Characteristics of Wall Shear Stress and Pressure of Intracranial Atherosclerosis Analyzed by a Computational Fluid Dynamics Model: A Pilot Study

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Abstract

Background: Although wall shear stress (WSS) and pressure play important roles in plaque vulnerability, characteristics of the two indices in intracranial atherosclerosis (ICAS) have not been fully investigated yet. This study aimed to elucidate this issue by means of establishing a non-invasive computational fluid dynamics method with time-of-flight magnetic resonance angiography (TOF-MRA) of the whole cerebral artery.

Materials and Methods: Subjects with symptomatic ICAS in the middle cerebral artery domain were enrolled, excluding those with concomitant internal carotid artery stenosis. Based on patient-specific TOF-MRA images for three-dimensional (3D) meshes and arterial blood pressure with patient-specific carotid artery ultrasonography for inlet boundary conditions, patients' three-dimensional hemodynamics were modeled by a finite element method governed by Navier-Stokes equations.

Results: Among the 55 atherosclerotic lesions analyzed by this TOF-MRA based computational fluid dynamics model, the maximum WSS (WSS _max) was most frequently detected at the apex points and the upper half of the upstream sections of the lesions, whereas the maximum pressure was most often located at the lower half of the upstream sections. As the percent stenosis increases, the relative value of WSS _max and pressure drop increased with significantly increasing steep beyond 50% stenosis. Moreover, WSS _max was found to linearly correlate with pressure drop in ICAS.

Conclusions: This study on ICAS revealed certain trends of longitudinal distribution of WSS and pressure and the influences of percent stenosis on cerebral hemodynamics, as well as the correlations between WSS and pressure drop. It represents a step forward in applying computational flow simulation techniques in studying ICAS and stroke, in a patient-specific manner.

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Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis.

Marc I Chimowitz, Michael Lynn, Harriet Howlett-Smith … (2005)

Atherosclerotic intracranial arterial stenosis is an important cause of stroke. Warfarin is commonly used in preference to aspirin for this disorder, but these therapies have not been compared in a randomized trial. We randomly assigned patients with transient ischemic attack or stroke caused by angiographically verified 50 to 99 percent stenosis of a major intracranial artery to receive warfarin (target international normalized ratio, 2.0 to 3.0) or aspirin (1300 mg per day) in a double-blind, multicenter clinical trial. The primary end point was ischemic stroke, brain hemorrhage, or death from vascular causes other than stroke. After 569 patients had undergone randomization, enrollment was stopped because of concerns about the safety of the patients who had been assigned to receive warfarin. During a mean follow-up period of 1.8 years, adverse events in the two groups included death (4.3 percent in the aspirin group vs. 9.7 percent in the warfarin group; hazard ratio for aspirin relative to warfarin, 0.46; 95 percent confidence interval, 0.23 to 0.90; P=0.02), major hemorrhage (3.2 percent vs. 8.3 percent, respectively; hazard ratio, 0.39; 95 percent confidence interval, 0.18 to 0.84; P=0.01), and myocardial infarction or sudden death (2.9 percent vs. 7.3 percent, respectively; hazard ratio, 0.40; 95 percent confidence interval, 0.18 to 0.91; P=0.02). The rate of death from vascular causes was 3.2 percent in the aspirin group and 5.9 percent in the warfarin group (P=0.16); the rate of death from nonvascular causes was 1.1 percent and 3.8 percent, respectively (P=0.05). The primary end point occurred in 22.1 percent of the patients in the aspirin group and 21.8 percent of those in the warfarin group (hazard ratio, 1.04; 95 percent confidence interval, 0.73 to 1.48; P=0.83). Warfarin was associated with significantly higher rates of adverse events and provided no benefit over aspirin in this trial. Aspirin should be used in preference to warfarin for patients with intracranial arterial stenosis. Copyright 2005 Massachusetts Medical Society.

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Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis.

Daniele Romano, C Sila, Daniel Stern … (2006)

Antithrombotic therapy for intracranial arterial stenosis was recently evaluated in the Warfarin versus Aspirin for Symptomatic Intracranial Disease (WASID) trial. A prespecified aim of WASID was to identify patients at highest risk for stroke in the territory of the stenotic artery who would be the target group for a subsequent trial comparing intracranial stenting with medical therapy. WASID was a randomized, double-blinded, multicenter trial involving 569 patients with transient ischemic attack or ischemic stroke due to 50% to 99% stenosis of a major intracranial artery. Median time from qualifying event to randomization was 17 days, and mean follow-up was 1.8 years. Multivariable Cox proportional hazards models were used to identify factors associated with subsequent ischemic stroke in the territory of the stenotic artery. Subsequent ischemic stroke occurred in 106 patients (19.0%); 77 (73%) of these strokes were in the territory of the stenotic artery. Risk of stroke in the territory of the stenotic artery was highest with severe stenosis > or =70% (hazard ratio 2.03; 95% confidence interval 1.29 to 3.22; P=0.0025) and in patients enrolled early ( or =70%, after recent symptoms, and in women.

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Plaque rupture in the carotid artery is localized at the high shear stress region: a case report.

Jolanda Wentzel, Frank J. H. Gijsen, Aad van der Lugt … (2007)

Cerebrovascular events are related to atherosclerotic disease in the carotid arteries and are frequently caused by rupture of a vulnerable plaque. These ruptures are often observed at the upstream region of the plaque, where the wall shear stress (WSS) is considered to be highest. High WSS is known for its influence on many processes affecting tissue regression. Until now, there have been no serial studies showing the relationship between plaque rupture and WSS. Summary of Case- We investigated a serial MRI data set of a 67-year-old woman with a plaque in the carotid artery at baseline and an ulcer at 10-month follow up. The lumen, plaque components (lipid/necrotic core, intraplaque hemorrhage), and ulcer were segmented and the lumen contours at baseline were used for WSS calculation. Correlation of the change in plaque composition with the WSS at baseline showed that the ulcer was generated exclusively at the high WSS location. In this serial MRI study, we found plaque ulceration at the high WSS location of a protruding plaque in the carotid artery. Our data suggest that high WSS influences plaque vulnerability and therefore may become a potential parameter for predicting future events.

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Author and article information

Contributors

Zimo Chen: URI : http://loop.frontiersin.org/people/751158/overview

Jia Liu: URI : http://loop.frontiersin.org/people/709817/overview

Yong Jiang: URI : http://loop.frontiersin.org/people/617687/overview

Xinyi Leng: URI : http://loop.frontiersin.org/people/549713/overview

Yongjun Wang: URI : http://loop.frontiersin.org/people/597073/overview

Journal

Journal ID (nlm-ta): Front Neurol

Journal ID (iso-abbrev): Front Neurol

Journal ID (publisher-id): Front. Neurol.

Title: Frontiers in Neurology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1664-2295

Publication date (Electronic): 17 January 2020

Publication date Collection: 2019

Volume: 10

Electronic Location Identifier: 1372

Affiliations

[1] ¹Department of Neurology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China

[2] ²China National Clinical Research Center for Neurological Diseases , Beijing, China

[3] ³Center of Stroke, Beijing Institute for Brain Disorders , Beijing, China

[4] ⁴Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease , Beijing, China

[5] ⁵Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences , Shenzhen, China

[6] ⁶Department of Radiology, Beijing Tiantan Hospital, Capital Medical University , Beijing, China

[7] ⁷Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin, China

Author notes

Edited by: Maurizio Acampa, Siena University Hospital, Italy

Reviewed by: Edward Feldmann, Brown University, United States; Futoshi Mori, Iwate Medical University, Japan

*Correspondence: Yongjun Wang yongjunwang@ 123456ncrcnd.org.cn

This article was submitted to Stroke, a section of the journal Frontiers in Neurology

Article

DOI: 10.3389/fneur.2019.01372

PMC ID: 6978719

PubMed ID: 32010041

SO-VID: 207f8ea9-9910-424d-92f2-e0d2cf2250e6

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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 18 July 2019

Date accepted : 11 December 2019

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Figures: 4, Tables: 2, Equations: 0, References: 32, Pages: 9, Words: 5719

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Characteristics of Wall Shear Stress and Pressure of Intracranial Atherosclerosis Analyzed by a Computational Fluid Dynamics Model: A Pilot Study

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Probing cerebral hemodynamics with BOLD fMRI

Most cited references 26

Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis.

Predictors of ischemic stroke in the territory of a symptomatic intracranial arterial stenosis.

Plaque rupture in the carotid artery is localized at the high shear stress region: a case report.

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