Key result
Computational blood flow simulations demonstrated that abnormal wall shear stress in coronary artery aneurysms correlates with aspect ratio rather than maximum diameter alone.
Observational (n=3)
No
Patient-specific computational fluid dynamics in Kawasaki disease suggests that hemodynamic parameters like wall shear stress may better stratify thrombotic risk in coronary artery aneurysms than maximum diameter alone.
Aspect ratio may refine aneurysm risk stratification beyond diameter; leaves open prospective validation of wall shear stress metrics.
[first paragraph of article]Coronary artery aneurysms (CAA) as a result of Kawasaki disease (KD) create abnormal flow conditions that can ultimately lead to thrombosis, with associated risks of myocardial infarction and sudden death. The primary long-term clinical decision required for KD patients with aneurysms is whether to treat with anticoagulation therapy. Current clinical guidelines recommend CAA diameter 8 mm or Z-score >10 as the criterion for initiating systemic anticoagulation therapy. In general, these aneurysms cause regions of flow stagnation, but the complexity of their geometry including changes in diameter, tortuosity and even proximal and distal stenoses make it difficult to evaluate thrombotic risk and predict patient outcomes based solely on a single anatomical measurement taken from image data, usually the maximum aneurysm diameter.
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Gutiérrez et al. (2018) conducted an observational in Kawasaki disease (n=3). Coronary artery aneurysm geometry (aspect ratio vs maximum diameter) vs. Normal coronary arteries was evaluated on Time averaged wall shear stress (TAWSS) and percentage area exposed to low wall shear stress. Computational blood flow simulations demonstrated that abnormal wall shear stress in coronary artery aneurysms correlates with aspect ratio rather than maximum diameter alone.
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