurcations stenting. On the other hand, the Nano-Crush technique has recently become part of the repertoire of double stenting techniques, providing evidence that the use of ultrathin strut stents and very minimal crush would be beneficial for both the physiological and rheological properties of the complex bifurcations, even in LM scenario, leading to a lower rate of thrombosis and restenosis at both side branch and true carina. Finally, the newest generation of ultrathin strut stents are gaining a reputation for its safe and effective use in LM treatment thanks to improved design with increased expansion rate capable of LM treatment up to 5-6 mm diameter. The modern crush techniques, such as DK-Crush and Nano-Crush, are providing excellent results on mid and long-term follow up, suggesting that minimal crushing obtained using ultra-thin stents is a good way to obtain surgical-like outcomes in the treatment of complex LM bifurcation disease.
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Affiliation(s)
- Gianluca Rigatelli
- Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo 45100, Italy.
| | - Marco Zuin
- Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara 44124, Italy
| | - Debradata Dash
- Interventional Cardiology, Thumbay Hospital, Ajman 415555, United Arab Emirates
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Narata AP, de Moura FS, Larrabide I, Perrault CM, Patat F, Bibi R, Velasco S, Januel AC, Cognard C, Chapot R, Bouakaz A, Sennoga CA, Marzo A. The Role of Hemodynamics in Intracranial Bifurcation Arteries after Aneurysm Treatment with Flow-Diverter Stents. AJNR Am J Neuroradiol 2018; 39:323-330. [PMID: 29170270 DOI: 10.3174/ajnr.a5471] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/02/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Treatment of intracranial bifurcation aneurysms with flow-diverter stents can lead to caliber changes of the distal vessels in a subacute phase. This study aims to evaluate whether local anatomy and flow disruption induced by flow-diverter stents are associated with vessel caliber changes in intracranial bifurcations. MATERIALS AND METHODS Radiologic images and demographic data were acquired for 25 patients with bifurcation aneurysms treated with flow-diverter stents. Whisker plots and Mann-Whitney rank sum tests were used to evaluate if anatomic data and caliber changes could be linked. Symmetry/asymmetry were defined as diameter ratio 1 = symmetric and diameter ratio <1 = asymmetric. Computational fluid dynamics was performed on idealized and patient-specific anatomies to evaluate flow changes induced by flow-diverter stents in the jailed vessel. RESULTS Statistical analysis identified a marked correspondence between asymmetric bifurcation and caliber change. Symmetry ratios were lower for cases showing narrowing or subacute occlusion (medium daughter vessel diameter ratio = 0.59) compared with cases with posttreatment caliber conservation (medium daughter vessel diameter ratio = 0.95). Computational fluid dynamics analysis in idealized and patient-specific anatomies showed that wall shear stress in the jailed vessel was more affected when flow-diverter stents were deployed in asymmetric bifurcations (diameter ratio <0.65) and less affected when deployed in symmetric anatomies (diameter ratio ∼1.00). CONCLUSIONS Anatomic data analysis showed statistically significant correspondence between caliber changes and bifurcation asymmetry characterized by diameter ratio <0.7 (P < .001). Similarly, computational fluid dynamics results showed the highest impact on hemodynamics when flow-diverter stents are deployed in asymmetric bifurcations (diameter ratio <0.65) with noticeable changes on wall sheer stress fields. Further research and clinical validation are necessary to identify all elements involved in vessel caliber changes after flow-diverter stent procedures.
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Affiliation(s)
- A P Narata
- From the University Hospital of Tours (A.P.N., R.B.), Tours, France
| | - F S de Moura
- Engineering, Modeling, and Applied Social Sciences Center (F.S.d.M.), Federal University of ABC, Santo André, Brazil
| | - I Larrabide
- PLADEMA-CONICET (I.L.), Universidad Nacional del Centro de la Provincia de Buenos Aires, Tandil, Argentina
| | - C M Perrault
- Mechanical Engineering Department, INSIGNEO Institute for in Silico Medicine (C.M.P., A.M.), University of Sheffield, Sheffield, United Kingdom
| | - F Patat
- UMR "Imagerie et Cerveau," Inserm U930 (F.P., A.B., C.A.S.), Université Francois Rabelais, Tours, France
| | - R Bibi
- From the University Hospital of Tours (A.P.N., R.B.), Tours, France
| | - S Velasco
- University Hospital of Poitiers (S.V.), Poitiers, France
| | - A-C Januel
- University Hospital of Toulouse (A.-C.J., C.C.), Toulouse, France
| | - C Cognard
- University Hospital of Toulouse (A.-C.J., C.C.), Toulouse, France
| | - R Chapot
- Alfried Krupp Krankenhaus (R.C.), Essen, Germany
| | - A Bouakaz
- UMR "Imagerie et Cerveau," Inserm U930 (F.P., A.B., C.A.S.), Université Francois Rabelais, Tours, France
| | - C A Sennoga
- UMR "Imagerie et Cerveau," Inserm U930 (F.P., A.B., C.A.S.), Université Francois Rabelais, Tours, France
| | - A Marzo
- Mechanical Engineering Department, INSIGNEO Institute for in Silico Medicine (C.M.P., A.M.), University of Sheffield, Sheffield, United Kingdom
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Sun Z, Chaichana T. An investigation of correlation between left coronary bifurcation angle and hemodynamic changes in coronary stenosis by coronary computed tomography angiography-derived computational fluid dynamics. Quant Imaging Med Surg 2017; 7:537-548. [PMID: 29184766 DOI: 10.21037/qims.2017.10.03] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background To investigate the correlation between left coronary bifurcation angle and coronary stenosis as assessed by coronary computed tomography angiography (CCTA)-generated computational fluid dynamics (CFD) analysis when compared to the CCTA analysis of coronary lumen stenosis and plaque lesion length with invasive coronary angiography (ICA) as the reference method. Methods Thirty patients (22 males, mean age: 59±6.9 years) with calcified plaques at the left coronary artery were included in the study with all patients undergoing CCTA and ICA examinations. CFD simulation was performed to analyze hemodynamic changes to the left coronary artery models in terms of wall shear stress, wall pressure and flow velocity, with findings correlated to the coronary stenosis and degree of bifurcation angle. Calcified plaque length was measured in the left coronary artery with diagnostic value compared to that from coronary lumen and bifurcation angle assessments. Results Of 26 significant stenosis at left anterior descending (LAD) and 13 at left circumflex (LCx) on CCTA, only 14 and 5 of them were confirmed to be >50% stenosis at LAD and LCx respectively on ICA, resulting in sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100%, 52%, 49% and 100%. The mean plaque length was measured 5.3±3.6 and 4.4±1.9 mm at LAD and LCx, respectively, with diagnostic sensitivity, specificity, PPV and NPV being 92.8%, 46.7%, 61.9% and 87.5% for extensively calcified plaques. The mean bifurcation angle was measured 83.9±13.6º and 83.8±13.3º on CCTA and ICA, respectively, with no significant difference (P=0.98). The corresponding sensitivity, specificity, PPV and NPV were 100%, 78.6%, 84.2% and 100% based on bifurcation angle measurement on CCTA, 100%, 73.3%, 78.9% and 100% based on bifurcation angle measurements on ICA, respectively. Wall shear stress was noted to increase in the LAD and LCx models with significant stenosis and wider angulation (>80º), but demonstrated little or no change in most of the coronary models with no significant stenosis and narrower angulation (<80º). Conclusions This study further clarifies the relationship between left coronary bifurcation angle and significant stenosis, with angulation measurement serving as a more accurate approach than coronary lumen assessment or plaque lesion length for determining significant coronary stenosis. Left coronary bifurcation angle is suggested to be incorporated into coronary artery disease (CAD) assessment when diagnosing significant CAD.
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Affiliation(s)
- Zhonghua Sun
- Department of Medical Radiation Sciences, Curtin University, Perth, Australia
| | - Thanapong Chaichana
- Department of Mathematics and Computer Science, Liverpool Hope University, Liverpool, England, UK
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Bruse JL, Giusti G, Baker C, Cervi E, Hsia TY, Taylor AM, Schievano S. Statistical Shape Modeling for Cavopulmonary Assist Device Development: Variability of Vascular Graft Geometry and Implications for Hemodynamics. J Med Device 2017; 11. [PMID: 28479938 DOI: 10.1115/1.4035865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Patients born with a single functional ventricle typically undergo three-staged surgical palliation in the first years of life, with the last stage realizing a cross-like total cavopulmonary connection (TCPC) of superior and inferior vena cavas (SVC and IVC) with both left and right pulmonary arteries, allowing all deoxygenated blood to flow passively back to the lungs (Fontan circulation). Even though within the past decades more patients survive into adulthood, the connection comes at the prize of deficiencies such as chronic systemic venous hypertension and low cardiac output, which ultimately may lead to Fontan failure. Many studies have suggested that the TCPC's inherent insufficiencies might be addressed by adding a cavopulmonary assist device (CPAD) to provide the necessary pressure boost. While many device concepts are being explored, few take into account the complex cardiac anatomy typically associated with TCPCs. In this study, we focus on the extra cardiac conduit vascular graft connecting IVC and pulmonary arteries as one possible landing zone for a CPAD and describe its geometric variability in a cohort of 18 patients that had their TCPC realized with a 20mm vascular graft. We report traditional morphometric parameters and apply statistical shape modeling to determine the main contributors of graft shape variability. Such information may prove useful when designing CPADs that are adapted to the challenging anatomical boundaries in Fontan patients. We further compute the anatomical mean 3D graft shape (template graft) as a representative of key shape features of our cohort and prove this template graft to be a significantly better approximation of population and individual patient's hemodynamics than a commonly used simplified tube geometry. We therefore conclude that statistical shape modeling results can provide better models of geometric and hemodynamic boundary conditions associated with complex cardiac anatomy, which in turn may impact on improved cardiac device development.
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Affiliation(s)
- Jan L Bruse
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
| | - Giuliano Giusti
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
| | - Catriona Baker
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
| | - Elena Cervi
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
| | - Tain-Yen Hsia
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
| | - Andrew M Taylor
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
| | - Silvia Schievano
- Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children
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Chiastra C, Gallo D, Tasso P, Iannaccone F, Migliavacca F, Wentzel JJ, Morbiducci U. Healthy and diseased coronary bifurcation geometries influence near-wall and intravascular flow: A computational exploration of the hemodynamic risk. J Biomech 2017; 58:79-88. [PMID: 28457603 DOI: 10.1016/j.jbiomech.2017.04.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 04/08/2017] [Accepted: 04/11/2017] [Indexed: 01/09/2023]
Abstract
Local hemodynamics has been identified as one main determinant in the onset and progression of atherosclerotic lesions at coronary bifurcations. Starting from the observation that atherosensitive hemodynamic conditions in arterial bifurcation are majorly determined by the underlying anatomy, the aim of the present study is to investigate how peculiar coronary bifurcation anatomical features influence near-wall and intravascular flow patterns. Different bifurcation angles and cardiac curvatures were varied in population-based, idealized models of both stenosed and unstenosed bifurcations, representing the left anterior descending (LAD) coronary artery with its diagonal branch. Local hemodynamics was analyzed in terms of helical flow and exposure to low/oscillatory shear stress by performing computational fluid dynamics simulations. Results show that bifurcation angle impacts lowly hemodynamics in both stenosed and unstenosed cases. Instead, curvature radius influences the generation and transport of helical flow structures, with smaller cardiac curvature radius associated to higher helicity intensity. Stenosed bifurcation models exhibit helicity intensity values one order of magnitude higher than the corresponding unstenosed cases. Cardiac curvature radius moderately affects near-wall hemodynamics of the stenosed cases, with smaller curvature radius leading to higher exposure to low shear stress and lower exposure to oscillatory shear stress. In conclusion, the proposed controlled benchmark allows investigating the effect of various geometrical features on local hemodynamics at the LAD/diagonal bifurcation, highlighting that cardiac curvature influences near wall and intravascular hemodynamics, while bifurcation angle has a minor effect.
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Affiliation(s)
- Claudio Chiastra
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands; Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Diego Gallo
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Paola Tasso
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | | | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Umberto Morbiducci
- Polito(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
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Rigatelli G, Dell'Avvocata F, Zuin M, Vassiliev D, Mazza A, Dinh HD. Complex coronary bifurcation revascularization by means of very minimal crushing and ultrathin biodegradable polymer DES: Feasibility and 1-year outcomes of the "Nano-crush" technique. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:22-27. [PMID: 27566904 DOI: 10.1016/j.carrev.2016.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 06/26/2016] [Accepted: 07/06/2016] [Indexed: 02/08/2023]
Abstract
AIM To assess feasibility and 1-year outcomes of ultrathin biodegradable polymer double stenting using a very minimal crushing (nano-crush technique) in a series of patients with large (≥2.5mm) complex coronary bifurcation. METHODS From January 2015 to June 2016, patients referred for large (≥2.5mm) complex coronary bifurcation percutaneous coronary interventions (PCI) were enrolled to receive Orsiro (Biotronik Inc., Bulack, Switzerland) double stenting using a very minimal crush technique (nano-crush). Per our institutional protocol, follow-up was conducted by physical examination at 1, 6, 12month and yearly whereas angiographic control was eventually scheduled at 6-8months on the basis of symptoms recurrence or/and positive induced ischemia tests. RESULTS Fifty-two patients (15 females mean age 77.2±6.2years) were enrolled. Mean angles between main branch and side branch were 63.6±21.3°. The mean diameter and length of implanted stents were 3.8±0.4mm and 27.1±8.7mm in main branch and 2.8±0.3mm and 22.1±.7.1mm in side branch. Immediate success was 100%. Clinical follow-up was available for 100% of patients: at a mean follow-up of 12.0±2.6months, no patient death, or acute myocardial infarction or target vessel revascularization were observed. Angiographic follow-up was available in 25/52 patients (48%) at a mean time from the procedure of 7.2±0.5months and showed no significant angiographic restenosis. CONCLUSIONS The revascularization of complex large (≥2.5mm) coronary bifurcation disease using the nano-crush technique and the ultrathin polymer biodegradable stent appeared feasible in our small study with promising 1year outcomes.
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Affiliation(s)
- Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.
| | - Fabio Dell'Avvocata
- Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Department of Internal Medicine, Rovigo General Hospital, Rovigo, Italy
| | - Dobrin Vassiliev
- Cardiology Clinic, Alexandroska University Hospital, Sofia, Bulgaria
| | - Alberto Mazza
- Department of Internal Medicine, Rovigo General Hospital, Rovigo, Italy
| | - Huy D Dinh
- Interventional Cardiology Department, Tam Duc Heart Hospital, Ho Chi Minh City, Vietnam
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41
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Chiastra C, Iannaccone F, Grundeken MJ, Gijsen FJH, Segers P, De Beule M, Serruys PW, Wykrzykowska JJ, van der Steen AFW, Wentzel JJ. Coronary fractional flow reserve measurements of a stenosed side branch: a computational study investigating the influence of the bifurcation angle. Biomed Eng Online 2016; 15:91. [PMID: 27495804 PMCID: PMC4974683 DOI: 10.1186/s12938-016-0211-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/20/2016] [Indexed: 12/31/2022] Open
Abstract
Background Coronary hemodynamics and physiology specific for bifurcation lesions was not well understood. To investigate the influence of the bifurcation angle on the intracoronary hemodynamics of side branch (SB) lesions computational fluid dynamics simulations were performed. Methods A parametric model representing a left anterior descending—first diagonal coronary bifurcation lesion was created according to the literature. Diameters obeyed fractal branching laws. Proximal and distal main branch (DMB) stenoses were both set at 60 %. We varied the distal bifurcation angles (40°, 55°, and 70°), the flow splits to the DMB and SB (55 %:45 %, 65 %:35 %, and 75 %:25 %), and the SB stenoses (40, 60, and 80 %), resulting in 27 simulations. Fractional flow reserve, defined as the ratio between the mean distal stenosis and mean aortic pressure during maximal hyperemia, was calculated for the DMB and SB (FFRSB) for all simulations. Results The largest differences in FFRSB comparing the largest and smallest bifurcation angles were 0.02 (in cases with 40 % SB stenosis, irrespective of the assumed flow split) and 0.05 (in cases with 60 % SB stenosis, flow split 55 %:45 %). When the SB stenosis was 80 %, the difference in FFRSB between the largest and smallest bifurcation angle was 0.33 (flow split 55 %:45 %). By describing the ΔPSB−QSB relationship using a quadratic curve for cases with 80 % SB stenosis, we found that the curve was steeper (i.e. higher flow resistance) when bifurcation angle increases (ΔP = 0.451*Q + 0.010*Q2 and ΔP = 0.687*Q + 0.017*Q2 for 40° and 70° bifurcation angle, respectively). Our analyses revealed complex hemodynamics in all cases with evident counter-rotating helical flow structures. Larger bifurcation angles resulted in more pronounced helical flow structures (i.e. higher helicity intensity), when 60 or 80 % SB stenoses were present. A good correlation (R2 = 0.80) between the SB pressure drop and helicity intensity was also found. Conclusions Our analyses showed that, in bifurcation lesions with 60 % MB stenosis and 80 % SB stenosis, SB pressure drop is higher for larger bifurcation angles suggesting higher flow resistance (i.e. curves describing the ΔPSB−QSB relationship being steeper). When the SB stenosis is mild (40 %) or moderate (60 %), SB resistance is minimally influenced by the bifurcation angle, with differences not being clinically meaningful. Our findings also highlighted the complex interplay between anatomy, pressure drops, and blood flow helicity in bifurcations.
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Affiliation(s)
- Claudio Chiastra
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.,Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Francesco Iannaccone
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.,IbiTech-bioMMeda, Department of Electronics and Information Systems iMinds Medical IT, Ghent University, Ghent, Belgium
| | - Maik J Grundeken
- The Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank J H Gijsen
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Patrick Segers
- IbiTech-bioMMeda, Department of Electronics and Information Systems iMinds Medical IT, Ghent University, Ghent, Belgium
| | - Matthieu De Beule
- IbiTech-bioMMeda, Department of Electronics and Information Systems iMinds Medical IT, Ghent University, Ghent, Belgium.,FEops bvba, Ghent, Belgium
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Joanna J Wykrzykowska
- The Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.
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