Hemodynamic-Based Evaluation on Thrombosis Risk of Fusiform Coronary Artery Aneurysms Using Computational Fluid Dynamic Simulation Method

Coronary artery aneurysms (CAAs) have been reported to associate with an increased risk for thrombosis. Distinct to the brain aneurysm, which can cause a rupture, CAA’s threat is more about its potential to induce thrombosis, leading to myocardial infarction. Case reports suggest that thrombosis risk varied with the different CAA diameters and hemodynamics effects (usually wall shear stress (WSS), oscillatory shear index (OSI), and relative residence time (RRT)) may relate to the thrombosis risk. However, currently, due to the rareness of the disease, there is limited knowledge of the hemodynamics effects of CAA. The aim of the study was to estimate the relationship between hemodynamic effects and different diameters of CAAs. Computational fluid dynamics (CFD) provides a noninvasive means of hemodynamic research. Four three-dimensional models were constructed, representing coronary arteries with a normal diameter (1x) and CAAs with diameters two (2x), three (3x), and five times (5x) that of the normal diameter. A lumped parameter model (LPM) which can capture the feature of coronary blood flow supplied the boundary conditions. WSS in the aneurysm decreased 97.7% apparently from 3.51 Pa (1x) to 0.08 Pa (5x). OSI and RRT in the aneurysm were increased apparently by two orders of magnitude from 0.01 (1x) to 0.30 (5x), and from 0.38 Pa−1 (1x) to 51.59 Pa−1 (5x), separately. Changes in the local volume of the CAA resulted in dramatic changes in local hemodynamic parameters. The findings demonstrated that thrombosis risk increased with increasing diameter and was strongly exacerbated at larger diameters of CAA. The 2x model exhibited the lowest thrombosis risk among the models, suggesting the low-damage (medication) treatment may work. High-damage (surgery) treatment may need to be considered when CAA diameter is 3 times or higher. This diameter classification method may be a good example for constructing a more complex hemodynamic-based risk stratification method and could support clinical decision-making in the assessment of CAA.

[1]  Charles A. Taylor,et al.  Computational fluid dynamics applied to cardiac computed tomography for noninvasive quantification of fractional flow reserve: scientific basis. , 2013, Journal of the American College of Cardiology.

[2]  Charles A. Taylor,et al.  Patient-Specific Modeling of Blood Flow and Pressure in Human Coronary Arteries , 2010, Annals of Biomedical Engineering.

[3]  P. Bártolo,et al.  Optimisation of a Novel Spiral-Inducing Bypass Graft Using Computational Fluid Dynamics , 2017, Scientific Reports.

[4]  Bastien Chopard,et al.  Combinational Optimization of Strut Placement for Intracranial Stent Using a Realistic Aneurysm , 2014 .

[5]  S. Gent,et al.  Examination of near-wall hemodynamic parameters in the renal bridging stent of various stent graft configurations for repairing visceral branched aortic aneurysms. , 2016, Journal of vascular surgery.

[6]  Xiaochuan Sun,et al.  Clinical value of homodynamic numerical simulation applied in the treatment of cerebral aneurysm , 2017, Experimental and therapeutic medicine.

[7]  Charles A. Taylor,et al.  Quantification of Hemodynamics in Abdominal Aortic Aneurysms During Rest and Exercise Using Magnetic Resonance Imaging and Computational Fluid Dynamics , 2010, Annals of Biomedical Engineering.

[8]  Charles A. Taylor,et al.  In Vivo Validation of Numerical Prediction of Blood Flow in Arterial Bypass Grafts , 2002, Annals of Biomedical Engineering.

[9]  J. Kuijer,et al.  Flow profiles in the left anterior descending and the right coronary artery assessed by MR velocity quantification: effects of through-plane and in-plane motion of the heart. , 1999, Journal of computer assisted tomography.

[10]  T. Wonnacott,et al.  Relation between diameter and flow in major branches of the arch of the aorta. , 1992, Journal of biomechanics.

[11]  A. Hazel,et al.  Spatial comparison between wall shear stress measures and porcine arterial endothelial permeability. , 2004, American journal of physiology. Heart and circulatory physiology.

[12]  C. Stoeckert,et al.  Coexisting proinflammatory and antioxidative endothelial transcription profiles in a disturbed flow region of the adult porcine aorta. , 2004, Proceedings of the National Academy of Sciences of the United States of America.

[13]  T. Henry,et al.  Increased Prevalence of Coronary Artery Aneurysms Among Cocaine Users , 2005, Circulation.

[14]  J. Moake,et al.  Platelets and shear stress. , 1996, Blood.

[15]  Justin S. Tran,et al.  Hemodynamic variables in aneurysms are associated with thrombotic risk in children with Kawasaki disease. , 2019, International journal of cardiology.

[16]  M. Lesch,et al.  Coronary artery aneurysm: a review. , 1997, Progress in cardiovascular diseases.

[17]  Makoto Ohta,et al.  Haemodynamic effects of stent diameter and compaction ratio on flow-diversion treatment of intracranial aneurysms: A numerical study of a successful and an unsuccessful case. , 2017, Journal of biomechanics.

[18]  B. López,et al.  Patient-Specific Computational Modeling , 2012 .

[19]  J. Titus,et al.  Giant aneurysms of coronary arteries and saphenous vein grafts: angiographic findings and histopathological correlates. , 2005, Cardiovascular pathology : the official journal of the Society for Cardiovascular Pathology.

[20]  Thomas Redel,et al.  Hemodynamics at the ostium of cerebral aneurysms with relation to post-treatment changes by a virtual flow diverter: A computational fluid dynamics study , 2013, 2013 35th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[21]  L. Languino,et al.  Fibrinogen mediates leukocyte-endothelium bridging in vivo at low shear forces. , 1996, Blood.

[22]  Narendra Kurnia Putra,et al.  Endothelial cell distributions and migration under conditions of flow shear stress around a stent wire. , 2019, Technology and health care : official journal of the European Society for Engineering and Medicine.

[23]  K Hashino,et al.  Long-term consequences of Kawasaki disease. A 10- to 21-year follow-up study of 594 patients. , 1996, Circulation.

[24]  David A. Steinman,et al.  A Framework for Geometric Analysis of Vascular Structures: Application to Cerebral Aneurysms , 2009, IEEE Transactions on Medical Imaging.

[25]  N. Stergiopulos,et al.  Determinants of stroke volume and systolic and diastolic aortic pressure. , 1996, The American journal of physiology.

[26]  Shin-ichiro Sugiyama,et al.  Relative residence time prolongation in intracranial aneurysms: a possible association with atherosclerosis. , 2013, Neurosurgery.

[27]  O. Teixeira,et al.  Long-term consequences of Kawasaki disease. , 1997, Circulation.

[28]  Tzung K Hsiai,et al.  Pulsatile Versus Oscillatory Shear Stress Regulates NADPH Oxidase Subunit Expression: Implication for Native LDL Oxidation , 2003, Circulation research.

[29]  Tim A. Fonte,et al.  Computational Fluid Dynamics Applied to Cardiac Computed Tomography for Noninvasive Quantification of Fractional Flow Reserve , 2022 .

[30]  Huiping Zhang,et al.  Coronary artery aneurysm formation after drug-coated balloon treatment of de novo lesions , 2018, Medicine.

[31]  L. Antiga,et al.  Quantitative Analysis of Bulk Flow in Image-Based Hemodynamic Models of the Carotid Bifurcation: The Influence of Outflow Conditions as Test Case , 2010, Annals of Biomedical Engineering.

[32]  A. Haverich,et al.  Surgical Treatment of Coronary Artery Aneurysms , 2017, The Thoracic and Cardiovascular Surgeon.

[33]  Yubing Shi,et al.  Review of Zero-D and 1-D Models of Blood Flow in the Cardiovascular System , 2011, Biomedical engineering online.

[34]  C A Taylor,et al.  Outflow boundary conditions for 3D simulations of non-periodic blood flow and pressure fields in deformable arteries , 2010, Computer methods in biomechanics and biomedical engineering.

[35]  Foad Kabinejadian,et al.  Coronary artery bypass grafting hemodynamics and anastomosis design: a biomedical engineering review , 2013, Biomedical engineering online.

[36]  Y. Chatzizisis,et al.  Pathogenetic mechanisms of coronary ectasia. , 2008, International journal of cardiology.

[37]  T. Ohkubo,et al.  Reduced shear stress and disturbed flow may lead to coronary aneurysm and thrombus formations , 2007, Pediatrics international : official journal of the Japan Pediatric Society.

[38]  Andrew M Kahn,et al.  When children with Kawasaki disease grow up: Myocardial and vascular complications in adulthood. , 2009, Journal of the American College of Cardiology.

[39]  I. Kilic,et al.  Coronary Artery Aneurysms: A Review of the Epidemiology, Pathophysiology, Diagnosis, and Treatment , 2017, Front. Cardiovasc. Med..

[40]  L. Antiga,et al.  Correlations among indicators of disturbed flow at the normal carotid bifurcation. , 2009, Journal of biomechanical engineering.

[41]  A. Hughes,et al.  Image-based carotid flow reconstruction: a comparison between MRI and ultrasound. , 2004, Physiological measurement.

[42]  Kevin R Johnson,et al.  Coronary artery flow measurement using navigator echo gated phase contrast magnetic resonance velocity mapping at 3.0 T. , 2008, Journal of biomechanics.

[43]  R. Pridie,et al.  Coronary artery ectasia. Its prevalence and clinical significance in 4993 patients. , 1985, British heart journal.

[44]  S. Chien,et al.  Effects of disturbed flow on vascular endothelium: pathophysiological basis and clinical perspectives. , 2011, Physiological reviews.