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Role of Occlusion Position in Coronary Artery Fistulas with Terminal Aneurysms: A Hemodynamic Perspective
Haoyao Cao1, Da Li1, Yan Li1
1Department of Applied Mechanics, Sichuan University, No. 24, South Section of First Ring Road, Chengdu, 610065, Sichuan, People's Republic of China.
Insights
Proximal occlusion of coronary arterial fistulas (CAFs) by removing aneurysms may reduce thrombosis risk. This surgical approach improves hemodynamics and alleviates blood-stealing phenomena, potentially preventing myocardial infarction.
Area of Science:
- Cardiovascular Surgery
- Medical Imaging
- Hemodynamics
Background:
- Coronary arterial fistulas (CAFs) can lead to thrombosis, causing angina and myocardial infarction.
- Understanding the impact of occlusion position on CAF thrombosis risk is crucial for patient management.
Purpose of the Study:
- To evaluate how the occlusion position in CAFs with terminal aneurysms influences hemodynamic risk stratification for thrombosis.
- To compare hemodynamic changes and clinical outcomes between different CAF occlusion strategies.
Main Methods:
- Twelve patient-specific CAF models were created from computed tomography angiogram (CTA) data.
- Models were grouped into preserved, distal occlusion (aneurysm-reserved), and proximal occlusion (aneurysm-removed) groups.
- Hemodynamic analysis was performed and compared with clinical follow-up data.
Main Results:
- Significant differences in fistula hemodynamics were observed post-treatment.
- Aneurysm-removed occlusions demonstrated improved resolution of CAF blood-stealing.
- Proximal occlusion alleviated flow disturbances and reduced areas of high oscillatory shear index (OSI), correlating with observed thrombosis regions.
Conclusions:
- Proximal occlusion, involving aneurysm removal, appears to reduce post-surgical thrombosis risk in CAFs.
- Further large-cohort studies are needed to validate the efficacy of this approach in preventing thrombosis.
Purpose:
Thrombosis within an occluded coronary arterial fistula (CAF) may cause angina and myocardial infarction. This study aims to estimate how the occlusion position of CAFs with terminal aneurysm affects the risk stratification of thrombosis in the fistula in terms of hemodynamics.
Methods:
Twelve CAF models were reconstructed based on patient-specific computed tomography angiogram (CTA) images. They were classified into three groups: preserved group (untreated fistula), aneurysm-reserved group (occluded at the fistula terminal: distal occlusion) and aneurysm-removed group (occluded before the aneurysm: proximal occlusion). Hemodynamics results were analyzed and compared with the clinical follow-up results.
Results:
The results showed that: (1) Hemodynamic patterns within the fistula before and after treatment were significantly different among patients. (2) Aneurysm-removed occlusions showed better improvements with respect to the CAF blood-stealing phenomena. (3) Irrespective of whether aneurysms were removed or not, a disturbed flow pattern was observed. Areas having high OSI and low TAWSS were present in the post-occluded CAFs. The removal of the aneurysm, however, would alleviate the flow disturbance, and decrease the proportion of the area of OSI > 0.3. (4) The thrombosis region spotted in the follow-up patient CTAs was consistent with the computed high OSI area.
Conclusions:
A proximal occlusion, namely, removing the aneurysm of the CAF, may help in reducing the risk of thrombosis after surgery. However, follow-up studies with a larger cohort should be carried out to test and verify this speculation in the future.
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