Benedict Verhegghe

(1) Background: We aimed to assess the validity of laser Doppler vibrometry (LDV) as an emerging method to measure the local pulse wave velocity (PWV) from skin displacement generated by the pressure pulse inside an underlying artery. (2) Methods: A finite element model representing a simplified common carotid artery embedded within a soft tissue mimicking material was used to reproduce how tissue motions due to a wave propagation along the artery radiates to the skin surface. A parametric study was set up, varying: (i) the pressure conditions inside the artery (shock and traveling pressure impulse), (ii) the arterial depth and (iii) the geometry in a patient-specific artery model. (3) Results: under all conditions, the arterial pulse induced primary and secondary waves at the skin surface; of which the propagation speed deviated from the imposed PWV (deviations between −5.0% to 47.0% for the primary wave front). (4) Conclusions: the propagation of a short pressure impulse induced complex skin displacement patterns revealing a complicated link between PWV and measured propagation speeds at the skin surface. Wave propagation at the skin level may convey information about arterial PWV, however, advanced signal analysis techniques will be necessary to extract local PWV values.

Femur segmentation can be an important tool in orthopedic surgical planning. However, in order to overcome the need of an experienced user with extensive knowledge on the techniques, segmentation should be fully automatic. In this paper a new fully automatic femur segmentation method for CT images is presented. This method is also able to define automatically the medullary canal and performs well even in low resolution CT scans. Fully automatic femoral segmentation was performed adapting a template mesh of the femoral volume to medical images. In order to achieve this, an adaptation of the active shape model (ASM) technique based on the statistical shape model (SSM) and local appearance model (LAM) of the femur with a novel initialization method was used, to drive the template mesh deformation in order to fit the in-image femoral shape in a time effective approach. With the proposed method a 98% convergence rate was achieved. For high resolution CT images group the average error is less than 1mm. For the low resolution image group the results are also accurate and the average error is less than 1.5mm. The proposed segmentation pipeline is accurate, robust and completely user free. The method is robust to patient orientation, image artifacts and poorly defined edges. The results excelled even in CT images with a significant slice thickness, i.e., above 5mm. Medullary canal segmentation increases the geometric information that can be used in orthopedic surgical planning or in finite element analysis.

Endovascular treatment for patients with a proximal neck anatomy outside instructions for use is an ongoing topic of debate in endovascular aneurysm repair. This paper employs the finite element method to offer insight into possible adverse effects of deploying a stent graft into an angulated geometry. The effect of angulation, straight neck length and device oversize was investigated in a full factorial parametric analysis. Stent apposition, area reduction of the graft, asymmetry of contact forces and the ability to find a good seal were investigated. Most adverse effects are expected for combinations of high angulation and short straight landing zones. Higher oversize has a beneficiary effect, but not enough to compensate the adverse effects of (very) short and angulated angles. Our analysis shows that for an angle between the suprarenal aorta and proximal neck above 60°, proximal kinking of the device can occur. The method used offers a engineering view on the morphological limits of EVAR for a clinically used device.

In vivo visualization of cardiovascular structures is possible using medical images. However, one has to realize that the resulting 3D geometries correspond to in vivo conditions. This entails an internal stress state to be present in the in vivo measured geometry of e.g. a blood vessel due to the presence of the blood pressure. In order to correct for this in vivo stress, this paper presents an inverse method to restore the original zero-pressure geometry of a structure, and to recover the in vivo stress field of the final, loaded structure. The proposed backward displacement method is able to solve the inverse problem iteratively using fixed point iterations, but can be significantly accelerated by a quasi-Newton technique in which a least-squares model is used to approximate the inverse of the Jacobian. The here proposed backward displacement method allows for a straightforward implementation of the algorithm in combination with existing structural solvers, even if the structural solver is a black box, as only an update of the coordinates of the mesh needs to be performed.

Carotid artery stenting (CAS) has emerged as a minimally invasive alternative to endarterectomy but its use in clinical treatment is limited due to the post-stenting complications. Haemodynamic actors, related to blood flow in the stented vessel, have been suggested to play a role in the endothelium response to stenting, including adverse reactions such as in-stent restenosis and late thrombosis. Accessing the flow-related shear forces acting on the endothelium in vivo requires space and time resolutions which are currently not achievable with non-invasive clinical imaging techniques but can be obtained from image-based computational analysis. In this study, we present a framework for accurate determination of the wall shear stress (WSS) in a mildly stenosed carotid artery after the implantation of a stent, resembling the commercially available Acculink (Abbott Laboratories, Abbott Park, Illinois, USA). Starting from angiographic CT images of the vessel lumen and a micro-CT scan of the stent, a finite element analysis is carried out in order to deploy the stent in the vessel, reproducing CAS in silico. Then, based on the post-stenting anatomy, the vessel is perfused using a set of boundary conditions: total pressure is applied at the inlet, and impedances that are assumed to be insensitive to the presence of the stent are imposed at the outlets. Evaluation of the CAS outcome from a geometrical and haemodynamic perspective shows the presence of atheroprone regions (low time-average WSS, high relative residence time) colocalised with stent malapposition and stent strut interconnections. Stent struts remain unapposed in the ostium of the external carotid artery disturbing the flow and generating abnormal shear forces, which could trigger thromboembolic events.

The aim of this study is to analyze the shape and flow changes of a patient‐specific carotid artery after carotid artery stenting (CAS) performed using an open‐cell (stent‐O) or a closed‐cell (stent‐C) stent design. First, a stent reconstructed from micro‐computed tomography (microCT) is virtually implanted in a left carotid artery reconstructed from CT angiography. Second, an objective analysis of the stent‐to‐vessel apposition is used to quantify the lumen cross‐sectional area and the incomplete stent apposition (ISA). Third, the carotid artery lumen is virtually perfused in order to quantify its resistance to flow and its exposure to atherogenic or thrombogenic hemodynamic conditions. After CAS, the minimum cross‐sectional area of the internal carotid artery (ICA) (external carotid artery [ECA]) changes by +54% (−12%) with stent‐O and +78% (−17%) with stent‐C; the resistance to flow of the ICA (ECA) changes by −21% (+13%) with stent‐O and −26% (+18%) with stent‐C. Both stent designs suffer from ISA but the malapposed stent area is larger with stent‐O than stent‐C (29.5 vs. 14.8 mm²). The untreated vessel is not exposed to atherogenic flow conditions whereas an area of 67.6 mm² (104.9) occurs with stent‐O (stent‐C). The area of the stent surface exposed to thrombogenic risk is 5.42 mm² (7.7) with stent‐O (stent‐C). The computer simulations of stenting in a patient's carotid artery reveal a trade‐off between cross‐sectional size and flow resistance of the ICA (enlarged and circularized) and the ECA (narrowed and ovalized). Such a trade‐off, together with malapposition, atherogenic risk, and thrombogenic risk is stent‐design dependent.

SUMMARY: Technological advances are often inspired by nature, considering that engineering is frequently faced by the same challenges as organisms in nature. One such interesting challenge is creating a structure that is at the same time stiff in a certain direction, yet flexible in another. The seahorse tail combines both radial stiffness and bending flexibility in a particularly elegant way: even though the tail is covered in a protective armour, it still shows sufficient flexibility to fully function as a prehensile organ. We therefore study the complex mechanics and dynamics of the musculoskeletal system of the seahorse tail from an engineering point of view. The seahorse tail derives its combination of flexibility and resilience from a chain of articulating skeletal segments. A versatile dynamic model of those segments was constructed, on the basis of automatic recognition of joint positions and muscle attachments. Both muscle structures that are thought to be responsible for ventral and ventral–lateral tail bending, namely the median ventral muscles and the hypaxial myomere muscles, were included in the model. Simulations on the model consist mainly of dynamic multi‐body simulations. The results show that the sequential structure of uniformly shaped bony segments can remain flexible because of gliding joints that connect the corners of the segments. Radial stiffness on the other hand is obtained through the support that the central vertebra provides to the tail plating. Such insights could help in designing biomedical instruments that specifically require both high bending flexibility and radial stiffness (e.g. flexible stents and steerable catheters).Copyright © 2012 John Wiley & Sons, Ltd.