A fractal physics explanation for acute thrombotic occlusion in an apparently healthy coronary artery

Abstract

A fractal physics explanation for acute thrombotic occlusion in an apparently healthy coronary arteryThe acute arterial occlusion of an artery that has no significant preexistent lesions leads to dramatic consequences due to the lack of collateral substitutive circulation, as this kind of circulation usually develops within years in the presence of hemodynamic significant stenosis (1).Classical models which explain this phenomenon take into account the cracking of an intimal atheroma plaque, the activation of the prothrombogenic cascade through the denudation of the endothelium, and the formation of a completely occlusive thrombus in certain circumstances (2, 3). At least one counterargument should be considered: Why does an occlusive thrombus form so quickly in the absence of a stenosis when the sanguine flux is unaltered? Why the "wash-out'' phenomenon does not appear?Without contradicting these usual models, through a fractal model (4, 5), we will prove that the blocking of the lumen of an absolutely healthy artery can happen as a result of the "stopping effect" (even in the absence of disputable cracked and nonprotrusive atheroma plaque), in the conditions of a normal sanguine circulation.Therefore, if we consider blood a Bingham-type rheological fluid, then (1) where is the viscosity tangential unitary effort, is the deformation tangential unitary effort, is the velocity gradient with respect to the normal on the transversal section, and is the viscosity coefficient.Our fractal model (4, 5) was used for in vivo analyses of 10 clinical cases of patients with acute occlusive thrombus on an absolutely healthy artery. These cases were selected during a 2-year period (2013)(2014)(2015). Patients with atrial fibrillation were excluded for preventing mismatch with thromboembolic acute coronary occlusion. Patients with patent foramen ovale (diagnosed by transesophageal echocardiography) were excluded to avoid a paradoxical coronary embolism. Intravascular ultrasound or coronary CT angiography were not performed in these patients; although some irregularities could be seen on angiography, it is clear that there are no significant ulcerated atheroma plaques or major signs of parietal atherosclerosis. Also, in patients >50 years, an absolutely normal coronary wall is more likely a utopia. We performed EKG Holter monitoring in all patients for exclusion of paroxysmal atrial fibrillation.We present here the two most relevant cases (Fig. 1a-h) with thrombus dimensions of ≥60 mm (for the other eight cases, the thrombus dimensions were between 30 and 60 mm). For all the cases, our theoretical results were verified by coronarography images. 1) Patient 1 was a 52-year-old male patient who was diagnosed with acute inferolateral ischemia. Coronary angiography revealed an acute occlusive thrombus (4-4.5 mm diameter and 60-80 mm length) at the junction between segments I and II of the right coronary artery. After thrombus aspiration, a distal thrombotic embolism appeared with an apparently healthy artery (or possible minimal les...

Evaluating atrial fibrillations through strange attractors dynamics

“…To this end, we would like to continue our research by analyzing ventricular fibrillations patterns. Taking into account the multi-fractality property of biological structures, a theoretical model based on harmonic mapping on multi-fractal manifolds could prove useful in correlating our results -for further details see (Agop et al 2008;Colotin et al 2009;Bujoreanu et al 2017;Tesloianu et al 2017).…”

On the Chameleonic Behaviour of Cholesterol through a Fractal/Multifractal Model

“…It is true that this is an innovative and atypical approach, but we could now demonstrate what once started as a supposition, and was later observed in multiple studies, the harmful effect of the "good" cholesterol. Despite the lack of extensive papers in this field, we have previously used this particular approach to explain acute thrombotic occlusion in an apparently healthy coronary artery through a similar fractal physics model [24].…”