Numerical modeling of residual type B aortic dissection: longitudinal analysis of favorable and unfavorable evolution

Residual type B aortic dissection was numerically investigated to highlight the contribution of biomechanical parameters to the pathology's evolution. Patient-specific geometries from cases involving both favorable and unfavorable evolution were modeled to assess their hemodynamic features. This original approach was supported by a longitudinal study confirming the association between morphological changes, hemodynamic features, adverse clinical outcomes, and CT-angioscan observations on the same patient. Comparing one patient with unfavorable evolution with one with favorable one, we identify potential biomechanical indicators predictive of unfavorable evolution: (i) a patent false lumen with a flow rate above 50% of inlet flow rate; (ii) high wall shear stress above 18 Pa at entry tears, and above 10 Pa at some regions of the false lumen wall; (iii) low time-averaged wall shear stress in distal false lumen below 0.5 Pa; (iv) vortical structure dynamics. Although these comparisons could only be conducted on 2 patients and need to be confirmed by a larger number of cases, our findings point to these hemodynamic markers as possible candidates for early evaluation of the pathology's evolution towards an unfavorable scenario. Graphical Abstract Correlation between hemodynamics index and thrombus initiation for unfavorable case. ET₂ and ET₃ are entry tear numbers 2 and 3 respectively. WSS is wall shear stress. TAWSS is time average shear stress.