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Optical Coherence Tomography Based Biomechanical Fluid-Structure Interaction Analysis of Coronary Atherosclerosis Progression
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Flow dynamic differences between Kawasaki Disease patients with coronary artery aneurysms and ectasia

Brennan J Vogl1, Joseph Chibuike Nwokeafor1, Emily Hyatt1

  • 1Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA.

Journal of Cardiovascular Computed Tomography
|July 11, 2025
PubMed

Insights

Kawasaki Disease (KD) coronary artery aneurysms (CAAs) show distinct flow dynamics linked to higher thrombosis risk compared to ectasia (CAE). Hemodynamics offer new insights for KD risk stratification beyond geometry.

Area of Science:

  • Cardiovascular Medicine
  • Pediatric Cardiology
  • Biomedical Engineering

Background:

  • Untreated Kawasaki Disease (KD) can cause coronary artery (CA) dilations, including CA aneurysms (CAA) and CA ectasia (CAE).
  • Current treatment decisions for KD-related CA dilations rely on geometric measurements, which have limitations in predicting outcomes.
  • Understanding the relationship between flow dynamics and clinical outcomes in different CA dilation morphologies is crucial.

Purpose of the Study:

  • To correlate differences in hemodynamic flow dynamics between CAA, CAE, and combined CAA+CAE morphologies.
  • To link these flow dynamics to clinical outcomes and thrombotic potential in patients with Kawasaki Disease.
  • To explore the utility of hemodynamic metrics in risk stratification for KD-induced CA dilations.

Main Methods:

  • A multicenter retrospective study involving 50 KD patient CA dilation models.
  • Categorization of dilations into CAA (n=30), CAE (n=14), and CAA+CAE (n=6).
  • Creation of patient-specific 3D digital CA models for geometric measurements and computational fluid dynamics (CFD) simulations.
  • Calculation of hemodynamic metrics: time-average wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and average wall shear stress (AWSS).

Main Results:

  • CAAs exhibited larger diameters and consistently low TAWSS with extensive regions of high RRT and OSI.
  • CAEs showed higher dilation length and aspect ratio, with elevated RRT in some cases but minimal OSI.
  • CAA+CAE cases displayed variable, diffuse flow patterns with limited spatial overlap of hemodynamic metrics.

Conclusions:

  • Significant variations in flow dynamics exist across different coronary artery dilation morphologies in Kawasaki Disease.
  • The hemodynamic profile of isolated CAAs suggests the highest likelihood of thrombosis.
  • Hemodynamic metrics show promise as mechanistic markers for thrombotic potential, complementing anatomical measurements for KD risk stratification.
Abstract

Keywords:
AneurysmsComputational fluid dynamicsEctasiaKawasaki diseaseZ-score

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