Martín-Araguz A, Ruiz-Aláez A, García de la Rocha M L, Fernández-Armayor V, Delgado-Reyes S, Moreno-Martínez J M
Servicio de Neurología, Hospital del Aire, Madrid, España.
Rev Neurol. 1997 Dec;25(148):2021-31.
Atherosclerosis is a generalized vascular disorder which tends to be localized to specific arterial territories. At the bifurcation of the carotid artery there is a marked predisposition to form plaques of atheroma on the postero-external wall. This tendency is due to the kinematics of fluids and their particular morphological characteristics which are unique in the vascular system. The carotid tree is a physical, non-lineal or in 'non-equilibrium', dynamic system which depends on the fluctuating contribution of energy from the cardiac cycle. It has fractal geometry which follows the Law of Biology of maximum efficiency with a minimum of effort.
The complexity of the relationship between the haemo-rheological and anatomical factors, and the periodic oscillation of flow does not permit use of simple models and classical determinist equations to describe idealized systems of continuous movement and Newtonian fluids. On the contrary, since we are considering a complex dissipative dynamic system. It has marked intrinsic operational freedom adapting its responses to external disturbances well, thus determining vasculo-cerebral autoregulation. The theories of Determinist Chaos and of the Science of Complexity imply the existence of emerging properties which exceed those of the individual elements in the dynamic systems in non-equilibrium, which tend to function in the 'frontier of chaos' at the critical points of phase transition. The carotid tree has non-linear properties, appearance of order and fractal 'sibisemejanza'. Pseudo-chaotic vortices appear--in regions of phase transition between laminar flow and turbulence--with the emergence of a 'strange attractor' near to the postero-external wall of the bulb.
The anatomical and kinematic complexity of the system, together with the irreversibility of the second Law of Thermodynamics, lead to a long-term tendency towards the appearance of a region of stagnant flow with increased Entropy in the territory of the strange attractor which determines--as an inevitable long-term outcome--the tendency to the appearance of atherosclerosis at this particular point.
动脉粥样硬化是一种全身性血管疾病,往往局限于特定的动脉区域。在颈动脉分叉处,后外壁明显易形成动脉粥样斑块。这种倾向归因于流体的运动学及其在血管系统中独特的形态特征。颈动脉树是一个物理的、非线性或“非平衡”的动态系统,它依赖于心动周期中能量的波动贡献。它具有分形几何结构,遵循以最小努力实现最大效率的生物学规律。
血液流变学和解剖学因素之间关系的复杂性,以及血流的周期性振荡,使得无法使用简单模型和经典确定性方程来描述连续运动和牛顿流体的理想化系统。相反,由于我们考虑的是一个复杂的耗散动态系统。它具有显著的内在运行自由度,能很好地适应外部干扰的反应,从而决定血管-脑自动调节。确定性混沌理论和复杂性科学理论意味着存在一些新兴特性,这些特性超越了非平衡动态系统中单个元素的特性,它们倾向于在相变临界点的“混沌边缘”发挥作用。颈动脉树具有非线性特性、有序外观和分形“自相似性”。在层流和湍流之间的相变区域会出现伪混沌涡旋,在球部后外壁附近会出现一个“奇怪吸引子”。
该系统的解剖学和运动学复杂性,以及热力学第二定律的不可逆性,导致在奇怪吸引子区域长期出现一个熵增加的滞流区域,这决定了——作为不可避免的长期结果——在这个特定点出现动脉粥样硬化的倾向。