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Hemodynamic Environments for the Progression of Carotid Stenosis: The NHO Carotid CFD Study
Shunichi Fukuda1, Yuji Shimogonya2, Aoi Watanabe1
1Department of Neurosurgery and (S.F., A.W., Y.Y., S.M., K.F., M.F.), National Hospital Organization Kyoto Medical Center, Japan.
Insights
Hemodynamic factors predict carotid stenosis progression. Lower time-averaged wall shear stress (WSS) and higher oscillatory shear index are linked to progression in moderate stenosis, while higher WSS and transverse WSS are linked in severe stenosis.
Area of Science:
- Cardiovascular Research
- Medical Imaging
- Biomedical Engineering
Background:
- Hemodynamic stress is crucial in atherosclerosis development.
- Predicting atherosclerosis progression solely by risk factors is challenging.
- Hemodynamic environments promoting stenosis progression are not fully understood, especially at the carotid bifurcation.
Purpose of the Study:
- To identify hemodynamic predictors of carotid stenosis progression.
- To investigate the role of specific hemodynamic metrics in atherosclerosis at the carotid bifurcation.
Main Methods:
- Prospective observational study analyzing 361 stenotic carotid arteries.
- Computational fluid dynamics (CFD) used for patient-specific arterial geometry and flow.
- Multivariate analysis compared hemodynamic metrics between stenosis progression and non-progression groups, controlling for known risk factors.
Main Results:
- In 30-55% stenosis, progression correlated with lower distal time-averaged wall shear stress (WSS) and higher oscillatory shear index (OSI).
- In 56-70% stenosis, progression linked to higher WSS and transverse WSS at the stenotic and distal sites.
- In 71-99% stenosis, progression associated with higher distal OSI.
Conclusions:
- Specific hemodynamic environments predict carotid stenosis progression at the bifurcation.
- Hemodynamic risk stratification for stenosis progression varies with stenosis severity.
- Integrating hemodynamic predictors with traditional risk factors may improve prediction accuracy for high-risk cases.
Background:
Hemodynamic stress plays an important role in the development of atherosclerosis. It is difficult to sufficiently predict the progression of atherosclerosis and consequent stenosis based on known risk factors alone. This may be partly because the hemodynamic environments that promote stenosis progression remain unclear. The carotid bifurcation is the preferred site of atherosclerosis. In this prospective observational study, we sought to identify hemodynamic predictors of carotid stenosis progression.
Methods:
Computational fluid dynamics analysis was performed using arterial geometry and flow velocity specific to individual patients. Hemodynamic metrics were compared by multivariate analysis between the presence or absence of stenosis progression, using known risk factors as confounding factors.
Results:
A total of 545 patients were enrolled, and 361 stenotic arteries in 313 patients were analyzed, 38 of which had progressive stenosis. Among the carotid arteries with 30% to 55% area stenosis, those with stenosis progression had significantly lower time-averaged wall shear stress (WSS; odds ratio [OR], 0.078 [95% CI, 0.012-0.492]; P=0.0067) distal to the stenosis site and significantly higher oscillatory shear index (OR, 2.37 [95% CI, 1.17-4.82]; P=0.016). Among carotid arteries with 56% to 70% stenosis, those with stenosis progression had significantly higher time-averaged WSS (OR, 2.36 [95% CI, 1.19-4.72]; P=0.014) and transverse WSS (OR, 3.03 [95% CI, 1.45-6.34]; P=0.0033), a metric for multidirectional WSS disturbance, at the stenotic site and significantly higher transverse WSS (OR, 2.30 [95% CI, 1.20-4.42]; P=0.012) at the distal site. Arteries with 71% to 99% stenosis and stenosis progression had significantly higher oscillatory shear index (OR, 1.91 [95% CI, 1.05-3.47]; P=0.033) at the distal site.
Conclusions:
These data suggest the specific hemodynamic environments involved in the stenosis progression at bifurcation and that hemodynamic risk for stenosis progression differs depending on the degree of stenosis. Combining these hemodynamic predictors with known risk factors may allow a more accurate selection of cases at high risk of progression.
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