ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Coronary Artery Disease
This article is part of the Research TopicInnovative Modeling and Simulation in Thrombosis and Hemostasis: Enhancing Diagnosis and TreatmentView all 7 articles
Multidirectional Wall Shear Stress is Associated with Thrombotic Risk in Isolated Coronary Artery Ectasia
Provisionally accepted
Jiejun Sun1
Muyun Tang1Shitong Liu2Zhenyu Liu1Zhujun Shen1
Hongzhi Xie1
Wei Wu1Hao Qian1Liang Wang1Zhiyu Zhang1
Ran Tian1*
Shuyang Zhang1*- 1Peking Union Medical College Hospital, Beijing, China
- 2Beijing Uninsim Tech Co. Ltd, Beijing, China
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Background Thrombosis is a critical and lethal complication of isolated coronary artery ectasia (iCAE), potentially linked to hemodynamic changes, particularly wall shear stress (WSS) alterations. However, the association between thrombosis and multidirectionality of blood flow, and thus of WSS, is not well defined. Methods This study retrospectively enrolled 34 patients diagnosed with iCAE. In total, 53 ectatic coronary arteries were identified for hemodynamics analysis, of which 11 had thrombosis and 42 did not. This study retrospectively enrolled 53 ectatic coronary arteries were identified for hemodynamics analysis, of which 11 had thrombosis and 42 did not. We used an automated workstation for coronary three-dimensional reconstruction and conducted computational fluid dynamics (CFD) analysis. Particularly, we analyzed the mean changes in the following multidirectional WSS metrics at the ectatic segments: time-averaged WSS (TAWSS), oscillatory shear index (OSI), relative residence time (RRT), transverse WSS (transWSS), cross-flow index (CFI), and topological shear variation index (TSVI). Results Local TAWSSmean, OSImean, RRTmean, transWSSmean, CFImean, and TSVImean of iCAE with thrombosis were significantly higher than those of iCAE without thrombosis (p<0.05 for all). Logistic regression analyses indicated that RRTmean (OR=1.010, 95%CI: 1.002-1.019, p=0.021) and transWSSmean (OR=1.992, 95%CI: 1.257-2.939, p=0.003) were independently associated with the risk of thrombosis among patients with iCAE. The RRTmean+transWSSmean model (Area Under the Curve (AUC)= 0.911) exhibited a greater capacity for identifying the risk of thrombosis among patients with iCAE compared to maximum vascular diameter (MVD) (AUC=0.789, p=0.048). Conclusions Multidirectional WSS metrics can help identify iCAE with a higher risk of thrombosis. It can improve thrombosis risk stratification.
Keywords: Isolated coronary artery ectasia, Hemodynamic changes, computational fluid dynamics, Wall Shear Stress, Thrombosis
Received: 14 Sep 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Sun, Tang, Liu, Liu, Shen, Xie, Wu, Qian, Wang, Zhang, Tian and Zhang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Ran Tian, ron_tian@163.com
Shuyang Zhang, shuyangzhang103@nrdrs.org
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