Pressure- and flow-driven biomechanical factors associate with carotid atherosclerosis assessed by computed tomography angiography
Aikaterini Tziotziou (Erasmus MC)
Yanjing Liu (Erasmus MC)
Federica Fontana (TU Delft - Medical Instruments & Bio-Inspired Technology)
Juul Bierens (Maastricht University Medical Center)
Paul J. Nederkoorn (Amsterdam UMC)
Pim A. de Jong (University Medical Center Utrecht, Universiteit Utrecht)
M. Eline Kooi (Maastricht University Medical Center)
Werner Mess (Maastricht University Medical Center)
Aad van der Lugt (Erasmus MC)
Antonius F.W. van der Steen (Erasmus MC)
Daniel Bos (Erasmus MC)
Jolanda J. Wentzel (Erasmus MC)
Ali C. Akyildiz (Erasmus MC, TU Delft - Medical Instruments & Bio-Inspired Technology)
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Abstract
Background and aims: Local biomechanical factors are known to influence atherosclerosis in extracranial carotid arteries. While the role of some flow-driven biomechanical factors has been investigated, the influence of pressure-driven mechanical wall stress (MWS) has received limited attention. In this study, the association of the pressure-driven and flow-driven biomechanical factors with carotid atherosclerosis was examined. Methods: Carotid arteries (n = 150) with mild-to-moderate stenosis from 75 symptomatic patients (Plaque-At-Risk study) were imaged using multi-detector computed tomography angiography (MDCTA) at the time of inclusion and after 2 years. Structural changes in carotid wall and calcifications were quantified from MDCTA data while the local baseline biomechanical factors in the carotids were determined using fluid-structure interaction (FSI) computational models. The associations of the local pressure-driven and flow-driven biomechanical factors with the carotid wall and calcification changes were studied using Generalized Linear Mixed models. Results: Over two years, plaque sectors, with calcified and non-calcified sectors combined, exhibited minimal change in wall thickness, likely due to medical treatment. High MWS was associated (p < 0.001) with a reduction in plaque thickness. In calcified plaque sectors, high MWS and low oscillatory shear index (OSI) were associated (p < 0.001) with greater calcification thickness increase. The distance between the lumen and calcification decreased over time, especially in the sectors exposed to high time-averaged wall shear stress (TAWSS) and high MWS. Conclusions: Our results suggest that the pressure-driven local MWS and flow-driven OSI and TAWSS significantly correlate with the development of calcified and non-calcified plaques in carotid arteries. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01208025.
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