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Comparison of left anterior descending coronary artery hemodynamics before and after angioplasty
S D Ramaswamy1, S C Vigmostad, A Wahle
1Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa 52242, USA.
Insights
Arterial motion significantly impacts coronary artery disease (CAD) hemodynamics. Intervention alters blood flow mechanics, reducing harmful shear stress and improving flow dynamics in the left anterior descending artery.
Area of Science:
- Cardiovascular Science
- Biomedical Engineering
- Medical Imaging
Background:
- Coronary artery disease (CAD) involves atherosclerosis, influenced by blood flow mechanics.
- Coronary arteries exhibit unique hemodynamic patterns due to cardiac motion.
- Understanding these hemodynamics is crucial for targeted atherosclerosis treatment.
Purpose of the Study:
- To investigate the effects of arterial motion and geometry on left anterior descending (LAD) artery hemodynamics.
- To compare pre- and post-intervention hemodynamic changes following clinical treatment for CAD.
Main Methods:
- 3D reconstruction of LAD segments at 10 cardiac phases using intravascular ultrasound (IVUS) and biplane angiography.
- Computational fluid dynamics (CFD) analysis with an arbitrary Lagrangian-Eulerian formulation.
- Quantification of arterial motion, wall shear stress (WSS), and oscillatory shear index (OSI).
Main Results:
- Post-intervention showed increased systolic arterial translation and reduced out-of-plane motion.
- Time-averaged axial WSS decreased significantly post-intervention (9.5 Pa to 3.53 Pa).
- Oscillatory shear stress was substantially reduced after intervention, indicating improved flow patterns.
Conclusions:
- Clinical intervention significantly alters LAD artery motion and hemodynamics.
- Reduced WSS and oscillatory shear stress post-intervention suggest a less atherogenic environment.
- CFD analysis integrating IVUS and angiography provides valuable insights into CAD progression and treatment effects.
Abstract:
Coronary artery disease (CAD) is characterized by the progression of atherosclerosis, a complex pathological process involving the initiation, deposition, development, and breakdown of the plaque. The blood flow mechanics in arteries play a critical role in the targeted locations and progression of atherosclerotic plaque. In coronary arteries with motion during the cardiac contraction and relaxation, the hemodynamic flow field is substantially different from the other arterial sites with predilection of atherosclerosis. In this study, our efforts focused on the effects of arterial motion and local geometry on the hemodynamics of a left anterior descending (LAD) coronary artery before and after clinical intervention to treat the disease. Three-dimensional (3D) arterial segments were reconstructed at 10 phases of the cardiac cycle for both pre- and postintervention based on the fusion of intravascular ultrasound (IVUS) and biplane angiographic images. An arbitrary Lagrangian-Eulerian formulation was used for the computational fluid dynamic analysis. The measured arterial translation was observed to be larger during systole after intervention and more out-of-plane motion was observed before intervention, indicating substantial alterations in the cardiac contraction after angioplasty. The time averaged axial wall shear stress ranged from -0.2 to 9.5 Pa before intervention compared to -0.02 to 3.53 Pa after intervention. Substantial oscillatory shear stress was present in the preintervention flow dynamics compared to that in the postintervention case.
