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Li L, Yang B, Dmytriw AA, Li Y, Gong H, Bai X, Zhang C, Chen J, Dong J, Wang Y, Gao P, Wang T, Luo J, Xu X, Feng Y, Zhang X, Yang R, Ma Y, Jiao L. Correlations between intravascular pressure gradients and cerebral blood flow in patients with symptomatic, medically refractory, anterior circulation artery stenosis: an exploratory study. J Neurointerv Surg 2024; 16:608-614. [PMID: 37402573 DOI: 10.1136/jnis-2023-020144] [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: 02/15/2023] [Accepted: 06/09/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Fractional flow reserve is widely used in coronary disease management, with a threshold of 0.80. However, similar thresholds are unclear in functional assessment of intracranial atherosclerotic stenosis (ICAS). OBJECTIVE To investigate the potential threshold values in functional assessment of ICAS by studying the relation between pressure-derived indexes and perfusion parameters derived from arterial spin labeling (ASL). METHODS Patients were consecutively screened between June 2019 and December 2020. The translesional gradient indices were measured by pressure guidewire under resting-state conditions and recorded as mean distal/proximal pressure ratios (Pd/Pa) and translesional pressure difference (Pa-Pd). Preoperative and postoperative cerebral blood flow (CBF) bilaterally and the relative cerebral blood flow ratio (rCBF) were measured and recorded by ASL imaging. Patients were defined as having reversible hemodynamic insufficiency only if the preoperative rCBF was <0.9 and the postoperative rCBF≥0.9. Preoperative and postoperative Pd/Pa or Pa-Pd values of those patients were used to calculate the threshold. RESULTS Twenty-five patients (19 men, 6 women) with a mean age of 56.7±9.4 years were analyzed. Seventeen patients (68%) had lesions at the M1 segment of the middle cerebral artery, eight patients (32%) had lesions in the intracranial internal carotid artery. In 14 of the 25 patients, the preoperative rCBF was <0.9 and the postoperative rCBF≥0.9. Cut-off values of Pd/Pa=0.81 and Pa-Pd=8 mm Hg were suggested to be associated with hemodynamic insufficiency. CONCLUSIONS In a highly selected subgroup with ICAS, cut-off values of translesional pressure gradients (Pd/Pa=0.81 or Pa-Pd=8 mm Hg) were preliminarily established, which may facilitate clinical decision-making in the management of ICAS.
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Affiliation(s)
- Long Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Bin Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Neuroradiology and Neurointervention, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yanling Li
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, Beijing, Beijing, China
| | - Haozhi Gong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Chao Zhang
- Neuroendovascular Program, Beijing Escope Technology Inc, Beijing, Beijing, China
| | - Jian Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Jia Dong
- Department of Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
| | - Yabing Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Peng Gao
- Department of Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Jichang Luo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Xin Xu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Renjie Yang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing, China
- Department of Interventional Neuroradiology, Xuanwu Hospital Capital Medical University, Beijing, Beijing, China
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Chen LH, Spagnolo-Allende A, Yang D, Qiao Y, Gutierrez J. Epidemiology, Pathophysiology, and Imaging of Atherosclerotic Intracranial Disease. Stroke 2024; 55:311-323. [PMID: 38252756 PMCID: PMC10827355 DOI: 10.1161/strokeaha.123.043630] [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] [Indexed: 01/24/2024]
Abstract
Intracranial atherosclerotic disease (ICAD) is one of the most common causes of stroke worldwide. Among people with stroke, those of East Asia descent and non-White populations in the United States have a higher burden of ICAD-related stroke compared with Whites of European descent. Disparities in the prevalence of asymptomatic ICAD are less marked than with symptomatic ICAD. In addition to stroke, ICAD increases the risk of dementia and cognitive decline, magnifying ICAD societal burden. The risk of stroke recurrence among patients with ICAD-related stroke is the highest among those with confirmed stroke and stenosis ≥70%. In fact, the 1-year recurrent stroke rate of >20% among those with stenosis >70% is one of the highest rates among common causes of stroke. The mechanisms by which ICAD causes stroke include plaque rupture with in situ thrombosis and occlusion or artery-to-artery embolization, hemodynamic injury, and branch occlusive disease. The risk of stroke recurrence varies by the presumed underlying mechanism of stroke, but whether techniques such as quantitative magnetic resonance angiography, computed tomographic angiography, magnetic resonance perfusion, or transcranial Doppler can help with risk stratification beyond the degree of stenosis is less clear. The diagnosis of ICAD is heavily reliant on lumen-based studies, such as computed tomographic angiography, magnetic resonance angiography, or digital subtraction angiography, but newer technologies, such as high-resolution vessel wall magnetic resonance imaging, can help distinguish ICAD from stenosing arteriopathies.
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Affiliation(s)
- Li Hui Chen
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Antonio Spagnolo-Allende
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Dixon Yang
- Department of Neurology, Rush University, Chicago, IL, USA
| | - Ye Qiao
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Jose Gutierrez
- Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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Charles JH, Desai S, Jean Paul A, Hassan A. Multimodal imaging approach for the diagnosis of intracranial atherosclerotic disease (ICAD): Basic principles, current and future perspectives. Interv Neuroradiol 2024; 30:105-119. [PMID: 36262087 PMCID: PMC10956456 DOI: 10.1177/15910199221133170] [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: 09/17/2022] [Accepted: 09/29/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To review the different imaging modalities utilized in the diagnosis of Intracranial Atherosclerotic Disease (ICAD) including their latest development and relevance in management of ICAD. METHODS A review of the literature was conducted through a search in google scholar, PubMed/Medline, EMBASE, Scopus, clinical trials.gov and the Cochrane Library. Search terms included, "imaging modalities in ICAD," "ICAD diagnostic," "Neuroimaging of ICAD," "Evaluation of ICAD". A summary and comparison of each modality's basic principles, advantages and disadvantages were included. RESULTS A total of 144 articles were identified and reviewed. The most common imaging used in ICAD diagnoses were DSA, CTA, MRA and TCD. They all had proven accuracy, their own benefits, and limitations. Newer modalities such as VWI, IVUS, OCT, PWI and CFD provide more detailed information regarding the vessel walls, plaque characteristics, and flow dynamics, which play a tremendous role in treatment guidance. In certain clinical scenarios, using more than one modality has been shown to be helpful in ICAD identification. The rapidly evolving software related to imaging studies, such as virtual histology, are very promising for the diagnostic and management of ICAD. CONCLUSIONS ICAD is a common cause of recurrent ischemic stroke. Its management can be both medical and/or procedural. Many different imaging modalities are used in its diagnosis. In certain clinical scenario, a combination of two more modalities can be critical in the management of ICAD. We expect that continuous development of imaging technique will lead to individualized and less invasive management with adequate outcome.
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Affiliation(s)
| | - Sohum Desai
- Department of Endovascular Surgical Neuroradiology, Valley Baptist Medical Center, Harlingen, Texas, USA
| | - Axler Jean Paul
- School of Medicine, State University of Haiti, Port Au Prince, Haiti
| | - Ameer Hassan
- Department of Endovascular Surgical Neuroradiology, Valley Baptist Medical Center, Harlingen, Texas, USA
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Yin Z, Zhou C, Guo J, Wei Y, Ma Y, Zhou F, Zhu W, Zhang LJ. CT-derived fractional flow reserve in intracranial arterial stenosis: A pilot study based on computational fluid dynamics. Eur J Radiol 2024; 171:111285. [PMID: 38181628 DOI: 10.1016/j.ejrad.2024.111285] [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: 05/29/2023] [Revised: 10/14/2023] [Accepted: 01/01/2024] [Indexed: 01/07/2024]
Abstract
BACKGROUND CT-derived fractional flow reserve (CT-FFR) has been widely applied in coronary hemodynamic assessment. However, the feasieablity and standardization measurement in intracranial artery stenosis (ICAS) remains to be defined. PURPOSE To demonstrate the feasibility of CT-FFR in ICAS functional assessment and explore the optimal CT-FFR measurement position with invasive FFR as reference standard. MATERIALS AND METHODS Nineteen patients (mean age, 58.6 years ± 1.9 [SD]; 13 men) with moderate to severe (≥50 %) ICAS undergoing guidewire-based pressure measurement and preoperative head CT angiography (CTA) were retrospectively enrolled. CT-FFR was measured in the following standard measurement positions, including the end of stenosis (D0), 1 cm distal to the stenosis (D1) and 2 cm distal to the stenosis (D2). Diagnostic performance of CT-FFR was assessed by the area under the curve (AUC) of receiver operating characteristic curves by assuming invasive FFR ≤ 0.80 or 0.75 as hemodynamically significant stenosis. RESULTS Excellent intra- and inter-observer agreement (ICC range, 0.930-0.992) was observed for CT-FFR measurement in different positions. Under different FFR thresholds, the diagnostic performance of CT-FFRD1 showed perfect prediction with AUC values of 1.000 (95 % CI: 0.824, 1.000). The sensitivity, specificity and AUC of CT-FFRD1 ≤ 0.80 in detecting FFR ≤ 0.80 was 0.94 (95 % CI: 0.68, 1.00), 1.00 (95 % CI: 0.31, 1.00) and 0.969 (95 % CI: 0.772, 1.000), respectively. Similar performance of CT-FFRD1 ≤ 0.75 was obtained for identifying FFR ≤ 0.75 with the AUC of 0.964. The strongest correlation (r = 0.915, p < 0.001) and agreement (mean difference: 0.02, 95 % limits of agreement: -0.16 to 0.19) were observed between CT-FFRD1 and FFR. CONCLUSION Cerebral CT-derived fractional flow reserve (CT-FFR) measured 1 cm distal to stenosis achieved the most comparable results with invasive FFR, which indicated its potentially promising clinical application for evaluating the functional relevance of intracranial artery stenosis.
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Affiliation(s)
- Zhuhao Yin
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu 210002, China
| | - Changsheng Zhou
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Jian Guo
- Shanghai United Imaging Medical Technology Group Co., Ltd., Shanghai 201807, China
| | - Yuan Wei
- Shanghai United Imaging Medical Technology Group Co., Ltd., Shanghai 201807, China
| | - Yifei Ma
- Shanghai United Imaging Medical Technology Group Co., Ltd., Shanghai 201807, China
| | - Fan Zhou
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Wusheng Zhu
- Department of Neurology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, China
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, Jiangsu 210002, China; Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210002, China.
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5
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Yang P, Wan S, Wang J, Hu Y, Ma N, Wang X, Zhang Y, Zhang L, Zhu X, Shen F, Zheng Q, Wang M, Leng X, Fiehler J, Siddiqui AH, Miao Z, Xiang J, Liu J. Hemodynamic assessment for intracranial atherosclerosis from angiographic images: a clinical validation study. J Neurointerv Surg 2024; 16:204-208. [PMID: 37185108 DOI: 10.1136/jnis-2023-020073] [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: 01/09/2023] [Accepted: 04/04/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Intracranial atherosclerotic stenosis (ICAS) is one of the leading causes of ischemic stroke. Conventional anatomical analysis by CT angiography, MRI, or digital subtraction angiography can provide valuable information on the anatomical changes of stenosis; however, they are not sufficient to accurately evaluate the hemodynamic severity of ICAS. The goal of this study was to assess the diagnostic performance of the pressure ratio across intracranial stenoses (termed as fractional flow (FF)) derived from cerebral angiography for the diagnosis of hemodynamically significant ICAS defined by pressure wire-derived FF. METHODS This retrospective study represents a feasible and reliable method for calculating the FF from cerebral angiography (AccuFFicas). Patients (n=121) who had undergone wire-based measurement of FF and cerebral angiography were recruited. The accuracy of the computed pressure ratio was evaluated using wire-based FF as the reference standard. RESULTS The mean value of wire-based FF was 0.78±0.19, while the computed AccuFFicas had an average value of 0.79±0.18. Good correlation (Pearson's correlation coefficient r=0.92, P<0.001) between AccuFFicas and FF was observed. Bland-Altman analysis showed that the mean difference between AccuFFicas and FF was -0.01±0.07, indicating good agreement. The area under the curve (AUC) of AccuFFicas in predicting FF≤0.70, FF≤0.75, and FF≤0.80 was 0.984, 0.986, and 0.962, respectively. CONCLUSION Angiography-based FF computed from cerebral angiographic images could be an effective computational tool for evaluating the hemodynamic significance of ICAS.
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Affiliation(s)
- Pengfei Yang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shu Wan
- Brain Center, Zhejiang Hospital, Hangzhou, China
| | - Jun Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yumeng Hu
- ArteryFlow Technology Co., Ltd, Hangzhou, China
| | - Ning Ma
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Beijing, China
| | - Xiaohui Wang
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yongwei Zhang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Lei Zhang
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xuan Zhu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Fang Shen
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Qian Zheng
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Ming Wang
- Brain Center, Zhejiang Hospital, Hangzhou, China
| | | | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Zhongrong Miao
- Interventional Neuroradiology Center, Beijing Tiantan Hospital, Beijing, China
| | | | - Jianmin Liu
- Neurovascular Center, Changhai Hospital, Naval Medical University, Shanghai, China
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Saba L, Scicolone R, Johansson E, Nardi V, Lanzino G, Kakkos SK, Pontone G, Annoni AD, Paraskevas KI, Fox AJ. Quantifying Carotid Stenosis: History, Current Applications, Limitations, and Potential: How Imaging Is Changing the Scenario. Life (Basel) 2024; 14:73. [PMID: 38255688 PMCID: PMC10821425 DOI: 10.3390/life14010073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/24/2023] [Accepted: 12/29/2023] [Indexed: 01/24/2024] Open
Abstract
Carotid artery stenosis is a major cause of morbidity and mortality. The journey to understanding carotid disease has developed over time and radiology has a pivotal role in diagnosis, risk stratification and therapeutic management. This paper reviews the history of diagnostic imaging in carotid disease, its evolution towards its current applications in the clinical and research fields, and the potential of new technologies to aid clinicians in identifying the disease and tailoring medical and surgical treatment.
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Affiliation(s)
- Luca Saba
- Department of Radiology, University of Cagliari, 09042 Cagliari, Italy;
| | - Roberta Scicolone
- Department of Radiology, University of Cagliari, 09042 Cagliari, Italy;
| | - Elias Johansson
- Neuroscience and Physiology, Sahlgrenska Academy, 41390 Gothenburg, Sweden;
| | - Valentina Nardi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, USA;
| | - Stavros K. Kakkos
- Department of Vascular Surgery, University of Patras, 26504 Patras, Greece;
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy; (G.P.); (A.D.A.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Andrea D. Annoni
- Centro Cardiologico Monzino IRCCS, Via C. Parea 4, 20138 Milan, Italy; (G.P.); (A.D.A.)
| | | | - Allan J. Fox
- Department of Medical Imaging, Neuroradiology Section, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada;
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Kizhisseri M, Gharaie S, Boopathy SR, Lim RP, Mohammadzadeh M, Schluter J. Differential sensitivities to blood pressure variations in internal carotid and intracranial arteries: a numerical approach to stroke prediction. Sci Rep 2023; 13:22319. [PMID: 38102319 PMCID: PMC10724219 DOI: 10.1038/s41598-023-49591-3] [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: 09/25/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023] Open
Abstract
Stroke remains a global health concern, necessitating early prediction for effective management. Atherosclerosis-induced internal carotid and intra cranial stenosis contributes significantly to stroke risk. This study explores the relationship between blood pressure and stroke prediction, focusing on internal carotid artery (ICA) branches: middle cerebral artery (MCA), anterior cerebral artery (ACA), and their role in hemodynamics. Computational fluid dynamics (CFD) informed by the Windkessel model were employed to simulate patient-specific ICA models with introduced stenosis. Central to our investigation is the impact of stenosis on blood pressure, flow velocity, and flow rate across these branches, incorporating Fractional Flow Reserve (FFR) analysis. Results highlight differential sensitivities to blood pressure variations, with M1 branch showing high sensitivity, ACA moderate, and M2 minimal. Comparing blood pressure fluctuations between ICA and MCA revealed heightened sensitivity to potential reverse flow compared to ICA and ACA comparisons, emphasizing MCA's role. Blood flow adjustments due to stenosis demonstrated intricate compensatory mechanisms. FFR emerged as a robust predictor of stenosis severity, particularly in the M2 branch. In conclusion, this study provides comprehensive insights into hemodynamic complexities within major intracranial arteries, elucidating the significance of blood pressure variations, flow attributes, and FFR in stenosis contexts. Subject-specific data integration enhances model reliability, aiding stroke risk assessment and advancing cerebrovascular disease understanding.
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Affiliation(s)
- Muhsin Kizhisseri
- School of Engineering, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
| | - Saleh Gharaie
- School of Engineering, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia.
| | | | | | | | - Jorg Schluter
- School of Engineering, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
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8
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Cheng Y, Chen J, Zhao Q, Zhang J, Gao J. Association of carotid wall shear stress measured by vector flow mapping technique with ba-PWV: a pilot study. Front Cardiovasc Med 2023; 10:1293106. [PMID: 38144371 PMCID: PMC10748391 DOI: 10.3389/fcvm.2023.1293106] [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: 09/12/2023] [Accepted: 10/31/2023] [Indexed: 12/26/2023] Open
Abstract
Objective Arterial stiffness is an important tissue biomarker of the progression of atherosclerotic diseases. Brachial-ankle pulse wave velocity (ba-PWV) is a gold standard of arterial stiffness measurement widely used in Asia. Changes in vascular wall shear stress (WSS) lead to artery wall remodeling, which could give rise to an increase in arterial stiffness. The study aimed to explore the association between ba-PWV and common carotid artery (CCA) WSS measured by a newly invented vascular vector flow mapping (VFM) technique. Methods We included 94 subjects free of apparent cardiovascular disease (CVD) and divided them into a subclinical atherosclerosis (SA) group (N = 47) and non subclinical atherosclerosis (NSA) group (N = 47). CCA WSS was measured using the VFM technique. Bivariate correlations between CCA WSS and other factors were assessed with Pearson's, Spearman's, or Kendall's coefficient of correlation, as appropriate. Partial correlation analysis was conducted to examine the influence of age and sex. Multiple linear stepwise regression was used for the analysis of independent determinants of CCA WSS. Receiver operating characteristic (ROC) analysis was performed to find the association between CCA WSS and 10-year CVD risk. Results The overall subjects had a mean age of 47.9 ± 11.2 years, and males accounted for 52.1%. Average systolic CCA WSS was significantly correlated with ba-PWV (r = -0.618, p < 0.001) in the SA group. Multiple linear stepwise regression analysis confirmed that ba-PWV was an independent determinant of average systolic CCA WSS (β = -0.361, p = 0.003). The area under the curve (AUC) of average systolic CCA WSS for 10-year CVD risk ≥10% was 0.848 (p < 0.001) in the SA group. Conclusions Average systolic CCA WSS was significantly correlated with ba-PWV and was associated with 10-year CVD risk ≥10% in the SA group. Therefore, CCA WSS measured by the VFM technique could be used for monitoring and screening subjects with potential CVD risks.
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Affiliation(s)
- Yi Cheng
- Department of Diagnostic Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Chen
- Department of Diagnostic Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qing Zhao
- Department of Diagnostic Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinghan Zhang
- Department of Diagnostic Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Junyi Gao
- Department of Cardiovascular Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Chen W, Song X, Wei H, Fu M, Chen S, Wei C, Zheng Z, Wu J, Li R. Variations of arterial compliance and vascular resistance due to plaque or infarct in a single vascular territory of the middle cerebral artery. Quant Imaging Med Surg 2023; 13:7802-7813. [PMID: 38106282 PMCID: PMC10722046 DOI: 10.21037/qims-23-222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/06/2023] [Indexed: 12/19/2023]
Abstract
Background Arterial compliance (AC) and vascular resistance (VR) are crucial for the regulation capacity of the vascular system. However, alterations of these features and hemodynamics due to atherosclerosis in a single intracranial artery territory have not been extensively investigated. Thus this study aimed to examine the AC, VR, and hemodynamic variations due to plaque and infarction in the middle cerebral artery (MCA). Methods Patients with symptomatic MCA atherosclerosis were recruited. Both sides of the MCA were assessed and then classified according to the following scheme: group 0, without plaque; group 1, with plaque but without infarct; group 2, with plaque and infarct in the supplying territories. Data on AC, VR, blood flow, and pulsatility index (PI) were obtained based on 4D flow magnetic resonance imaging (MRI) and the Windkessel model. Results A total of 63 patients were recruited. After 17 MCAs were excluded (occlusion, n=6; poor image quality, n=11), datasets on 109 MCAs were finally collected and classified into group 0 (n=39), group 1 (n=40), and group 2 (n=30). From groups 0 to 2, there was a decrease in AC (0.0060±0.0031 vs. 0.0052±0.0029 vs. 0.0026±0.0020 mL/mmHg) and an increase in VR [28.65±16.11 vs. 42.59±27.53 vs. 63.21±40.37 mmHg/(mL/s)]. Compared to group 1, group 2 had significantly decreased AC (0.0052±0.0029 vs. 0.0026±0.0020 mL/mmHg; P=0.003) and increased VR [42.59±27.53 vs. 63.21±40.37 mmHg/(mL/s); P=0.021]. From group 0 to group 2, there was a decrease in blood flow (179.29±73.57 vs. 125.11±59.04 vs. 92.05±48.79 mL/min; P<0.001). The PI varied significantly among the 3 groups (0.86±0.20 vs. 1.12±0.50 vs. 0.79±0.16; P<0.001), with group 1 having the highest PI. Conclusions With the occurrence of plaque and infarct, AC and blood flow progressively decrease while VR increases. The PI was the highest in the group with plaque and without infarct. Assessments of vascular function and hemodynamics in a single artery territory can clarify comprehensive alterations in the cerebral vascular system (CVS).
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Affiliation(s)
- Wenwen Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Xiaowei Song
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Hanyu Wei
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Mingzhu Fu
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Shuo Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Chenming Wei
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhuozhao Zheng
- Department of Radiology, Beijing Tsinghua Changgung Hospital, Beijing, China
| | - Jian Wu
- Department of Neurology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
- IDG/McGovern Institute for Brain Research at Tsinghua University, Beijing, China
| | - Rui Li
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
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Kamimura T, Aoki S, Nezu T, Eto F, Shiga Y, Nakamori M, Imamura E, Mizoue T, Wakabayashi S, Maruyama H. Association between Carotid Wall Shear Stress-Based Vascular Vector Flow Mapping and Cerebral Small Vessel Disease. J Atheroscler Thromb 2023; 30:1165-1175. [PMID: 36328567 PMCID: PMC10499442 DOI: 10.5551/jat.63756] [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: 06/09/2022] [Accepted: 10/10/2022] [Indexed: 09/05/2023] Open
Abstract
AIM Wall shear stress (WSS) is the frictional force caused by viscous blood flowing along the vessel wall. Decreased WSS is associated with local vascular endothelial dysfunction and atherosclerosis. The vector flow mapping (VFM) technique detects the direction of intracardiac blood flow and WSS on the vessel wall with echocardiography. In this study, we examined carotid WSS by applying the VFM technique to the carotid arteries and evaluated its relationship with cerebral small vessel disease (SVD). METHODS This is a single-center, prospective, observational study. We investigated the association between carotid WSS and SVD imaging, and cognitive outcomes in consecutive 113 patients with acute lacunar infarction. RESULTS Carotid WSS was negatively associated with age (r=-0.376, p<0.001). Lower WSS was correlated with total SVD scores (ρ=-0.304, p=0.004), especially with enlarged perivascular space (EPVS) in the basal ganglia >10 (p<0.001). The carotid intima-media thickness was not associated with the total SVD score (ρ=-0.183, p=0.052). Moreover, lower WSS was associated with executive dysfunction. CONCLUSION EPVS has recently been reported as a marker of early SVD imaging, and executive dysfunction is common in vascular cognitive impairment. These results suggested that decreased carotid WSS based on vascular VFM, which can be measured easily, is associated with imaging and cognitive changes in the early stages of SVD.
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Affiliation(s)
- Teppei Kamimura
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Shiro Aoki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Tomohisa Nezu
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Futoshi Eto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yuji Shiga
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Eiji Imamura
- Department of Neurology, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | - Tatsuya Mizoue
- Department of Neurosurgery, Suiseikai Kajikawa Hospital, Hiroshima, Japan
| | | | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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11
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Zhao X, Meng L, Tong X, Xu X, Wang W, Miao Z, Mo D. A novel computational fluid dynamic method and validation for assessing distal cerebrovascular microcirculatory resistance. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 230:107338. [PMID: 36640605 DOI: 10.1016/j.cmpb.2023.107338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 01/02/2023] [Accepted: 01/04/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND OBJECTIVE The non-invasive assessment of microcirculatory resistance could improve the treatment of cerebrovascular stenosis. This study aimed to validate a novel computational strategy for determining the reference value of microcirculatory resistance in patients with cerebrovascular stenosis. METHODS We reconstructed a patient-specific 3-dimensional model of the extracranial-intracranial arteries. A computational strategy incorporating patient-specific pressure-wire measurements was developed to estimate the blood flow rate and microcirculatory resistance. Throughout the computational fluid dynamics (CFD) simulation, the boundary conditions were adjusted according to the developed algorithm. Pearson correlation and Bland-Altman analyses were used to quantify the correlation and agreement between CFD calculations and transcranial Doppler (TCD) assessment. RESULTS A strong correlation was found between the CFD-based and invasive distal pressure measurements (P<0.0001). Meanwhile, the CFD and TCD-based flow measurements were highly correlated (r = 0.853; P = 0.001). Furthermore, there was a correlation between the mean velocity measured by CFD and the mean velocity measured by TCD (r = 0.777; P<0.001). Good agreement was observed between the mass flow by CFD simulation and volumetric flow by TCD (P = 0.0266, mean difference: -0.7814 mmHg, limits of agreement, -4.0905 - 2.5276). However, the mean velocities from CFD simulation were in less agreement with those from the TCD assessment (P = 0.3992, mean difference, -0.0485; limits of agreement, -0.6141 - 0.5170). Results of the CFD simulation indicate that the flow resistance varies greatly between individuals. CONCLUSIONS The computational strategy of incorporating patient-specific pressure-wire measurements may serve as an effective approach to evaluate the actual reference values of microcirculatory resistance. In addition, an individualized assessment of non-invasive flow resistance is necessary for the accurate determination of non-invasive cerebrovascular pressure.
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Affiliation(s)
- Xi Zhao
- Central Research Institute, United Imaging Healthcare, Shanghai, China.
| | | | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Xu
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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12
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Schollenberger J, Braet DJ, Hernandez-Garcia L, Osborne NH, Figueroa CA. A magnetic resonance imaging-based computational analysis of cerebral hemodynamics in patients with carotid artery stenosis. Quant Imaging Med Surg 2023; 13:1126-1137. [PMID: 36819242 PMCID: PMC9929419 DOI: 10.21037/qims-22-565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 11/28/2022] [Indexed: 01/09/2023]
Abstract
Management of asymptomatic carotid artery stenosis (CAS) relies on measuring the percentage of stenosis. The aim of this study was to investigate the impact of CAS on cerebral hemodynamics using magnetic resonance imaging (MRI)-informed computational fluid dynamics (CFD) and to provide novel hemodynamic metrics that may improve the understanding of stroke risk. CFD analysis was performed in two patients with similar degrees of asymptomatic high-grade CAS. Three-dimensional anatomical-based computational models of cervical and cerebral blood flow were constructed and calibrated patient-specifically using phase-contrast MRI flow and arterial spin labeling perfusion data. Differences in cerebral hemodynamics were assessed in preoperative and postoperative models. Preoperatively, patient 1 demonstrated large flow and pressure reductions in the stenosed internal carotid artery, while patient 2 demonstrated only minor reductions. Patient 1 exhibited a large amount of flow compensation between hemispheres (80.31%), whereas patient 2 exhibited only a small amount of collateral flow (20.05%). There were significant differences in the mean pressure gradient over the stenosis between patients preoperatively (26.3 vs. 1.8 mmHg). Carotid endarterectomy resulted in only minor hemodynamic changes in patient 2. MRI-informed CFD analysis of two patients with similar clinical classifications of stenosis revealed significant differences in hemodynamics which were not apparent from anatomical assessment alone. Moreover, revascularization of CAS might not always result in hemodynamic improvements. Further studies are needed to investigate the clinical impact of hemodynamic differences and how they pertain to stroke risk and clinical management.
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Affiliation(s)
- Jonas Schollenberger
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Drew J. Braet
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Luis Hernandez-Garcia
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA;,Functional MRI Laboratory, University of Michigan, Ann Arbor, MI, USA
| | | | - C. Alberto Figueroa
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA;,Department of Surgery, University of Michigan, Ann Arbor, MI, USA
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13
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Rostam-Alilou AA, Jarrah HR, Zolfagharian A, Bodaghi M. Fluid-structure interaction (FSI) simulation for studying the impact of atherosclerosis on hemodynamics, arterial tissue remodeling, and initiation risk of intracranial aneurysms. Biomech Model Mechanobiol 2022; 21:1393-1406. [PMID: 35697948 DOI: 10.1007/s10237-022-01597-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/19/2022] [Indexed: 12/11/2022]
Abstract
The biomechanical and hemodynamic effects of atherosclerosis on the initiation of intracranial aneurysms (IA) are not yet clearly discovered. Also, studies for the observation of hemodynamic variation due to atherosclerotic stenosis and its impact on arterial remodeling and aneurysm genesis remain a controversial field of vascular engineering. The majority of studies performed are relevant to computational fluid dynamic (CFD) simulations. CFD studies are limited in consideration of blood and arterial tissue interactions. In this work, the interaction of the blood and vessel tissue because of atherosclerotic occlusions is studied by developing a fluid and structure interaction (FSI) analysis for the first time. The FSI presents a semi-realistic simulation environment to observe how the blood and vessels' structural interactions can increase the accuracy of the biomechanical study results. In the first step, many different intracranial vessels are modeled for an investigation of the biomechanical and hemodynamic effects of atherosclerosis in arterial tissue remodeling. Three physiological conditions of an intact artery, the artery with intracranial atherosclerosis (ICAS), and an atherosclerotic aneurysm (ACA) are employed in the models with required assumptions. Finally, the obtained outputs are studied with comparative and statistical analyses according to the intact model in a normal physiological condition. The results show that existing occlusions in the cross-sectional area of the arteries play a determinative role in changing the hemodynamic behavior of the arterial segments. The undesirable variations in blood velocity and pressure throughout the vessels increase the risk of arterial tissue remodeling and aneurysm formation.
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Affiliation(s)
- Ali A Rostam-Alilou
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK
| | - Hamid R Jarrah
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK
| | - Ali Zolfagharian
- School of Engineering, Deakin University, Geelong, 3216, Australia
| | - Mahdi Bodaghi
- Department of Engineering, School of Science and Technology, Nottingham Trent University, Nottingham, NG11 8NS, UK.
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14
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Huang K, Yao W, Du J, Wang F, Han Y, Chang Y, Liu R, Ye R, Zhu W, Tu S, Liu X. Functional Assessment of Cerebral Artery Stenosis by Angiography-Based Quantitative Flow Ratio: A Pilot Study. Front Aging Neurosci 2022; 14:813648. [PMID: 35177976 PMCID: PMC8845469 DOI: 10.3389/fnagi.2022.813648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Increasing attention has been paid to the hemodynamic evaluation of cerebral arterial stenosis. We aimed to demonstrate the performance of angiography-based quantitative flow ratio (QFR) to assess hemodynamic alterations caused by luminal stenoses, using invasive fractional pressure ratios (FPRs) as a reference standard. Methods Between March 2013 and December 2019, 29 patients undergoing the pressure gradient measurement of cerebral atherosclerosis were retrospectively enrolled. Wire-based FPR was defined by the arterial pressure distal to the stenotic lesion (Pd) to proximal (Pa) pressure ratios (Pd/Pa). FPR < 0.70 or FPR < 0.75 was assumed as hemodynamically significant stenosis. The new method of computing QFR from a single angiographic view, i.e., the Murray law-based QFR, was applied to the interrogated vessel. An artificial intelligence algorithm was developed to realize the automatic delineation of vascular contour. Results Fractional pressure ratio and QFR were assessed in 38 vessels from 29 patients. Excellent correlation and agreement were observed between QFR and FPR [r = 0.879, P < 0.001; mean difference (bias): −0.006, 95% limits of agreement: −0.198 to 0.209, respectively). Intra-observer and inter-observer reliability in QFR were excellent (intra-class correlation coefficients, 0.996 and 0.973, respectively). For predicting FPR < 0.70, the area under the receiver-operating characteristic curves (AUC) of QFR was 0.946 (95% CI, 0.820 to 0.993%). The sensitivity and specificity of QFR < 0.70 for identifying FPR < 0.70 was 88.9% (95% CI, 65.3 to 98.6%) and 85.0% (95% CI, 62.1 to 96.8%). For predicting FPR < 0.75, QFR showed similar performance with an AUC equal to 0.926. Conclusion Computational QFR from a single angiographic view achieved comparable results to the wire-based FPR. The excellent diagnostic performance and repeatability empower QFR with high feasibility in the functional assessment of cerebral arterial stenosis.
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Affiliation(s)
- Kangmo Huang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Weihe Yao
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Juan Du
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Fang Wang
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yunfei Han
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yunxiao Chang
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- Pulse Medical Imaging Technology, Shanghai, China
| | - Rui Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ruidong Ye
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wusheng Zhu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shengxian Tu
- Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Shengxian Tu,
| | - Xinfeng Liu
- Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, China
- Stroke Center and Department of Neurology, The First Affiliated Hospital of University of Science and Technology of China (USTC), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Xinfeng Liu,
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15
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Kim SJ, Schneider DJ, Feldmann E, Liebeskind DS. Intracranial atherosclerosis: Review of imaging features and advances in diagnostics. Int J Stroke 2022; 17:599-607. [PMID: 34983259 DOI: 10.1177/17474930211066427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intracranial atherosclerotic disease is one of the leading causes of ischemic strokes and poses a moderate risk of recurrence. Diagnosis is currently limited to stenosis on luminal imaging, which likely underestimates the true prevalence of the disease. Detection of non-stenosing intracranial atherosclerosis is important in order to optimize secondary stroke prevention strategies. This review collates findings from the early seminal trials and the latest studies in advanced radiological techniques that characterize symptomatic intracranial atherosclerotic disease across various imaging modalities. While computed tomography angiography (CTA) and magnetic resonance angiography (MRA) comprise diagnostic mainstays in identifying stenotic changes secondary to atherosclerosis, emerging techniques such as high-resolution MRA, quantitative MRA, and computational fluid dynamics may reveal a myriad of other underlying pathophysiological mechanisms.
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Affiliation(s)
- Song J Kim
- Vascular Neurology and Neurocritical Care, Sutter Health Comprehensive Stroke Care Center, San Francisco, CA, USA
| | - David J Schneider
- Cardiovascular Research Institute of Vermont, The University of Vermont, Colchester, VT, USA
| | - Edward Feldmann
- Neurosciences and Rehabilitation, Baystate Health, Springfield, MA, USA
| | - David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Los Angeles, CA, USA
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16
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Marlevi D, Schollenberger J, Aristova M, Ferdian E, Ma Y, Young AA, Edelman ER, Schnell S, Figueroa CA, Nordsletten DA. Noninvasive quantification of cerebrovascular pressure changes using 4D Flow MRI. Magn Reson Med 2021; 86:3096-3110. [PMID: 34431550 DOI: 10.1002/mrm.28928] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/24/2021] [Accepted: 06/25/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE Hemodynamic alterations are indicative of cerebrovascular disease. However, the narrow and tortuous cerebrovasculature complicates image-based assessment, especially when quantifying relative pressure. Here, we present a systematic evaluation of image-based cerebrovascular relative pressure mapping, investigating the accuracy of the routinely used reduced Bernoulli (RB), the extended unsteady Bernoulli (UB), and the full-field virtual work-energy relative pressure ( ν WERP) method. METHODS Patient-specific in silico models were used to generate synthetic cerebrovascular 4D Flow MRI, with RB, UB, and ν WERP performance quantified as a function of spatiotemporal sampling and image noise. Cerebrovascular relative pressures were also derived in 4D Flow MRI from healthy volunteers ( n = 8 ), acquired at two spatial resolutions (dx = 1.1 and 0.8 mm). RESULTS The in silico analysis indicate that accurate relative pressure estimations are inherently coupled to spatial sampling: at dx = 1.0 mm high errors are reported for all methods; at dx = 0.5 mm ν WERP recovers relative pressures at a mean error of 0.02 ± 0.25 mm Hg, while errors remain higher for RB and UB (mean error of -2.18 ± 1.91 and -2.18 ± 1.87 mm Hg, respectively). The dependence on spatial sampling is also indicated in vivo, albeit with higher correlative dependence between resolutions using ν WERP (k = 0.64, R2 = 0.81 for dx = 1.1 vs. 0.8 mm) than with RB or UB (k = 0.04, R2 = 0.03, and k = 0.07, R2 = 0.07, respectively). CONCLUSION Image-based full-field methods such as ν WERP enable cerebrovascular relative pressure mapping; however, accuracy is directly dependent on utilized spatial resolution.
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Affiliation(s)
- David Marlevi
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jonas Schollenberger
- Department of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Maria Aristova
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Edward Ferdian
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Yue Ma
- Department of Radiology, Northwestern University, Chicago, IL, USA
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Alistair A Young
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
- School of Biomedical Engineering and Imaging Sciences, The Rayne Institute, King's College London, London, UK
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Susanne Schnell
- Department of Radiology, Northwestern University, Chicago, IL, USA
- Department of Medical Physics, Institute of Physics, University of Greifswald, Greifswald, Germany
| | - C Alberto Figueroa
- Department of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - David A Nordsletten
- Department of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
- School of Biomedical Engineering and Imaging Sciences, The Rayne Institute, King's College London, London, UK
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17
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Hossain SS, Starosolski Z, Sanders T, Johnson MJ, Wu MCH, Hsu MC, Milewicz DM, Annapragada A. Image-based patient-specific flow simulations are consistent with stroke in pediatric cerebrovascular disease. Biomech Model Mechanobiol 2021; 20:2071-2084. [PMID: 34283347 PMCID: PMC8666092 DOI: 10.1007/s10237-021-01495-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
Moyamoya disease (MMD) is characterized by narrowing of the distal internal carotid artery and the circle of Willis (CoW) and leads to recurring ischemic and hemorrhagic stroke. A retrospective review of data from 50 pediatric MMD patients revealed that among the 24 who had a unilateral stroke and were surgically treated, 11 (45.8%) had a subsequent, contralateral stroke. There is no reliable way to predict these events. After a pilot study in Acta-/- mice that have features of MMD, we hypothesized that local hemodynamics are predictive of contralateral strokes and sought to develop a patient-specific analysis framework to noninvasively assess this stroke risk. A pediatric MMD patient with an occlusion in the right middle cerebral artery and a right-sided stroke, who was surgically treated and then had a contralateral stroke, was selected for analysis. By using an unsteady Navier-Stokes solver within an isogeometric analysis framework, blood flow was simulated in the CoW model reconstructed from the patient's postoperative imaging data, and the results were compared with those from an age- and sex-matched control subject. A wall shear rate (WSR) > 60,000 s-1 (about 12 × higher than the coagulation threshold of 5000 s-1 and 9 × higher than control) was measured in the terminal left supraclinoid artery; its location coincided with that of the subsequent postsurgical left-sided stroke. A parametric study of disease progression revealed a strong correlation between the degree of vascular morphology altered by MMD and local hemodynamic environment. The results suggest that an occlusion in the CoW could lead to excessive contralateral WSRs, resulting in thromboembolic ischemic events, and that WSR could be a predictor of future stroke.
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Affiliation(s)
- Shaolie S Hossain
- Molecular Cardiology Research Laboratory, Texas Heart Institute, 6770 Bertner Avenue, Houston, TX, 77030, USA.
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA.
| | - Zbigniew Starosolski
- Translational Imaging Group, Texas Children's Hospital, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Travis Sanders
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA
| | - Michael J Johnson
- Oden Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA
| | - Michael C H Wu
- Department of Mechanical Engineering, Iowa State University, Ames, IA, USA
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, Ames, IA, USA
| | - Dianna M Milewicz
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center Houston, Houston, TX, USA
| | - Ananth Annapragada
- Translational Imaging Group, Texas Children's Hospital, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
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18
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Lin CH, Hsu KC, Liang CK, Lee TH, Liou CW, Lee JD, Peng TI, Shih CS, Fann YC. A disease-specific language representation model for cerebrovascular disease research. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 211:106446. [PMID: 34627022 PMCID: PMC8551061 DOI: 10.1016/j.cmpb.2021.106446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Effectively utilizing disease-relevant text information from unstructured clinical notes for medical research presents many challenges. BERT (Bidirectional Encoder Representation from Transformers) related models such as BioBERT and ClinicalBERT, pre-trained on biomedical corpora and general clinical information, have shown promising performance in various biomedical language processing tasks. OBJECTIVES This study aims to explore whether a BERT-based model pre-trained on disease-related clinical information can be more effective for cerebrovascular disease-relevant research. METHODS This study proposed the StrokeBERT which was initialized from BioBERT and pre-trained on large-scale cerebrovascular disease related clinical text information. The pre-trained corpora contained 113,590 discharge notes, 105,743 radiology reports, and 38,199 neurological reports. Two real-world empirical clinical tasks were conducted to validate StrokeBERT's performance. The first task identified extracranial and intracranial artery stenosis from two independent sets of radiology angiography reports. The second task predicted the risk of recurrent ischemic stroke based on patients' first discharge information. RESULTS In stenosis detection, StrokeBERT showed improved performance on targeted carotid arteries, with an average AUC compared to that of ClinicalBERT of 0.968 ± 0.021 and 0.956 ± 0.018, respectively. In recurrent ischemic stroke prediction, after 10-fold cross-validation on 1,700 discharge information, StrokeBERT presented better prediction ability (AUC±SD = 0.838 ± 0.017) than ClinicalBERT (AUC±SD = 0.808 ± 0.045). The attention scores of StrokeBERT showed better ability to detect and associate cerebrovascular disease related terms than current BERT based models. CONCLUSIONS This study shows that a disease-specific BERT model improved the performance and accuracy of various disease-specific language processing tasks and can readily be fine-tuned to advance cerebrovascular disease research and further developed for clinical applications.
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Affiliation(s)
- Ching-Heng Lin
- Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan; Bioinformatics Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States
| | - Kai-Cheng Hsu
- Bioinformatics Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States; Department of Medicine, China Medical University, Taichung, Taiwan; Artificial Intelligence Center for Medical Diagnosis, China Medical University Hospital, Taichung, Taiwan; Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Kuang Liang
- Bioinformatics Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, United States; Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Medicine, Kaohsiung Veterans General Hospital Kaohsiung, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Wei Liou
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tsung-I Peng
- Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Sen Shih
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yang C Fann
- Bachelor Program in Artificial Intelligence, Chang Gung University, Taoyuan, Taiwan.
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19
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Liu H, Lan L, Abrigo J, Ip HL, Soo Y, Zheng D, Wong KS, Wang D, Shi L, Leung TW, Leng X. Comparison of Newtonian and Non-newtonian Fluid Models in Blood Flow Simulation in Patients With Intracranial Arterial Stenosis. Front Physiol 2021; 12:718540. [PMID: 34552505 PMCID: PMC8450390 DOI: 10.3389/fphys.2021.718540] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background Newtonian fluid model has been commonly applied in simulating cerebral blood flow in intracranial atherosclerotic stenosis (ICAS) cases using computational fluid dynamics (CFD) modeling, while blood is a shear-thinning non-Newtonian fluid. We aimed to investigate the differences of cerebral hemodynamic metrics quantified in CFD models built with Newtonian and non-Newtonian fluid assumptions, in patients with ICAS. Methods We built a virtual artery model with an eccentric 75% stenosis and performed static CFD simulation. We also constructed CFD models in three patients with ICAS of different severities in the luminal stenosis. We performed static simulations on these models with Newtonian and two non-Newtonian (Casson and Carreau-Yasuda) fluid models. We also performed transient simulations on another patient-specific model. We measured translesional pressure ratio (PR) and wall shear stress (WSS) values in all CFD models, to reflect the changes in pressure and WSS across a stenotic lesion. In all the simulations, we compared the PR and WSS values in CFD models derived with Newtonian, Casson, and Carreau-Yasuda fluid assumptions. Results In all the static and transient simulations, the Newtonian/non-Newtonian difference on PR value was negligible. As to WSS, in static models (virtual and patient-specific), the rheological difference was not obvious in areas with high WSS, but observable in low WSS areas. In the transient model, the rheological difference of WSS areas with low WSS was enhanced, especially during diastolic period. Conclusion Newtonian fluid model could be applicable for PR calculation, but caution needs to be taken when using the Newtonian assumption in simulating WSS especially in severe ICAS cases.
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Affiliation(s)
- Haipeng Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.,Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China.,Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Linfang Lan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Hing Lung Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Yannie Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Dingchang Zheng
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Lin Shi
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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20
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Schollenberger J, Osborne NH, Hernandez-Garcia L, Figueroa CA. A Combined Computational Fluid Dynamics and Arterial Spin Labeling MRI Modeling Strategy to Quantify Patient-Specific Cerebral Hemodynamics in Cerebrovascular Occlusive Disease. Front Bioeng Biotechnol 2021; 9:722445. [PMID: 34485260 PMCID: PMC8416094 DOI: 10.3389/fbioe.2021.722445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Cerebral hemodynamics in the presence of cerebrovascular occlusive disease (CVOD) are influenced by the anatomy of the intracranial arteries, the degree of stenosis, the patency of collateral pathways, and the condition of the cerebral microvasculature. Accurate characterization of cerebral hemodynamics is a challenging problem. In this work, we present a strategy to quantify cerebral hemodynamics using computational fluid dynamics (CFD) in combination with arterial spin labeling MRI (ASL). First, we calibrated patient-specific CFD outflow boundary conditions using ASL-derived flow splits in the Circle of Willis. Following, we validated the calibrated CFD model by evaluating the fractional blood supply from the main neck arteries to the vascular territories using Lagrangian particle tracking and comparing the results against vessel-selective ASL (VS-ASL). Finally, the feasibility and capability of our proposed method were demonstrated in two patients with CVOD and a healthy control subject. We showed that the calibrated CFD model accurately reproduced the fractional blood supply to the vascular territories, as obtained from VS-ASL. The two patients revealed significant differences in pressure drop over the stenosis, collateral flow, and resistance of the distal vasculature, despite similar degrees of clinical stenosis severity. Our results demonstrated the advantages of a patient-specific CFD analysis for assessing the hemodynamic impact of stenosis.
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Affiliation(s)
- Jonas Schollenberger
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States
| | - Nicholas H Osborne
- Department of Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Luis Hernandez-Garcia
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.,Functional MRI Laboratory, University of Michigan, Ann Arbor, MI, United States
| | - C Alberto Figueroa
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.,Department of Surgery, University of Michigan, Ann Arbor, MI, United States
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21
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Pavlin-Premrl D, Boopathy SR, Nemes A, Mohammadzadeh M, Monajemi S, Ko BS, Campbell BCV. Computational Fluid Dynamics in Intracranial Atherosclerosis - Lessons from Cardiology: A Review of CFD in Intracranial Atherosclerosis. J Stroke Cerebrovasc Dis 2021; 30:106009. [PMID: 34343837 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Intracranial atherosclerosis is a common cause of stroke with a high recurrence rate. Haemodynamically significant lesions are associated with a particularly high risk of recurrence. Computational fluid dynamics (CFD) is a tool that has been investigated to identify haemodynamically significant lesions. CFD in the intracranial vasculature benefits from the precedent set by cardiology, where CFD is an established clinical tool. This precedent is particularly important in CFD as models are very heterogenous. There are many decisions-points in the model-creation process, usually involving a trade-off between computational expense and accuracy. OBJECTIVES This study aimed to review published CFD models in intracranial atherosclerosis and compare them to those used in cardiology. METHODS A systematic search for all published computational fluid dynamics models applied to intracranial atherosclerosis was performed. Each study was analysed as regards to the different steps in creating a fluid dynamics model and findings were compared with established cardiology CFD models. RESULTS AND CONCLUSION 38 papers were screened and 12 were included in the final analysis. There were important differences between coronary and intracranial atherosclerosis models in the following areas: area of interest segmented, use of transient models vs steady-state models, boundary conditions, methods for solving the fluid dynamics equations and validation. These differences may be high-yield areas to explore for future research.
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Affiliation(s)
- Davor Pavlin-Premrl
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Grattan St, Parkville 3052, Victoria, Australia.
| | | | - Andras Nemes
- SeeMode Technologies, Melbourne, Victoria, Australia
| | | | | | - Brian S Ko
- Monash Heart, Monash Medical Centre, Melbourne, Victoria, Australia
| | - Bruce C V Campbell
- Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Grattan St, Parkville 3052, Victoria, Australia
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22
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Liebeskind DS, Hinman JD, Kaneko N, Kitajima H, Honda T, De Havenon AH, Feldmann E, Nogueira RG, Prabhakaran S, Romano JG, Callas PW, Schneider DJ. Endothelial Shear Stress and Platelet FcγRIIa Expression in Intracranial Atherosclerotic Disease. Front Neurol 2021; 12:646309. [PMID: 33716947 PMCID: PMC7947292 DOI: 10.3389/fneur.2021.646309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 02/05/2021] [Indexed: 11/13/2022] Open
Abstract
Intracranial atherosclerotic disease (ICAD) has been characterized by the degree of arterial stenosis and downstream hypoperfusion, yet microscopic derangements of endothelial shear stress at the luminal wall may be key determinants of plaque growth, vascular remodeling and thrombosis that culminate in recurrent stroke. Platelet interactions have similarly been a principal focus of treatment, however, the mechanistic basis of anti-platelet strategies is largely extrapolated rather than directly investigated in ICAD. Platelet FcγRIIa expression has been identified as a potent risk factor in cardiovascular disease, as elevated expression markedly increases the risk of recurrent events. Differential activation of the platelet FcγRIIa receptor may also explain the variable response of individual patients to anti-platelet medications. We review existing data on endothelial shear stress and potential interactions with the platelet FcγRIIa receptor that may alter the evolving impact of ICAD, based on local pathophysiology at the site of arterial stenosis. Current methods for quantification of endothelial shear stress and platelet activation are described, including tools that may be readily adapted to the clinical realm for further understanding of ICAD.
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Affiliation(s)
- David S Liebeskind
- Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jason D Hinman
- Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Naoki Kaneko
- Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Hiroaki Kitajima
- Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Tristan Honda
- Department of Neurology, Neurovascular Imaging Research Core and UCLA Stroke Center, University of California, Los Angeles, Los Angeles, CA, United States
| | - Adam H De Havenon
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Edward Feldmann
- Department of Neurology, The University of Massachusetts Medical School-Baystate, Springfield, MA, United States
| | - Raul G Nogueira
- Department of Neurology, Marcus Stroke & Neuroscience Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Shyam Prabhakaran
- Department of Neurology, The University of Chicago, Chicago, IL, United States
| | - Jose G Romano
- Department of Neurology, University of Miami, Miami, FL, United States
| | - Peter W Callas
- Department of Biostatistics, University of Vermont, Burlington, VT, United States
| | - David J Schneider
- Department of Medicine, Cardiovascular Research Institute, University of Vermont, Burlington, VT, United States
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23
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Chen R, Wu B, Cheng Z, Shiu WS, Liu J, Liu L, Wang Y, Wang X, Cai XC. A parallel non-nested two-level domain decomposition method for simulating blood flows in cerebral artery of stroke patient. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3392. [PMID: 32783371 DOI: 10.1002/cnm.3392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 06/11/2023]
Abstract
Numerical simulation of blood flows in patient-specific arteries can be useful for the understanding of vascular diseases, as well as for surgery planning. In this paper, we simulate blood flows in the full cerebral artery of stroke patients. To accurately resolve the flow in this rather complex geometry with stenosis is challenging and it is also important to obtain the results in a short amount of computing time so that the simulation can be used in pre- and/or post-surgery planning. For this purpose, we introduce a highly scalable, parallel non-nested two-level domain decomposition method for the three-dimensional unsteady incompressible Navier-Stokes equations with an impedance outlet boundary condition. The problem is discretized with a stabilized finite element method on unstructured meshes in space and a fully implicit method in time, and the large nonlinear systems are solved by a preconditioned parallel Newton-Krylov method with a two-level Schwarz method. The key component of the method is a non-nested coarse problem solved using a subset of processor cores and its solution is interpolated to the fine space using radial basis functions. To validate and verify the proposed algorithm and its highly parallel implementation, we consider a case with available clinical data and show that the computed result matches with the measured data. Further numerical experiments indicate that the proposed method works well for realistic geometry and parameters of a full size cerebral artery of an adult stroke patient on a supercomputers with thousands of processor cores.
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Affiliation(s)
- Rongliang Chen
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen Key Laboratory for Exascale Engineering and Scientific Computing, Shenzhen, China
| | - Bokai Wu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Zaiheng Cheng
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Wen-Shin Shiu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jia Liu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinhong Wang
- The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao-Chuan Cai
- Department of Mathematics, University of Macau, Macau, China
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24
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Donahue WP, Newhauser WD. Computational feasibility of simulating whole-organ vascular networks. Biomed Phys Eng Express 2020; 6:055028. [PMID: 33444259 DOI: 10.1088/2057-1976/abaf5b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The human body contains approximately 20 billion blood vessels, which transport nutrients, oxygen, immune cells, and signals throughout the body. The brain's vasculature includes up to 9 billion of these vessels to support cognition, motor processes, and myriad other vital functions. To model blood flowing through a vasculature, a geometric description of the vessels is required. Previously reported attempts to model vascular geometries have produced highly-detailed models. These models, however, are limited to a small fraction of the human brain, and little was known about the feasibility of computationally modeling whole-organ-sized networks. We implemented a fractal-based algorithm to construct a vasculature the size of the human brain and evaluated the algorithm's speed and memory requirements. Using high-performance computing systems, the algorithm constructed a vasculature comprising 17 billion vessels in 1960 core-hours, or 49 minutes of wall-clock time, and required less than 32 GB of memory per node. We demonstrated strong scalability that was limited mainly by input/output operations. The results of this study demonstrated, for the first time, that it is feasible to computationally model the vasculature of the whole human brain. These findings provide key insights into the computational aspects of modeling whole-organ vasculature.
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Affiliation(s)
- William P Donahue
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, United States of America
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25
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Bahrami S, Norouzi M. Hemodynamic impacts of hematocrit level by two-way coupled FSI in the left coronary bifurcation. Clin Hemorheol Microcirc 2020; 76:9-26. [DOI: 10.3233/ch-200854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Cardiovascular disease is now under the influence of several factors that encourage researchers to investigate the flow of these vessels. Oscillation influences the blood circulation in the volume of red blood cells (RBC) strongly. Therefore, in this study, its effects have been considered on hemodynamic parameters in the elastic wall and coronary bifurcation. In this study, a 3D geometry of non-Newtonian and pulsatile blood circulation is considered in the left coronary artery bifurcation. The Casson model with various hematocrits is analyzed in elastic and rigid walls. The wall shear stress (WSS) cannot show the stenosis artery alone, therefore, the oscillatory shear index (OSI) is represented as a hemodynamic parameter of WSS individually of time. The results are determined using two-way fluid-structure interaction (FSI) coupling method using an arbitrary Lagrangian-Eulerian method. The most prominent difference in velocity happened in the bifurcation and at hematocrit 30 with yield stress 6.59E-04 Pa. The backflow and vortex flow in the LCx branch grown with increasing shear rates. The likelihood of plaque generation at the ending of the LM branch is observed in hematocrits 10 and 20, while the WSS magnitude is normal in the hematocrit 60 with the greatest yield stress in the bifurcation. The shear stress among the rigid and elastic models is the highest at the ending of the LM branch. The wall shear stress magnitude among the models decreased at most of 24.49% by dividing the flow. Time-independent results for models showed that there is the highest value of OSI at the bifurcation, which then quickly dropped.
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Affiliation(s)
- Saeed Bahrami
- Faculty of Mechanical Engineering, Shahrood University of Technology, Shahrood, Semnan, Iran
| | - Mahmood Norouzi
- Faculty of Mechanical Engineering, Shahrood University of Technology, Shahrood, Semnan, Iran
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26
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Donahue WP, Newhauser WD, Wong H, Moreno J, Dey J, Wilson VL. Computational feasibility of calculating the steady-state blood flow rate through the vasculature of the entire human body. Biomed Phys Eng Express 2020; 6:055026. [PMID: 33444257 DOI: 10.1088/2057-1976/abaf5d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The human body contains approximately 20 billion individual blood vessels that deliver nutrients and oxygen to tissues. While blood flow is a well-developed field of research, no previous studies have calculated the blood flow rates through more than 5 million connected vessels. The goal of this study was to test if it is computationally feasible to calculate the blood flow rates through a vasculature equal in size to that of the human body. We designed and implemented a two-step algorithm to calculate the blood flow rates using principles of steady-state fluid dynamics. Steady-state fluid dynamics is an accurate approximation for the microvascular and venous structures in the human body. To determine the computational feasibility, we measured and evaluated the execution time, scalability, and memory usage to quantify the computational requirements. We demonstrated that it is computationally feasible to calculate the blood flow rate through 17 billion vessels in 6.5 hours using 256 compute nodes. The computational modeling of blood flow rate in entire organisms may find application in research on drug delivery, treatment of cancer metastases, and modulation of physiological performance.
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Affiliation(s)
- William P Donahue
- Department of Physics and Astronomy, Louisiana State University, Baton Rouge, LA, United States of America
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27
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Lee WJ, Jeong SK, Han KS, Lee SH, Ryu YJ, Sohn CH, Jung KH. Impact of Endothelial Shear Stress on the Bilateral Progression of Unilateral Moyamoya Disease. Stroke 2020; 51:775-783. [DOI: 10.1161/strokeaha.119.028117] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
In unilateral moyamoya disease, altered endothelial shear stress on the intact-side terminal internal carotid artery might trigger the progression to bilateral disease. We analyzed the endothelial shear stress parameters of the normally appearing terminal internal carotid artery in unilateral moyamoya disease and its association with the progression to bilateral disease.
Methods—
This retrospective cohort study included patients diagnosed with unilateral moyamoya disease by cerebral angiography and followed-up with regular magnetic resonance imaging/magnetic resonance angiography evaluations for >1 year. Endothelial shear stress parameters acquired were mean and maximum signal intensity gradients (SIG) and SIG SD at the vessel boundary in time-of-flight sequences in initial brain magnetic resonance imaging/magnetic resonance angiography. Contralateral disease progression defined as the detection of newly developed vessel steno-occlusion with an magnetic resonance angiography steno-occlusive stage of ≥2, in the previously intact side of the brain on follow-up magnetic resonance imaging/magnetic resonance angiography evaluation.
Results—
Among 146 patients (66 males [45.2%] and 80 females [54.8%]; 76 pediatric [52.1%]), contralateral disease progression was detected in 43 patients (29.5%) after a mean follow-up of 4.3±2.4 years. Multivariate analysis showed that SIG SD was significantly associated with this progression (odds ratio, 13.001 [95% CI, 1.764−95.794],
P
=0.012). In receiver operating characteristic curve analysis, SIG SD predicted the contralateral progression with area under the curve values of 0.803 (95% CI, 0.726−0.880,
P
<0.001). The regression model was reproduced in the external cohort of 31 patients.
Conclusions—
Increased spatial variability of the endothelial shear stress around the normally appearing terminal internal carotid artery, as measured by SIG SD in time-of-flight sequences, may predict the contralateral progression of unilateral moyamoya disease.
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Affiliation(s)
- Woo-Jin Lee
- From the Department of Neurology (W.-J.L., K.-H.J.), Seoul National University Hospital, South Korea
| | - Seul-Ki Jeong
- Jeong Seul-Ki Neurology Clinic, Medi Image, Inc, Seoul, South Korea (S.-K.J.)
| | - Kap-Soo Han
- Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea (K.-S.H.)
| | - Sang Hyuk Lee
- Nuclear Equipment Qualification & Safety Research Group, Korea Institute of Machinery & Materials, Daejeon, South Korea (S.H.L.)
| | - Young Jin Ryu
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea (Y.J.R.)
| | - Chul-Ho Sohn
- Department of Radiology (C.-H.S.), Seoul National University Hospital, South Korea
| | - Keun-Hwa Jung
- From the Department of Neurology (W.-J.L., K.-H.J.), Seoul National University Hospital, South Korea
- Program in Neuroscience, Neuroscience Research Institute of SNUMRC, College of Medicine, Seoul National University, South Korea (K.-H.J.)
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28
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Chen Z, Qin H, Liu J, Wu B, Cheng Z, Jiang Y, Liu L, Jing L, Leng X, Jing J, Wang Y, Wang Y. Characteristics of Wall Shear Stress and Pressure of Intracranial Atherosclerosis Analyzed by a Computational Fluid Dynamics Model: A Pilot Study. Front Neurol 2020; 10:1372. [PMID: 32010041 PMCID: PMC6978719 DOI: 10.3389/fneur.2019.01372] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 12/11/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Although wall shear stress (WSS) and pressure play important roles in plaque vulnerability, characteristics of the two indices in intracranial atherosclerosis (ICAS) have not been fully investigated yet. This study aimed to elucidate this issue by means of establishing a non-invasive computational fluid dynamics method with time-of-flight magnetic resonance angiography (TOF-MRA) of the whole cerebral artery. Materials and Methods: Subjects with symptomatic ICAS in the middle cerebral artery domain were enrolled, excluding those with concomitant internal carotid artery stenosis. Based on patient-specific TOF-MRA images for three-dimensional (3D) meshes and arterial blood pressure with patient-specific carotid artery ultrasonography for inlet boundary conditions, patients' three-dimensional hemodynamics were modeled by a finite element method governed by Navier-Stokes equations. Results: Among the 55 atherosclerotic lesions analyzed by this TOF-MRA based computational fluid dynamics model, the maximum WSS (WSSmax) was most frequently detected at the apex points and the upper half of the upstream sections of the lesions, whereas the maximum pressure was most often located at the lower half of the upstream sections. As the percent stenosis increases, the relative value of WSSmax and pressure drop increased with significantly increasing steep beyond 50% stenosis. Moreover, WSSmax was found to linearly correlate with pressure drop in ICAS. Conclusions: This study on ICAS revealed certain trends of longitudinal distribution of WSS and pressure and the influences of percent stenosis on cerebral hemodynamics, as well as the correlations between WSS and pressure drop. It represents a step forward in applying computational flow simulation techniques in studying ICAS and stroke, in a patient-specific manner.
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Affiliation(s)
- Zimo Chen
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Haiqiang Qin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jia Liu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Bokai Wu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Zaiheng Cheng
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yong Jiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Lina Jing
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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29
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Lan L, Leng X, Ip V, Soo Y, Abrigo J, Liu H, Fan F, Ma SH, Ma K, Ip BYM, Chan KL, Mok VCT, Liebeskind DS, Wong KS, Leung TW. Sustaining cerebral perfusion in intracranial atherosclerotic stenosis: The roles of antegrade residual flow and leptomeningeal collateral flow. J Cereb Blood Flow Metab 2020; 40:126-134. [PMID: 30351176 PMCID: PMC6928549 DOI: 10.1177/0271678x18805209] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We aimed to investigate the roles of antegrade residual flow and leptomeningeal collateral flow in sustaining cerebral perfusion distal to an intracranial atherosclerotic stenosis (ICAS). Patients with apparently normal cerebral perfusion distal to a symptomatic middle cerebral artery (MCA)-M1 stenosis were enrolled. Computational fluid dynamics models were built based on CT angiography to obtain a translesional pressure ratio (PR) to gauge the residual antegrade flow. Leptomeningeal collaterals (LMCs) were scaled on CT angiography. Cerebral perfusion metrics were obtained in CT perfusion maps. Among 83 patients, linear regression analyses revealed that both translesional PR and LMC scale were independently associated with relative ipsilesional mean transit time (rMTT). Subgroup analyses showed that ipsilesional rMTT was significantly associated with translesional PR (p < 0.001) rather than LMC scale in those with a moderate (50-69%) MCA stenosis, which, however, was only significantly associated with LMC scale (p = 0.051) in those with a severe (70-99%) stenosis. Antegrade residual flow and leptomeningeal collateral flow have complementary effects in sustaining cerebral perfusion distal to an ICAS, while cerebral perfusion may rely more on the collateral circulation in those with a severe stenosis.
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Affiliation(s)
- Linfang Lan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Department of Neurology, The First affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Xinyi Leng, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China. Thomas W Leung, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Vincent Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Yannie Soo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Haipeng Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Florence Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Sze Ho Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Karen Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Bonaventure YM Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Ka Lung Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Vincent CT Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Leng X, Lan L, Ip HL, Abrigo J, Scalzo F, Liu H, Feng X, Chan KL, Fan FSY, Ma SH, Fang H, Xu Y, Li J, Zhang B, Xu Y, Soo YOY, Mok VCT, Yu SCH, Liebeskind DS, Wong KS, Leung TW. Hemodynamics and stroke risk in intracranial atherosclerotic disease. Ann Neurol 2019; 85:752-764. [PMID: 30840312 DOI: 10.1002/ana.25456] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/04/2019] [Accepted: 03/05/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate whether hemodynamic features of symptomatic intracranial atherosclerotic stenosis (sICAS) might correlate with the risk of stroke relapse, using a computational fluid dynamics (CFD) model. METHODS In a cohort study, we recruited patients with acute ischemic stroke attributed to 50 to 99% ICAS confirmed by computed tomographic angiography (CTA). With CTA-based CFD models, translesional pressure ratio (PR = pressurepoststenotic /pressureprestenotic ) and translesional wall shear stress ratio (WSSR = WSSstenotic - throat /WSSprestenotic ) were obtained in each sICAS lesion. Translesional PR ≤ median was defined as low PR and WSSR ≥4th quartile as high WSSR. All patients received standard medical treatment. The primary outcome was recurrent ischemic stroke in the same territory (SIT) within 1 year. RESULTS Overall, 245 patients (median age = 61 years, 63.7% males) were analyzed. Median translesional PR was 0.94 (interquartile range [IQR] = 0.87-0.97); median translesional WSSR was 13.3 (IQR = 7.0-26.7). SIT occurred in 20 (8.2%) patients, mostly with multiple infarcts in the border zone and/or cortical regions. In multivariate Cox regression, low PR (adjusted hazard ratio [HR] = 3.16, p = 0.026) and high WSSR (adjusted HR = 3.05, p = 0.014) were independently associated with SIT. Patients with both low PR and high WSSR had significantly higher risk of SIT than those with normal PR and WSSR (risk = 17.5% vs 3.0%, adjusted HR = 7.52, p = 0.004). INTERPRETATION This work represents a step forward in utilizing computational flow simulation techniques in studying intracranial atherosclerotic disease. It reveals a hemodynamic pattern of sICAS that is more prone to stroke relapse, and supports hypoperfusion and artery-to-artery embolism as common mechanisms of ischemic stroke in such patients. Ann Neurol 2019;85:752-764.
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Affiliation(s)
- Xinyi Leng
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Shenzhen Research Institute, Chinese University of Hong Kong, Shenzhen, China
| | - Linfang Lan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Neurology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hing Lung Ip
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, China
| | - Fabien Scalzo
- Neurovascular Imaging Research Core and UCLA Stroke Center, Department of Neurology, University of California, Los Angeles, Los Angeles, CA
| | - Haipeng Liu
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, China
| | - Xueyan Feng
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Ka Lung Chan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Florence S Y Fan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Sze Ho Ma
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Hui Fang
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuming Xu
- Department of Neurology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingwei Li
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bing Zhang
- Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yun Xu
- Department of Neurology, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Yannie O Y Soo
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Simon C H Yu
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, China
| | - David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Department of Neurology, University of California, Los Angeles, Los Angeles, CA
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, China
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Vali A, Aristova M, Vakil P, Abdalla R, Prabhakaran S, Markl M, Ansari SA, Schnell S. Semi-automated analysis of 4D flow MRI to assess the hemodynamic impact of intracranial atherosclerotic disease. Magn Reson Med 2019; 82:749-762. [PMID: 30924197 DOI: 10.1002/mrm.27747] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/03/2019] [Accepted: 03/02/2019] [Indexed: 01/02/2023]
Abstract
PURPOSE This study evaluated the feasibility of using 4D flow MRI and a semi-automated analysis tool to assess the hemodynamic impact of intracranial atherosclerotic disease (ICAD). The ICAD impact was investigated by evaluating pressure drop (PD) at the atherosclerotic stenosis and changes in cerebral blood flow distribution in patients compared to healthy controls. METHODS Dual-venc 4D flow MRI was acquired in 25 healthy volunteers and 16 ICAD patients (ICA, N = 3; MCA, N = 13) with mild (<50%), moderate (50-69%), or severe (>70%) intracranial stenosis. A semi-automated analysis tool was developed to quantify velocity and flow from 4D flow MRI and to evaluate cerebral blood flow redistribution. PD at stenosis was estimated using the Bernoulli equation. The PD calculation was examined by an in vitro phantom study against flow simulations. RESULTS Flow analysis in controls indicated symmetry in blood flow rate (FR) and peak velocity (PV) between the brain hemispheres. For patients, PV in the affected hemisphere was significantly (65%) higher than the normal side (P = 0.002). However, FR to both hemispheres of the brain was the same. The PD depicted significant correlation with PV asymmetry in patients (ρ = 0.67 and P = 0.02), and it was significantly higher for severe compared to moderate stenosis (3.73 vs. 2.30 mm Hg, P = 0.02). CONCLUSION 4D flow MRI quantification enables assessment of the hemodynamic impact of ICAD. The significant difference of the PD between patients with severe and moderate stenosis and its correlation with PV asymmetry suggest that PD may be a pertinent hemodynamic biomarker to evaluate ICAD.
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Affiliation(s)
- Alireza Vali
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Maria Aristova
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Parmede Vakil
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Ramez Abdalla
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | | | - Michael Markl
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois
| | - Sameer A Ansari
- Department of Radiology, Northwestern University, Chicago, Illinois.,Department of Neurology, Northwestern University, Chicago, Illinois.,Department of Neurological Surgery, Northwestern University, Chicago, Illinois
| | - Susanne Schnell
- Department of Radiology, Northwestern University, Chicago, Illinois
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32
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Liebeskind DS. Mapping the collaterome for precision cerebrovascular health: Theranostics in the continuum of stroke and dementia. J Cereb Blood Flow Metab 2018; 38:1449-1460. [PMID: 28555527 PMCID: PMC6125977 DOI: 10.1177/0271678x17711625] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/04/2017] [Accepted: 04/29/2017] [Indexed: 01/10/2023]
Abstract
Precision cerebrovascular health or individualized long-term preservation of the brain and associated blood vessels, is predicated on understanding, diagnosing, and tailoring therapies for people at risk of ischemic injury associated with stroke and vascular dementia. The associated imaging patterns are sculpted by the protective effect of the collaterome, the innate compensatory ability of the brain and vasculature to offset hypoperfusion when antegrade or normal arterial inflow pathways are compromised. Theranostics or rational and synchronous use of diagnostic studies in tandem with specific therapies to optimally guide patient outcomes in ischemic brain disorders may capitalize on the pivotal role of the collaterome. Understanding the functional impact of the collaterome across populations of individuals would advance translational science on the brain, while questions with immediate clinical implications may be prioritized. Big data and systematic analyses are necessary to develop normative standards, multimodal imaging atlases, and delineation of specific patterns to guide clinical management. Large-scale, systematic imaging analyses of the collaterome provide a platform for translational work on cerebral collateral circulation and hemodynamics and a theranostic framework with direct clinical implications. This article frames incipient research objectives to guide precision stroke medicine in coming years, building upon the collaterome concept in brain health.
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Affiliation(s)
- David S Liebeskind
- Neurovascular Imaging Research Core and UCLA Stroke Center, Los Angeles, CA, USA
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33
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Permeability and fluid flow-induced wall shear stress of bone tissue scaffolds: Computational fluid dynamic analysis using Newtonian and non-Newtonian blood flow models. Comput Biol Med 2018; 99:201-208. [DOI: 10.1016/j.compbiomed.2018.06.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/02/2018] [Accepted: 06/18/2018] [Indexed: 12/17/2022]
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34
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Tsivgoulis G, Safouris A, Kim DE, Alexandrov AV. Recent Advances in Primary and Secondary Prevention of Atherosclerotic Stroke. J Stroke 2018; 20:145-166. [PMID: 29886715 PMCID: PMC6007302 DOI: 10.5853/jos.2018.00773] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/13/2018] [Accepted: 05/23/2018] [Indexed: 01/09/2023] Open
Abstract
Atherosclerosis is a major cause of ischemic stroke that can be effectively prevented with appropriate lifestyle modifications and control of cardiovascular risk factors. Medical advances in recent years along with aggressive cardiovascular risk factor modifications have resulted in decreased recurrence rates of atherosclerotic stroke. Non-statin lipid-lowering molecules have recently shown clinical benefit and are recommended for very high-risk patients to reduce their risk of stroke. Aggressive hypertension treatment is crucial to reduce atherosclerotic stroke risk. Advances in antithrombotic treatments include combinations of antiplatelets and new antiplatelet agents in the acute phase post-stroke, which carries a high risk of recurrence. Intensive medical treatment has also limited the indications for carotid interventions, especially for asymptomatic disease. Intracranial atherosclerotic disease may provoke stroke through various mechanisms; it is increasingly recognized as a cause of ischemic stroke with advanced imaging and is best managed with lifestyle modifications and medical therapy. The diagnostic search for the vulnerable culprit atherosclerotic plaque is an area of intense research, from the level of the intracranial arteries to that of the aortic arch. Ultrasonography and novel magnetic resonance imaging techniques (high-resolution vessel-wall imaging) may assist in the identification of vulnerable atherosclerotic plaques as the underlying cause in cryptogenic or misdiagnosed non-atherosclerotic ischemic stroke. Vertebrobasilar atherosclerotic disease is less common than carotid artery disease; thus, high-quality data on effective prevention strategies are scarcer. However, aggressive medical treatment is also the gold standard to reduce cerebrovascular disease located in posterior circulation.
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Affiliation(s)
- Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Apostolos Safouris
- Second Department of Neurology, “Attikon” University Hospital, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
- Stroke Unit, Metropolitan Hospital, Pireus, Greece
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Andrei V. Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, USA
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35
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Leng X, Lan L, Ip HL, Fan F, Ma SH, Ma K, Liu H, Yan Z, Liu J, Abrigo J, Soo YOY, Liebeskind DS, Wong KS, Leung TW. Translesional pressure gradient and leptomeningeal collateral status in symptomatic middle cerebral artery stenosis. Eur J Neurol 2017; 25:404-410. [PMID: 29171118 DOI: 10.1111/ene.13521] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/20/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Leptomeningeal collateral (LMC) status governs the prognosis of large artery occlusive stroke, although factors determining LMC status are not fully elucidated. The aim was to investigate metrics affecting LMC status in such patients by using computational fluid dynamics (CFD) models based on computed tomography angiography (CTA). METHODS In this cross-sectional study, patients with recent ischaemic stroke or transient ischaemic attack attributed to atherosclerotic M1 middle cerebral artery (MCA) stenosis (50%-99%) were recruited. Demographic, clinical and imaging data of these patients were collected. Ipsilesional LMC status was graded as good or poor by assessing the laterality of anterior and posterior cerebral arteries in CTA. A CFD model based on CTA was constructed to reflect focal hemodynamics in the distal internal carotid artery, M1 MCA and A1 anterior cerebral artery. Pressure gradients were calculated across culprit MCA stenotic lesions in CFD models. Predictors for good LMC status were sought in univariate and multivariate analyses. RESULTS Amongst the 85 patients enrolled (mean age 61.5 ± 10.9 years), 38 (44.7%) had good ipsilesional LMC status. The mean pressure gradient across MCA lesions was 14.8 ± 18.1 mmHg. Advanced age (P = 0.030) and a larger translesional pressure gradient (P = 0.029) independently predicted good LMCs. A lower fasting blood glucose level also showed a trend for good LMCs (P = 0.058). CONCLUSIONS Our study suggested a correlation between translesional pressure gradient and maturation of LMCs in intracranial atherosclerotic disease. Further studies with more exquisite and dynamic monitoring of cerebral hemodynamics and LMC evolution are needed to verify the current findings.
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Affiliation(s)
- X Leng
- Division of Neurology, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.,Shenzhen Research Institute, Chinese University of Hong Kong, Shenzhen, China
| | - L Lan
- Division of Neurology, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - H L Ip
- Division of Neurology, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - F Fan
- Division of Neurology, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - S H Ma
- Division of Neurology, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - K Ma
- Division of Neurology, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - H Liu
- Division of Neurology, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China.,Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Z Yan
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - J Liu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - J Abrigo
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Y O Y Soo
- Division of Neurology, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - D S Liebeskind
- Neurovascular Imaging Research Core, Department of Neurology, University of California, Los Angeles, CA, USA
| | - K S Wong
- Division of Neurology, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - T W Leung
- Division of Neurology, Department of Medicine and Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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36
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Cai B, Peng B. Intracranial artery stenosis: Current status of evaluation and treatment in China. Chronic Dis Transl Med 2017; 3:197-206. [PMID: 29354802 PMCID: PMC5747500 DOI: 10.1016/j.cdtm.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Indexed: 01/15/2023] Open
Abstract
Intracranial artery stenosis (ICAS), a common cause of ischemic stroke, is a growing cause of concern in China. Recently, many epidemiological, etiological, pathophysiological, therapy, and diagnostic imaging studies have focused on ICAS, and guidelines and consensus on the diagnosis and treatment of ICAS have been published and updated by domestic experts. Such work is pivotal to our enhanced comprehension, diagnosis, and treatment of ICAS. In this review, we summarize the latest progress in the evaluation and treatment of ICAS in China.
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Affiliation(s)
- Bin Cai
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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Impact of Side Branches on the Computation of Fractional Flow in Intracranial Arterial Stenosis Using the Computational Fluid Dynamics Method. J Stroke Cerebrovasc Dis 2017; 27:44-52. [PMID: 29107636 DOI: 10.1016/j.jstrokecerebrovasdis.2017.02.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 01/12/2017] [Accepted: 02/02/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Computational fluid dynamics (CFD) allows noninvasive fractional flow (FF) computation in intracranial arterial stenosis. Removal of small artery branches is necessary in CFD simulation. The consequent effects on FF value needs to be judged. METHODS An idealized vascular model was built with 70% focal luminal stenosis. A branch with one third or one half of the radius of the parent vessel was added at a distance of 5, 10, 15 and 20 mm to the lesion. With pressure and flow rate applied as inlet and outlet boundary conditions, CFD simulations were performed. Flow distribution at bifurcations followed Murray's law. By including or removing side branches, five patient-specific intracranial artery models were simulated. Transient simulation was performed on a patient-specific model, with a larger branch for validation. Branching effect was considered trivial if the FF difference between paired models (branches included or removed) was within 5%. RESULTS Compared with the control model without a branch, in all idealized models the relative differences of FF was within 2%. In five pairs of cerebral arteries (branches included/removed), FFs were 0.876 and 0.877, 0.853 and 0.858, 0.874 and 0.869, 0.865 and 0.858, 0.952 and 0.948. The relative difference in each pair was less than 1%. In transient model, the relative difference of FF was 3.5%. CONCLUSION The impact of removing side branches with radius less than 50% of the parent vessel on FF measurement accuracy is negligible in static CFD simulations, and minor in transient CFD simulation.
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38
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Leng X, Lan L, Ip VHL, Liu H, Abrigo J, Liebeskind DS, Wong LKS, Leung TW. Noninvasive fractional flow in intracranial atherosclerotic stenosis: Reproducibility, limitations, and perspectives. J Neurol Sci 2017; 381:150-152. [PMID: 28991669 DOI: 10.1016/j.jns.2017.08.3239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 07/28/2017] [Accepted: 08/21/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Xinyi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
| | - Linfang Lan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
| | - Vincent H L Ip
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
| | - Haipeng Liu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
| | - Jill Abrigo
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, China
| | - David S Liebeskind
- Neurovascular Imaging Research Core, Department of Neurology, University of California, Los Angeles, CA, USA
| | - Lawrence K S Wong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China
| | - Thomas W Leung
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, China.
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39
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Liu J, Yan Z, Pu Y, Shiu WS, Wu J, Chen R, Leng X, Qin H, Liu X, Jia B, Song L, Wang Y, Miao Z, Wang Y, Liu L, Cai XC. Functional assessment of cerebral artery stenosis: A pilot study based on computational fluid dynamics. J Cereb Blood Flow Metab 2017; 37:2567-2576. [PMID: 27702878 PMCID: PMC5531352 DOI: 10.1177/0271678x16671321] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The fractional pressure ratio is introduced to quantitatively assess the hemodynamic significance of severe intracranial stenosis. A computational fluid dynamics-based method is proposed to non-invasively compute the FPRCFD and compared against fractional pressure ratio measured by an invasive technique. Eleven patients with severe intracranial stenosis considered for endovascular intervention were recruited and an invasive procedure was performed to measure the distal and the aortic pressure ( Pd and Pa). The fractional pressure ratio was calculated as [Formula: see text]. The computed tomography angiography was used to reconstruct three-dimensional (3D) arteries for each patient. Cerebral hemodynamics was then computed for the arteries using a mathematical model governed by Navier-Stokes equations and with the outflow conditions imposed by a model of distal resistance and compliance. The non-invasive [Formula: see text], [Formula: see text], and FPRCFD were then obtained from the computational fluid dynamics calculation using a 16-core parallel computer. The invasive and non-invasive parameters were tested by statistical analysis. For this group of patients, the computational fluid dynamics method achieved comparable results with the invasive measurements. The fractional pressure ratio and FPRCFD are very close and highly correlated, but not linearly proportional, with the percentage of stenosis. The proposed computational fluid dynamics method can potentially be useful in assessing the functional alteration of cerebral stenosis.
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Affiliation(s)
- Jia Liu
- 1 Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Zhengzheng Yan
- 1 Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yuehua Pu
- 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wen-Shin Shiu
- 1 Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jianhuang Wu
- 1 Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Rongliang Chen
- 1 Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Xinyi Leng
- 3 Faculty of Medicine, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Haiqiang Qin
- 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Liu
- 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baixue Jia
- 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ligang Song
- 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yilong Wang
- 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhongrong Miao
- 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yongjun Wang
- 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liping Liu
- 2 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiao-Chuan Cai
- 1 Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,4 Department of Computer Science, University of Colorado, Boulder, USA
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Lee KE, Ryu AJ, Shin ES, Shim EB. Physiome approach for the analysis of vascular flow reserve in the heart and brain. Pflugers Arch 2017; 469:613-628. [PMID: 28353154 DOI: 10.1007/s00424-017-1961-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/02/2017] [Accepted: 02/20/2017] [Indexed: 01/10/2023]
Abstract
This work reviews the key aspects of coronary and neurovascular flow reserves with an emphasis on physiomic modeling characteristics by the use of a variety of numerical approaches. First, we explain the definition of fractional flow reserve (FFR) in coronary artery and introduce its clinical significance. Then, computational researches for obtaining FFR are reviewed, and their clinical outcomes are compared. In the case of cerebrovascular reserve (CVR), in spite of substantial progress in the simulation of cerebral hemodynamics, only a few computational studies exist. Thus, we discuss the limitations of CVR simulation study and suggest the challenging issue to overcome these. Also, the future direction of physiomic researches for the flow reserves in coronary arteries and cerebral arteries is described. Also, we introduce a machine learning algorithm trained by the existing physiomic simulation data of flow reserve and suggest a prospective research direction related to this.
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Affiliation(s)
- Kyung Eun Lee
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Kangwondaehak-gil, Chuncheon-si, Kangwon-do, 200-701, Republic of Korea
| | - Ah-Jin Ryu
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Kangwondaehak-gil, Chuncheon-si, Kangwon-do, 200-701, Republic of Korea
| | - Eun-Seok Shin
- Department of Cardiology, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Eun Bo Shim
- Department of Mechanical and Biomedical Engineering, Kangwon National University, Kangwondaehak-gil, Chuncheon-si, Kangwon-do, 200-701, Republic of Korea.
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Jia B, Liebeskind DS, Song L, Xu X, Sun X, Liu L, Wang B, Miao Z. Performance of computed tomography angiography to determine anterograde and collateral blood flow status in patients with symptomatic middle cerebral artery stenosis. Interv Neuroradiol 2017; 23:267-273. [PMID: 28335662 DOI: 10.1177/1591019917694480] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background The purpose of this study was to determine the performance of computed tomography angiography (CTA) by using a scoring system to predict anterograde and collateral blood flow status in patients with symptomatic middle cerebral artery (MCA) stenosis with use of conventional angiography as standard reference. Methods We retrospectively identified all consecutive patients with unilateral symptomatic MCA stenosis in our center who underwent conventional angiography and CTA within 1 month. The anterograde and collateral blood flow (AnCo) scoring system consisted of anterograde score (AnS) and collateral score (CoS). Evaluation of the CTA images was done independently by two readers, based on the AnCo scoring system. The conventional angiography was assessed by using the Thrombolysis in Cerebral Infarction (TICI) and American Society of Interventional and Therapeutic Neuroradiology (ASITN/SIR) scoring system to determine the status of anterograde and collateral blood flow. Diagnostic performance of AnCo was evaluated by using the area under the receiver operating characteristic (ROC) curve. Results A total of 61 patients were included in the analysis with mean age of 53.4 ± 11.0 years. AnS demonstrated a strong correlation with TICI with statistical significance ( r = 0.786; p < 0.001). CoS had a modest yet statistically significant correlation with ASITN/SIR ( r = 0.574; p < 0.001). The ROC curve analysis for AnS demonstrated an area under the curve (AUC) of 0.894 ( p < 0.001) and the ROC curve analysis for CoS showed an AUC of 0.824 ( p < 0.001). Conclusions CTA was a potential method to evaluate anterograde and collateral blood flow status in patients with symptomatic unilateral MCA stenosis.
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Affiliation(s)
- Baixue Jia
- 1 Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China.,2 China National Clinical Research Center for Neurological Diseases, China.,3 Center of Stroke, Beijing Institute for Brain Disorders, China.,4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | | | - Ligang Song
- 1 Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China.,2 China National Clinical Research Center for Neurological Diseases, China.,3 Center of Stroke, Beijing Institute for Brain Disorders, China.,4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Xiaotong Xu
- 1 Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China.,2 China National Clinical Research Center for Neurological Diseases, China.,3 Center of Stroke, Beijing Institute for Brain Disorders, China.,4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Xuan Sun
- 1 Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China.,2 China National Clinical Research Center for Neurological Diseases, China.,3 Center of Stroke, Beijing Institute for Brain Disorders, China.,4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Lian Liu
- 1 Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China.,2 China National Clinical Research Center for Neurological Diseases, China.,3 Center of Stroke, Beijing Institute for Brain Disorders, China.,4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Bo Wang
- 1 Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China.,2 China National Clinical Research Center for Neurological Diseases, China.,3 Center of Stroke, Beijing Institute for Brain Disorders, China.,4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
| | - Zhongrong Miao
- 1 Department of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, China.,2 China National Clinical Research Center for Neurological Diseases, China.,3 Center of Stroke, Beijing Institute for Brain Disorders, China.,4 Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China
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Jia Q, Liu H, Li Y, Wang X, Jia J, Li Y. Combination of Magnetic Resonance Angiography and Computational Fluid Dynamics May Predict the Risk of Stroke in Patients with Asymptomatic Carotid Plaques. Med Sci Monit 2017; 23:479-488. [PMID: 28126983 PMCID: PMC5292986 DOI: 10.12659/msm.902995] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Atherosclerosis plaques in the carotid arteries frequently have been found in patients with stroke. However, the pathogenesis of carotid plaque from asymptomatic to cerebrovascular events is a complex process which is still not completely understood. We aimed to investigate the prognosis of asymptomatic carotid atherosclerotic plaques by use of magnetic resonance angiography (MRA) combined with computational fluid dynamics (CFD). Material/Methods We prospectively studied a cohort of 228 participants (mean age 59.21±8.48) with asymptomatic carotid atherosclerotic plaques; mean follow-up duration was 1147.56±224.84 days. Plaque morphology parameters were obtained by MRA analysis. Lumen area (LA) and total vessel area (TVA) were measured, and wall area (WA=TVA−LA) and normalized wall area index (NWI=WA/TVA) were calculated. CFD analysis was performed to evaluate hemodynamic characteristics, including wall pressure (WP) and wall shear stress (WSS). Independent risk factors for stroke were obtained by Cox regression analysis. The area under the curve (AUC) of receiver operator characteristic (ROC) and Z-statistic test were used to evaluate risk factors. Results Logistics regression analysis showed NWI (OR: 3.472, 95% CI: 2.943–4.096, P=0.11) and WSS (OR: 6.974, 95% CI: 1.070–45.453, P=0.42) were independent risk factors of stroke for patients with asymptomatic carotid plaques. The area under the ROC curve values for WSS, NWI, and WSS+NWI were 0.772, 0.798, and 0.903, respectively. Conclusions The combination of plaque morphology characteristics NWI and hemodynamic parameter WSS may predict the risk of stroke in patients with asymptomatic carotid plaques.
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Affiliation(s)
- Qian Jia
- Second Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (mainland).,Department of Cardiology, School of Medicine, Nankai University, Tianjin, China (mainland)
| | - Hongbin Liu
- Second Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Yanping Li
- Second Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (mainland).,Outpatient Department of North China Military Materials Procurement Bureau, Tianjin, China (mainland)
| | - Xiaoxi Wang
- Second Department of Geriatric Cardiology, Chinese PLA General Hospital, Beijing, China (mainland)
| | - Jinju Jia
- Department of Cardiology, Jizhong Energy Xingtai Mig General Hospital, Xingtai, Hebei, China (mainland)
| | - Yuying Li
- Department of Radiology, Chinese PLA General Hospital, Beijing, China (mainland)
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Pu Y, Lan L, Leng X, Wong LKS, Liu L. Intracranial atherosclerosis: From anatomy to pathophysiology. Int J Stroke 2017; 12:236-245. [PMID: 28067615 DOI: 10.1177/1747493016685716] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Intracranial atherosclerotic stenosis is an important etiology subtype of ischemic stroke. Stenosis severity was thought to be the main reference index for clinical treatment and research. However, stenosis could not reflect the ischemia risk completely, instead the hemodynamic state across the lesion, the extent of collateral circulation, and perfusion impairment downstream the stenosis are more important. Aims We write this review aimed to summarize novel angiographic methods applied in the evaluation of functional severity of ICAS, and commented on their limitations and prospects in future research. Summary of review The main methods to estimate cerebral blood flow including fractional flow assessed by signal intensity ratio, computational fluid dynamics analysis or pressure wire, quantitative magnetic resonance angiography. Fractional flow as a series cerebral hemodynamic parameters may reflect the status of collateral circulation and cerebral blood flow. But the accuracy of the methods was not validated. The method to calculate fractional flow reserve in cardiovascular disease cannot duplicate in cerebrovascular disease. Fractional flow measurement by floating a pressure guidewire across the intracranial stenosis was technically feasible and safe. In the future researches, a non-invasive method should be established to identify high-risk intracranial lesions and may help in decision-making. Conclusions The relationship between stenosis and cerebral blood flow was individualized. Cerebral hemodynamic criteria should be used to screen patients to endovascular treatment, which will optimize the diagnosis and treatment strategies for patients with symptomatic intracranial artery stenosis.
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Affiliation(s)
- Yuehua Pu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Linfang Lan
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xinyi Leng
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Lawrence KS Wong
- Department of Medicine and Therapeutics, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Miao Z, Liebeskind DS, Lo W, Liu L, Pu Y, Leng X, Song L, Xu X, Jia B, Gao F, Mo D, Sun X, Liu L, Ma N, Wang B, Wang Y, Wang Y. Fractional Flow Assessment for the Evaluation of Intracranial Atherosclerosis: A Feasibility Study. INTERVENTIONAL NEUROLOGY 2016; 5:65-75. [PMID: 27610123 DOI: 10.1159/000444333] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE Current studies on endovascular intervention for intracranial atherosclerosis select patients based on luminal stenosis. Coronary studies demonstrated that fractional flow measurements assess ischemia better than anatomical stenosis and can guide patient selection for intervention. We similarly postulated that fractional flow can be used to assess ischemic stroke risk. METHODS This was a feasibility study to assess the technical use and safety of applying a pressure guidewire to measure fractional flow across intracranial stenoses. Twenty patients with severe intracranial stenosis were recruited. The percentage of luminal stenosis, distal to proximal pressure ratios (fractional flow) and the fractional flow gradients across the stenosis were measured. Procedural success rate and safety outcomes were documented. RESULTS All 20 patients had successful crossing of stenosis by the pressure guidewire. Ten patients underwent angioplasty, and 5 had stenting performed. There was one perforator stroke, but not related to the use of the pressure wire. For the 13 patients with complete pre- and postintervention data, the mean preintervention stenosis, fractional flow and translesional pressure gradient were 76.2%, 0.66 and 29.9 mm Hg, whilst the corresponding postintervention measurements were 24.7%, 0.88 and 10.9 mm Hg, respectively. Fractional flow (r = -0.530, p = 0.001) and the translesional pressure gradient (r = 0.501, p = 0.002) only had a modest correlation with the luminal stenosis. CONCLUSION Fractional flow measurement by floating a pressure guidewire across the intracranial stenosis was technically feasible and safe in this study. Further studies are needed to validate its use for ischemic stroke risk assessment.
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Affiliation(s)
- ZhongRong Miao
- Departments of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | | | - WaiTing Lo
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, SAR, China
| | - LiPing Liu
- Departments of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - YueHua Pu
- Departments of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - XinYi Leng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - LiGang Song
- Departments of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - XiaoTong Xu
- Departments of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - BaiXue Jia
- Departments of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Feng Gao
- Departments of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - DaPeng Mo
- Departments of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xuan Sun
- Departments of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lian Liu
- Departments of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ning Ma
- Departments of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Bo Wang
- Departments of Interventional Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - YiLong Wang
- Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - YongJun Wang
- Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
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Turski P, Scarano A, Hartman E, Clark Z, Schubert T, Rivera L, Wu Y, Wieben O, Johnson K. Neurovascular 4DFlow MRI (Phase Contrast MRA): emerging clinical applications. ACTA ACUST UNITED AC 2016. [DOI: 10.1186/s40809-016-0019-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Ohhara Y, Oshima M, Iwai T, Kitajima H, Yajima Y, Mitsudo K, Krdy A, Tohnai I. Investigation of blood flow in the external carotid artery and its branches with a new 0D peripheral model. Biomed Eng Online 2016; 15:16. [PMID: 26846094 PMCID: PMC4743235 DOI: 10.1186/s12938-016-0133-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 01/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-specific modelling in clinical studies requires a realistic simulation to be performed within a reasonable computational time. The aim of this study was to develop simple but realistic outflow boundary conditions for patient-specific blood flow simulation which can be used to clarify the distribution of the anticancer agent in intra-arterial chemotherapy for oral cancer. METHODS In this study, the boundary conditions are expressed as a zero dimension (0D) resistance model of the peripheral vessel network based on the fractal characteristics of branching arteries combined with knowledge of the circulatory system and the energy minimization principle. This resistance model was applied to four patient-specific blood flow simulations at the region where the common carotid artery bifurcates into the internal and external carotid arteries. RESULTS Results of these simulations with the proposed boundary conditions were compared with the results of ultrasound measurements for the same patients. The pressure was found to be within the physiological range. The difference in velocity in the superficial temporal artery results in an error of 5.21 ± 0.78 % between the numerical results and the measurement data. CONCLUSIONS The proposed outflow boundary conditions, therefore, constitute a simple resistance-based model and can be used for performing accurate simulations with commercial fluid dynamics software.
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Affiliation(s)
- Yoshihito Ohhara
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Marie Oshima
- Department of Interfaculty Initiative in Information Studies, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
- Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo, 153-8505, Japan.
| | - Toshinori Iwai
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Hiroaki Kitajima
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Yasuharu Yajima
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Kenji Mitsudo
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Absy Krdy
- Department of Interfaculty Initiative in Information Studies, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
- Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo, 153-8505, Japan.
| | - Iwai Tohnai
- Department of Oral and Maxillofacial Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
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Nam HS, Scalzo F, Leng X, Ip HL, Lee HS, Fan F, Chen X, Soo Y, Miao Z, Liu L, Feldmann E, Leung T, Wong KS, Liebeskind DS. Hemodynamic Impact of Systolic Blood Pressure and Hematocrit Calculated by Computational Fluid Dynamics in Patients with Intracranial Atherosclerosis. J Neuroimaging 2015; 26:331-8. [PMID: 26598796 DOI: 10.1111/jon.12314] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 10/09/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Success in clinical trials of intracranial atherosclerosis (ICAS) is related to accurate identification of high-risk patients. Noninvasive computational fluid dynamics (CFD) of stenotic lesions may enhance therapeutic decision-making. We determined whether physiologic parameters change downstream cerebral hemodynamics in patients with ICAS. METHODS Consecutive ICAS patients who underwent both CT angiography (CTA) and digital subtraction angiography were enrolled. CFD models were made using CTA source images. Inlet boundary conditions were defined using three ranges of systolic blood pressure (BP) (109.2, 158, and 225 mmHg) and hematocrit (27.3, 40.2, and 48.8). Ratios of pressure, shear strain rates (SSR), and flow velocity across the lesion were calculated using CFD simulations. A linear mixed model was used for the statistical analysis of repeated simulations. RESULTS Among the 56 patients, 32 had moderate stenosis (50-69%) and 24 had severe stenosis (70-99%). A linear mixed model revealed that the ratio of pressure was predicted by systolic BP and stenosis group interaction (P = .036). These pressure decreases were associated with systolic BP (P < .001) and stenosis group (P < .001), but not with hematocrit (P = .337). Post-hoc analysis revealed that pressure decreases were more profound in the severe stenosis than the moderate stenosis group when comparing high and low systolic BP (P = .0108). Ratios of SSR and velocity were only associated in the stenosis group. CONCLUSIONS Our study showed that systolic BP along with the degree of stenosis was associated with pressure decreases across stenotic lesions. Physiologic conditions may superimpose further changes in post-stenotic or downstream blood flow.
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Affiliation(s)
- Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Fabien Scalzo
- Neurovascular Imaging Research Core, University of California, Los Angeles, CA
| | - Xinyi Leng
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hing Lung Ip
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Florence Fan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiangyan Chen
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yannie Soo
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhongrong Miao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liping Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Thomas Leung
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Sing Wong
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong SAR, China
| | - David S Liebeskind
- Neurovascular Imaging Research Core, University of California, Los Angeles, CA
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Chang W, Huang M, Chien A. Emerging techniques for evaluation of the hemodynamics of intracranial vascular pathology. Neuroradiol J 2015; 28:19-27. [PMID: 25924168 DOI: 10.15274/nrj-2014-10115] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Advances in imaging modalities have improved the assessment of intracranial hemodynamics using non-invasive techniques. This review examines new imaging modalities and clinical applications of currently available techniques, describes pathophysiology and future directions in hemodynamic analysis of intracranial stenoses, aneurysms and arteriovenous malformations and explores how hemodynamic analysis may have prognostic value in predicting clinical outcomes and assist in risk stratification. The advent of new technologies such as pseudo-continuous arterial spin labeling, accelerated magnetic resonance angiography (MRA) techniques, 4D digital subtraction angiography, and improvements in clinically available techniques such as phase-contrast MRA may change the landscape of vascular imaging and modify current clinical practice guidelines.
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Affiliation(s)
| | | | - Aichi Chien
- UCLA Department of Radiology; Los Angeles, CA, USA
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49
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Park JB, Koo BK. Noninvasive hemodynamic assessment using coronary computed tomography angiography: the present and future. Interv Cardiol 2015. [DOI: 10.2217/ica.14.65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Leung TW, Wang L, Soo YOY, Ip VHL, Chan AYY, Au LWC, Fan FSY, Lau AYL, Leung H, Abrigo J, Wong A, Mok VCT, Ng PW, Tsoi TH, Li SH, Man CBL, Fong WC, Wong KS, Yu SCH. Evolution of intracranial atherosclerotic disease under modern medical therapy. Ann Neurol 2015; 77:478-86. [PMID: 25557926 DOI: 10.1002/ana.24340] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/26/2014] [Accepted: 12/07/2014] [Indexed: 01/05/2023]
Affiliation(s)
- Thomas W. Leung
- Division of Neurology, Department of Medicine and Therapeutics
| | - Lily Wang
- Division of Neurology, Department of Medicine and Therapeutics
| | | | | | - Anne Y. Y. Chan
- Division of Neurology, Department of Medicine and Therapeutics
| | - Lisa W. C. Au
- Division of Neurology, Department of Medicine and Therapeutics
| | | | - Alex Y. L. Lau
- Division of Neurology, Department of Medicine and Therapeutics
| | - Howan Leung
- Division of Neurology, Department of Medicine and Therapeutics
| | - Jill Abrigo
- Department of Diagnostic and Interventional Radiology; Prince of Wales Hospital, Chinese University of Hong Kong
| | - Adrian Wong
- Division of Neurology, Department of Medicine and Therapeutics
| | | | - Ping Wing Ng
- Department of Medicine and Geriatrics; United Christian Hospital
| | - Tak Hong Tsoi
- Department of Medicine; Pamela Youde Nethersole Eastern Hospital
| | - Siu Hung Li
- Department of Medicine; North District Hospital
| | | | - Wing Chi Fong
- Department of Medicine; Queen Elizabeth Hospital; Hong Kong
| | - Ka Sing Wong
- Division of Neurology, Department of Medicine and Therapeutics
| | - Simon C. H. Yu
- Department of Diagnostic and Interventional Radiology; Prince of Wales Hospital, Chinese University of Hong Kong
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