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Hemodynamic Impact of Systolic Blood Pressure and Hematocrit Calculated by Computational Fluid Dynamics in Patients with Intracranial Atherosclerosis

Authors
 Hyo Suk Nam  ;  Fabien Scalzo  ;  Xinyi Leng  ;  Hing Lung Ip  ;  Hye Sun Lee  ;  Florence Fan  ;  Xiangyan Chen  ;  Yannie Soo  ;  Zhongrong Miao  ;  Liping Liu  ;  Edward Feldmann  ;  Thomas Leung  ;  Ka Sing Wong  ;  David S. Liebeskind 
Citation
 JOURNAL OF NEUROIMAGING, Vol.26(3) : 331-338, 2016 
Journal Title
JOURNAL OF NEUROIMAGING
ISSN
 1051-2284 
Issue Date
2016
MeSH
Aged ; Aged, 80 and over ; Angiography, Digital Subtraction ; Blood Pressure/physiology* ; Computed Tomography Angiography ; Computer Simulation* ; Female ; Hematocrit* ; Hemodynamics/physiology* ; Humans ; Hydrodynamics* ; Intracranial Arteriosclerosis/physiopathology* ; Male ; Middle Aged ; Software* ; Stroke/physiopathology
Keywords
Hemodynamics ; atherosclerosis ; blood pressure ; stroke
Abstract
OBJECTIVE: Success in clinical trials of intracranial atherosclerosis (ICAS) is related to accurate identification of high-risk patients. Noninvasive computational fluid dynamics (CFD) of stenotic lesions may enhance therapeutic decision-making. We determined whether physiologic parameters change downstream cerebral hemodynamics in patients with ICAS. METHODS: Consecutive ICAS patients who underwent both CT angiography (CTA) and digital subtraction angiography were enrolled. CFD models were made using CTA source images. Inlet boundary conditions were defined using three ranges of systolic blood pressure (BP) (109.2, 158, and 225 mmHg) and hematocrit (27.3, 40.2, and 48.8). Ratios of pressure, shear strain rates (SSR), and flow velocity across the lesion were calculated using CFD simulations. A linear mixed model was used for the statistical analysis of repeated simulations. RESULTS: Among the 56 patients, 32 had moderate stenosis (50-69%) and 24 had severe stenosis (70-99%). A linear mixed model revealed that the ratio of pressure was predicted by systolic BP and stenosis group interaction (P = .036). These pressure decreases were associated with systolic BP (P < .001) and stenosis group (P < .001), but not with hematocrit (P = .337). Post-hoc analysis revealed that pressure decreases were more profound in the severe stenosis than the moderate stenosis group when comparing high and low systolic BP (P = .0108). Ratios of SSR and velocity were only associated in the stenosis group. CONCLUSIONS: Our study showed that systolic BP along with the degree of stenosis was associated with pressure decreases across stenotic lesions. Physiologic conditions may superimpose further changes in post-stenotic or downstream blood flow.
Full Text
http://onlinelibrary.wiley.com/doi/10.1111/jon.12314/abstract
DOI
10.1111/jon.12314
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/152093
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