Fukuda Shunichi, Shimogonya Yuji, Watanabe Aoi, Yoshimoto Yuko, Maruyama Setsurou, Yonemoto Naohiro, Fujiwara Kazuha, Fukuda Miyuki, Yasoda Akihiro
Department of Neurosurgery and (S.F., A.W., Y.Y., S.M., K.F., M.F.), National Hospital Organization Kyoto Medical Center, Japan.
Department of Mechanical Engineering, College of Engineering, Nihon University, Koriyama, Japan (Y.S.).
Arterioscler Thromb Vasc Biol. 2025 Aug;45(8):1448-1458. doi: 10.1161/ATVBAHA.125.322928. Epub 2025 Jun 12.
Hemodynamic stress plays an important role in the development of atherosclerosis. It is difficult to sufficiently predict the progression of atherosclerosis and consequent stenosis based on known risk factors alone. This may be partly because the hemodynamic environments that promote stenosis progression remain unclear. The carotid bifurcation is the preferred site of atherosclerosis. In this prospective observational study, we sought to identify hemodynamic predictors of carotid stenosis progression.
Computational fluid dynamics analysis was performed using arterial geometry and flow velocity specific to individual patients. Hemodynamic metrics were compared by multivariate analysis between the presence or absence of stenosis progression, using known risk factors as confounding factors.
A total of 545 patients were enrolled, and 361 stenotic arteries in 313 patients were analyzed, 38 of which had progressive stenosis. Among the carotid arteries with 30% to 55% area stenosis, those with stenosis progression had significantly lower time-averaged wall shear stress (WSS; odds ratio [OR], 0.078 [95% CI, 0.012-0.492]; =0.0067) distal to the stenosis site and significantly higher oscillatory shear index (OR, 2.37 [95% CI, 1.17-4.82]; =0.016). Among carotid arteries with 56% to 70% stenosis, those with stenosis progression had significantly higher time-averaged WSS (OR, 2.36 [95% CI, 1.19-4.72]; =0.014) and transverse WSS (OR, 3.03 [95% CI, 1.45-6.34]; =0.0033), a metric for multidirectional WSS disturbance, at the stenotic site and significantly higher transverse WSS (OR, 2.30 [95% CI, 1.20-4.42]; =0.012) at the distal site. Arteries with 71% to 99% stenosis and stenosis progression had significantly higher oscillatory shear index (OR, 1.91 [95% CI, 1.05-3.47]; =0.033) at the distal site.
These data suggest the specific hemodynamic environments involved in the stenosis progression at bifurcation and that hemodynamic risk for stenosis progression differs depending on the degree of stenosis. Combining these hemodynamic predictors with known risk factors may allow a more accurate selection of cases at high risk of progression.
血流动力学应激在动脉粥样硬化的发展中起重要作用。仅基于已知风险因素难以充分预测动脉粥样硬化的进展及随之而来的狭窄。这可能部分是因为促进狭窄进展的血流动力学环境仍不清楚。颈动脉分叉是动脉粥样硬化的好发部位。在这项前瞻性观察研究中，我们试图确定颈动脉狭窄进展的血流动力学预测因素。
使用个体患者特定的动脉几何形状和流速进行计算流体动力学分析。以已知风险因素作为混杂因素，通过多变量分析比较有无狭窄进展情况下的血流动力学指标。
共纳入545例患者，分析了313例患者的361条狭窄动脉，其中38条有狭窄进展。在面积狭窄30%至55%的颈动脉中，有狭窄进展的动脉在狭窄部位远端的时间平均壁面切应力（WSS；优势比[OR]，0.078[95%CI，0.012 - 0.492]；P = 0.0067）显著更低，振荡切变指数（OR，2.37[95%CI，1.17 - 4.82]；P = 0.016）显著更高。在狭窄56%至70%的颈动脉中，有狭窄进展的动脉在狭窄部位的时间平均WSS（OR，2.36[95%CI，1.19 - 4.72]；P = 0.014）和横向WSS（OR，3.03[95%CI，1.45 - 6.34]；P = 0.0033，多方向WSS紊乱的一个指标）显著更高，在远端部位的横向WSS（OR，2.30[95%CI，1.20 - 4.42]；P = 0.012）也显著更高。狭窄71%至99%且有狭窄进展的动脉在远端部位的振荡切变指数（OR，1.91[95%CI，1.05 - 3.47]；P = 0.033）显著更高。
这些数据表明了分叉处狭窄进展所涉及的特定血流动力学环境，且狭窄进展的血流动力学风险因狭窄程度而异。将这些血流动力学预测因素与已知风险因素相结合，可能有助于更准确地选择进展风险高的病例。
