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High Middle Cerebral Artery Wall Shear Stress in Branch Atheromatous Disease: A Computational Fluid Dynamics Analysis
Yorito Hattori1,2, Shuta Imada3, Ryo Usui1
1Department of Neurology, National Cerebral and Cardiovascular Center.
Insights
Computational fluid dynamics revealed higher wall shear stress (WSS) in patients with branch atheromatous disease (BAD) compared to small-vessel occlusion (SVO). Elevated WSS in the M1 segment is an independent risk factor for BAD, aiding in diagnosis.
Area of Science:
- Neurology
- Biomedical Engineering
- Cardiovascular Research
Background:
- Branch atheromatous disease (BAD) causes early neurological deterioration, with unclear underlying mechanisms.
- Abnormal wall shear stress (WSS) is linked to endothelial dysfunction and plaque instability.
- Distinguishing BAD from small-vessel occlusion (SVO) is crucial for understanding perforating artery disease.
Purpose of the Study:
- To investigate differences in WSS between BAD and SVO using computational fluid dynamics (CFD).
- To determine if CFD can identify WSS patterns associated with BAD.
- To explore the role of WSS as a risk factor for BAD.
Main Methods:
- A cross-sectional observational study included patients with acute neurological symptoms.
- Computational fluid dynamics (CFD) analyzed WSS and blood flow velocity in the M1 segment of the middle cerebral artery.
- Patients were selected based on the absence of major artery stenosis/occlusion via MRA and carotid ultrasonography.
Main Results:
- A significantly higher proportion of BAD patients (74.1%) exhibited a WSS ratio >1 compared to SVO patients (40.7%).
- Higher WSS in the ipsilesional M1 segment was an independent risk factor for BAD (aOR 4.38).
- Blood flow velocity in the M1 segment did not show an association with BAD.
Conclusions:
- Elevated M1 segment WSS, identified by CFD, is a risk factor for vulnerable plaque development in branch artery orifices.
- CFD analysis of WSS may serve as a valuable diagnostic tool for branch atheromatous disease (BAD).
- Understanding WSS dynamics can improve the diagnosis and management of BAD.
Aim:
Branch atheromatous disease (BAD), characterized by the occlusion of perforating branches near the orifice of a parent artery, often develops early neurological deterioration because the mechanisms underlying BAD remain unclear. Abnormal wall shear stress (WSS) is strongly associated with endothelial dysfunction and plaque growth or rupture. Therefore, we hypothesized that computational fluid dynamics (CFD) modeling could detect differences in WSS between BAD and small-vessel occlusion (SVO), both of which result from perforating artery occlusion/stenosis.
Methods:
This cross-sectional observational study included consecutive patients admitted to our institution within 7 days after symptom onset who met the following criteria: absence of stenosis/occlusion in the intracranial major arteries on brain magnetic resonance angiography (MRA) or extracranial carotid arteries on carotid ultrasonography. The WSS and blood flow velocity in the M1 segment of the middle cerebral artery were analyzed using CFD based on MRA.
Results:
The number of patients with a WSS ratio (ipsilesional/contralesional) of ＞1 was significantly higher in patients with BAD (n = 27) than in those with SVO (n = 27) [20 (74.1%) vs. 11 (40.7%), p = 0.013]. Higher WSS on ipsilesional M1 than on contralesional M1 was an independent risk factor for BAD (adjusted odds ratio 4.38, 95% confidence interval 1.29-14.82, p = 0.018). Blood flow velocity in the M1 segment was not associated with BAD.
Conclusions:
In patients with BAD, higher M1 segment WSS on CFD can be a risk factor for the development of vulnerable plaques in branch orifices. Moreover, the use of CFD may contribute to the diagnosis of BAD.
