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Biomedical Engineering / Biomedizinische Technik

Joint Journal of the German Society for Biomedical Engineering in VDE and the Austrian and Swiss Societies for Biomedical Engineering and the German Society of Biomaterials

Editor-in-Chief: Dössel, Olaf

Editorial Board: Augat, Peter / Habibović, Pamela / Haueisen, Jens / Jahnen-Dechent, Wilhelm / Jockenhoevel, Stefan / Knaup-Gregori, Petra / Lenarz, Thomas / Leonhardt, Steffen / Plank, Gernot / Radermacher, Klaus M. / Schkommodau, Erik / Stieglitz, Thomas / Boenick, Ulrich / Jaramaz, Branislav / Kraft, Marc / Lenthe, Harry / Lo, Benny / Mainardi, Luca / Micera, Silvestro / Penzel, Thomas / Robitzki, Andrea A. / Schaeffter, Tobias / Snedeker, Jess G. / Sörnmo, Leif / Sugano, Nobuhiko / Werner, Jürgen /


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1862-278X
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Volume 59, Issue 6

Issues

Volume 57 (2012)

Analysis of emboli and blood flow in the ophthalmic artery to understand retinal artery occlusion

Tim A.S. Kaufmann
  • Corresponding author
  • Institute of Applied Medical Engineering, Helmholtz Institute, Department of Cardiovascular Engineering, RWTH Aachen University, Aachen, Germany
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Christoph Leisser / Jeannie Gemsa
  • Institute of Applied Medical Engineering, Helmholtz Institute, Department of Cardiovascular Engineering, RWTH Aachen University, Aachen, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Ulrich Steinseifer
  • Institute of Applied Medical Engineering, Helmholtz Institute, Department of Cardiovascular Engineering, RWTH Aachen University, Aachen, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2014-07-16 | DOI: https://doi.org/10.1515/bmt-2014-0002

Abstract

Retinal artery occlusion (RAO) is a common ocular vascular occlusive disorder that may lead to partial or complete retinal ischemia with sudden visual deterio ration and visual field defects. Although RAO has been investigated since 1859, the main mechanism is still not fully understood. While hypoperfusion of the ophthalmic artery (OA) due to severe stenosis of the internal carotid artery might lead to RAO, emboli are assumed to be the main reason. Intra-arterial thrombolysis is not a sufficient treatment for RAO, and current research is mainly focused on risk factors. In this study, a computational fluid dynamic model is presented to analyse flow conditions and clot behaviour at the junction of the internal carotid artery and OA based on a realistic geometry from a RAO patient. Clot diameters varied between 5 and 200 μm, and the probability of clots reaching the OA or being washed into the brain was analysed. Results show sufficient blood flow and perfusion pressure at the end of OA. The probability that clots from the main blood flow will to be washed into the brain is 7.32±1.08%. A wall shear stress hotspot is observed at the curvature proximal to the internal carotid artery/OA junction. Clots released from this hotspot have a higher probability of causing RAO. The occurrence of such patient-specific pathophysiologies will have to be considered in the future.

Keywords: computational fluid dynamics; embolism; retinal artery occlusion

References

  • [1]

    Anderson DC, Kappelle LJ, Eliasziw M, et al. Occurrence of hemispheric and retinal ischemia in atrial fibrillation compared with carotid stenosis. Stroke 2002; 33: 1963–1967.PubMedCrossrefGoogle Scholar

  • [2]

    Ballyk PD, Steinman DA, Ethier CR. Simulation of non-Newtonian blood flow in an end-to-side anastomosis. Biorheology 1994; 31: 565–586.Google Scholar

  • [3]

    Cheung N, Lim L, Wang JJ, et al. Prevalence and risk factors of retinal arteriolar emboli: the Singapore Malay Eye Study. Am J Ophthalmol 2008; 146: 620–624.CrossrefWeb of SciencePubMedGoogle Scholar

  • [4]

    Dunlap AB, Kosmorsky GS, Kashyap VS. The fate of patients with retinal artery occlusion and Hollenhorst plaque. J Vasc Surg 2007; 46: 1125–1129.CrossrefPubMedGoogle Scholar

  • [5]

    Groen HC, Gijsen FJ, van der Lugt A, et al. Plaque rupture in the carotid artery is localized at the high shear stress region: a case report. Stroke 2007; 38: 2379–2381.CrossrefGoogle Scholar

  • [6]

    Hayreh SS. Prevalent misconceptions about acute retinal vascular occlusive disorders. Prog Retin Eye Res 2005; 24: 493–519.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [7]

    Hayreh SS, Podhajsky P. Ocular neovascularization with retinal vascular occlusion. II. Occurrence in central and branch retinal artery occlusion. Arch Ophthalmol 1982; 100: 1585–1596.CrossrefPubMedGoogle Scholar

  • [8]

    Hayreh SS, Zimmerman MB. Central retinal artery occlusion: visual outcome. Am J Ophthalmol 2005; 140: 376–391.PubMedGoogle Scholar

  • [9]

    Hayreh SS, Zimmerman MB. Fundus changes in central retinal artery occlusion. Retina 2007; 27: 276–289.PubMedCrossrefGoogle Scholar

  • [10]

    Hayreh SS, Podhajsky PA, Zimmerman MB. Branch retinal artery occlusion: natural history of visual outcome. Ophthalmology 2009; 116: 1188–1194.e1-4.PubMedCrossrefGoogle Scholar

  • [11]

    Hayreh SS, Podhajsky PA, Zimmerman MB. Retinal artery occlusion: associated systemic and ophthalmic abnormalities. Ophthalmology 2009; 116: 1928–1936.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [12]

    Hur J, Kim YJ, Lee HJ, et al. Quantification and characterization of obstructive coronary plaques using 64-slice computed tomography: a comparison with intravascular ultrasound. J Comput Assist Tomogr 2009; 33: 186–192.Web of SciencePubMedCrossrefGoogle Scholar

  • [13]

    Kaiser HJ, Schotzau A, Flammer J. Blood-flow velocities in the extraocular vessels in normal volunteers. Am J Ophthalmol 1996; 122: 364–370.PubMedCrossrefGoogle Scholar

  • [14]

    Kaufmann TAS, Hormes M, Laumen M, et al. Flow distribution during cardiopulmonary bypass in dependency on the outflow cannula positioning. Artificial Organs 2009; 33: 988–992.Web of ScienceCrossrefPubMedGoogle Scholar

  • [15]

    Kaufmann TAS, Hormes M, Laumen M, et al. The impact of aortic/subclavian outflow cannulation for cardiopulmonary bypass and cardiac support: A computational fluid dynamics study. Artificial Organs 2009; 33: 727–732.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [16]

    Kaufmann TAS, Schmitz-Rode T, Steinseifer U. Implementation of cerebral autoregulation into computational fluid dynamics studies of cardiopulmonary bypass. Artif Organs 2012; 36: 754–758.Web of ScienceCrossrefPubMedGoogle Scholar

  • [17]

    Kaufmann TAS, Wong KC, Schmitz-Rode T, Steinseifer U. Mimicking of cerebral autoregulation by flow-dependent cerebrovascular resistance: a feasibility study. Artif Organs 2012; 36: E97–E101.Web of ScienceCrossrefGoogle Scholar

  • [18]

    Klein R, Klein BE, Jensen SC, et al. Retinal emboli and stroke: the Beaver Dam Eye Study. Arch Ophthalmol 1999; 117: 1063–1068.PubMedCrossrefGoogle Scholar

  • [19]

    Klein R, Klein BE, Moss SE, Meuer SM. Retinal emboli and cardiovascular disease: the Beaver Dam Eye Study. Arch Ophthalmol 2003; 121: 1446–1451.CrossrefPubMedGoogle Scholar

  • [20]

    Laumen M, Kaufmann T, Timms D, et al. Flow analysis of ventricular assist device inflow and outflow cannula positioning using a naturally shaped ventricle and aortic branch. Artificial Organs 2010; 34: 798–806.Web of ScienceCrossrefPubMedGoogle Scholar

  • [21]

    Leisser C. Hyperlipidaemia and increased systemic blood pressure – is there a connection to retinal artery occlusion? Spektrum Augenheilkd 2010; 24: 154–156.CrossrefWeb of ScienceGoogle Scholar

  • [22]

    Leisser C. Risk factors of retinal artery occlusion. Spektrum Augenheilkd 2012; 26: 202–204.CrossrefWeb of ScienceGoogle Scholar

  • [23]

    Mead GE, Lewis SC, Wardlaw JM, Dennis MS. Comparison of risk factors in patients with transient and prolonged eye and brain ischemic syndromes. Stroke 2002; 33: 2383–2390.CrossrefGoogle Scholar

  • [24]

    Mizener JB, Podhajsky P, Hayreh SS. Ocular ischemic syndrome. Ophthalmology 1997; 104: 859–864.PubMedCrossrefGoogle Scholar

  • [25]

    Pillunat LE, Anderson DR, Knighton RW, Joos KM, Feuer WJ. Autoregulation of human optic nerve head circulation in response to increased intraocular pressure. Exp Eye Res 1997; 64: 737–744.PubMedCrossrefGoogle Scholar

  • [26]

    Saba L, Mallarin G. Window settings for the study of calcified carotid plaques with multidetector CT angiography. AJNR Am J Neuroradiol 2009; 30: 1445–1450.CrossrefGoogle Scholar

  • [27]

    Schmidt D, Hetzel A, Geibel-Zehender A, Schulte-Mönting J. Systemic diseases in non-inflammatory branch and central retinal artery occlusion–an overview of 416 patients. Eur J Med Res 2007; 12: 595–603.PubMedGoogle Scholar

  • [28]

    Schumacher M, Schmidt D, Jurklies B, et al. Central retinal artery occlusion: local intra-arterial fibrinolysis versus conservative treatment, a multicenter randomized trial. Ophthalmology 2010; 117: 1367–1375.e1.CrossrefWeb of SciencePubMedGoogle Scholar

  • [29]

    Sharma S, Pater JL, Lam M, Cruess AF. Can different types of retinal emboli be reliably differentiated from one another? An inter- and intraobserver agreement study. Can J Ophthalmol 1998; 33: 144–148.PubMedGoogle Scholar

  • [30]

    Tang D, Teng Z, Canton G, et al. Local critical stress correlates better than global maximum stress with plaque morphological features linked to atherosclerotic plaque vulnerability: an in vivo multi-patient study. Biomed Eng Online, 2009; 8: 15.Web of ScienceCrossrefGoogle Scholar

  • [31]

    von Graefe A. Ueber Embolie der Arteriacentralisretinae als Ursache plotzlicher Erblindung. Albrecht von Graefes ArchOphthalmol 1859; 5: 136–157.Google Scholar

  • [32]

    Weger M, Renner W, Pinter O, et al. Role of factor V Leiden and prothrombin 20210A in patients with retinal artery occlusion. Eye 2003; 17: 731–734.Google Scholar

  • [33]

    Wong TY, Klein R. Retinal arteriolar emboli: epidemiology and risk of stroke. Curr Opin Ophthalmol 2002; 13: 142–146.PubMedCrossrefGoogle Scholar

  • [34]

    Wong TY, Larsen EK, Klein R, et al. Cardiovascular risk factors for retinal vein occlusion and arteriolar emboli: the Atherosclerosis Risk in Communities and Cardiovascular Health studies. Ophthalmology 2005; 112: 540–547.PubMedCrossrefGoogle Scholar

About the article

Corresponding author: Tim A.S. Kaufmann, Institute of Applied Medical Engineering, Helmholtz Institute, Department of Cardiovascular Engineering, RWTH Aachen University, Pauwelsstraße 20, 52074 Aachen, Germany, Phone: +492418080540, Fax: +492418082144, E-mail: ; and enmodes GmbH, Aachen, Germany


Received: 2014-01-13

Accepted: 2014-06-20

Published Online: 2014-07-16

Published in Print: 2014-12-01


Citation Information: Biomedical Engineering / Biomedizinische Technik, Volume 59, Issue 6, Pages 471–477, ISSN (Online) 1862-278X, ISSN (Print) 0013-5585, DOI: https://doi.org/10.1515/bmt-2014-0002.

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