Influence of renal artery stenosis morphology on hemodynamics

Xiong, Zhuxiang; Yuan, Ding; Wang, Jiarong; Zheng, Tinghui; Fan, Yubo

doi:10.1080/10255842.2021.1883592

Cited by 6 publications

(9 citation statements)

References 23 publications

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“…First, to ensure the full development of blood flow in the stent, we extend the length of the model inlet by 10 times the diameter. Second, the pulsating velocity waveform ( Xiong et al, 2021 ) was used at the inlet of all models ( Figure 3 ). Third, the computational models were geometrically asymmetrical, phase shift of pressure and different flow splits at two iliac outlets may occur ( Grinberg and Karniadakis, 2008 ).…”

Section: Methodsmentioning

confidence: 99%

A Comparative Study on the Hemodynamic Performance Within Cross and Non-cross Stent-Grafts for Abdominal Aortic Aneurysms With an Angulated Neck

et al. 2021

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Objectives: Cross-limb stent grafts for endovascular aneurysm repair (EVAR) are often employed for abdominal aortic aneurysms (AAAs) with significant aortic neck angulation. Neck angulation may be coronal or sagittal; however, previous hemodynamic studies of cross-limb EVAR stent grafts (SGs) primarily utilized simplified planar neck geometries. This study examined the differences in flow patterns and hemodynamic parameters between crossed and non-crossed limb SGs at different spatial neck angulations.Methods: Ideal models consisting of 13 cross and 13 non-cross limbs were established, with coronal and sagittal angles ranging from 0 to 90°. Computational fluid dynamics (CFD) was used to capture the hemodynamic information, and the differences were compared.Results: With regards to the pressure drop index, the maximum difference caused by the configuration and angular direction was 4.6 and 8.0%, respectively, but the difference resulting from the change in aneurysm neck angle can reach 27.1%. With regards to the SAR-TAWSS index, the maximum difference caused by the configuration and angular direction was 7.8 and 9.8%, respectively, but the difference resulting from the change in aneurysm neck angle can reach 26.7%. In addition, when the aneurysm neck angle is lower than 45°, the configuration and angular direction significantly influence the OSI and helical flow intensity index. However, when the aneurysm neck angle is greater than 45°, the hemodynamic differences of each model at the same aneurysm neck angle are reduced.Conclusion: The main factor affecting the hemodynamic index was the angle of the aneurysm neck, while the configuration and angular direction had little effect on the hemodynamics. Furthermore, when the aneurysm neck was greatly angulated, the cross-limb technique did not increase the risk of thrombosis.

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Section: Methodsmentioning

confidence: 99%

A Comparative Study on the Hemodynamic Performance Within Cross and Non-cross Stent-Grafts for Abdominal Aortic Aneurysms With an Angulated Neck

et al. 2021

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“…In cases of mild renal artery disease with a stenosis severity of less than 50%, conservative medical treatment is often sufficient, primarily focusing on hypertension control [ 15 ]. As the degree of stenosis progresses, it becomes challenging to effectively manage blood pressure, and the potential for irreversible damage to renal function increases [ 15 , 16 ]. When the degree of stenosis exceeds 70%, surgical intervention like stent implantation angioplasty is required to effectively address the condition [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

“…As the degree of stenosis progresses, it becomes challenging to effectively manage blood pressure, and the potential for irreversible damage to renal function increases [ 15 , 16 ]. When the degree of stenosis exceeds 70%, surgical intervention like stent implantation angioplasty is required to effectively address the condition [ 15 , 16 ]. Nevertheless, there is currently a lack of consensus regarding the necessity of emergency intervention for patients with moderate RAS (50–70%) as determined using angiography.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, there is currently a lack of consensus regarding the necessity of emergency intervention for patients with moderate RAS (50–70%) as determined using angiography. Hemodynamic severity seems to be a key factor in judging whether surgical intervention is needed [ 13 , 15 , 16 ]. For instance, clinicians can invasively measure a patient’s renal flow reserve fraction (FFR).…”

Section: Introductionmentioning

confidence: 99%

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Evaluating Short-Term and Long-Term Risks Associated with Renal Artery Stenosis Position and Severity: A Hemodynamic Study

Zhao,

Shi,

Jin

et al. 2023

Bioengineering

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Background: Moderate renal artery stenosis (50–70%) may lead to uncontrolled hypertension and eventually cause irreversible damage to renal function. However, the clinical criteria for interventional treatment are still ambiguous in this condition. This study investigated the impact of the position and degree of renal artery stenosis on hemodynamics near the renal artery to assess the short-term and long-term risks associated with this disease. Methods: Calculation models with different degrees of stenosis (50%, 60%, and 70%) located at different positions in the right renal artery were established based on the computed tomography angiography (CTA) of a personalized case. And computational fluid dynamics (CFD) was used to analyze hemodynamic surroundings near the renal artery. Results: As the degree of stenosis increases and the stenosis position is far away from the aorta, there is a decrease in renal perfusion. An analysis of the wall shear stress (WSS)-related parameters indicated areas near the renal artery (downstream of the stenosis and the entrance of the right renal artery) with potential long-term risks of thrombosis and inflammation. Conclusion: The position and degree of stenosis play a significant role in judging short-term risks associated with renal perfusion. Moreover, clinicians should consider not only short-term risks but also independent long-term risk factors, such as certain regions of 50% stenosis with adequate renal perfusion may necessitate prompt intervention.

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“…Compared to traditional clinical imaging, CFD analysis provides quantitative hemodynamic data linked to thrombotic and atherosclerotic risk, including intravascular and near wall flow features such as the streamlines of blood flow, time-averaged wall shear stress (TAWSS), and oscillatory shear index (OSI). It has also been used extensively in clinical applications such as abdominal aortic aneurysm rupture risk prediction ( Qiu et al, 2018 ), investigation of the hemodynamic effects of morphologic stenosis parameters on renal artery stenosis ( Xiong et al, 2021 ), and the choice of occlusion position in cases of coronary artery fistula ( Cao et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Characteristics of Patients With Suspected Coronary Heart Disease at Their Initial Visit

Cao

Zhao

et al. 2021

Front. Physiol.

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PurposeIt is difficult for doctors to decide whether patients with suspected coronary heart disease classified as Coronary Artery Disease Reporting and Data System (CAD-RADS) < 3 should be administered preventive treatment, or whether non-atherosclerotic chest pain should be considered. The aim of the current study was to investigate coronary hemodynamic characteristics in such patients, which may provide more information on their stenosis and be helpful for initial diagnoses.MethodsTwo patient-specific models were reconstructed based on the coronary computed tomographic angiography underwent in 2012. Patient 1 was classified as CAD-RADS 0, and was readmitted to hospital due to coronary artery disease within 5 years. Patient 2 was classified as CAD-RADS 2, and has experienced no adverse events to date. Computational fluid dynamics (CFD) analysis was used to obtain hemodynamic parameters including flow rate waveform, flow streamlines, time-average wall shear stress (TAWSS), and oscillatory shear index (OSI).ResultsPatient 1 exhibited no physiological characteristics of right coronary artery flow waveform, large areas of low TAWSS, and slow blood flow in the proximal and middle segments of the left anterior descending branch. Patient 2 exhibited reduced coronary supply, small and separate areas of abnormal TAWSS, and a higher left anterior descending branch OSI than patient 1.ConclusionHemodynamic abnormalities may play an important role in the prognosis of patients with coronary stenosis, and patient-specific hemodynamic characteristics may facilitate more accurate initial diagnosis, and better management. Overall hemodynamics (along the whole vessel) warranted attention at the time of the initial visit in patients classified as CAD-RADS < 3.

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Influence of renal artery stenosis morphology on hemodynamics

Cited by 6 publications

References 23 publications

A Comparative Study on the Hemodynamic Performance Within Cross and Non-cross Stent-Grafts for Abdominal Aortic Aneurysms With an Angulated Neck

A Comparative Study on the Hemodynamic Performance Within Cross and Non-cross Stent-Grafts for Abdominal Aortic Aneurysms With an Angulated Neck

Evaluating Short-Term and Long-Term Risks Associated with Renal Artery Stenosis Position and Severity: A Hemodynamic Study

Hemodynamic Characteristics of Patients With Suspected Coronary Heart Disease at Their Initial Visit

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