Role of Occlusion Position in Coronary Artery Fistulas with Terminal Aneurysms: A Hemodynamic Perspective

Cao, Haoyao; Li, Da; Li, Yan; Qiu, Yue; Liu, Jing; Pu, Huaxia; Peng, Liqing; Zheng, Tinghui

doi:10.1007/s13239-020-00468-w

Cited by 13 publications

(13 citation statements)

References 22 publications

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“…In the contrast, OSI, an indicator of the pulsatility of WSS direction, results from the flow unsteadiness over a cardiac cycle, and if the flow remains laminar, the general flow features of the flow field within the SGs are mainly decided by the geometric features of the computational models. Maybe that’s why a good match between abnormal OSI and thrombosis occurrence has been reported even though no patient-specific boundary condition was available ( Cao et al, 2020 ). In addition, the flow pattern can be directly visualized by 4D MRI in the clinical application ( Liu et al, 2014 ).…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…This study used the same patient-specific models as our previous research ( Cao et al, 2020 ). Four patient-specific models were reconstructed based on computed tomography angiography (CTA) images, as shown in Figure 1 .…”

Section: Methodsmentioning

confidence: 99%

“…( Georgakarakos et al, 2009 ; Menichini et al, 2017 ; Bosi et al, 2018 ; García-Isla., 2018 ). In our previous studies, four patient-specific CAF models were studied using CFD ( Cao et al, 2019 , 2020 ), with conventional hemodynamics parameters such as time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI) to evaluate the thrombosis risk. The results showed that a proximal occlusion to remove the terminal aneurysm may potentially reduce the post-operative thrombotic risk ( Cao et al, 2019 ), while a terminal occlusion of CAF fistula may increase the risk of thrombosis.…”

Section: Introductionmentioning

confidence: 99%

A Hemodynamic Analysis of the Thrombosis Within Occluded Coronary Arterial Fistulas With Terminal Aneurysms Using a Blood Stasis Model

et al. 2022

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Objective: The aim of this study is to numerically evaluate thrombosis risk within occluded coronary arterial fistulas (CAF) with terminal aneurysms, and provide guidance in choosing occlusion positions, with clinical observations as reference.Method: Four patients with CAF were studied, with different occlusion positions in actual treatments. Hemodynamics simulations were conducted, with blood residue predicted using the blood stasis model. Three types of models (untreated model, aneurysm-reserved model and aneurysm-removed model) were studeid for each patient. Four metrics, i.e., proportion of high oscillatory shear index (OSI), area of high OSI, old blood volume fraction (OBVF)) and old blood volume (OBV) was obtained to distinguish the thrombosis risk of different treatments (proximal or distal occlusion), comparing with the follow-up CTA.Results: For all the postopertive models, the high OBVF, high OSI(>0.3) and low time-averaged wall shear stress (TAWSS) regions were mainly at the distal fistula, indicating these regions were prone to thrombosis. The regions where blood residue remains are roughly regions of high OSI, corresponding well with clinical observations. In contrast, TAWSS failed to distinguish the difference in thrombosis risk. Absolute values (area of high OSI, OBV) can better reflect the degree of thrombosis risk between treatment types compared with percentage values (proportion of high OSI, OBVF). By comparing with the actual clinical treatments and observations, the OBV is superior to the area of high OSI in determining treatment type.Conclusion: The OBV, a volumetric parameter for blood stasis, can better account for the CAF thrombosis and reflect the degree of blood stasis compared with OSI or TAWSS, is a more appropriate metric for thrombosis in the fistula. Together with morphological parameters, the OBV could guide clinicians to formulate more appropriate surgical plans, which is of great significance for the preoperative evaluation and treatment prognosis of CAF patients.

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“…The simulations were run until the pressure fields at the inlet and outlet did not change more than 1% from the previous cycle, and the data from the last cycle were selected as the result. Additional details are described in Sengupta et al (2014) and Cao et al (2020) .…”

Section: Methodsmentioning

confidence: 99%

“…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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Role of Occlusion Position in Coronary Artery Fistulas with Terminal Aneurysms: A Hemodynamic Perspective

Cited by 13 publications

References 22 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

A Hemodynamic Analysis of the Thrombosis Within Occluded Coronary Arterial Fistulas With Terminal Aneurysms Using a Blood Stasis Model

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

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