Department of Computer Science and Technology, Southwest University of Science and Technology, No. 59, middle of Qinglong Avenue, Fucheng District, Mianyang, 621010, China.
Department of Cardiology, Mianyang Central Hospital, Mianyang, 621000, China.
Comput Methods Programs Biomed. 2024 Jun;249:108144. doi: 10.1016/j.cmpb.2024.108144. Epub 2024 Mar 24.
Iatrogenic coronary artery dissection is a complication of coronary intimal injury and dissection due to improper catheter manipulation. The impact of tear direction on the prognosis of coronary artery dissection (CAD) remains unclear. This study examines the hemodynamic effects of different tear directions (transverse and longitudinal) of CAD and evaluates the risk of thrombosis, rupture and further dilatation of CAD.
Two types of CAD models (Type I: transverse tear, Type II: longitudinal tear) were reconstructed from the aorto-coronary CTA dataset of 8 healthy cases. Four WSS-based indicators were analyzed, including time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), and cross flow index (CFI). A thrombus growth model was also introduced to predict the trend of thrombus growth in CAD with two different tear directions.
For most of the WSS-based indicators, including TAWSS, RRT, and CFI, no statistically significant differences were observed across the CAD models with varying tear directions, except for OSI, where a significant difference was noted (p < 0.05). Meanwhile, in terms of thrombus growth, the thrombus growing at the tear of the Type I (transverse tear) CAD model extended into the true lumen earlier than that of the Type II (longitudinal tear) model.
Numerical simulations suggest that: (1) The CAD with transverse tear have a high risk of further tearing of the dissection at the distal end of the tear. (2) The CAD with longitudinal tear create a hemodynamic environment characterized by low TAWSS and high OSI in the false lumen, which may additionally increase the risk of vessel wall injury. (3) The CAD with transverse tear may have a higher risk of thrombosis and coronary obstruction and myocardial ischemia in the early phase of the dissection.
医源性冠状动脉夹层是由于导管操作不当导致冠状动脉内膜损伤和夹层所致的并发症。撕裂方向对冠状动脉夹层（CAD）预后的影响尚不清楚。本研究探讨了 CAD 不同撕裂方向（横向和纵向）的血流动力学效应，并评估了 CAD 血栓形成、破裂和进一步扩张的风险。
从 8 例健康病例的主动脉-冠状动脉 CTA 数据集重建了两种 CAD 模型（I 型：横向撕裂，II 型：纵向撕裂）。分析了基于壁面切应力（WSS）的四个指标，包括时均壁面切应力（TAWSS）、振荡剪切指数（OSI）、相对居留时间（RRT）和交叉流指数（CFI）。还引入了血栓生长模型来预测两种不同撕裂方向的 CAD 血栓生长趋势。
对于大多数基于 WSS 的指标，包括 TAWSS、RRT 和 CFI，在具有不同撕裂方向的 CAD 模型中，除 OSI 外，没有观察到统计学上的显著差异（p<0.05）。同时，在血栓生长方面，I 型（横向撕裂）CAD 模型撕裂处的血栓比 II 型（纵向撕裂）模型更早延伸至真腔。
数值模拟表明：（1）横向撕裂的 CAD 在下一个撕裂的远端有进一步撕裂的高风险。（2）纵向撕裂的 CAD 在假腔中产生了低 TAWSS 和高 OSI 的血流动力学环境，这可能会增加血管壁损伤的风险。（3）在夹层的早期，横向撕裂的 CAD 可能有更高的血栓形成和冠状动脉阻塞以及心肌缺血风险。
