Angiographic methods for the study of fluid mechanical factors in atherogenesis

The purpose of this thesis is to investigate the feasibility of using angiographic methods to study, in vivo, fluid mechanical phenomena believed to influence the development and localization of atherosclerotic lesions, in particular, separated flow. This involved developing a method to recognize separated flow by digital analysis of cineangiography films, testing this method both with model measurements and in a clinical material, and a detailed analysis of certain methodological problems. In addition, methods have been developed to measure the tortuosity of arteries, a phenomenon which may, according to fluid mechanical theory, promote the occurrence of separated flow. In a glass model of an arterial bifurcation, a pump generated a pulsatile flow resembling that in large arteries. Using LDV (laser Doppler velocimetry) as a reference method, three velocity profiles in the symmetry plane of the model were recorded. During diastole, extensive separated flow was demonstrated in the larger branch of the bifurcation. The flow was then cineradiographed during injection of contrast medium, and the image sequence was transferred to an image analysis workstation. Treating the image sequence as a set of time-intensity curves, time parameters representing the arrival time of the contrast agent were computed. In the resulting parametric images, zones of delayed filling were identified and found to correspond to the separated flow. Viscosity was measured for seven radiographic contrast media and, as expected, the highest values were found for the largest molecules. For iohexol and ioxaglate, which were studied in detail, a linear relation to temperature and a quadratic relation to concentration were found. Whole-blood viscosity was measured for 5 healthy volunteers at high and low shear rates, before and after mixing with contrast agents in varying proportions. At low shear, viscosity decreased, while at high shear, it increased with increasing contrast concentration. The conclusion was that modern contrast media, despite their higher viscosity, seem to affect blood rheology less than older agents. In a study of the imaging characteristics of the digitization equipment for cinefilms, the resolution proved comparable to that of an entirely digital system, while the noise level was higher. Algorithms for the correction of variations in exposure and geometric distortion are also presented. The method for analysis of cinefilms, tried in the model study, was applied, with slight modifications, to a material of 26 patients with hyperlipidemia and slight or moderate atherosclerosis.(ABSTRACT TRUNCATED AT 400 WORDS)