Atrial fibrillation (AF) is the most common irregular heartbeat among the world's population and is a major contributor to cardiogenic embolisms and acute ischemic stroke (AIS). However, the role AF flow plays in the trajectory paths of cardiogenic emboli has not been experimentally investigated. A physiological simulation system was designed to analyze the trajectory patterns of bovine embolus analogs (EAs) (n = 720) through four patient-specific models, under three flow conditions: steady flow, normal pulsatile flow, and AF pulsatile flow. It was seen that EA trajectory paths were proportional to the percentage flowrate split of 25–31% along the branching vessels. Overall, AF flow conditions increased trajectories through the left- (LCCA) and right (RCCA)-common carotid artery by 25% with respect to normal pulsatile flow. There was no statistical difference in the distribution of clot trajectories when the clot was released from the right, left, or anterior positions. Significantly, more EAs traveled through the brachiocephalic trunk (BCT) than through the LCCA or the left subclavian. Yet of the EAs that traveled through the common carotid arteries, there was a greater affiliation toward the LCCA compared to the RCCA (p < 0.05).
Issue Section:
Research Papers
References
1.
Lakhan
, S. E.
, Kirchgessner
, A.
, and Hofer
, M.
, 2009
, “Inflammatory Mechanisms in Ischemic Stroke: Therapeutic Approaches
,” J. Transl. Med.
, 7
, p. 97
.2.
Kannel
, W. B.
, and Benjamin
, E. J.
, 2008
, “Status of the Epidemiology of Atrial Fibrillation
,” Med. Clin. North Am.
, 92
(1
), pp. 17
–40
.3.
Kelley
, R. E.
, and Alireza
, M.
, 2003
, “Cardioembolic Stroke: An Update
,” South. Med. J.
, 96
(4
), p. 343
.4.
Beldi
, G.
, Beng
, L.
, Siegel
, G.
, Bisch-Knaden
, S.
, and Candinas
, D.
, 2007
, “Prevention of Perioperative Thromboembolism in Patients With Atrial Fibrillation
,” Br. J. Surg.
, 94
(11
), pp. 1351
–1355
.5.
Blackshear
, J. L.
, and Odell
, J. A.
, 1996
, “Appendage Obliteration to Reduce Stroke in Cardiac Surgical Patients With Atrial Fibrillation
,” Ann. Thorac. Surg.
, 61
(2
), pp. 755
–759
.6.
Menke
, J.
, Lüthje
, L.
, Kastrup
, A.
, and Larsen
, J.
, 2010
, “Thromboembolism in Atrial Fibrillation
,” Am. J. Cardiol.
, 105
(4
), pp. 502
–510
.7.
Fuster
, V.
, Ryden
, L. E.
, Cannom
, D. S.
, Crijns
, H. J.
, Curtis
, A. B.
, Ellenbogen
, K. A.
, Halperin
, J. L.
, Le Heuzey
, J. Y.
, Kay
, G. N.
, Lowe
, J. E.
, Olsson
, S. B.
, Prystowsky
, E. N.
, Tamargo
, J. L.
, Wann
, S.
, Smith
, S. C.
, Jr., Jacobs
, A. K.
, Adams
, C. D.
, Anderson
, J. L.
, Antman
, E. M.
, Halperin
, J. L.
, Hunt
, S. A.
, Nishimura
, R.
, Ornato
, J. P.
, Page
, R. L.
, Riegel
, B.
, Priori
, S. G.
, Blanc
, J. J.
, Budaj
, A.
, Camm
, A. J.
, Dean
, V.
, Deckers
, J. W.
, Despres
, C.
, Dickstein
, K.
, Lekakis
, J.
, McGregor
, K.
, Metra
, M.
, Morais
, J.
, Osterspey
, A.
, Tamargo
, J. L.
, and Zamorano
, J. L.
, 2006
, “Guidelines for the Management of Patients With Atrial Fibrillation
,” Circulation
, 114
(7), pp. 257
–354
.8.
Heeringa
, J.
, van der Kuip
, D. A.
, Hofman
, A.
, Kors
, J. A.
, van Herpen
, G.
, Stricker
, B. H.
, Stijnen
, T.
, Lip
, G. Y.
, and Witteman
, J. C.
, 2006
, “Prevalence, Incidence and Lifetime Risk of Atrial Fibrillation: The Rotterdam Study
,” Eur. Heart J.
, 27
(8
), pp. 949
–953
.9.
Prystowsky
, E. N.
, 2008
, “The History of Atrial Fibrillation: The Last 100 Years
,” J. Cardiovasc. Electrophysiol.
, 19
(6
), pp. 575
–582
.10.
Choi
, H. W.
, Navia
, J. A.
, and Kassab
, G. S.
, 2013
, “Stroke Propensity Is Increased Under Atrial Fibrillation Hemodynamics: A Simulation Study
,” PLoS One
, 8
(9), p. e78435
.11.
Khodaee
, F.
, Vahidi
, B.
, and Fatouraee
, N.
, 2016
, “Analysis of Mechanical Parameters on the Thromboembolism Using a Patient-Specific Computational Model
,” Biomech. Model Machanobiol.
, 15
(5
), pp. 1295
–1305
.12.
Osorio
, A. F.
, Osorio
, R.
, Ceballos
, A.
, Tran
, R.
, Clark
, W.
, Divo
, E. A.
, Argueta-Morales
, I. R.
, Kassab
, A. J.
, and DeCampli
, W. M.
, 2013
, “Computational Fluid Dynamics Analysis of Surgical Adjustment of Left Ventricular Assist Device Implantation to Minimize Stroke Risk
,” Comput. Methods Biomech. Biomed. Eng.
, 16
(6
), pp. 622
–632
.13.
Choi
, H. W.
, Lou
, T.
, Navia
, J. A.
, and Kassab
, G. S.
, 2017
, “Role of Aortic Geometry on Stroke Propensity Based on Simulations of Patients Specific Models
,” Sci. Rep.
, 7
, p. 7065
.14.
Fabbri
, D.
, Long
, Q.
, Das
, S.
, and Pinelli
, M.
, 2014
, “Computational Modelling of Emboli Travel Trajectories in Cerebral Arteries: Influence of Microembolic Particle Size and Density
,” Biomech. Model. Mechanobiol.
, 13
(2
), pp. 289
–302
.15.
Shadden
, S. C.
, and Arzani
, A.
, 2015
, “Lagrangian Postprocessing of Computational Hemodynamics
,” Ann. Biomed. Eng.
, 43
(1
), pp. 41
–58
.16.
Mukherjee
, D.
, and Shadden
, S. C.
, 2017
, “Inertial Particle Dynamics in Large Artery Flows–Implications for Modeling Arterial Embolisms
,” J. Biomech.
, 52
, pp. 155
–164
.17.
Mukherjee
, D.
, Padilla
, J.
, and Shadden
, S. C.
, 2016
, “Numerical Investigation of Fluid–Particle Interactions for Embolic Stroke
,” Theor. Comput. Fluid Dyn.
, 30
(1–2
), pp. 23
–39
.18.
Mukherjee
, D.
, Jani
, N. D.
, Selvaganesan
, K.
, Weng
, C. L.
, and Shadden
, S. C.
, 2016
, “Computational Assessment of the Relation Between Embolism Source and Embolus Distribution to the Circle of Willis for Improved Understanding of Stroke Etiology
,” ASME J. Biomech. Eng.
, 138
(8
), p. 081008
.19.
Aycock
, K. I.
, Campbell
, R. L.
, Manning
, K. B.
, and Craven
, B. A.
, 2017
, “A Resolved Two-Way Coupled CFD/6-DOF Approach for Predicting Embolus Transport and the Embolus-Trapping Efficiency of IVC Filters
,” Biomech. Model. Mechanobiol.
, 16
(3
), pp. 851
–869
.20.
Conti
, M.
, Vandenberghe
, S.
, Marconi
, S.
, Ferrari
, E.
, Romarowski
, R. M.
, Morganti
, S.
, Auricchio
, F.
, and Demertzis
, S.
, 2018
, “Reversed Auxiliary Flow to Reduce Embolism Risk During TAVI: A Computational Simulation and Experimental Study
,” Cardiovasc. Eng. Technol.
, 10
(1
), pp. 124
–135
.21.
Mukherjee
, D.
, Jani
, N. D.
, Narvid
, J.
, and Shadden
, S. C.
, 2018
, “The Role of Circle of Willis Anatomy Variations in Cardio-Embolic Stroke: A Patient-Specific Simulation Based Study
,” Ann. Biomed. Eng.
, 46
(8
), pp. 1128
–1145
.22.
Bushi
, D.
, Grad
, Y.
, Einav
, S.
, Yodfat
, O.
, Nishri
, B.
, and Tanne
, D.
, 2005
, “Hemodynamic Evaluation of Embolic Trajectory in an Arterial Bifurcation
,” Stroke
, 36
(12
), pp. 2696
–2700
.23.
Chung
, E. M. L.
, Hague
, J. P.
, Chanrion
, M.-A.
, Ramnarine
, K. V.
, Katsogridakis
, E.
, and Evans
, D. H.
, 2010
, “Embolus Trajectory Through a Physical Replica of the Major Cerebral Arteries
,” Stroke
, 41
(4
), pp. 647
–652
.24.
Fahy
, P.
, Malone
, F.
, McCarthy
, E.
, McCarthy
, P.
, Thornton
, J.
, Brennan
, P.
, O'Hare
, A.
, Looby
, S.
, Sultan
, S.
, Hynes
, N.
, and Morris
, L.
, 2015
, “An In Vitro Evaluation of Emboli Trajectories Within a Three-Dimensional Physical Model of the Circle of Willis Under Cerebral Blood Flow Conditions
,” Ann. Biomed. Eng.
, 43
(9
), pp. 2265
–2278
.25.
Chueh
, J. Y.
, Puri
, A. S.
, Wakhloo
, A. K.
, and Gounis
, M. J.
, 2014
, “Risk of Distal Embolization With Stent Retriever Thrombectomy and ADAPT
,” J. Neurointervent Surg
, 8
(2), pp. 197–202.26.
Clark
, W. D.
, Eslahpazir
, B. A.
, Argueta-Morales
, I. R.
, Kassab
, A. J.
, Divo
, E. A.
, and DeCampli
, W. M.
, 2015
, “Comparison Between Bench-Top and Computational Modelling of Cerebral Thromboembolism in Ventricular Assist Device Circulation
,” Cardiovasc. Eng. Technol.
, 6
(3
), pp. 242
–255
.27.
Pollanen
, M. S.
, 1991
, “Behavior of Suspended Particles at Bifurcations: Implications for Embolism
,” Phys. Med. Biol.
, 36
(3
), pp. 397
–401
.28.
Uflacker
, R.
, 2007
, Atlas of Vascular Anatomy: An Angiographic Approach, Lippincott Williams & Wilkins, Charleston, SC, pp. 133
–163
.29.
Ou
, P.
, Celermajer
, D. S.
, Mousseaux
, E.
, Giron
, A.
, Aggoun
, Y.
, Szezepanski
, I.
, Sidi
, D.
, and Bonnet
, D.
, 2007
, “Vascular Remodeling After ‘Successful’ Repair of Coarctation Impact of Aortic Arch Geometry
,” J. Am. Coll. Cardiol.
, 49
(8
), pp. 883
–890
.30.
Agnoletti
, G.
, Ou
, P.
, Celermajer
, D. S.
, Boudjemline
, Y.
, Marini
, D.
, Bonnet
, D.
, and Aggoun
, Y.
, 2008
, “Acute Angulation of the Aortic Arch Predisposes a Patient to Ascending Aortic Dilatation and Aortic Regurgitation Late After the Arterial Switch Operation for Transposition of the Great Arteries
,” J. Thorac. Cardiovasc. Surg.
, 135
(3
), pp. 568
–572
.31.
Demertzis
, S.
,Hurni
, S.
, Stalder
, M.
, Gahl
, B.
, Herrmann
, G.
, and Van den Berg
, J.
, 2010
, “Aortic Arch Morphometry in Living Humans
,” J. Anat.
, 217
(5
), pp. 588
–596
.32.
Reymond
, P.
, Merenda
, F.
, Perren
, F.
, Ruefenacht
, D.
, and Stergiopulos
, N.
, 2009
, “Validation of a One-Dimensional Model of the Systemic Arterial Tree
,” Am. Physiol. Soc.
, 297
(1
), pp. 208
–222
.33.
Clark
, D. M.
, Plumb
, V. J.
, Epstein
, A. E.
, and Kay
, G. N.
, 1997
, “Hemodynamic Effects of an Irregular Sequence of Ventricular Cycle Lengths During Atrial Fibrillation
,” J. Am. Coll. Cardiol.
, 30
(4
), pp. 1039
–1045
.34.
Stein
, P. D.
, and Sabbah
, H. N.
, 1976
, “Turbulent Blood Flow in the Ascending Aorta of Humans With Normal and Diseased Aortic Valves
,” Circ. Res.
, 39
(1
), pp. 58
–65
.35.
Hennen
, B.
, Markwirth
, T.
, Scheller
, B.
, Schäfers
, H. J.
, and Wendler
, O.
, 2001
, “Do Changes in Blood Flow in the Subclavian Artery Affect Flow Volume in IMA Grafts After Complete Arterial Revascularization With the T-Graft Technique?
,” Thorac. Cardiovasc. Surg.
, 49
(2
), pp. 84
–88
.36.
Tokuda
, Y.
, Song
, M. H.
, Ueda
, Y.
, Usui
, A.
, Akita
, T.
, Yoneyama
, S.
, and Maruyama
, S.
, 2008
, “Three-Dimensional Numerical Simulation of Blood Flow in the Aortic Arch During Cardiopulmonary Bypass
,” Eur. J. Cardio-Thorac. Surg.
, 33
(2
), pp. 164
–167
.37.
Sato
, K.
, Ogoh
, S.
, Hirasawa
, A.
, Oue
, A.
, and Sadamoto
, T.
, 2011
, “The Distribution of Blood Flow in the Carotid and Vertebral Arteries During Dynamic Exercise in Humans
,” J. Physiol.
, 589
(11
), pp. 2847
–2856
.38.
Benim
, A. C.
, Nahavandi
, A.
, Assmann
, A.
, Schubert
, D.
, Feindt
, P.
, and Suh
, S. H.
, 2011
, “Simulation of Blood Flow in Human Aorta With Emphasis on Outlet Boundary Conditions
,” Appl. Math. Modell.
, 35
(7
), pp. 3175
–3188
.39.
Bürk
, J.
, Blanke
, P.
, Stankovic
, Z.
, Barker
, A.
, Russe
, M.
, Geiger
, J.
, Frydrychowicz
, A.
, Langer
, M.
, and Markl
, M.
, 2012
, “Evaluation of 3D Blood Flow Patterns and Wall Shear Stress in the Normal and Dilated Thoracic Aorta Using Flow Sensitive 4D CMR
,” J. Cardiovasc. Magn. Reson.
, 14
, p. 84
.40.
Malone
, F.
, MacCarthy
, E.
, Delassus
, P.
, Fahy
, P.
, Kennedy
, J.
, Fagan
, A. J.
, and Morris
, L.
, 2018
, “The Mechanical Characterisation of Bovine Embolus Analogues Under Various Loading Conditions
,” Cardiovasc. Eng. Technol.
, 9
(3
), pp. 489
–502
.41.
Chueh
, J. K.
, Wakhloo
, A. K.
, Hendricks
, G. H.
, Silva
, C. F.
, Weaver
, J. P.
, and Gounis
, M. J.
, 2011
, “Mechanical Characterisation of Thromboemboli in Acute Ischemic Stroke and Laboratory Embolus Analogs
,” Am. J. Neurobiol.
, 32
(7
), pp. 1237
–1244
. 42.
Thambidorai
, S. K.
, Murray
, R. D.
, Parakh
, K.
, Shah
, T. K.
, Black
, I. W.
, Jasper
, S. E.
, Li
, J.
, Apperson-Hansen
, C.
, Asher
, C. R.
, Grimm
, R. A.
, and Klein
, A. L.
, 2005
, “Utility of Transesophageal Echocardiography in Identification of Thrombogenic Milieu in Patients With Atrial Fibrillation (An ACUTE Ancillary Study)
,” Am. J. Cardiol.
, 96
(7
), pp. 935
–941
.43.
Madhwal
, S.
, Rajagopal
, V.
, Bhatt
, D. L.
, Bajzer
, C. T.
, Whitlow
, P.
, and Kapadia
, S. R.
, 2008
, “Predictors of Difficult Carotid Stenting as Determined by Aortic Arch Angiography
,” J. Invasive Cardiol
, 20
(5
), pp. 200
–204
.44.
Chung
, J. W.
, Park
, S. H.
, and Kim
, N.
, 2014
, “Trial of ORG 10172 in Acute Stroke Treatment (TOAST) Classification and Vascular Territory of Ischemic Stroke Lesions Diagnosed by Diffusion-Weighted Imaging
,” J. Am. Heart Assoc.
, 3
(4
), p. e001119
.45.
Sanna
, T.
, Diener
, H.-C.
, Passman
, R. S.
, Di Lazzaro
, V.
, Bernstein
, R. A.
, Morillo
, C. A.
, Rymer
, M. M.
, Thijs
, V.
, Rogers
, T.
, Beckers
, F.
, Lindborg
, K.
, Brachmann
, J.
, and CRYSTAL AF Investigators,
2014
, “Cryptogenic Stroke and Underlying Atrial Fibrillation
,” N. Engl. J. Med.
, 370
(26
), pp. 2478
–2486
.46.
Park
, K. Y.
, Kim
, Y. B.
, Chung
, P. W.
, Moon
, H. S.
, Suh
, B. C.
, Yoon
, K. J.
, and Lee
, Y. T.
, 2014
, “Right Side Propensity of Cardiogenic Emboli in Acute Ischemic Stroke With Atrial Fibrillation
,” Scand. Cardiovasc. J.
, 48
(6
), pp. 335
–338
.47.
Gold
, M.
, Khamesi
, M.
, Sivakuma
, M.
, Natarajan
, V.
, Motahari
, H.
, and Caputo
, N.
, 2018
, “Right-Left Propensity of Cardiogenic Cerebral Embolism in Standard Versus Bovine Aortic Arch Variant
,” Clin. Anat.
, 31
(3), pp. 310–313.48.
Meyer
, J. S.
, Charney
, J. Z.
, Rivera
, V. M.
, and Mathew
, M. T.
, 1971
, “Cerebral Embolization: Prospective Clinical Analysis of 42 Cases
,” Stroke
, 2
(6
), pp. 541
–554
.49.
Hedna
, W. S.
, Bodhit
, A. N.
, Ansari
, S.
, Falchook
, A. D.
, Stead
, L.
, Heilman
, K. M.
, and Waters
, M. F.
, 2013
, “Hemispheric Differences in Ischemic Stroke: Is Left Hemisphere Stroke More Common?
,” J. Clin. Neurol.
, 9
(2
), pp. 97
–102
.50.
Rodriguez Hernandez
, S.
, Kroon
, A. A.
, van boztel
, M. P. J.
, Mess
, W. H.
, Lodder
, J.
, Jolles
, J.
, and de leeuw
, P. W.
, 2003
, “Is There Side Predilection for Cerebrovascular Disease?
,” Hypertension
, 42
(1
), pp. 56
–60
.51.
Gralla
, J.
, Schroth
, G.
, Remonda
, L.
, Fleischmann
, A.
, Fandino
, J.
, Slotboom
, J.
, and Brekenfeld
, C.
, 2006
, “A Dedicated Animal Model for Mechanical Thrombectomy in Acute Stroke
,” AJNR
, 27
(6
), pp. 1357
–1361
.52.
Chandler
, A. B.
, 1958
, “In Vitro Thrombotic Coagulation of the Blood; a Method for Producing a Thrombus
,” Lab Invest.
, 7
(2
), pp. 110
–114
.53.
Mutch
, N. J.
, Moore
, N. R.
, Mattsson
, C.
, Jonasson
, H.
, Green
, A. R.
, and Booth
, N. A.
, 2008
, “The Use of the Chandler Loop to Examine the Interaction Potential of NXY—059 on the Thrombolytic Properties of rtPA on Human Thrombi In Vitro
,” Br. J. Pharmacol.
, 153
(1
), pp. 124
–131
.54.
Leary
, M. C.
, and Caplan
, L. R.
, 2008
, “Cardioembolic Stroke: An Update on Etiology, Diagnosis and Management
,” Ann. Indian Acad. Neurol.
, 11
(5
), pp. 52
–63
.Copyright © 2019 by ASME
You do not currently have access to this content.
