Evaluation of flow velocities after carotid artery stenting through split spectrum Doppler optical coherence tomography and computational fluid dynamics modeling.

Hemodynamics plays a critical role in the development of atherosclerosis, specifically in regions of curved vasculature such as bifurcations exhibiting irregular blood flow profiles. Carotid atherosclerotic disease can be intervened by stent implantation, but this may result in greater alterations to local blood flow and consequently further complications. This study demonstrates the use of a variant of Doppler optical coherence tomography (DOCT) known as split spectrum DOCT (ssDOCT) to evaluate hemodynamic patterns both before and after stent implantation in the bifurcation junction in the internal carotid artery (ICA). Computational fluid dynamics (CFD) models were constructed to simulate blood velocity profiles and compared to the findings achieved through ssDOCT images. Both methods demonstrated noticeable alterations in hemodynamic patterns following stent implantation, with features such as slow velocity regions at the neck of the bifurcation and recirculation zones at the stent struts. Strong correlation between CFD models and ssDOCT images demonstrate the potential of ssDOCT imaging in the optimization of stent implantation in the clinical setting.

[1]  Barry Vuong,et al.  Endovascular optical coherence tomography intensity kurtosis: visualization of vasa vasorum in porcine carotid artery , 2012, Biomedical optics express.

[2]  Michael D Hill,et al.  Stenting versus endarterectomy for treatment of carotid-artery stenosis. , 2010, The New England journal of medicine.

[3]  Pierre Lane,et al.  High speed, wide velocity dynamic range Doppler optical coherence tomography (Part IV): split spectrum processing in rotary catheter probes. , 2014, Optics express.

[4]  D. Holdsworth,et al.  Characterization of volumetric flow rate waveforms in the normal internal carotid and vertebral arteries , 2005, Physiological measurement.

[5]  R. Vanninen,et al.  Imaging of carotid artery stenosis: clinical efficacy and cost-effectiveness. , 1995, AJNR. American journal of neuroradiology.

[6]  E. Edelman,et al.  Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. , 2007, Journal of the American College of Cardiology.

[7]  Brian C. Wilson,et al.  Improved phase-resolved optical Doppler tomography using the Kasai velocity estimator and histogram segmentation , 2002 .

[8]  J. Saw Carotid artery stenting for stroke prevention. , 2014, The Canadian journal of cardiology.

[9]  Siamak Najarian,et al.  Analysis of wall shear stress in stented coronary artery using 3D computational fluid dynamics modeling , 2008 .

[10]  Renu Virmani,et al.  Pathological findings at bifurcation lesions: the impact of flow distribution on atherosclerosis and arterial healing after stent implantation. , 2010, Journal of the American College of Cardiology.

[11]  Peter Heider,et al.  Flow Velocities After Carotid Artery Stenting: Impact of Stent Design. A Fluid Dynamics Study in a Carotid Artery Model with Laser Doppler Anemometry , 2004, CardioVascular and Interventional Radiology.

[12]  K. Cunningham,et al.  The role of shear stress in the pathogenesis of atherosclerosis , 2005, Laboratory Investigation.

[13]  R. Virmani,et al.  Biological responses in stented arteries. , 2013, Cardiovascular research.

[14]  Yiannis S. Chatzizisis,et al.  Role of endothelial shear stress in stent restenosis and thrombosis: pathophysiologic mechanisms and implications for clinical translation. , 2012, Journal of the American College of Cardiology.

[15]  David W Holdsworth,et al.  Flow patterns in carotid bifurcation models using pulsed Doppler ultrasound: effect of concentric vs. eccentric stenosis on turbulence and recirculation. , 2010, Ultrasound in medicine & biology.

[16]  U. Heinzmann,et al.  Residence Time in Niches of Stagnant Flow Determines Fibrin Clot Formation in an Arterial Branching Model - Detailed Flow Analysis and Experimental Results , 1995, Thrombosis and Haemostasis.

[17]  D. Ku,et al.  Fluid mechanics of vascular systems, diseases, and thrombosis. , 1999, Annual review of biomedical engineering.

[18]  Timothy J. Gundert,et al.  Local hemodynamic changes caused by main branch stent implantation and subsequent virtual side branch balloon angioplasty in a representative coronary bifurcation. , 2010, Journal of applied physiology.

[19]  M. Leon,et al.  Arterial remodeling after coronary angioplasty: a serial intravascular ultrasound study. , 1996, Circulation.

[20]  Julius Pekar,et al.  High speed, wide velocity dynamic range Doppler optical coherence tomography (Part I): System design, signal processing, and performance. , 2003, Optics express.

[21]  D. Birchall,et al.  Analysis of haemodynamic disturbance in the atherosclerotic carotid artery using computational fluid dynamics , 2006, European Radiology.

[22]  Barry Vuong,et al.  In vivo feasibility of endovascular Doppler optical coherence tomography , 2012, Biomedical optics express.