Exploring the Relationships Between Hemodynamic Stresses in the Carotid Arteries

Ziegler, Magnus; Alfraeus, Jesper; Good, Elin; Engvall, Jan; Muinck, Ebo D. de; Dyverfeldt, Petter

doi:10.3389/fcvm.2020.617755

Cited by 8 publications

(6 citation statements)

References 45 publications

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“…Atherosclerosis is thought of as subject to a triad of, and especially interactions among, systemic risk factors, haemodynamic forces, and the biological response of the wall ( 2 ). Atherosclerosis is related to systemic risk factors, which can be aggravated by lifestyle factors such as high caloric diet, physical inactivity, and smoking, but atherosclerosis is, in a sense, a geometrically focal disease ( 3 , 4 ). Plaque progression and eventually plaque rupture is influenced by a complex interaction between biological and haemodynamic factors ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Wall shear stress and its role in atherosclerosis

Zhou

Chen

et al. 2023

Front. Cardiovasc. Med.

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Atherosclerosis (AS) is the major form of cardiovascular disease and the leading cause of morbidity and mortality in countries around the world. Atherosclerosis combines the interactions of systemic risk factors, haemodynamic factors, and biological factors, in which biomechanical and biochemical cues strongly regulate the process of atherosclerosis. The development of atherosclerosis is directly related to hemodynamic disorders and is the most important parameter in the biomechanics of atherosclerosis. The complex blood flow in arteries forms rich WSS vectorial features, including the newly proposed WSS topological skeleton to identify and classify the WSS fixed points and manifolds in complex vascular geometries. The onset of plaque usually occurs in the low WSS area, and the plaque development alters the local WSS topography. low WSS promotes atherosclerosis, while high WSS prevents atherosclerosis. Upon further progression of plaques, high WSS is associated with the formation of vulnerable plaque phenotype. Different types of shear stress can lead to focal differences in plaque composition and to spatial variations in the susceptibility to plaque rupture, atherosclerosis progression and thrombus formation. WSS can potentially gain insight into the initial lesions of AS and the vulnerable phenotype that gradually develops over time. The characteristics of WSS are studied through computational fluid dynamics (CFD) modeling. With the continuous improvement of computer performance-cost ratio, WSS as one of the effective parameters for early diagnosis of atherosclerosis has become a reality and will be worth actively promoting in clinical practice. The research on the pathogenesis of atherosclerosis based on WSS is gradually an academic consensus. This article will comprehensively review the systemic risk factors, hemodynamics and biological factors involved in the formation of atherosclerosis, and combine the application of CFD in hemodynamics, focusing on the mechanism of WSS and the complex interactions between WSS and plaque biological factors. It is expected to lay a foundation for revealing the pathophysiological mechanisms related to abnormal WSS in the progression and transformation of human atherosclerotic plaques.

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Section: Introductionmentioning

confidence: 99%

Wall shear stress and its role in atherosclerosis

Zhou

Chen

et al. 2023

Front. Cardiovasc. Med.

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“…The co-localized anatomical images obtained with 4D Flow MRI offer several opportunities for investigations of the relationship between vascular blood flow and vascular anatomy. Tortuosity, for example, can be straightforwardly mapped based on a vessel centerline extracted from 3D segmentations of phase-contrast MR angiograms derived by combining the magnitude and velocity vector images ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

Helical flow in tortuous aortas and its relationship to turbulence: A whole-aorta 4D flow MRI study

Dyverfeldt

Trenti

Ziegler

et al. 2023

Front. Cardiovasc. Med.

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BackgroundIncreased vascular tortuosity is a hallmark of ageing of the vascular system, including the aorta. However, the impact of tortuosity on aortic blood flow is unknown. We hypothesized that increased tortuosity would be associated with increased blood flow helicity and with decreased degree of blood flow turbulence as measured by the turbulent kinetic energy (TKE).Methods4D Flow MR images covering the entire aorta from the aortic valve to the iliac bifurcation were acquired in 23 normal volunteers aged 18–30 years (“Young”) and 23 normal volunteers aged 66–76 years (“Old”) without aortic disease. The aorta was segmented and divided into four regions: the ascending, descending, suprarenal abdominal and infrarenal abdominal aorta. Tortuosity, helicity, TKE, flow velocity, and Reynolds number were computed for the whole aorta and for each section.ResultsTortuosity and helicity were higher whereas TKE, velocity, and Reynolds number were lower in Old than in Young, for all aortic regions (p < 0.05) except for helicity in the descending aorta. Tortuosity correlated positively with helicity and negatively with TKE for all aortic regions (Spearman rho=±0.45–±0.72, p < =0.002) except for TKE in the ascending aorta. Further, helicity correlated with TKE in the descending, suprarenal abdominal and infrarenal abdominal aorta (Spearman rho=−0.56–−0.77).ConclusionTortuosity increases with age and blood flow in tortuous aortas is more helical. Increasing helicity, in turn, is associated with decreasing TKE.

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“…These findings indirectly suggest that there are different underlying mechanisms of stroke in CW patients and CW with plaque patients. Therefore, in future research, the construction of animal CW models and CW with plaque models, as well as the exploration of the similarities and differences between the two based on the stereo-geometric spatial position relationship and hemodynamic changes [ 19 , 30 ], may help further explain the mechanisms of stroke occurrence caused by CW.…”

Section: Discussionmentioning

confidence: 99%

The differences between carotid web and carotid web with plaque: based on multimodal ultrasonic and clinical characteristics

Hou,

Li,

Zhang

et al. 2024

Insights Imaging

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Objective This study aimed to examine the clinical and multimodal ultrasonic characteristics differences between carotid web (CW) and CW with plaque as well as the potential risk factors for stroke caused by CW. Methods We retrospectively enrolled patients diagnosed with CW by CTA or high-resolution MRI (HRMRI) and simultaneously underwent contrast enhanced ultrasound (CEUS) and superb microvascular imaging examinations from January 2015 to October 2022. The CW angle was measured using computer-aided software. The variations between CW and CW with plaque were evaluated, and univariable and multivariable logistic regressions were utilized to identify possible risk predictors for stroke caused by CW. Results Two hundred ninety-nine patients with an average age of 60.85 (± 8.77) years were included. Sex, age, history of smoking, alcohol, hypertension, diabetes mellitus, homocysteine level, and treatment, as well as web length and thickness, luminal stenosis, location wall, number, CW angle, and CEUS enhancement, were quite different among CW and CW with plaque patients (p < 0.05). The logistic regression analysis showed that web length was an independent predictor of luminal stenosis in CW patients. For patients with CW and plaque, plaque and web thickness, as well as plaque enhancement, were associated with stenosis. Furthermore, luminal stenosis and plaque length were risk factors for symptoms. Conclusion The multimodal ultrasonic and clinical manifestations of CW and CW with plaque are quite different. Web length is an independent risk factor for carotid artery stenosis in CW patients, whereas luminal stenosis and plaque length were risk factors for symptoms in CW with plaque patients. Critical relevance statement Exploring the similarities and differences between the carotid web and the carotid web with plaque, based on the stereo-geometric spatial position relationship and hemodynamic changes, may provide further insights into the underlying mechanisms of stroke occurrence caused by the carotid web. Key points 1. Multimodal ultrasonic and clinical manifestations of carotid web and carotid web with plaque are substantially different. 2. A thin triangular endoluminal defect is identified as a typical feature of the web on superb microvascular imaging, and two kinds of typical ultrasonic features of CW with plaque are also identified. 3. Web length is an independent risk factor for carotid stenosis in carotid web patients, whereas luminal stenosis and plaque length are risk factors for symptoms in patients with CW and plaque. Graphical Abstract

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Exploring the Relationships Between Hemodynamic Stresses in the Carotid Arteries

Cited by 8 publications

References 45 publications

Wall shear stress and its role in atherosclerosis

Wall shear stress and its role in atherosclerosis

Helical flow in tortuous aortas and its relationship to turbulence: A whole-aorta 4D flow MRI study

The differences between carotid web and carotid web with plaque: based on multimodal ultrasonic and clinical characteristics

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