Prediction of Long Term Restenosis Risk After Surgery in the Carotid Bifurcation by Hemodynamic and Geometric Analysis

Domanin, Maurizio; Gallo, Diego; Vergara, Christian; Biondetti, Pietro; Forzenigo, L.V.; Morbiducci, Umberto

doi:10.1007/s10439-019-02201-8

Cited by 25 publications

(34 citation statements)

References 41 publications

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“…Further details about the surgical cohort are reported elsewhere. 11,18 All patients were then submitted to Doppler ultrasound (DUS) follow-up at 3, 24 and 60 months. Cases of restenosis were defined by a peak systolic velocity (PSV) of > 130 cm/s as measured by DUS (an indicator of the presence of a diameter stenosis greater than 50%, 1 according to the European Carotid Stenosis Trial standard).…”

Section: Patient Population Datamentioning

confidence: 99%

“…Pre-CEA and Post-CEA Cohorts Magnetic resonance angiography (MRA) acquisitions were performed before and within a month after surgery to obtain the pre-CEA and post-CEA 3D geometry of the carotid bifurcations with a level set approach using the Vascular Modeling Toolkit software (VMTK, www.vmtk.org), as detailed elsewhere. 11,18 Blood was modelled as an incompressible homogeneous Newtonian fluid, 23,26 under laminar flow and rigid wall assumptions. 10,18 The governing equations of fluid motion were solved numerically using the finiteelement library LifeV (http://www.lifev.org) in discretized fluid domains discretized with tetrahedral meshes.…”

Section: Computational Hemodynamicsmentioning

confidence: 99%

“…To complement the WSS topological skeleton characterization, the luminal distribution of Time-Averaged Wall Shear Stress (TAWSS) magnitude along the cardiac cycle was also evaluated, as the exposure to low TAWSS values was previously linked to an increased long-term restenosis risk. 11 The exposure to low TAWSS values was quantified by the relative surface area exposed to TAWSS values below a threshold value, corresponding to the 20th percentile of the pooled TAWSS distribution of the healthy models in the CCA3-ICA5-ECA2 region. This variable is denoted as Low Shear Area (LSA).…”

Section: Wss Topological Skeleton Analysis and Quantitative Descriptionmentioning

confidence: 99%

“…Oscillatory WSS was not considered here as a previous investigation on the post-CEA cohort reported a not significant association with IMT. 11…”

Section: Wss Topological Skeleton Analysis and Quantitative Descriptionmentioning

confidence: 99%

“…For the purpose of contextualization of the results, the WSS topological skeleton analysis was (1) extended to a computational hemodynamics dataset of 46 ostensibly healthy carotid bifurcation models, and (2) complemented with the analysis of the exposure to low WSS, which was previously demonstrated to be directly associated to adverse vascular responses on the same post-CEA dataset adopted here. 11…”

Section: Introductionmentioning

confidence: 99%

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Wall Shear Stress Topological Skeleton Independently Predicts Long-Term Restenosis After Carotid Bifurcation Endarterectomy

et al. 2020

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Wall Shear Stress (WSS) topological skeleton, composed by fixed points and the manifolds linking them, reflects the presence of blood flow features associated to adverse vascular response. However, the influence of WSS topological skeleton on vascular pathophysiology is still underexplored. This study aimed to identify direct associations between the WSS topological skeleton and markers of vascular disease from real-world clinical longitudinal data of long-term restenosis after carotid endarterectomy (CEA). Personalized computational hemodynamic simulations were performed on a cohort of 13 carotid models pre-CEA and at 1 month after CEA. At 60 months after CEA, intima-media thickness (IMT) was measured to detect long-term restenosis. The analysis of the WSS topological skeleton was carried out by applying a Eulerian method based on the WSS vector field divergence. To provide objective thresholds for WSS topological skeleton quantitative analysis, a computational hemodynamic dataset of 46 ostensibly healthy carotid bifurcation models was considered. CEA interventions did not completely restore physiological WSS topological skeleton features. Significant associations emerged between IMT at 60 months follow-up and the exposure to (1) high temporal variation of WSS contraction/expansion (R2 = 0.51, p < 0.05), and (2) high fixed point residence times, weighted by WSS contraction/expansion strength (R2 = 0.53, p < 0.05). These WSS topological skeleton features were statistically independent from the exposure to low WSS, a previously reported predictor of long-term restenosis, therefore representing different hemodynamic stimuli and potentially impacting differently the vascular response. This study confirms the direct association between WSS topological skeleton and markers of vascular disease, contributing to elucidate the mechanistic link between flow disturbances and clinical observations of vascular lesions.

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Section: Patient Population Datamentioning

confidence: 99%

Section: Computational Hemodynamicsmentioning

confidence: 99%

Section: Wss Topological Skeleton Analysis and Quantitative Descriptionmentioning

confidence: 99%

“…Oscillatory WSS was not considered here as a previous investigation on the post-CEA cohort reported a not significant association with IMT. 11…”

Section: Wss Topological Skeleton Analysis and Quantitative Descriptionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Wall Shear Stress Topological Skeleton Independently Predicts Long-Term Restenosis After Carotid Bifurcation Endarterectomy

et al. 2020

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Investigation of hemodynamic markers for stenosis development

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Radulovic

Buick

2021

Engineering Reports

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Different hemodynamic markers for stenosis development are considered, assessed and compared. A recently proposed numerical approach is employed, where stenosis development is modeled based on the local hemodynamic conditions at the artery wall, determined using the lattice Boltzmann method. A range of hemodynamic markers, commonly associated in the literature with the progression of atherosclerosis, were considered. It was observed that using the oscillatory shear index, which is related to the wall shear stress oscillating from its mean direction, did not produce a realistic stenosis development. The other markers produced stenosis growth comparable with observations from the literature.

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Carotid Endarterectomy

Hara

Rai

2022

Advances and Technical Standards in Neurosurgery

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Prediction of Long Term Restenosis Risk After Surgery in the Carotid Bifurcation by Hemodynamic and Geometric Analysis

Cited by 25 publications

References 41 publications

Wall Shear Stress Topological Skeleton Independently Predicts Long-Term Restenosis After Carotid Bifurcation Endarterectomy

Wall Shear Stress Topological Skeleton Independently Predicts Long-Term Restenosis After Carotid Bifurcation Endarterectomy

Investigation of hemodynamic markers for stenosis development

Carotid Endarterectomy

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