Perspective on CFD studies of coronary artery disease lesions and hemodynamics: A review

Abstract

Coronary artery disease (CAD) is the most common cardiovascular disease. Early diagnosis of CAD's physiological significance is of utmost importance for guiding individualized risk-tailored treatment strategies. In this paper, we first review the state-of-the-art clinical diagnostic indices to quantify the severity of CAD and the associated invasive and noninvasive imaging technologies in order to quantify the anatomical parameters of diameter stenosis, area stenosis, and hemodynamic indices of coronary flow reserve and fractional flow reserve. With the development of computational technologies and CFD methods, tremendous progress has been made in applying image-based CFD simulation techniques to elucidate the effects of hemodynamics in vascular pathophysiology toward the initialization and progression of CAD. So then, we review the advancements of CFD technologies in patient-specific modeling, involving the development of geometry reconstruction, boundary conditions, and fluid-structure interaction. Next, we review the applications of CFD to stenotic sites, in order to compute their hemodynamic parameters and study the relationship between the hemodynamic conditions and the clinical indices, to thereby assess the amount of viable myocardium and candidacy for percutaneous coronary intervention. Finally, we review the strengths and limitations of current researches of applying CFD to CAD studies.

Numerical analysis of the effect of turbulence transition on the hemodynamic parameters in human coronary arteries

“…Intravascular ultrasound (IVUS) imaging with tissue characterization is considered as gold standard in evaluating progression or regression of plaques (29). In vivo IVUS images obtained from patients was used in the present study with consent.…”

Wall shear stress in the development of in-stent restenosis revisited. A critical review of clinical data on shear stress after intracoronary stent implantation

“…Regarding WSS modeling, it is not clear at present whether an assumption of non-pulsatile steady flow provides enough information about the mechanism of restenosis after stent implantation. Even when the cyclic variation of the pulsatile flow is incorporated, it is still questionable whether we can analyze the flow alone without the stress and strain of a much higher magnitude inside the vessel wall as a consequence of the radial stretching of the implanted stent [42]. The rapid development of computational fluid dynamics methods provides a promise to elucidate the role of hemodynamic forces in the pathological processes of the formation of exaggerated intimal thickness after stent implantation.…”

Coronary artery segmentation via Hessian filter and curve-skeleton extraction

“…2. Additionally, we can extract the curve-skeleton and compute cross sectional area of the coronary arteries, which are critical for quantifying the anatomic significance of coronary artery stenosis [19]. The aorta part can be removed from the segmented coronary arteries for the goal of reducing undetermined image noise disturbance.…”