Shear rate is a better marker of symptomatic ischemic cerebrovascular events than velocity or diameter in severe carotid artery stenosis

Hariri, Nizar; Russell, Todd; Kasper, Gregory; Lurie, Fedor

doi:10.1016/j.jvs.2018.04.036

Cited by 13 publications

(7 citation statements)

References 22 publications

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“…Compared with patients with carotid artery stenosis without ischemic symptoms, patients with ischemic symptoms had higher WSS proximal and at the narrowest portion of stenosis, indicating that the higher the WSS in the narrowest area, the greater the risk of plaque rupture and detachment. This is in line with the literature reporting that wall shear obtained by measuring peak systolic velocity at the narrowest portion of stenosis can be a better predictor of ischemic stroke than the degree of stricture [20,21] .…”

Section: Discussionsupporting

confidence: 92%

A Preliminary Study of Wall Shear Stress in Carotid Artery Stenting

Xiao-yong

Chen

Huang

et al. 2023

Preprint

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Objective: To characterize carotid wall shear stress (WSS)following carotid artery stenting (CAS) in patients with carotid stenosis. Methods: Twenty-eight patients with carotid stenosis treated with CAS between March 2021 to May 2022 in the eighth medical center of the PLA General Hospital were selected for our study. Carotid ultrasound was performed before the operation, one week post-operation, and six months post-operation. Carotid artery WSS was detected by blood flow vector imaging, and the changes in WSS before and after the operation were collected. Genetic testing of drugs was detected for patients with restenosis. Results: Pre-operative WSS of the proximal, narrowest region, and distal carotid arteries in patients with ischemic carotid artery stenosis was 7.88±3.18Pa, 14.36±6.66Pa, and 1.55±1.15Pa, respectively. Comparatively, pre-operative WSS of the proximal, narrowest region and distal carotid arteries in patients without ischemic symptoms was 5.02±1.99Pa, 9.68±4.23Pa, and 1.10±0.68Pa, respectively, with a significant difference between the two groups (p<0.001). Overall WSSof the proximal, narrowest region, and distal carotid arteries in patients before CAS was 6.68±3.0Pa, 12.47±5.98Pa, and 1.39±0. 96Pa. WSS of the proximal, narrowest region, and distal carotid was 4.15±1.42Pa, 6.71±2.64Pa, and1.86±1.13Pa one week after CAS, compared to 4.44±1.91Pa, 7.90±4.38Pa, and 2. 36±1.09Pa six months after CAS. WSS of the proximal and narrowest region of the carotid artery was reduced after carotid stenting, and the difference was statistically significant (p<0.001). There was no statistically significant difference in WSS between one week and six months after stenting (P > 0.05). Conclusion: Changes in carotid WSS are closely related to carotid stenosis, which can provide important hemodynamic information for the treatment of CAS. The technique has important application value in pre-operative evaluation, curative effect evaluation, and long-term follow-up.

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Section: Discussionsupporting

confidence: 92%

A Preliminary Study of Wall Shear Stress in Carotid Artery Stenting

Xiao-yong

Chen

Huang

et al. 2023

Preprint

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“…Blood flow and haemodynamic forces also affect localized thrombin generation, fibrin formation and structure. Upon activation by collagen, thrombin or high shear, a subpopulation of platelets externalize the procoagulant phospholipid phosphatidylserine (PS) and release PS-exposed microvesicles, resulting in localized thrombin generation and fibrin formation [57,58]. In contrast, platelet activation by ADP, vWF, or thromboxane A 2 does not generate procoagulant platelets.…”

Section: Static Versus Pathological Flow Conditionsmentioning

confidence: 99%

Point-of-care platelet function tests: relevance to arterial thrombosis and opportunities for improvement

Gorog

Becker

2020

J Thromb Thrombolysis

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Studies using whole blood platelet aggregometry as a laboratory research tool, provided important insights into the mechanism and modulators of platelet aggregation. Subsequently, a number of point-of-care (POC) platelet function tests (PFTs) were developed for clinical use, based on the concept that an individual’s thrombotic profile could be assessed in vitro by assessing the response to stimulation of platelet aggregation by specific, usually solo agonists such as adenosine diphosphate (ADP), collagen and thrombin. However, adjusting antiplatelet medication in order to improve the results of such POC PFTs has not translated into a meaningful reduction in cardiovascular events, which may be attributable to important differences between the POC PFT techniques and in vivo conditions, including patient-to-patient variability. Important limitations of most tests include the use of citrate-anticoagulated blood. Citrate directly and irreversibly diminishes platelet function and even after recalcification, it may result in altered platelet aggregation in response to ADP, epinephrine or collagen, and interfere with thrombin generation from activated platelets. Furthermore, most tests do not employ flowing blood and therefore do not assess the effect of high shear forces on platelets that initiate, propagate and stabilize arterial thrombi. Finally, the effect of endogenous thrombolysis, due to fibrinolysis and dislodgement, which ultimately determines the outcome of a thrombotic stimulus, is mostly not assessed. In order to accurately reflect an individual’s predisposition to arterial thrombosis, future tests of thrombotic status which overcome these limitations should be used, to improve cardiovascular risk prediction and to guide pharmacotherapy.

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“…In clinical practice, knowledge of WSS is currently not integrated into the decision-making algorithm for the management of carotid stenosis [3]. Although an elevation of the WSS is suggested as a vulnerability factor, those preliminary results should, however, be confirmed [8,10,11]. We hope that this technique will lead to a broader validation of this biomarker as a second step.…”

Section: Limitationsmentioning

confidence: 99%

“…For these reasons, WSS could be an important factor in the vulnerability of a carotid plaque. A rough assessment of the shear rate, obtained from the peak systolic velocity with conventional spectral Doppler associated with the smallest diameter measurement, showed that it was a better predictor of ischemic stroke than the stenosis grade [11].…”

Section: Introductionmentioning

confidence: 99%

Wall Shear Stress Measurement by Ultrafast Vector Flow Imaging for Atherosclerotic Carotid Stenosis

et al. 2019

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Objective Carotid plaque vulnerability assessment could guide the decision to perform endarterectomy. Ultrafast ultrasound imaging (UF) can evaluate local flow velocities over an entire 2D image, allowing measurement of the wall shear stress (WSS). We aimed at evaluating the feasibility of WSS measurement in a prospective series of patients with carotid stenosis. Methods UF acquisitions, performed with a linear probe, had an effective frame rate of 5000 Hz. The flow velocity was imaged over the entire plaque area. WSS was computed with the vector field speed using the formula: with the blood velocity and μ, the blood viscosity. The WSS measurement method was validated using a calibrated phantom. In vivo, WSS was analyzed in 5 areas of the carotid wall: common carotid artery, plaque ascent, plaque peak, plaque descent, internal carotid artery. Results Good correlation was found between in vitro measurement and the theoretical WSS values (R2 = 0.95; p < 0.001). 33 patients were prospectively evaluated, with a median carotid stenosis degree of 80 % [75–85]. The maximum WSS value over the cardiac cycle follows the shape of the plaque with an increase during the ascent, reaching its maximum value of 3.25 Pa [2.26–4.38] at the peak of the plaque, and a decrease after passing of the peak (0.93 Pa [0.80–1.19]) lower than the WSS values in the non-stenotic areas (1.47 Pa [1.12–1.77] for the common carotid artery). Conclusion UF allowed local and direct evaluation of the plaque’s WSS, thus better characterizing local hemodynamics to identify areas of vulnerability. Key Points:

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Shear rate is a better marker of symptomatic ischemic cerebrovascular events than velocity or diameter in severe carotid artery stenosis

Cited by 13 publications

References 22 publications

A Preliminary Study of Wall Shear Stress in Carotid Artery Stenting

A Preliminary Study of Wall Shear Stress in Carotid Artery Stenting

Point-of-care platelet function tests: relevance to arterial thrombosis and opportunities for improvement

Wall Shear Stress Measurement by Ultrafast Vector Flow Imaging for Atherosclerotic Carotid Stenosis

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