Key result
Steeper proximal stenosis slopes link to ~5-fold greater high OSI area, indicating higher disease progression.
Why the study?
The proximal shape of atherosclerotic plaque disrupts hemodynamics and causes disease progression, but its effects across varying severity and proximal slopes remain to be numerically addressed.
The proximal slope of an arterial stenosis significantly influences hemodynamics, with high and medium slopes predisposing to higher disease progression risk than low slopes of the same severity.
Stenosis proximal slope may modulate progression risk beyond severity; animal data leaves open human translation and intervention targets.
Purpose Atherosclerosis is an arterial disease that forms plaque, occludes the lumen and is stratified with stenosis severity. The proximal shape of the plaque disrupts hemodynamics and causes disease progression. The present study aims to numerically address the hemodynamics in distinct plaque shapes with varying severity and proximal slope. Design/methodology/approach Fluid flow simulations in stenosis are performed using the open-source software OpenFOAM. The inlet pulsatile nature is addressed with physiological rest and exercise conditions of Womersley profiles. The axisymmetric plaque surfaces are generated with varying proximal slopes and are termed as high, medium and low-slope stenoses. Distinct severities, including mild (56%), moderate (75%) and severe (89%) are integrated into respective stenosis shapes. Further, three-dimensional studies are performed on severe stenosis at rest condition. Findings The results show that during rest condition, high slope stenosis exhibits a substantial rise in time-averaged wall shear stress (TAWSS) and records a peak value, irrespective of severity. The exercise condition imposed higher wall shear stress gradients in high-slope stenoses. It mitigates plaque progression on the distal region of low-slope stenosis, quantified with low oscillatory shear index (OSI) values. Further, the shear thinning behavior of blood is analyzed with a power-law model on severe stenosis. This effect shows a notable variation in TAWSS on high slope stenosis and reduced in low slope when compared with the Newtonian model. Originality/value In spite of the same severity (89%), stenotic walls of high and medium slope shapes are prone to high disease progression. The phenomenon is quantified with high OSI (> 0.4) on stenosis walls, which is over 20% of the total surface area in high and medium slope shape and limited to 4% in low slope shape. Overall, this study proposes the importance of the proximal slope supplement for stenosis severity that influences hemodynamics.
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Ankani et al. (2025) studied Atherosclerosis and arterial stenosis. Varying proximal stenosis shapes (high, medium, and low slope) was evaluated on Hemodynamics including time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI). High and medium proximal slope stenosis shapes exhibited high oscillatory shear index (>0.4) over 20% of the surface area compared to 4% in low slope shapes, indicating higher disease progression.
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