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Published on: July 19, 2016
Lesion Eccentricity Plays a Key Role in Determining the Pressure Gradient of Serial Stenotic Lesions: Results from a
L van de Velde1,2,3, E Groot Jebbink4,5, K Jain6
1Multi-Modality Medical Imaging M3i Group, TechMed Centre, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands. lennartvelde@gmail.com.
Insights
Serial arterial stenotic lesions can become hemodynamically significant, especially when eccentric. Even mild lesions may cause significant pressure gradients under high flow conditions, impacting arterial disease assessment.
Area of Science:
- Cardiovascular physiology
- Medical fluid dynamics
- Computational modeling
Background:
- Arterial disease frequently involves multiple stenotic lesions.
- Predicting the hemodynamic significance of multiple mild lesions is challenging.
Purpose of the Study:
- To assess the hemodynamic significance of idealized serial stenotic lesions.
- To simulate the interaction of multiple lesions using computational fluid dynamics.
Main Methods:
- Simulated blood flow in 34 serial lesions using SimVascular software.
- Investigated moderate (15 mL/s) and high (30 mL/s) flow rates.
- Modeled combinations of concentric and eccentric lesions with varying distances and eccentricities.
Main Results:
- Combined pressure gradients ranged from 3.8-7.7 mmHg (moderate flow) to 12.5-24.3 mmHg (high flow).
- Eccentricity doubled the pressure gradient compared to concentric lesions.
- Serial eccentric lesions at high flow often exceeded the sum of individual lesion gradients.
Conclusions:
- Lesion eccentricity significantly increases hemodynamic impact in both single and serial stenoses.
- Two non-significant 50% stenoses can collectively achieve hemodynamic significance under hyperemic conditions.
Purpose:
In arterial disease, the presence of two or more serial stenotic lesions is common. For mild lesions, it is difficult to predict whether their combined effect is hemodynamically significant. This study assessed the hemodynamic significance of idealized serial stenotic lesions by simulating their hemodynamic interaction in a computational flow model.
Materials And Methods:
Flow was simulated with SimVascular software in 34 serial lesions, using moderate (15 mL/s) and high (30 mL/s) flow rates. Combinations of one concentric and two eccentric lesions, all 50% area reduction, were designed with variations in interstenotic distance and in relative direction of eccentricity. Fluid and fluid-structure simulations were performed to quantify the combined pressure gradient.
Results:
At a moderate flow rate, the combined pressure gradient of two lesions ranged from 3.8 to 7.7 mmHg, which increased to a range of 12.5-24.3 mmHg for a high flow rate. Eccentricity caused an up to two-fold increase in pressure gradient relative to concentric lesions. At a high flow rate, the combined pressure gradient for serial eccentric lesions often exceeded the sum of the individual lesions. The relative direction of eccentricity altered the pressure gradient by 15-25%. The impact of flow pulsatility and wall deformability was minor.
Conclusion:
This flow simulation study revealed that lesion eccentricity is an adverse factor in the hemodynamic significance of isolated stenotic lesions and in serial stenotic lesions. Two 50% lesions that are individually non-significant can combine more often than thought to hemodynamic significance in hyperemic conditions.
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