Wall Shear Stress Topological Skeleton Independently Predicts Long-Term Restenosis After Carotid Bifurcation Endarterect
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Annals of Biomedical Engineering ( 2020) https://doi.org/10.1007/s10439-020-02607-9
Original Article
Wall Shear Stress Topological Skeleton Independently Predicts Long-Term Restenosis After Carotid Bifurcation Endarterectomy UMBERTO MORBIDUCCI,1 VALENTINA MAZZI,1 MAURIZIO DOMANIN,2,3 GIUSEPPE DE NISCO,1 CHRISTIAN VERGARA,4 DAVID A. STEINMAN,5 and DIEGO GALLO 1 1
PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129 Turin, Italy; 2Department of Clinical Sciences and Community Health, Universita` di Milano, Milan, Italy; 3Unita` Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Ca` Granda Ospedale Maggiore Policlinico, Milan, Italy; 4Laboratory of Biological Structure Mechanics (LaBS), Dipartimento di Chimica, Materiali e Ingegneria Chimica ‘‘Giulio Natta’’, Politecnico di Milano, Milan, Italy; and 5Biomedical Simulation Laboratory, Department of Mechanical & Industrial Engineering, University of Toronto, Toronto, ON, Canada (Received 2 June 2020; accepted 2 September 2020) Associate Editor Ender A. Finol oversaw the review of this article.
Abstract—Wall Shear Stress (WSS) topological skeleton, composed by fixed points and the manifolds linking them, reflects the presence of blood flow features associated to adverse vascular response. However, the influence of WSS topological skeleton on vascular pathophysiology is still underexplored. This study aimed to identify direct associations between the WSS topological skeleton and markers of vascular disease from real-world clinical longitudinal data of long-term restenosis after carotid endarterectomy (CEA). Personalized computational hemodynamic simulations were performed on a cohort of 13 carotid models pre-CEA and at 1 month after CEA. At 60 months after CEA, intima-media thickness (IMT) was measured to detect long-term restenosis. The analysis of the WSS topological skeleton was carried out by applying a Eulerian method based on the WSS vector field divergence. To provide objective thresholds for WSS topological skeleton quantitative analysis, a computational hemodynamic dataset of 46 ostensibly healthy carotid bifurcation models was considered. CEA interventions did not completely restore physiological WSS topological skeleton features. Significant associations emerged between IMT at 60 months follow-up and the exposure to (1) high temporal variation of WSS contraction/expansion (R2 = 0.51, p < 0.05), and (2) high fixed point residence times, weighted by WSS contraction/expansion strength (R2 = 0.53, p < 0.05). These WSS topological skeleton features were statistically independent from the exposure to low WSS, a
Address correspondence to Diego Gallo, PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi, 24, 10129 Turin, Italy. Electronic mail: [email protected] Umberto Morbiducci and Valentina Mazzi contributed equally to this study.
previously reported predictor of long-term restenosis, therefore representing different
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