Rupture Risk Assessment of Cervical Spinal Manipulations on Carotid Atherosclerotic Plaque by a 3D Fluid-Structure Interaction Model.

Yili Chen,Qiming Liao,Xiaoyu Huang,Xuecheng Huang,Yikai Li,Yonghua Lao,Yang Chen,Shaoqun Zhang,Muhammad Shahbaz Yousaf

doi:10.1155/2021/8239326

Abstract

Method The FSI model, based on MRI data of an atherosclerosis patient, was used to simulate the deformations of the plaque and lumen during the process of two kinds of typical cSMT (the high-speed, low-amplitude spinal manipulation and the cervical rotatory manipulation). The biomechanical parameters were recorded, such as the highest wall shear stress (WSS), the maximum plaque wall stress (PWS), the wall tensile stress (Von mises stress, VWTS), and the strain. Result The max_WSS was 33.77 kPa in the most extensive deformation. The highest WSS region on the plaque surface was also the highest PWS region. The max_PWS in a 12% stretch was 55.11 kPa, which was lower than the rupture threshold. The max_VWTS of the cap in 12% stretch which approached the fracture stress level was 116.75 kPa. Moreover, the vessel's max_VWTS values in 10% and 12% stretch were 554.21 and 855.19 kPa. They were higher than the fracture threshold, which might cause media fracture. Meanwhile, the 7% stretched strain was 0.29, closed to the smallest experimental green strains at rupture. Conclusion The carotid arteries' higher stretch generated the higher stress level of the plaque. Cervical rotatory manipulation might cause plaque at a high risk of rupture in deformation after 12% stretch and more. Lower deformation of the plaque and artery caused by the high-speed, low-amplitude spinal manipulation might be safer.

Highlights

Cervical spinal manipulative therapy, as an effective treatment for neck pain and headaches, has been widely accepted [1]
There is still a controversy about whether Cervical spinal manipulative therapy (cSMT) could lead to a stroke in carotid atherosclerosis
Some therapists recommend that cSMT should not proceed in carotid atherosclerosis because of the risk of stroke

Summary

Introduction

Cervical spinal manipulative therapy (cSMT), as an effective treatment for neck pain and headaches, has been widely accepted [1]. According to a case report [2], in a high-risk stroke patient, cSMT could cause serious diseases such as a transient ischemic attack, paralysis, and shock. One of the major concerns for the safety of cSMT is the risk of stroke [3]. There is still a controversy about whether cSMT could lead to a stroke in carotid atherosclerosis. The rupture of plaque [4] caused most of the cerebral infarcti. The impacts of cSMT on carotid atherosclerotic plaque have not yet been clear cut. There is still safe hidden trouble between cSMT on carotid atherosclerotic plaque and rupture. Some therapists recommend that cSMT should not proceed in carotid atherosclerosis because of the risk of stroke. Others suggest that normative therapies are safer in the asymptomatic patient with stable plaque

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