Fluid-structure interaction study of penetrating atherosclerotic ulcers: Assessing progression and rupture risks

Penetrating atherosclerotic ulcer (PAU) is a distinct pathology in acute aortic syndrome that may progress to aortic dissection or rupture. Conservative management, which primarily focuses on controlling blood pressure and heart rate, is prone to failure. The construction of numerical simulation models to predict and analyze the PAU progression and rupture risks will aid clinicians in understanding and improving PAU management and treatment.

In this study, fluid-structure interaction simulations were employed to investigate the biomechanical characteristics of PAUs under various conditions, aiming to assess their risks of rupture and progression. Further correlation analyses were conducted to identify dominant factors influencing ulcer progression. A quantitative comparison of progression risk was conducted between a single big PAU and two small PAUs with equivalent total volumes.

The results demonstrate that as the PAU radius increases to 10 mm, the time-averaged wall shear stress (TAWSS) in the PAU dome region gradually decreases, falling significantly below the physiological range (1.0-3.0 Pa). Elevated blood pressure and heart rate primarily promote PAU rupture by influencing von Mises stress and displacement. Additionally, correlation analyses demonstrate that neither reducing blood pressure nor heart rate is sufficient to restore TAWSS to the physiological range (1.0-3.0 Pa). A single big PAU exhibits lower TAWSS in the dome region, indicating a higher progression risk compared to two small PAUs.

The evidence quantitatively supports the limitations of conservative management in halting PAU progression. Notably, a single big PAU carries a higher progression risk compared to two small PAUs, necessitating increased clinical intervention and monitoring.