Computational analysis of coupled blood-wall arterial LDL transport

The transport of macromolecules, such as low density lipoproteins (LDLs), across the artery wall and their accumulation in the wall is a key step in atherogenesis. Our objective was to model fluid flow within both the lumen and wall of a constricted, axisymmetric tube simulating a stenosed artery, and to then use this flow pattern to study LDL mass transport from the blood to the artery wall. Coupled analysis of lumenal blood flow and transmural fluid flow was achieved through the solution of Brinkman's model, which is an extension of the Navier-Stokes equations for porous media. This coupled approach offers advantages over traditional analyses of this problem, which have used possibly unrealistic boundary conditions at the blood-wall interface; instead, we prescribe a more natural pressure boundary condition at the adventitial vasa vasorum, and allow variations in wall permeability due to the occurrence of plaque. Numerical complications due to the convection dominated mass transport process (low LDL diffusivity) are handled by the streamline upwind/Petrov-Galerkin (SUPG) finite element method. This new fluid-plus-porous-wall method was implemented for conditions typical of LDL transport in a stenosed artery with a 75 percent area reduction (Peclet number=2 x 10(8)). The results show an elevated LDL concentration at the downstream side of the stenosis. For the higher Darcian wall permeability thought to occur in regions containing atheromatous lesions, this leads to an increased transendothelial LDL flux downstream of the stenosis. Increased transmural filtration in such regions, when coupled with a concentration-dependent endothelial permeability to LDL, could be an important contributor to LDL infiltration into the arterial wall. Experimental work is needed to confirm these results.     

Computational modeling of coupled blood-wall mass transport of LDL: effects of local wall shear stress

The work herein represents a novel approach for the modeling of low-density lipoprotein (LDL) transport from the artery lumen into the arterial wall, taking into account the effects of local wall shear stress (WSS) on the endothelial cell layer and its pathways of volume and solute flux. We have simulated LDL transport in an axisymmetric representation of a stenosed coronary artery, where the endothelium is represented by a three-pore model that takes into account the contributions of the vesicular pathway, normal junctions, and leaky junctions also employing the local WSS to yield the overall volume and solute flux. The fraction of leaky junctions is calculated as a function of the local WSS based on published experimental data and is used in conjunction with the pore theory to determine the transport properties of this pathway. We have found elevated levels of solute flux at low shear stress regions because of the presence of a larger number of leaky junctions compared with high shear stress regions. Accordingly, we were able to observe high LDL concentrations in the arterial wall in these low shear stress regions despite increased filtration velocity, indicating that the increase in filtration velocity is not sufficient for the convective removal of LDL.     

Multiphysics simulation of blood flow and LDL transport in a porohyperelastic arterial wall model

Atherosclerosis localizes at a bend andor bifurcation of an artery, and low density lipoproteins (LDL) accumulate in the intima. Hemodynamic factors are known to affect this localization and LDL accumulation, but the details of the process remain unknown. It is thought that the LDL concentration will be affected by the filtration flow, and that the velocity of this flow will be affected by deformation of the arterial wall. Thus, a coupled model of a blood flow and a deformable arterial wall with filtration flow would be invaluable for simulation of the flow field and concentration field in sequence. However, this type of highly coupled interaction analysis has not yet been attempted. Therefore, we performed a coupled analysis of an artery with multiple bends in sequence. First, based on the theory of porous media, we modeled a deformable arterial wall using a porohyperelastic model (PHEM) that was able to express both the filtration flow and the viscoelastic behavior of the living tissue, and simulated a blood flow field in the arterial lumen, a filtration flow field and a displacement field in the arterial wall using a fluid-structure interaction (FSI) program code by the finite element method (FEM). Next, based on the obtained results, we further simulated LDL transport using a mass transfer analysis code by the FEM. We analyzed the PHEM in comparison with a rigid model. For the blood flow, stagnation was observed downward of the bends. The direction of the filtration flow was only from the lumen to the wall for the rigid model, while filtration flows from both the wall to the lumen and the lumen to the wall were observed for the PHEM. The LDL concentration was high at the lumenwall interface for both the PHEM and rigid model, and reached its maximum value at the stagnation area. For the PHEM, the maximum LDL concentration in the wall in the radial direction was observed at the position of 3% wall thickness from the lumenwall interface, while for the rigid model, it was observed just at the lumenwall interface. In addition, the peak LDL accumulation area of the PHEM moved about according to the pulsatile flow. These results demonstrate that the blood flow, arterial wall deformation, and filtration flow all affect the LDL concentration, and that LDL accumulation is due to stagnation and the presence of filtration flow. Thus, FSI analysis is indispensable.     

Effects of transmural pressure on the transport and distribution of low density lipoproteins in the arterial wall

In an attempt to investigate the effects of transmural pressure on LDL transport and distribution across the arterial wall, uptake of labeled LDL has been measured in excised rabbit thoracic aorta, held at in vivo length and pressurized to 70 or 160 mmHg. The transmural distribution of LDL concentration across the wall was determined by examining serial frozen sections cut parallel to the luminal surface at 20 microns intervals from the intima to adventitia. The LDL concentration observed in the first luminal section at 160 mmHg was 20-fold higher than that obtained at 70 mmHg. The LDL concentrations decreased in the subsequent sections of the first half of the media and became similar, in the outer half of the media, to the values observed under normal pressure. These results might provide an account of one of the mechanisms involved in the deleterious effects of hypertension in atherogenesis.     

Numerical 3D-simulation of pulsatile wall shear stress in an arterial T-bifurcation model

The structure of pulsatile blood flow and wall shear stress in a 90° T-bifurcation model is analysed numerically. The nonlinear Navier-Stokes equations for time-dependent incompressible Newtonian fluid flow are approximated using a newly developed pressure correction, finite element method. The wall shear stress is calculated from the finite element velocity field. The investigation shows viscous flow phenomena such as flow separation and stagnation and the distribution of high and low wall shear stress during the pulse cycle. Furthermore, the effect of a sharp corner the bifurcation edge on the wall shear stress is analysed. Detailed local flow investigation is required to examine fluid dynamic contribution to the development of arterial diseases such as atherosclerosis and thrombosis.     

Simulation of Low Density Lipoprotein (LDL) permeation into multilayer coronary arterial wall: Interactive effects of wall shear stress and fluid-structure interaction in hypertension

Due to increased atherosclerosis-caused mortality, identification of its genesis and development is of great importance. Although, key factors of the origin of the disease is still unknown, it is widely believed that cholesterol particle penetration and accumulation in arterial wall is mainly responsible for further wall thickening and decreased rate of blood flow during a gradual progression. To date, various effective components are recognized whose simultaneous consideration would lead to a more accurate approximation of Low Density Lipoprotein (LDL) distribution within the wall. In this research, a multilayer Fluid-Structure Interaction (FSI) model is studied to simulate the penetration of LDL into the arterial wall. Distention impact on wall properties is taken into account by considering FSI and Wall Shear Stress (WSS) dependent endothelium properties. The results show intensified permeation of LDL whilst the FSI approach is applied. In addition, luminal distension prompted by FSI reduces WSS along lumen/wall interface, especially in hypertension. This effect leads to a lowered endothelial resistance against LDL permeation, comparing to the case in which WSS effect is overlooked. The results are in an acceptable consistency with the clinical researches on WSS effect on atherosclerosis development.     

Large eddy simulation of LDL surface concentration in a subject specific human aorta

The development of atherosclerosis is correlated to the accumulation of lipids in the arterial wall, which, in turn, may be caused by the build-up of low-density lipoproteins (LDL) on the arterial surface. The goal of this study was to model blood flow within a subject specific human aorta, and to study how the LDL surface concentration changed during a cardiac cycle. With measured velocity profiles as boundary conditions, a scale-resolving technique (large eddy simulation, LES) was used to compute the pulsatile blood flow that was in the transitional regime. The relationship between wall shear stress (WSS) and LDL surface concentration was investigated, and it was found that the accumulation of LDL correlated well with WSS. In general, regions of low WSS corresponded to regions of increased LDL concentration and vice versa. The instantaneous LDL values changed significantly during a cardiac cycle; during systole the surface concentration was low due to increased convective fluid transport, while in diastole there was an increased accumulation of LDL on the surface. Therefore, the near-wall velocity was investigated at four representative locations, and it was concluded that in regions with disturbed flow the LDL concentration had significant temporal changes, indicating that LDL accumulation is sensitive to not only the WSS but also near-wall flow.     

Effects of elastic property of the wall on flow characteristics through arterial stenoses

Hemodynamic characteristics of blood flow through arterial stenoses are numerically investigated in this work. The blood is assumed as a Newtonian fluid and the pulsatile nature of flow is modeled by using measured values of the flowrate and pressure for the canine femoral artery. An isotropic elastic and incompressible material is assumed for the wall at each axial section, but a non-uniform distribution of the shear modulus in axial direction is used to model the high stiffness of the wall at the stenosis location. Full Navier equations for a thick wall are used as the governing equations for the wall displacements. A continuous grid extending over the flow field and the wall is considered and governing equations are transformed for use in the computational domain. Discretized forms of the transformed wall and flow equations, which are coupled through the boundary conditions at their interface, are obtained by control volume method and simultaneously solved using the well-known SIMPLER algorithm. To study the effects of wall deformability, solutions are obtained for both rigid and elastic walls. The results indicate that deformability of the wall causes an increase in the time average of pressure drop, but a decrease in the maximum wall shear stress. Displacement and stress distributions in the wall are presented.     

Artery buckling analysis using a four-fiber wall model

Artery bent buckling has been suggested as a possible mechanism that leads to artery tortuosity, which is associated with aging, hypertension, atherosclerosis, and other pathological conditions. It is necessary to understand the relationship between microscopic wall structural changes and macroscopic artery buckling behavior. To this end, the objectives of this study were to develop arterial buckling equations using a microstructure-based 4-fiber reinforced wall model, and to simulate the effects of vessel wall microstructural changes on artery buckling. Our results showed that the critical pressure increased nonlinearly with the axial stretch ratio, and the 4-fiber model predicted higher critical buckling pressures than what the Fung model predicted. The buckling equation using the 4-fiber model captured the experimentally observed reduction of critical pressure induced by elastin degradation and collagen fiber orientation changes in the arterial wall. These results improve our understanding of arterial stability and its relationship to microscopic wall remodeling, and the model provides a useful tool for further studies.     

Effect of the endothelial glycocalyx layer on arterial LDL transport under normal and high pressure

To quantitatively investigate the role of the endothelial glycocalyx layer (EGL) in protecting the artery from excessive infiltration of atherogenic lipids such as low density lipoproteins (LDLs), a multilayer model with the EGL of an arterial segment was developed to numerically simulate the flow and the transport of LDLs under normal and high pressure. The transport parameters of the layers of the model were obtained from the hydrodynamic theory, the stochastic theory, and from the literature. The results showed that the increase in the thickness of the EGL could lead to a sharp drop in LDL accumulation in the intima. A partial damage to the EGL could compromise its barrier function, hence leading to enhanced infiltration/accumulation of LDLs within the wall of the arterial model. Without the EGL, hypertension could lead to a significantly enhanced LDL transport into the wall of the model. However, the intact EGL could protect the arterial wall from hypertension so that the LDL concentration in the intima layer was almost the same as that under normal pressure conditions. The results also showed that LDL concentration within the arterial wall increased with Φ (the fraction of leaky junctions) on the intima layer. The increase in LDL concentration with Φ was much more dramatic for the model without the EGL. For instance, without the EGL, a Φ of 0.0005 could lead LDL concentration within the arterial wall to be even higher than that predicted for the EGL intact model with a Φ of 0.002. In conclusion, an intact EGL with a sufficient thickness may act as a barrier to LDL infiltration into the arterial wall and has the potential to suppress the hypertension-driven hike of LDL infiltration/accumulation in the arterial wall.     

Steady flow and wall compression in stenotic arteries: a three-dimensional thick-wall model with fluid-wall interactions.

Severe stenosis may cause critical flow and wall mechanical conditions related to artery fatigue, artery compression, and plaque rupture, which leads directly to heart attack and stroke. The exact mechanism involved is not well understood. In this paper a nonlinear three-dimensional thick-wall model with fluid-wall interactions is introduced to simulate blood flow in carotid arteries with stenosis and to quantify physiological conditions under which wall compression or even collapse may occur. The mechanical properties of the tube wall were selected to match a thick-wall stenosis model made of PVA hydrogel. The experimentally measured nonlinear stress-strain relationship is implemented in the computational model using an incremental linear elasticity approach. The Navier-Stokes equations are used for the fluid model. An incremental boundary iteration method is used to handle the fluid-wall interactions. Our results indicate that severe stenosis causes considerable compressive stress in the tube wall and critical flow conditions such as negative pressure, high shear stress, and flow separation which may be related to artery compression, plaque cap rupture, platelet activation, and thrombus formation. The stress distribution has a very localized pattern and both maximum tensile stress (five times higher than normal average stress) and maximum compressive stress occur inside the stenotic section. Wall deformation, flow rates, and true severities of the stenosis under different pressure conditions are calculated and compared with experimental measurements and reasonable agreement is found.     

Computational study of LDL mass transport in the artery wall

A two-dimensional (2D) numerical simulation of convective–diffusive transport of LDL in the artery wall, coupled with the wall shear stress gradient (WSSG)-dependent LDL consumption of smooth muscle cells (SMCs) is presented. SMCs are modeled as an array of solid cylindrical pillars embedded in a continuous porous media which represents the interstitial proteoglycan and collagen fiber matrix. The internal elastic lamina (IEL), which separates the artery media from the intima, is modeled as an impermeable barrier to both water and LDL except for the fenestral pores that are assumed to be uniformly distributed over the IEL. The predictions demonstrate a range of interesting features of LDL transport and uptake in the media. For cells immediately below the fenestral pores, LDL uptake of SMCs is highly dependent on WSSG. Moreover, the rate of LDL consumption by SMCs is also affected by the diameter of the fenestral pore. This will be helpful in understanding the involvement of transmural transport processes in the initiation and development of atherosclerosis.     

A theory for water and macromolecular transport in the pulmonary artery wall with a detailed comparison to the aorta

The pulmonary artery (PA) wall, which has much higher hydraulic conductivity and albumin void space and approximately one-sixth the normal transmural pressure of systemic arteries (e.g, aorta, carotid arteries), is rarely atherosclerotic, except under pulmonary hypertension. This study constructs a detailed, two-dimensional, wall-structure-based filtration and macromolecular transport model for the PA to investigate differences in prelesion transport processes between the disease-susceptible aorta and the relatively resistant PA. The PA and aorta models are similar in wall structure, but very different in parameter values, many of which have been measured (and therefore modified) since the original aorta model of Huang et al. (23). Both PA and aortic model simulations fit experimental data on transwall LDL concentration profiles and on the growth of isolated endothelial (horseradish peroxidase) tracer spots with circulation time very well. They reveal that lipid entering the aorta attains a much higher intima than media concentration but distributes better between these regions in the PA than aorta and that tracer in both regions contributes to observed tracer spots. Solutions show why both the overall transmural water flow and spot growth rates are similar in these vessels despite very different material transport parameters. Since early lipid accumulation occurs in the subendothelial intima and since (matrix binding) reaction kinetics depend on reactant concentrations, the lower intima lipid concentrations in the PA vs. aorta likely lead to slower accumulation of bound lipid in the PA. These findings may be relevant to understanding the different atherosusceptibilities of these vessels.     

Adaptive regulation of wall shear stress optimizing vascular tree function

The branching structure of the mammalian arterial tree has been known to be close to that of an optimal conduit system of the minimum work model characterized as the branch system of constant wall shear rate. The physiological mechanism producing such construction was considered to be based on the local response of arterial caliber induced by the wall shear stress (shear rate × blood viscosity) and thereby maintaining this stress constant, which was previously observed at the canine common carotid artery shunted to the external jugular vein. The stress levels at various parts of the arterial system estimated from available data fell within ±50% of the mean (15 dyn/cm²), which was consistent with the value predicted from the model. Theoretical analyses on the cost function of the model indicated that the suspected variation of shear rate levels in the arterial tree due to the anomalous changes in blood viscosity which might bring about 3- to 4-fold differences between the minimum and maximum shear rates would cause less than 10% increase in the total energy cost. It was concluded that a local adaptive response to wall shear stress is the mechanism which effectively optimizes the design of the arterial tree.     

Accurate prediction of wall shear stress in a stented artery: newtonian versus non-newtonian models

A significant amount of evidence linking wall shear stress to neointimal hyperplasia has been reported in the literature. As a result, numerical and experimental models have been created to study the influence of stent design on wall shear stress. Traditionally, blood has been assumed to behave as a Newtonian fluid, but recently that assumption has been challenged. The use of a linear model; however, can reduce computational cost, and allow the use of Newtonian fluids (e.g., glycerine and water) instead of a blood analog fluid in an experimental setup. Therefore, it is of interest whether a linear model can be used to accurately predict the wall shear stress caused by a non-Newtonian fluid such as blood within a stented arterial segment. The present work compares the resulting wall shear stress obtained using two linear and one nonlinear model under the same flow waveform. All numerical models are fully three-dimensional, transient, and incorporate a realistic stent geometry. It is shown that traditional linear models (based on blood's lowest viscosity limit, 3.5 Pa s) underestimate the wall shear stress within a stented arterial segment, which can lead to an overestimation of the risk of restenosis. The second linear model, which uses a characteristic viscosity (based on an average strain rate, 4.7 Pa s), results in higher wall shear stress levels, but which are still substantially below those of the nonlinear model. It is therefore shown that nonlinear models result in more accurate predictions of wall shear stress within a stented arterial segment.     

Effect of residual stress and heterogeneity on circumferential stress in the arterial wall

Quantifying the stress distribution through the arterial wall is essential to studies of arterial growth and disease. Previous studies have shown that both residual stress, as measured by opening angle, and differing material properties for the media-intima and the adventitial layers affect the transmural circumferential stress (sigma theta) distribution. Because a lack of comprehensive data on a single species and artery has led to combinations from multiple sources, this study determined the sensitivity of sigma theta to published variations in both opening angle and layer thickness data. We fit material properties to previously published experimental data for pressure-diameter relations and opening angles of rabbit carotid artery, and predicted sigma theta through the arterial wall at physiologic conditions. Using a one-layer model, the ratio of sigma theta at the internal wall to the mean sigma theta decreased from 2.34 to 0.98 as the opening angle increased from 60 to 130 deg. In a two-layer model using a 95 deg opening angle, mean sigma theta in the adventitia increased (112 percent for 25 percent adventitia) and mean sigma theta in the media decreased (47 percent for 25 percent adventitia). These results suggest that both residual stress and wall layers have important effects on transmural stress distribution. Thus, experimental measurements of loading curves, opening angles, and wall composition from the same species and artery are needed to accurately predict the transmural stress distribution in the arterial wall.     

Design optimization of a helical endothelial cell culture device

The specific roles of mass transfer and fluid dynamic stresses on endothelial function, important in atherogenesis, are not known. Further, the effects of mass transfer and fluid dynamic stresses are difficult to separate because areas of “abnormal” mass transfer and “abnormal” wall shear stress tend to co-localize (where abnormal is defined as any deviation from the mass transfer rate or wall shear stress present in a long straight artery with the same flow rate and diameter). Our goal was to design a cell culture device which gives maximum separation between areas of abnormal shear stress and areas of abnormal mass transfer. We used design optimization principles to design a helical cell culture device. Using shear stress and mass transfer fields predicted by solving the governing equations, the area of the device which was exposed to low rates of mass transfer and normal levels of wall shear stress was determined. The design optimization method then maximized this area by varying the design variables, resulting in the optimum design. The optimum design had Reynolds number = 50, helical radius = 3.23 and helical pitch = 3.82. The area of the device which was exposed to low rates of mass transfer and regular levels of wall shear stress was about 4.5 times the inlet cross-sectional area of the device or about 5% of the device total internal surface area. An optimum design was successfully determined and the methodology used was shown to be robust. The area of the device which was exposed to low rates of mass transfer and regular levels of wall shear stress occurred in a defined region which should aid further experimental work.     

The Effect of a Spatially Heterogeneous Transmural Water Flux on Concentration Polarization of Low Density Lipoprotein in Arteries

Uptake of low density lipoprotein (LDL) by the arterial wall is likely to play a key role in atherogenesis. A particular process that may cause vascular scale heterogeneity in the rate of transendothelial LDL transport is the formation of a flow-dependent LDL concentration polarization layer on the luminal surface of the arterial endothelium. In this study, the effect of a spatially heterogeneous transmural water flux (that traverses the endothelium only via interendothelial cell clefts) on such concentration polarization is investigated numerically. Unlike in previous investigations, realistic intercellular cleft dimensions are used here and several values of LDL diffusivity are considered. Particular attention is paid to the spatially averaged LDL concentration adjacent to different regions of the endothelial surface, as such measures may be relevant to the rate of transendothelial LDL transport. It is demonstrated in principle that a heterogeneous transmural water flux can act to enhance such measures, and cause them to develop a shear dependence (in addition to that caused by vascular scale flow features, affecting the overall degree of LDL concentration polarization). However, it is shown that this enhancement and additional shear dependence are likely to be negligible for a physiologically realistic transmural flux velocity of 0.0439 μm s⁻¹ and an LDL diffusivity (in blood plasma) of 28.67 μm² s⁻¹. Hence, the results imply that vascular scale studies of LDL concentration polarization are justified in ignoring the effect of a spatially heterogeneous transmural water flux.     

Haemodynamics and wall remodelling of a growing cerebral aneurysm: a computational model

We have developed a computational simulation model for investigating an often postulated hypothesis connected with aneurysm growth. This hypothesis involves a combination of two parallel and interconnected mechanisms: according to the first mechanism, an endothelium-originating and wall shear stress-driven apoptotic behavior of smooth muscle cells, leading to loss of vascular tone is believed to be important to the aneurysm behavior. Vascular tone refers to the degree of constriction experienced by a blood vessel relative to its maximally dilated state. All resistance and capacitance vessels under basal conditions exhibit some degree of smooth muscle contraction that determines the diameter, and hence tone, of the vessel. The second mechanism is connected to the arterial wall remodeling. Remodeling of the arterial wall under constant tension is a biomechanical process of rupture, degradation and reconstruction of the medial elastin and collagen fibers. In order to investigate these two mechanisms within a computationally tractable framework, we devise mechanical analogues that involve three-dimensional haemodynamics, yielding estimates of the wall shear stress and pressure fields and a quasi-steady approach for the apoptosis and remodeling of the wall. These analogues are guided by experimental information for the connection of stimuli to responses at a cellular level, properly averaged over volumes or surfaces. The model predicts aneurysm growth and can attribute specific roles to the two mechanisms involved: the smooth muscle cell-related loss of tone is important to the initiation of aneurysm growth, but cannot account alone for the formation of fully grown sacks; the fiber-related remodeling is pivotal for the latter.