Flow Patterns in Carotid Webs: A Patient-Based Computational Fluid Dynamics Study

K. C. J. Compagne; K. Dilba; E. J. Postema; A. C. G. M. van Es; B. J. Emmer; C. B. L. M. Majoie; W. H. van Zwam; D. W. J. Dippel; J. J. Wentzel; A. van der Lugt; F. J. H. Gijsen; MR CLEAN Investigators

doi:10.3174/ajnr.A6012

Flow Patterns in Carotid Webs: A Patient-Based Computational Fluid Dynamics Study

K. C. J. Compagne, K. Dilba, E. J. Postema, A. C. G. M. van Es, B. J. Emmer, C. B. L. M. Majoie, W. H. van Zwam, D. W. J. Dippel, J. J. Wentzel, A. van der Lugt, F. J. H. Gijsen^*, MR CLEAN Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

22 Citations (Web of Science)

Abstract

BACKGROUND AND PURPOSE: Carotid webs are increasingly recognized as an important cause of (recurrent) ischemic stroke in patients without other cardiovascular risk factors. Hemodynamic flow patterns induced by these lesions might be associated with thrombus formation. The aim of our study was to evaluate flow patterns of carotid webs using computational fluid dynamics.

MATERIALS AND METHODS: Patients with a carotid web in the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) were selected for hemodynamic evaluation with computational fluid dynamics models based on lumen segmentations obtained from CT angiography scans. Hemodynamic parameters, including the area of recirculation zone, time-averaged wall shear stress, transverse wall shear stress, and the oscillatory shear index, were assessed and compared with the contralateral carotid bifurcation.

RESULTS: In our study, 9 patients were evaluated. Distal to the carotid webs, recirculation zones were significantly larger compared with the contralateral bifurcation (63 versus 43 mm(2), P = .02). In the recirculation zones of the carotid webs and the contralateral carotid bifurcation, time-averaged wall shear stress values were comparable (both: median, 0.27 Pa; P = .30), while transverse wall shear stress and oscillatory shear index values were significantly higher in the recirculation zone of carotid webs (median, 0.25 versus 0.21 Pa; P = .02 and 0.39 versus 0.30 Pa; P = .04). At the minimal lumen area, simulations showed a significantly higher time-averaged wall shear stress in the web compared with the contralateral bifurcation (median, 0.58 versus 0.45 Pa; P = .01).

CONCLUSIONS: Carotid webs are associated with increased recirculation zones and regional increased wall shear stress metrics that are associated with disturbed flow. These findings suggest that a carotid web might stimulate thrombus formation, which increases the risk of acute ischemic stroke.

Original language	English
Pages (from-to)	703-708
Number of pages	6
Journal	American Journal of Neuroradiology
Volume	40
Issue number	4
DOIs	https://doi.org/10.3174/ajnr.A6012
Publication status	Published - Apr 2019

Keywords

ARTERY BIFURCATION
CORONARY-ARTERY
FIBROMUSCULAR DYSPLASIA
GEOMETRY
HEMODYNAMICS
MANAGEMENT
PULSATILE FLOW
RECURRENT
STROKE
WALL SHEAR-STRESS
HEALTHY

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10.3174/ajnr.A6012

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Compagne, K. C. J., Dilba, K., Postema, E. J., van Es, A. C. G. M., Emmer, B. J., Majoie, C. B. L. M., van Zwam, W. H., Dippel, D. W. J., Wentzel, J. J., van der Lugt, A., Gijsen, F. J. H., & MR CLEAN Investigators (2019). Flow Patterns in Carotid Webs: A Patient-Based Computational Fluid Dynamics Study. American Journal of Neuroradiology, 40(4), 703-708. https://doi.org/10.3174/ajnr.A6012

@article{9a5bbb316b5643d8a445948086818f15,

title = "Flow Patterns in Carotid Webs: A Patient-Based Computational Fluid Dynamics Study",

abstract = "BACKGROUND AND PURPOSE: Carotid webs are increasingly recognized as an important cause of (recurrent) ischemic stroke in patients without other cardiovascular risk factors. Hemodynamic flow patterns induced by these lesions might be associated with thrombus formation. The aim of our study was to evaluate flow patterns of carotid webs using computational fluid dynamics.MATERIALS AND METHODS: Patients with a carotid web in the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) were selected for hemodynamic evaluation with computational fluid dynamics models based on lumen segmentations obtained from CT angiography scans. Hemodynamic parameters, including the area of recirculation zone, time-averaged wall shear stress, transverse wall shear stress, and the oscillatory shear index, were assessed and compared with the contralateral carotid bifurcation.RESULTS: In our study, 9 patients were evaluated. Distal to the carotid webs, recirculation zones were significantly larger compared with the contralateral bifurcation (63 versus 43 mm(2), P = .02). In the recirculation zones of the carotid webs and the contralateral carotid bifurcation, time-averaged wall shear stress values were comparable (both: median, 0.27 Pa; P = .30), while transverse wall shear stress and oscillatory shear index values were significantly higher in the recirculation zone of carotid webs (median, 0.25 versus 0.21 Pa; P = .02 and 0.39 versus 0.30 Pa; P = .04). At the minimal lumen area, simulations showed a significantly higher time-averaged wall shear stress in the web compared with the contralateral bifurcation (median, 0.58 versus 0.45 Pa; P = .01).CONCLUSIONS: Carotid webs are associated with increased recirculation zones and regional increased wall shear stress metrics that are associated with disturbed flow. These findings suggest that a carotid web might stimulate thrombus formation, which increases the risk of acute ischemic stroke.",

keywords = "ARTERY BIFURCATION, CORONARY-ARTERY, FIBROMUSCULAR DYSPLASIA, GEOMETRY, HEMODYNAMICS, MANAGEMENT, PULSATILE FLOW, RECURRENT, STROKE, WALL SHEAR-STRESS, HEALTHY",

author = "Compagne, {K. C. J.} and K. Dilba and Postema, {E. J.} and {van Es}, {A. C. G. M.} and Emmer, {B. J.} and Majoie, {C. B. L. M.} and {van Zwam}, {W. H.} and Dippel, {D. W. J.} and Wentzel, {J. J.} and {van der Lugt}, A. and Gijsen, {F. J. H.} and {MR CLEAN Investigators}",

year = "2019",

month = apr,

doi = "10.3174/ajnr.A6012",

language = "English",

volume = "40",

pages = "703--708",

journal = "American Journal of Neuroradiology",

issn = "0195-6108",

publisher = "American Society of Neuroradiology",

number = "4",

}

TY - JOUR

T1 - Flow Patterns in Carotid Webs

T2 - A Patient-Based Computational Fluid Dynamics Study

AU - Compagne, K. C. J.

AU - Dilba, K.

AU - Postema, E. J.

AU - van Es, A. C. G. M.

AU - Emmer, B. J.

AU - Majoie, C. B. L. M.

AU - van Zwam, W. H.

AU - Dippel, D. W. J.

AU - Wentzel, J. J.

AU - van der Lugt, A.

AU - Gijsen, F. J. H.

AU - MR CLEAN Investigators

PY - 2019/4

Y1 - 2019/4

N2 - BACKGROUND AND PURPOSE: Carotid webs are increasingly recognized as an important cause of (recurrent) ischemic stroke in patients without other cardiovascular risk factors. Hemodynamic flow patterns induced by these lesions might be associated with thrombus formation. The aim of our study was to evaluate flow patterns of carotid webs using computational fluid dynamics.MATERIALS AND METHODS: Patients with a carotid web in the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) were selected for hemodynamic evaluation with computational fluid dynamics models based on lumen segmentations obtained from CT angiography scans. Hemodynamic parameters, including the area of recirculation zone, time-averaged wall shear stress, transverse wall shear stress, and the oscillatory shear index, were assessed and compared with the contralateral carotid bifurcation.RESULTS: In our study, 9 patients were evaluated. Distal to the carotid webs, recirculation zones were significantly larger compared with the contralateral bifurcation (63 versus 43 mm(2), P = .02). In the recirculation zones of the carotid webs and the contralateral carotid bifurcation, time-averaged wall shear stress values were comparable (both: median, 0.27 Pa; P = .30), while transverse wall shear stress and oscillatory shear index values were significantly higher in the recirculation zone of carotid webs (median, 0.25 versus 0.21 Pa; P = .02 and 0.39 versus 0.30 Pa; P = .04). At the minimal lumen area, simulations showed a significantly higher time-averaged wall shear stress in the web compared with the contralateral bifurcation (median, 0.58 versus 0.45 Pa; P = .01).CONCLUSIONS: Carotid webs are associated with increased recirculation zones and regional increased wall shear stress metrics that are associated with disturbed flow. These findings suggest that a carotid web might stimulate thrombus formation, which increases the risk of acute ischemic stroke.

AB - BACKGROUND AND PURPOSE: Carotid webs are increasingly recognized as an important cause of (recurrent) ischemic stroke in patients without other cardiovascular risk factors. Hemodynamic flow patterns induced by these lesions might be associated with thrombus formation. The aim of our study was to evaluate flow patterns of carotid webs using computational fluid dynamics.MATERIALS AND METHODS: Patients with a carotid web in the Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) were selected for hemodynamic evaluation with computational fluid dynamics models based on lumen segmentations obtained from CT angiography scans. Hemodynamic parameters, including the area of recirculation zone, time-averaged wall shear stress, transverse wall shear stress, and the oscillatory shear index, were assessed and compared with the contralateral carotid bifurcation.RESULTS: In our study, 9 patients were evaluated. Distal to the carotid webs, recirculation zones were significantly larger compared with the contralateral bifurcation (63 versus 43 mm(2), P = .02). In the recirculation zones of the carotid webs and the contralateral carotid bifurcation, time-averaged wall shear stress values were comparable (both: median, 0.27 Pa; P = .30), while transverse wall shear stress and oscillatory shear index values were significantly higher in the recirculation zone of carotid webs (median, 0.25 versus 0.21 Pa; P = .02 and 0.39 versus 0.30 Pa; P = .04). At the minimal lumen area, simulations showed a significantly higher time-averaged wall shear stress in the web compared with the contralateral bifurcation (median, 0.58 versus 0.45 Pa; P = .01).CONCLUSIONS: Carotid webs are associated with increased recirculation zones and regional increased wall shear stress metrics that are associated with disturbed flow. These findings suggest that a carotid web might stimulate thrombus formation, which increases the risk of acute ischemic stroke.

KW - ARTERY BIFURCATION

KW - CORONARY-ARTERY

KW - FIBROMUSCULAR DYSPLASIA

KW - GEOMETRY

KW - HEMODYNAMICS

KW - MANAGEMENT

KW - PULSATILE FLOW

KW - RECURRENT

KW - STROKE

KW - WALL SHEAR-STRESS

KW - HEALTHY

U2 - 10.3174/ajnr.A6012

DO - 10.3174/ajnr.A6012

M3 - Article

C2 - 30872422

SN - 0195-6108

VL - 40

SP - 703

EP - 708

JO - American Journal of Neuroradiology

JF - American Journal of Neuroradiology

IS - 4

ER -