Regions Of Low Shear Stress Research Articles

Computational model-based hemodynamic comparisons of traditional and modified idealized models of autologous radiocephalic fistula.

Autologous arteriovenous fistula (AVF) is a commonly used vascular access (VA) for hemodialysis, and hemodynamic changes are one of the main factors for its failure. To explore the effect of geometry on the hemodynamics in the AVF, a modified model is built with a gradual and smooth turn at the anastomosis and is compared with the traditional model, which has an abrupt sharp turn at the anastomisis. Transient computational fluid dynamics (CFD) simulations were performed for the comparison and analysis of the hemodynamic fields of the two models at different stages of the pulse cycle. The results showed that the low shear stress region and high oscillatory shear stress region in the modified AVF model coincided with regions of intimal hyperplasia that have been identified by previous studies. A comparison with the blood flow velocities measured in vivo was performed, and the error between the simulation results and the medical data was reduced by 22% in the modified model, which verifies the rationality and utility of the modified model.

Preparation and Application of Decanoic Acid/Arginine Hydrogels to a Transdermal Formulation.

We prepared a supramolecular hydrogel composed of decanoic acid and arginine (C10/Arg gel) and evaluated its application to a transdermal formulation. C10/Arg gel adjusted to pH 7 with 1 M NaOH aq or 1 M HCl aq provided a translucent hydrogel with a lamellar liquid crystal structure in the concentration region of decanoic acid ≥12% and arginine ≤9%. Rheological measurements showed that C10/Arg gel is a viscoelastic material with both solid and liquid properties, with elasticity being dominant over viscosity in the low shear stress region. The skin permeability of hydrocortisone (HC) and indomethacin (IM) from C10/Arg gels was investigated in vitro using hairless mouse skin and compared to control formulation drug suspensions (IM or HC) in water. The cumulative permeation amount of HC and IM from the C10/Arg gel at 10 h after application was approximately 16 and 11 times higher than that of the control, respectively. On the other hand, the flux of IM decreased with increasing arginine concentration, likely due to the acid-base interaction between Arg and IM in C10/Arg gel. Adequate drug skin permeation enhancement by C10/Arg gel requires optimizing the gel composition for each specific drug.

PI3KCIIα-Dependent Autophagy Program Protects From Endothelial Dysfunction and Atherosclerosis in Response to Low Shear Stress in Mice.

The ability to respond to mechanical forces is a basic requirement for maintaining endothelial cell (ECs) homeostasis, which is continuously subjected to low shear stress (LSS) and high shear stress (HSS). In arteries, LSS and HSS have a differential impact on EC autophagy processes. However, it is still unclear whether LSS and HSS differently tune unique autophagic machinery or trigger specific autophagic responses in ECs. Using fluid flow system to generate forces on EC and multiscale imaging analyses on ApoE-/- mice whole arteries, we studied the cellular and molecular mechanism involved in autophagic response to LSS or HSS on the endothelium. We found that LSS and HSS trigger autophagy activation by mobilizing specific autophagic signaling modules. Indeed, LSS-induced autophagy in endothelium was independent of the class III PI3K (phosphoinositide 3-kinase) VPS34 (vacuolar sorting protein 34) but controlled by the α isoform of class II PI3K (phosphoinositide 3-kinase class II α [PI3KCIIα]). Accordingly, reduced PI3KCIIα expression in ApoE-/- mice (ApoE-/-PI3KCIIα+/-) led to EC dysfunctions associated with increased plaque deposition in the LSS regions. Mechanistically, we revealed that PI3KCIIα inhibits mTORC1 (mammalian target of rapamycin complex 1) activation and that rapamycin treatment in ApoE-/-PI3KCIIα+/- mice specifically rescue autophagy in arterial LSS regions. Finally, we demonstrated that absence of PI3KCIIα led to decreased endothelial primary cilium biogenesis in response to LSS and that ablation of primary cilium mimics PI3KCIIα-decreased expression in EC dysfunction, suggesting that this organelle could be the mechanosensor linking PI3KCIIα and EC homeostasis. Our data reveal that mechanical forces variability within the arterial system determines EC autophagic response and supports a central role of PI3KCIIα/mTORC1 axis to prevent EC dysfunction in LSS regions.

Knockdown of TRPV2 inhibits the migration of RAW264.7 cells toward low fluid shear stress region.

Our previous studies have demonstrated that macrophages (RAW264.7) have a special ability for sensing the gradient of fluid shear stress (FSS) and migrate toward the low-FSS region. However, the molecular mechanism regulating this phenomenon is still unclear. In this study, we examined the transcriptome genes in RAW264.7 cells, MC3T3-E1 osteoblasts, mesenchymal stem cells, canine renal epithelial cells, and periodontal ligament cells. The expression levels of genes related to cell migration, force transfer, and force sensitivity in the Ca2+ signaling pathway were analyzed. We observed that the transient receptor potential cation channel type 2 (TRPV2) was highly expressed in RAW264.7 cells. Furthermore, we used lentiviral transfection to knockdown TRPV2 expression in RAW264.7 cells and studied the effect of TRPV2 on the migration of RAW264.7 cells under a gradient FSS field. The results showed that compared with normal cells, TRPV2-knockdown cells had impaired ability for sensing FSS gradient to migrate toward the low-FSS region and lower intracellular calcium response to FSS stimulation. This study may reveal the molecular mechanism of regulating the directional migration of macrophages under a gradient FSS field.

Hostile Hemodynamics in Distal Stent Graft-Induced New Entry Prior to Aortic Rupture: A Comparison of Transient versus Steady-State CFD Simulations.

Computational fluid dynamics (CFD) simulations model blood flow in aortic pathologies. The aim of our study was to understand the local hemodynamic environment at the site of rupture in distal stent graft-induced new entry (dSINE) after frozen elephant trunk with a clinically time efficient steady-flow simulation versus transient simulations. Steady-state simulations were performed for dSINE, prior and after its development and prior to aortic rupture. To account for potential turbulences due geometric changes at the dSINE location, Reynolds-averaged Navier-Stokes equations with the realizable k-ε model for turbulences were applied. Transient simulations were performed for comparison. Hemodynamic parameters were assessed at various locations of the aorta. Post-dSINE, jet-like flow due to luminal narrowing was observed which increased prior to rupture and resulted in focal neighbored regions of high and low wall shear stress (WSS). Prior to rupture, aortic diameter at the rupture site increased lowering WSS at the entire aortic circumference. Concurrently, WSS and turbulence increased locally above the entry tear at the inner aortic curvature. Turbulent kinetic energy and WSS elevation in the downstream aorta demonstrated enhanced stress on the native aorta. Results of steady-state simulations were in good qualitative agreement with transient simulations. Steady-flow CFD simulations feasible at clinical time scales prior to aortic rupture reveal a hostile hemodynamic environment at the dSINE rupture site in agreement with lengthy transient simulations. Consequently, our developed approach may be of value in treatment planning where a fast assessment of the local hemodynamic environment is essential.

Prediction of vortex structures in pulsatile flow through S-bend arterial geometry with different stenosis levels

Arterial stenosis poses a high cardiovascular risk, and clinical intervention is needed when these stenoses grow beyond a specific limit. The study of vortex dynamics in these diseased arteries can be beneficial to understand its severity. Therefore, in the present work, we have investigated the flow structures in an S-bend arterial geometry with different levels of stenosis using a sharp interface immersed boundary method. We have observed an onset of Kelvin-Helmholtz-type vortex roll-up for higher degrees of stenoses. Fluctuations in the wall shear stress are observed for higher stenosis degrees. However, these fluctuations depend on the position and length of the stenosis. Newtonian and non-Newtonian Carreau fluids predict similar vortex structures, although minor differences in the Kelvin-Helmholtz vortex structures and associated fluctuations are observed in the diastolic phase. The Newtonian fluid predicts a slightly longer low time-averaged wall shear stress (≤0.5 Pa) region immediately after the stenosis compared with the Carreau fluid in the 58 % blockage S-bend artery.

Biphasic flow dynamics and polarized mass transportation in branched hepatic sinusoids.

In fatty liver diseases, such as liver fibrosis and liver cirrhosis, blood flow in hepatic sinusoids, an elementary building block of the liver lobule, tends to bypass through collateral vessels inside sinusoids and presents distinct sinusoidal flows compared to normal physiological flows. It remains unclear in those flow characteristics in branched sinusoids and the correlation of pathological flows with liver lesions, mainly due to the difficulty of direct hemodynamics measurements in the sinusoids. Here, we developed a dual-branched theoretical model of hepatic sinusoidal flow to elucidate the relevant flow dynamics and mass transport. Numerical simulations, based on the lattice Boltzmann method, indicated that the flow velocity distribution in hepatic sinusoids is mainly dominated by endothelium permeability and presents a non-monotonic variation with the permeability at the fusion segment of these branched sinusoids. Flow-induced shear stress on the endothelium at the side of the Disse space exhibited a biphasic pattern, yielding a low shear stress region at the junctional site. Meanwhile, a highly polarized distribution of lipoproteins concentration was also presented at the low shear stress region, indicating a localized accumulation of typical hepatic serum proteins. Thus, this work provides the basic understanding of blood flow features and mass transport regulations in branched hepatic sinusoids.

High Fluid Shear Stress Inhibits Cytokine-Driven Smad2/3 Activation in Vascular Endothelial Cells.

Background Atherosclerosis occurs preferentially in regions of low and disturbed fluid shear stress (FSS) but is limited in regions of high laminar FSS as a result of inhibition of endothelial inflammatory pathways. Recent work has identified endothelial to mesenchymal transition (EndMT) driven by TGFβ2 (transforming growth factor beta 2)-Smad2/3 (mothers against decapentaplegic) signaling as a critical component of atherogenesis. However, interactions between FSS and EndMT in this context have not been investigated. Methods and Results Endothelial cells were treated with TGFβ2 and inflammatory cytokines (interleukin 1β and tumor necrosis factor alpha) with or without high FSS in a parallel plate flow chamber. Smad2/3 nuclear translocation and target gene expression, assayed by immunofluorescence and quantitative polymerase chain reaction, revealed that high FSS blocked the Smad2/3-EndMT pathway. In vivo, mice were injected with TGFβ2 and inflammatory cytokines, then regions of the aorta under low versus high FSS were examined. TGFβ2 and inflammatory cytokine treatment stimulated Smad2/3 nuclear translocation and target gene expression predominantly in regions of low FSS with little effect in regions of high FSS. Conclusions High FSS inhibits endothelial Smad2/3 activation and EndMT in response to inflammatory mediators, resulting in selective EndMT at athero-susceptible, low FSS regions of arteries.

Oridonin attenuates low shear stress-induced endothelial cell dysfunction and oxidative stress by activating the nuclear factor erythroid 2-related factor 2 pathway

BackgroundAtherosclerosis (AS) is the primary cause of cardiovascular disease and the incidence is extremely common; however, there are currently few drugs that can effectively treat AS. Although oridonin has been widely used to treat inflammation and cancer for numerous years, to the best of our knowledge, its protective effect against AS has not been reported. Therefore, the present study aimed to investigate whether oridonin attenuated AS.MethodsBy using text mining, chemometric and chemogenomic methods, oridonin was predicted to be a beneficial agent for the treatment of AS. A parallel flow chamber was used to establish a low shear stress (LSS)-induced endothelial cell (EC) dysfunction model. Briefly, ECs were exposed to 3 dyn/cm2 LSS for 30 min and subsequently treated with oridonin or transfected with a small interfering RNA (siRNA) targeting nuclear factor erythroid 2-related factor 2 (NRF2). Reactive oxygen species (ROS), superoxide dismutase (SOD), malondialdehyde (MDA), glutathione (GSH) and glutathione disulfide (GSSG) in EA.hy926 cells were analyzed to determine the level of oxidative stress. The nitric oxide (NO) levels and mRNA expression levels of endothelial NO synthase (eNOS), endothelin-1 (ET-1) and prostaglandin synthase (PGIS) in EA.hy926 cells were analyzed to determine EC dysfunction. Furthermore, the mRNA and protein expression levels of NRF2 were analyzed using reverse transcription-quantitative PCR and western blot. In addition, zebrafish were fed with a high-cholesterol diet to establish a zebrafish AS model, which was used to observe lipid accumulation and inflammation under a fluorescence microscope.ResultsWe found LSS led to oxidative stress and EC dysfunction; this was primarily indicated through the significantly decreased SOD and GSH content, the significantly increased MDA, GSSG and ROS content, the upregulated mRNA expression levels of ET-1, and the downregulated NO levels and mRNA expression levels of eNOS and PGIS in ECs. Notably, oridonin could improve LSS-induced oxidative stress and EC dysfunction, and the effects of oridonin were reversed by the transfection with NRF2 siRNA. Oridonin also attenuated lipid accumulation and neutrophil recruitment at the LSS regions in the zebrafish AS model.ConclusionsIn conclusion, the results of the present study suggested that oridonin may ameliorate LSS-induced EC dysfunction and oxidative stress by activating NRF2, thereby attenuating AS.

Computational Fluid Dynamics Model of Continuous-Flow Total Artificial Heart: Right Pump Impeller Design Changes to Improve Biocompatibility.

Cleveland Clinic is developing a continuous-flow total artificial heart (CFTAH). This novel design operates without valves and is suspended both axially and radially through the balancing of the magnetic and hydrodynamic forces. A series of long-term animal studies with no anticoagulation demonstrated good biocompatibility, without any thromboemboli or infarctions in the organs. However, we observed varying degrees of thrombus attached to the right impeller blades following device explant. No thrombus was found attached to the left impeller blades. The goals for this study were: (1) to use computational fluid dynamics (CFD) to gain insight into the differences in the flow fields surrounding both impellers, and (2) to leverage that knowledge in identifying an improved next-generation right impeller design that could reduce the potential for thrombus formation. Transient CFD simulations of the CFTAH at a blood flow rate and impeller rotational speed mimicking in vivo conditions revealed significant blade tip-induced flow separation and clustered regions of low wall shear stress near the right impeller that were not present for the left impeller. Numerous right impeller design variations were modeled, including changes to the impeller cone angle, number of blades, blade pattern, blade shape, and inlet housing design. The preferred, next-generation right impeller design incorporated a steeper cone angle, a primary/splitter blade design similar to the left impeller, and an increased blade curvature to better align the incoming flow with the impeller blade tips. The next-generation impeller design reduced both the extent of low shear regions near the right impeller surface and flow separation from the blade leading edges, while maintaining the desired hydraulic performance of the original CFTAH design.

A Hemodynamic Analysis of the Thrombosis Within Occluded Coronary Arterial Fistulas With Terminal Aneurysms Using a Blood Stasis Model.

Objective: The aim of this study is to numerically evaluate thrombosis risk within occluded coronary arterial fistulas (CAF) with terminal aneurysms, and provide guidance in choosing occlusion positions, with clinical observations as reference. Method: Four patients with CAF were studied, with different occlusion positions in actual treatments. Hemodynamics simulations were conducted, with blood residue predicted using the blood stasis model. Three types of models (untreated model, aneurysm-reserved model and aneurysm-removed model) were studeid for each patient. Four metrics, i.e., proportion of high oscillatory shear index (OSI), area of high OSI, old blood volume fraction (OBVF)) and old blood volume (OBV) was obtained to distinguish the thrombosis risk of different treatments (proximal or distal occlusion), comparing with the follow-up CTA. Results: For all the postopertive models, the high OBVF, high OSI(>0.3) and low time-averaged wall shear stress (TAWSS) regions were mainly at the distal fistula, indicating these regions were prone to thrombosis. The regions where blood residue remains are roughly regions of high OSI, corresponding well with clinical observations. In contrast, TAWSS failed to distinguish the difference in thrombosis risk. Absolute values (area of high OSI, OBV) can better reflect the degree of thrombosis risk between treatment types compared with percentage values (proportion of high OSI, OBVF). By comparing with the actual clinical treatments and observations, the OBV is superior to the area of high OSI in determining treatment type. Conclusion: The OBV, a volumetric parameter for blood stasis, can better account for the CAF thrombosis and reflect the degree of blood stasis compared with OSI or TAWSS, is a more appropriate metric for thrombosis in the fistula. Together with morphological parameters, the OBV could guide clinicians to formulate more appropriate surgical plans, which is of great significance for the preoperative evaluation and treatment prognosis of CAF patients.

Investigation of coronary artery tortuosity with atherosclerosis: A study on predicting plaque rupture and progression

This study investigated the effects of different patterns of coronary artery tortuosity (CAT) on the stress concentration of the plaques and the blood flow pattern inside an atherosclerotic artery to predict the risk of plaque rupture and progression. Four different loadings of the coronary artery, including pulsatile blood pressure as well as one-end twist around the artery axis at blood pressures of 74, 100, and 120 mmHg were considered. No study has addressed bent and twist buckling of an atherosclerotic artery considering pulsatile flow (for bent buckling), fluid-solid interaction, and different geometrical parameters of the plaque. The results showed that C-shape tortuosity under pulsatile blood pressure increased the maximum principal stress (MPS) by 10% to 58%, depending on plaque geometry. Application of one end twist, which led to tortuosity in the middle of the artery, increased MPS with rotation angle (e.g., an approximately 2-fold increase was observed for an internal pressure of 74 mmHg). At the moment of maximal transverse deformation, regions of low wall shear stress (WSS < 0.4 Pa) were formed after the tortuosity at the interior wall of the artery, making it prone to the formation of plaque. However, maximum WSS, which occurred at the stenotic region, will make the plaques more prone to rupture. The most influential parameters of plaque geometry on the amount of tortuosity, MPS, and WSS are the stenosis ratio, lipid core angle of 180°, plaque length, and fibrous cap thickness. Furthermore, the effect of mechanical properties of blood on WSS is studied.

Aneurysm Wall Enhancement Is Associated With Decreased Intrasaccular IL-10 and Morphological Features of Instability.

High-resolution vessel wall imaging plays an increasingly important role in assessing the risk of aneurysm rupture. To introduce an approach toward the validation of the wall enhancement as a direct surrogate parameter for aneurysm stability. A total of 19 patients harboring 22 incidental intracranial aneurysms were enrolled in this study. The aneurysms were dichotomized according to their aneurysm-to-pituitary stalk contrast ratio using a cutoff value of 0.5 (nonenhancing<0.5; enhancing≥0.5). We evaluated the association of aneurysm wall enhancement with morphological characteristics, hemodynamic features, and inflammatory chemokines directly measured inside the aneurysm. Differences in plasma concentration of chemokines and inflammatory molecules, morphological, and hemodynamic parameters were analyzed using the Welch test or Mann-Whitney U test. The concentration ΔIL-10 in the lumen of intracranial aneurysms with low wall enhancement was significantly increased compared to aneurysms with strong aneurysm wall enhancement (P=.014). The analysis of morphological and hemodynamic parameters showed significantly increased values for aneurysm volume (P=.03), aneurysm area (P=.044), maximal diameter (P=.049), and nonsphericity index (P=.021) for intracranial aneurysms with strong aneurysm wall enhancement. None of the hemodynamic parameters reached statistical significance; however, the total viscous shear force computed over the region of low wall shear stress showed a strong tendency toward significance (P=.053). Aneurysmal wall enhancement shows strong associations with decreased intrasaccular IL-10 and established morphological indicators of aneurysm instability.

Importance of Non-Newtonian Modeling of Blood Flow for Calcified Aortic Valves: Relevance to Sub-Clinical Thrombosis

Objective: The Newtonian assumption for blood has often been applied for aortic valve studies where high shear rates can be seen on the ventricularis side. However, in the presence of calcifications this assumption is suspect due to large flow disturbances, especially on the fibrosa side. Regions of low wall shear stress (WSS) have been known to lead to thrombogenesis in the cardiovascular system, and thus accurate blood flow modeling is required to predict these locations. This study looked at the applicability of a Newtonian and non-Newtonian, Carreau, model for blood on a healthy and calcified aortic valve geometry. Methods: A reconstructed human aortic heart valve from an 82-year old patient at the early diastolic phase was commercially acquired (Valve - 012 - Heart Print catalog, Materialize Inc., Plymouth MI). Inlet velocity of 1 cm/s was prescribed and an 80-mmHg pressure condition for the outlet boundary condition. Fluent (ANSYS Inc, Canonsburg, PA) was used for solving the unsteady Navier-Stokes equations. Combinations of a healthy or calcified valve and a Newtonian or a non-Newtonian model were then simulated. Results: WSS showed little difference between Newtonian and non-Newtonian models in the healthy valve (Figure 1A and Figure 1B). However, there was an underestimation of WSS in the calcified case using the Newtonian model compared to non-Newtonian (Figure 1C and Figure 1D) in certain core leaflet regions. Conclusions: The Newtonian assumption can be used for modeling blood flow of a healthy aortic valve, but a non-Newtonian model must be used in cases of valve disease, such as severely calcified aortic valves. These irregularities affect determining WSS where a few dynes/cm2 mark the difference between regions being susceptible to potential thrombus or not. Figure 1. Results on the fibrosa side of the aortic valve A) WSS using a Newtonian model on a healthy valve. B) WSS using a non-Newtonian, Carreau, model on a healthy valve. C) WSS using a Newtonian model on calcified valve. D) WSS using a non-Newtonian, Carreau, model on a calcified valve

Hemodynamic Changes in an Actively Rupturing Abdominal Aortic Aneurysm

Computational fluid dynamics were used to assess hemodynamic changes in an actively rupturing abdominal aortic aneurysm (AAA) over a 9-day period. Active migration of contrast from the lumen into the thickest region of intraluminal thrombus (ILT) was demonstrated until it ultimately breached the adventitial layer. Four days after symptom onset, there was a discrete disruption of adventitial calcium with bleb formation at the site of future rupture. Rupture occurred in a region of low wall shear stress and was associated with a marked increase in AAA diameter from 6.6 to 8.4 cm. The cross-sectional area of the flow lumen increased across all time points from 6.28 to 12.08 cm². The increase in luminal area preceded the increase in AAA diameter and was characterized by an overall deceleration in recirculation flow velocity with a coinciding increase in flow velocity penetrating the ILT. We show that there are significant hemodynamic and structural changes in the AAA flow lumen in advance of any appreciable increase in aortic diameter or rupture. The significant increase in AAA diameter with rupture suggests that AAA may actually rupture at smaller sizes than those measured on day of rupture. These findings have implications for algorithms the predict AAA rupture risk.

Fluid\u2013structure interactions (FSI) based study of low-density lipoproteins (LDL) uptake in the left coronary artery

The purpose of this study is to compare the effect of the different physical factors on low-density lipoproteins (LDL) accumulation from flowing blood to the arterial wall of the left coronary arteries. The three-dimensional (3D) computational model of the left coronary arterial tree is reconstructed from a patient-specific computed tomography angiography (CTA) image. The endothelium of the coronary artery is represented by a shear stress dependent three-pore model. Fluid–structure interaction (FSI) based numerical method is used to study the LDL transport from vascular lumen into the arterial wall. The results show that the high elastic property of the arterial wall decreases the complexity of the local flow field in the coronary bifurcation system. The places of high levels of LDL uptake coincide with the regions of low wall shear stress. In addition, hypertension promotes LDL uptake from flowing blood in the arterial wall, while the thickened arterial wall decreases this process. The present computer strategy combining the methods of coronary CTA image 3D reconstruction, FSI simulation, and three-pore modeling was illustrated to be effective on the simulation of the distribution and the uptake of LDL. This may have great potential for the early prediction of the local atherosclerosis lesion in the human left coronary artery.

Three-Dimensional Numerical Simulations and Antifouling Mechanism of Microorganisms on Microstructured Surfaces

As marine biofouling seriously affects the development and utilization of oceans, the antifouling technology of microstructured surface has become a research hotspot due to its green and environmentally friendly advantages. In the present research, the motion models of microorganisms on the surfaces of five rectangular micropits, in co-current and counter-current flow direction, were established. Dynamic mesh technology was used to simulate the movements of microorganisms with different radii in the near-wall area, and the fluid kinematics and shear stress distributions in different-sized micropits were compared. Furthermore, moving microorganisms were included in the three-dimensional microstructure model to achieve the real situation of biofouling. Simulation results revealed that the vortex flow velocity in the micropits increased with the increase of the inlet flow velocity and the existence of the vortex flow effectively reduced the formation of conditioning layers in the micropits. In the downstream and countercurrent directions, the average shear stresses on the wall decreased with the increase of the micropit depth and width, and the shear stress on the inner wall of the Mp1 micropit (a patterned surface arranged with cubes of 2 µm × 2 µm × 2 µm) was found to be the largest. A low shear stress region with a low flow velocity was formed around microorganisms in the process of approaching the microstructured surface. The shear stress gradient of micro-ridge steps increased with the approach of microorganisms, indicating that microridge edges had a better effect on reducing microbial attachment.

The influence of inlet velocity profile on predicted flow in type B aortic dissection

In order for computational fluid dynamics to provide quantitative parameters to aid in the clinical assessment of type B aortic dissection, the results must accurately mimic the hemodynamic environment within the aorta. The choice of inlet velocity profile (IVP) therefore is crucial; however, idealised profiles are often adopted, and the effect of IVP on hemodynamics in a dissected aorta is unclear. This study examined two scenarios with respect to the influence of IVP—using (a) patient-specific data in the form of a three-directional (3D), through-plane (TP) or flat IVP; and (b) non-patient-specific flow waveform. The results obtained from nine simulations using patient-specific data showed that all forms of IVP were able to reproduce global flow patterns as observed with 4D flow magnetic resonance imaging. Differences in maximum velocity and time-averaged wall shear stress near the primary entry tear were up to 3% and 6%, respectively, while pressure differences across the true and false lumen differed by up to 6%. More notable variations were found in regions of low wall shear stress when the primary entry tear was close to the left subclavian artery. The results obtained with non-patient-specific waveforms were markedly different. Throughout the aorta, a 25% reduction in stroke volume resulted in up to 28% and 35% reduction in velocity and wall shear stress, respectively, while the shape of flow waveform had a profound influence on the predicted pressure. The results of this study suggest that 3D, TP and flat IVPs all yield reasonably similar velocity and time-averaged wall shear stress results, but TP IVPs should be used where possible for better prediction of pressure. In the absence of patient-specific velocity data, effort should be made to acquire patient’s stroke volume and adjust the applied IVP accordingly.

Macrophage accumulation within coronary arterial wall in diabetic patients with acute coronary syndrome: a study with in-vivo intravascular imaging modalities

Background and aimsMacrophage accumulation in arteriosclerotic plaque of coronary arteries is involved in plaque destabilization. Atherosclerosis has been known to be progressive in patients with type 2 diabetes mellitus (DM). This study compared the features of 3-dimensional (3D) spatial distribution of macrophage accumulation within coronary artery wall between acute coronary syndrome (ACS) patients with DM (n = 20) and those without (non-DM, n = 20) by using intravascular ultrasound (IVUS) and optical coherence tomography (OCT).MethodsThe OCT-derived macrophage accumulation was measured within the proximal left anterior-descending artery. This measurement was performed for the whole vessel segment of interest, higher shear stress region (flow divider side) and lower shear stress region (the opposite side).ResultsNormalized macrophage accumulation per unit length of the whole segment of interest was significantly larger in ACS patients with DM than without. In non-DM patients, macrophage density per IVUS-derived plaque volume was significantly higher in high shear stress region compared to low shear stress region, however, there was no significant difference between the two regions in DM patients. The macrophage density in the low shear stress region was significantly higher in the DM group than in the non-DM group. A multivariate analysis showed that the presence of DM was a major determinant for macrophage distribution.ConclusionsMacrophage accumulation was more abundant and homogeneous within coronary arterial wall in DM patients with ACS compared to non-DM patients, suggesting that plaque destabilization may occur more widely throughout coronary wall in DM patients.

A Hemodynamic Mechanism Correlating with the Initiation of MCA Bifurcation Aneurysms.

Previous studies have reported that MCA bifurcation aneurysms usually emerge on inclined bifurcations; however, the reason is unclear. We designed this study to explore hemodynamic mechanisms that correlate with the initiation of MCA bifurcation aneurysms. Fifty-four patients with unilateral MCA bifurcation aneurysms and 54 control patients were enrolled in this study after propensity score matching, and their clinical and CTA data were collected. We extracted the morphologic features of aneurysmal MCA bifurcations to build a simplified MCA bifurcation model and performed a computational fluid dynamics analysis. The presence of MCA aneurysms correlated with smaller parent-daughter angles of MCA bifurcations (P < .001). Aneurysmal MCA bifurcations usually presented with inclined shapes. The computational fluid dynamics analysis demonstrated that when arterial bifurcations became inclined, the high-pressure regions and low wall shear stress regions shifted from the apexes of the arterial bifurcations to the inclined daughter arteries, while the initial sites of MCA bifurcation aneurysms often overlapped with the shifted high-pressure regions and low wall shear stress regions. Our results suggest that the initiation of MCA bifurcation aneurysms may correlate with shifts of high-pressure regions and low wall shear stress regions that occur on inclined MCA bifurcations.