Influence of morphology and hemodynamics on thrombosis in kawasaki disease patients

Abstract

Kawasaki Disease (KD) patients with co-occurrent coronary artery aneurysms (CAAs) are prone to thrombosis. This study explores the thrombotic influence of morphology and hemodynamics in KD patients with CAAs. Patient-specific computed tomography angiogram images of 9 patients were used to rebuild coronary models (including 23 aneurysms; 10 in thrombosed group, and 13 in non-thrombosed group) and perform computational simulations to obtain the hemodynamic parameters. The thrombosed and non-thrombosed groups were compared in terms of six parameters, namely, the maximum diameter (Dmax), aspect ratio (Rl/d), shape, time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT). The results showed that: (1) In thrombosed aneurysms, there were several vortex structures (eddy zone), of which the position changed continuously in a cardiac cycle. In non-thrombosed aneurysms, the streamlines showed a large streaming zone. (2) Abnormal hemodynamic areas of aneurysms with thrombosis tended to appear in the same region (especially the proximal and near myocardial side of aneurysms). (3) In the non-thrombosed group, there was a correlation between the morphological and hemodynamic parameters. In thrombosed aneurysms, the flow pulsatility has a significant impact on the flow pattern. The thrombosed coronary aneurysms exhibited more risk factors and the co-location of hemodynamic abnormalities was consistent with the position of thrombosis. A score of risk factors could provide the thrombotic information of coronary aneurysms, which might be helpful for long-term clinical management of KD patients.