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van de Velde L, Groot Jebbink E, Hagmeijer R, Versluis M, Reijnen MMPJ. Computational Fluid Dynamics for the Prediction of Endograft Thrombosis in the Superficial Femoral Artery. J Endovasc Ther 2023; 30:615-627. [DOI: https:/doi.org/10.1177/15266028221091890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Purpose: Contemporary diagnostic modalities, including contrast-enhanced computed tomography (CTA) and duplex ultrasound, have been insufficiently able to predict endograft thrombosis. This study introduces an implementation of image-based computational fluid dynamics (CFD), by exemplification with 4 patients treated with an endograft for occlusive disease of the superficial femoral artery (SFA). The potential of personalized CFD for predicting endograft thrombosis is investigated. Materials and Methods: Four patients treated with endografts for an occluded SFA were retrospectively included. CFD simulations, based on CTA and duplex ultrasound, were compared for patients with and without endograft thrombosis to investigate potential flow-related causes of endograft thrombosis. Time-averaged wall shear stress (TAWSS) was computed, which highlights areas of prolonged residence times of coagulation factors in the graft. Results: CFD simulations demonstrated normal TAWSS (>0.4 Pa) in the SFA for cases 1 and 2, but low levels of TAWSS (<0.4 Pa) in cases 3 and 4, respectively. Primary patency was achieved in cases 1 and 2 for over 2 year follow-up. Cases 3 and 4 were complicated by recurrent endograft thrombosis. Conclusion: The presence of a low TAWSS was associated with recurrent endograft thrombosis in subjects with otherwise normal anatomic and ultrasound assessment and a good distal run-off.
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Affiliation(s)
- Lennart van de Velde
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Erik Groot Jebbink
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Rob Hagmeijer
- Engineering Fluid Dynamics, University of Twente, Enschede, The Netherlands
| | - Michel Versluis
- Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Michel M. P. J. Reijnen
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands
- Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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van de Velde L, Groot Jebbink E, Hagmeijer R, Versluis M, Reijnen MMPJ. Computational Fluid Dynamics for the Prediction of Endograft Thrombosis in the Superficial Femoral Artery. J Endovasc Ther 2022:15266028221091890. [PMID: 35466777 DOI: 10.1177/15266028221091890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Contemporary diagnostic modalities, including contrast-enhanced computed tomography (CTA) and duplex ultrasound, have been insufficiently able to predict endograft thrombosis. This study introduces an implementation of image-based computational fluid dynamics (CFD), by exemplification with 4 patients treated with an endograft for occlusive disease of the superficial femoral artery (SFA). The potential of personalized CFD for predicting endograft thrombosis is investigated. MATERIALS AND METHODS Four patients treated with endografts for an occluded SFA were retrospectively included. CFD simulations, based on CTA and duplex ultrasound, were compared for patients with and without endograft thrombosis to investigate potential flow-related causes of endograft thrombosis. Time-averaged wall shear stress (TAWSS) was computed, which highlights areas of prolonged residence times of coagulation factors in the graft. RESULTS CFD simulations demonstrated normal TAWSS (>0.4 Pa) in the SFA for cases 1 and 2, but low levels of TAWSS (<0.4 Pa) in cases 3 and 4, respectively. Primary patency was achieved in cases 1 and 2 for over 2 year follow-up. Cases 3 and 4 were complicated by recurrent endograft thrombosis. CONCLUSION The presence of a low TAWSS was associated with recurrent endograft thrombosis in subjects with otherwise normal anatomic and ultrasound assessment and a good distal run-off.
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Affiliation(s)
- Lennart van de Velde
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.,Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Erik Groot Jebbink
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Rob Hagmeijer
- Engineering Fluid Dynamics, University of Twente, Enschede, The Netherlands
| | - Michel Versluis
- Physics of Fluids Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Michel M P J Reijnen
- Department of Surgery, Ziekenhuis Rijnstate, Arnhem, The Netherlands.,Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Raptis A, Tasso P, Batzalexis K, Gallo D, Xenos M, Morbiducci U, Giannoukas A. Remodeling effects of carotid artery stenting versus endarterectomy with patch angioplasty in terms of morphology and hemodynamics. Comput Biol Med 2022; 140:105072. [PMID: 34856465 DOI: 10.1016/j.compbiomed.2021.105072] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/23/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Carotid endarterectomy (CEA) remains the first-line treatment option of symptomatic and asymptomatic carotid stenosis, while stenting (CAS) is reserved for selected patients at high surgical risk. Here, we compare the vascular remodeling process in CEA- and CAS-treated patients with respect to morphological and hemodynamic features, because of their possible engagement in carotid atherosclerosis. METHODS Twelve (12) patients were included, half with patched CEA and half with CAS. Pre- and post-operative 3D image-based models of the carotid bifurcation were anatomically characterized in terms of flare, tortuosity, and curvature. Individual computational fluid dynamics simulations allowed to quantify the postoperative hemodynamic milieu in terms of (1) wall shear stress and (2) helical flow. RESULTS Carotid flare increased in all cases, but a more marked increase emerged after CEA compared to CAS. Tortuosity and curvature increased after CEA but decreased after CAS. CEA patients presented with significantly higher postoperative tortuosity than CAS patients. CEA was associated with a worse (non-statistically significant) score in all flow disturbance indicators vs. CAS. CONCLUSION The increased flare and tortuosity of the carotid bifurcation after CEA vs. CAS is a marked difference in the vascular remodeling process between the two modalities. CAS seems to induce a less pro-restenosis hemodynamic environment compared to CEA. The emerged differences stimulate further analysis on a larger cohort with long-term outcomes, to shed light on the clinical impact of the observations.
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Affiliation(s)
- Anastasios Raptis
- Laboratory for Vascular Simulations, Institute of Vascular Diseases, Larissa, Greece
| | - Paola Tasso
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Konstantinos Batzalexis
- Department of Vascular Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Diego Gallo
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Michalis Xenos
- Laboratory for Vascular Simulations, Institute of Vascular Diseases, Larissa, Greece; Department of Mathematics, University of Ioannina, Ioannina, Greece
| | - Umberto Morbiducci
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Athanasios Giannoukas
- Laboratory for Vascular Simulations, Institute of Vascular Diseases, Larissa, Greece; Department of Vascular Surgery, Faculty of Medicine, University of Thessaly, Larissa, Greece.
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Zheng Y, Yu B, Alexander D, Couper DJ, Boerwinkle E. Medium-term variability of the human serum metabolome in the Atherosclerosis Risk in Communities (ARIC) study. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2014; 18:364-73. [PMID: 24910946 DOI: 10.1089/omi.2014.0019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Metabolomics is a systems biology tool providing small molecule signatures of disease etiology. In order to estimate the biologic variability of the human serum metabolome, this study calculated intraclass correlation coefficients (ICCs) for 178 stably-detected metabolites measured by untargeted chromatography/mass spectrometry. We studied a subsample of 60 participants (57% males, 70% Caucasians, aged 73.77±5.3 years) in the Atherosclerosis Risk in Communities (ARIC) Study who provided two fasting serum samples 4-6 weeks apart. The median ICC across all metabolites was 0.60, and 82% of metabolites had at least fair variability (i.e., ICC>= 0.40). There was variation in the medium-term variability among metabolites, with those in the pathways of amino acid and lipid metabolism showing relatively high ICCs, and those in the carbohydrate pathway showing relatively low ICCs. The results of this study provide a valuable resource for future study design and outcome interpretation of mass spectrometry-based metabolomic studies in epidemiology.
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Affiliation(s)
- Yan Zheng
- 1 Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center at Houston , Houston, Texas
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Aristokleous N, Seimenis I, Georgiou GC, Papaharilaou Y, Brott BC, Nicolaides A, Anayiotos AS. Impact of Head Rotation on the Individualized Common Carotid Flow and Carotid Bifurcation Hemodynamics. IEEE J Biomed Health Inform 2014; 18:783-9. [DOI: 10.1109/jbhi.2014.2305575] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bijari PB, Wasserman BA, Steinman DA. Carotid bifurcation geometry is an independent predictor of early wall thickening at the carotid bulb. Stroke 2013; 45:473-8. [PMID: 24357655 DOI: 10.1161/strokeaha.113.003454] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Lumen geometry has long been suspected as a risk factor for atherosclerosis by virtue of its influence on blood flow disturbances. Confirmation of this geometric risk hypothesis has, however, proved challenging owing to possible effects of wall thickening on geometry and unproven links between candidate geometric variables and disturbed flow. The purpose of this study was to overcome these challenges. METHODS The study relied on imaging and risk factor data from progressively refined subsets of the Atherosclerosis Risk in Communities (ARIC) Carotid MRI study. Group 1 (n=467) included only nonstenotic cases having sufficient quality angiography for 3-dimensional analysis. Group 2 (n=346) excluded cases from group 1 having common and internal carotid artery wall thickness above previously identified thresholds for inward remodeling. Group 3 (n=294) excluded cases from group 2 having lumen irregularities and thus was least likely to include lumen geometries influenced by wall thickening. RESULTS Multiple linear regressions showed that for group 3, bifurcation flare and proximal curvature were independent predictors of internal carotid artery wall thickness, consistent with their previously demonstrated roles in predicting disturbed flow. For the broadest group 1, flare was an independent predictor of internal carotid artery wall thickness but with a sign change in regression coefficient reflecting effects of wall thickening on lumen geometry. CONCLUSIONS Carotid bifurcation geometry is an independent, albeit weak, predictor of its early wall thickening, but only when assumptions about geometric factors, and the influence of disease on them, are confronted. This highlights pitfalls of previous attempts to confirm geometric risk of atherosclerosis.
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Affiliation(s)
- Payam B Bijari
- From the Biomedical Simulation Laboratory, Department of Mechanical and Industrial Engineering and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada (P.B.B., D.A.S.); and Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (B.A.W.)
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Papaharilaou Y, Aristokleous N, Seimenis I, Khozeymeh MI, Georgiou GC, Brott BC, Eracleous E, Anayiotos AS. Effect of head posture on the healthy human carotid bifurcation hemodynamics. Med Biol Eng Comput 2012; 51:207-18. [PMID: 23143389 DOI: 10.1007/s11517-012-0985-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 10/29/2012] [Indexed: 11/25/2022]
Abstract
Head and neck postures may cause morphology changes to the geometry of the carotid bifurcation (CB) that alter the low and oscillating wall shear stress (WSS) regions previously reported as important in the development of atherosclerosis. Here the right and left CB were imaged by MRI in two healthy subjects in the neutral head posture with the subject in the supine position and in two other head postures with the subject in the prone position: (1) rightward rotation up to 80°, and (2) leftward rotation up to 80°. Image-based computational models were constructed to investigate the effect of posture on arterial geometry and local hemodynamics. The area exposure to unfavorable hemodynamics, based on thresholds set for oscillatory shear index (OSI), WSS and relative residence time, was used to quantify the hemodynamic impact on the wall. Torsion of the head was found to: (1) cause notable changes in the bifurcation and internal carotid artery angles and, in most cases, on cross-sectional area ratios for common, internal and external carotid artery, (2) change the spatial distribution of wall regions exposed to unfavorable hemodynamics, and (3) cause a marked change in the hemodynamic burden on the wall when the OSI was considered. These findings suggest that head posture may be associated with the genesis and development of atherosclerotic disease as well as complications in stenotic and stented vessels.
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Affiliation(s)
- Yannis Papaharilaou
- Institute of Applied and Computational Mathematics, Foundation for Research and Technology, Hellas, Heraklion, Crete, Greece
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Zhu C, Patterson AJ, Thomas OM, Sadat U, Graves MJ, Gillard JH. Carotid stenosis assessment with multi-detector CT angiography: comparison between manual and automatic segmentation methods. Int J Cardiovasc Imaging 2012; 29:899-905. [DOI: 10.1007/s10554-012-0148-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 10/29/2012] [Indexed: 10/27/2022]
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Tang H, van Walsum T, van Onkelen RS, Hameeteman R, Klein S, Schaap M, Tori FL, van den Bouwhuijsen QJ, Witteman JC, van der Lugt A, van Vliet LJ, Niessen WJ. Semiautomatic carotid lumen segmentation for quantification of lumen geometry in multispectral MRI. Med Image Anal 2012; 16:1202-15. [DOI: 10.1016/j.media.2012.05.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 05/14/2012] [Accepted: 05/31/2012] [Indexed: 11/25/2022]
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Sakellarios AI, Stefanou K, Siogkas P, Tsakanikas VD, Bourantas CV, Athanasiou L, Exarchos TP, Fotiou E, Naka KK, Papafaklis MI, Patterson AJ, Young VEL, Gillard JH, Michalis LK, Fotiadis DI. Novel methodology for 3D reconstruction of carotid arteries and plaque characterization based upon magnetic resonance imaging carotid angiography data. Magn Reson Imaging 2012; 30:1068-82. [PMID: 22617149 DOI: 10.1016/j.mri.2012.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 12/20/2011] [Accepted: 03/08/2012] [Indexed: 01/24/2023]
Abstract
In this study, we present a novel methodology that allows reliable segmentation of the magnetic resonance images (MRIs) for accurate fully automated three-dimensional (3D) reconstruction of the carotid arteries and semiautomated characterization of plaque type. Our approach uses active contours to detect the luminal borders in the time-of-flight images and the outer vessel wall borders in the T(1)-weighted images. The methodology incorporates the connecting components theory for the automated identification of the bifurcation region and a knowledge-based algorithm for the accurate characterization of the plaque components. The proposed segmentation method was validated in randomly selected MRI frames analyzed offline by two expert observers. The interobserver variability of the method for the lumen and outer vessel wall was -1.60%±6.70% and 0.56%±6.28%, respectively, while the Williams Index for all metrics was close to unity. The methodology implemented to identify the composition of the plaque was also validated in 591 images acquired from 24 patients. The obtained Cohen's k was 0.68 (0.60-0.76) for lipid plaques, while the time needed to process an MRI sequence for 3D reconstruction was only 30 s. The obtained results indicate that the proposed methodology allows reliable and automated detection of the luminal and vessel wall borders and fast and accurate characterization of plaque type in carotid MRI sequences. These features render the currently presented methodology a useful tool in the clinical and research arena.
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Affiliation(s)
- Antonis I Sakellarios
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, Ioannina, Greece
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Bijari PB, Antiga L, Gallo D, Wasserman BA, Steinman DA. Improved prediction of disturbed flow via hemodynamically-inspired geometric variables. J Biomech 2012; 45:1632-7. [PMID: 22552156 DOI: 10.1016/j.jbiomech.2012.03.030] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 03/16/2012] [Accepted: 03/31/2012] [Indexed: 10/28/2022]
Abstract
Arterial geometry has long been considered as a pragmatic alternative for inferring arterial flow disturbances, and their impact on the natural history and treatment of vascular diseases. Traditionally, definition of geometric variables is based on convenient shape descriptors, with only superficial consideration of their influence on flow and wall shear stress patterns. In the present study we demonstrate that a more studied consideration of the actual (cf. nominal) local hemodynamics can lead to substantial improvements in the prediction of disturbed flow by geometry. Starting from a well-characterized computational fluid dynamics (CFD) dataset of 50 normal carotid bifurcations, we observed that disturbed flow tended to be confined proximal to the flow divider, whereas geometric variables previously shown to be significant predictors of disturbed flow included features distal to the flow divider in their definitions. Flaring of the bifurcation leading to flow separation was redefined as the maximum relative expansion of the common carotid artery (CCA), proximal to the flow divider. The beneficial effect of primary curvature on flow inertia, via suppression of flow separation, was characterized by the in-plane tortuosity of CCA as it enters the flare region. Multiple linear regressions of these redefined geometric variables against various metrics of disturbed flow revealed R(2) values approaching 0.6, better than the roughly 0.3 achieved using the conventional shape-based variables, while maintaining their demonstrated real-world reproducibility. Such a hemodynamically-inspired approach to the definition of geometric variables may reap benefits for other applications where geometry is used as a surrogate marker of local hemodynamics.
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Affiliation(s)
- Payam B Bijari
- Biomedical Simulation Laboratory, Department of Mechanical & Industrial Engineering, and Institute of Biomaterials and Biomedical Engineering, University of Toronto, 5 King's College Road, Toronto, ON, Canada M5S 3G8
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