Background: Thrombosis is the main complication associated with cardiovascular disease, resulting in myocardial infarction and stroke, the leading causes of death globally. Adverse cardiovascular events in coronary artery disease patients are the result of plaque rupture or erosion in combination with occlusive thrombosis-promoting factors. Highly resolved 3D hemodynamic data at the stenosis is essential to model shear-sensitive thrombotic events in coronary artery disease.

Aims: This study aims to develop a computational framework for patient-specific, multi-scale, multi-physics simulations to investigate the process of clot formation from initial platelet deposition to total occlusion in atherothrombosis.

Methods: We developed a hybrid 1D-3D simulation framework to compute patient-specific coronary hemodynamics efficiently. A 1D model of the coronary flow is coupled to an image-based 3D model of the region of interest. This framework provides the advantages of reduced-order modeling, decreasing the global computational cost, allowing us to investigate fluid structures and transport phenomena at a very high resolution.

Results: We validated our 1D-3D model against full 3D coronary simulations in healthy and diseased conditions. Our results showed good agreement between the 3D and the 1D-3D models while reducing the computational cost by 40-fold compared to the 3D simulation. The 1D-3D model predicted left/right coronary flow distribution within 3% and provided an accurate estimation of fractional flow reserve and wall shear stress distribution at the stenosis comparable to the 3D simulation.

Comparison of full 3D and hybrid 1D-3D coronary flow simulation. Pressure distribution and velocity field (longitudinal slice at the location of the stenosis).

Conclusions: Significant savings in computational cost may allow modeling situations with changing geometry, such as growing thrombosis. Also, this approach would allow quantifying the time-dependent effect of thrombotic growth and occlusion on the global coronary circulation. We expect this modeling framework provides not only a tool to investigate adverse cardiovascular outcomes such as coronary thrombosis, but also a test-bed for anticoagulation drug testing.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/a-coupled-1d-3d-hybrid-model-for-patient-specific-coronary-flow-simulations-bridging-the-gap-between-macroscale-hemodynamics-and-microscale-thrombosis-models/