{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T18:28:47Z","timestamp":1783103327280,"version":"3.54.6"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T00:00:00Z","timestamp":1646006400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008562","name":"University of Texas at Austin","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008562","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:p>\n                    Moyamoya disease (MMD) is a progressive steno-occlusive cerebrovascular disease leading to recurrent stroke. There is a lack of reliable biomarkers to identify unilateral stroke MMD patients who are likely to progress to bilateral disease and experience subsequent contralateral stroke(s). We hypothesized that local hemodynamics are predictive of future stroke and set out to noninvasively assess this stroke risk in pediatric MMD patients. MR and X-ray angiography imaging were utilized to reconstruct patient-specific models of the circle of Willis of six pediatric MMD patients who had previous strokes, along with a control subject. Blood flow simulations were performed by using a Navier\u2013Stokes solver within an isogeometric analysis framework. Vascular regions with a wall shear rate (WSR) above the coagulation limit (&amp;gt;5,000\u2009s\n                    <jats:sup>\u22121<\/jats:sup>\n                    ) were identified to have a higher probability of thrombus formation, potentially leading to ischemic stroke(s). Two metrics, namely, \u201ccritical WSR coverage\u201d and \u201cWSR score,\u201d were derived to assess contralateral stroke risk and compared with clinical follow-up data. In two patients that suffered a contralateral stroke within 2\u2009months of the primary stroke, critical WSR coverages exceeding 50% of vessel surface and WSR scores greater than 6\u00d7 the control were present in multiple contralateral vessels. These metrics were not as clearly indicative of stroke in two additional patients with 3\u20135\u2009year gaps between primary and contralateral strokes. However, a longitudinal study of one of these two cases, where a subsequent timepoint was analyzed, suggested disease stabilization on the primary stroke side and an elevated contralateral stroke risk, which was confirmed by patient outcome data. This indicates that post-stroke follow-up at regular intervals might be warranted for secondary stroke prevention. The findings of this study suggest that WSR-based metrics could be predictive of future stroke risk after an initial stroke in pediatric MMD patients. In addition, better predictions may be possible by performing patient-specific hemodynamic analysis at multiple timepoints during patient follow-up to monitor changes in the WSR-based metrics.\n                  <\/jats:p>","DOI":"10.3389\/fphys.2022.846404","type":"journal-article","created":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T02:56:09Z","timestamp":1646016969000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Patient-Specific Modeling Could Predict Occurrence of Pediatric Stroke"],"prefix":"10.3389","volume":"13","author":[{"given":"John D.","family":"Horn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Johnson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zbigniew","family":"Starosolski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avner","family":"Meoded","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dianna M.","family":"Milewicz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananth","family":"Annapragada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaolie S.","family":"Hossain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,2,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1068","DOI":"10.1016\/j.jvs.2014.12.050","article-title":"Role of high shear rate in thrombosis","volume":"61","author":"Casa","year":"2015","journal-title":"J. Vasc. Surg."},{"key":"ref2","first-page":"233","article-title":"Hemodynamic impairment and stroke risk: prove it","volume":"22","author":"Derdeyn","year":"2001","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"378","DOI":"10.2176\/nmc.50.378","article-title":"Clinical features of unilateral moyamoya disease","volume":"50","author":"Hayashi","year":"2010","journal-title":"Neurol. Med. Chir."},{"key":"ref4","doi-asserted-by":"publisher","first-page":"S178","DOI":"10.1016\/S0303-8467(97)00043-7","article-title":"Long-term follow-up study of patients with unilateral moyamoya disease","volume":"99","author":"Hirotsune","year":"1997","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1228","DOI":"10.1002\/jmri.1880080608","article-title":"Limits to the accuracy of vessel diameter measurement in MR angiography","volume":"8","author":"Hoogeveen","year":"1998","journal-title":"J. Magn. 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Dis."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1161\/STROKEAHA.116.014529","article-title":"Infarct pattern and collateral status in adult moyamoya disease","volume":"48","author":"Kim","year":"2017","journal-title":"Stroke"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1161\/STROKEAHA.119.028117","article-title":"Impact of endothelial shear stress on the bilateral progression of unilateral moyamoya disease","volume":"51","author":"Lee","year":"2020","journal-title":"Stroke"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"2437","DOI":"10.1002\/ajmg.a.33657","article-title":"De novo ACTA2 mutation causes a novel syndrome of multisystemic smooth muscle dysfunction","author":"Milewicz","year":"2010","journal-title":"Am. J. Med. Genet. 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Focus."}],"container-title":["Frontiers in Physiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2022.846404\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T02:56:13Z","timestamp":1646016973000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2022.846404\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,28]]},"references-count":21,"alternative-id":["10.3389\/fphys.2022.846404"],"URL":"https:\/\/doi.org\/10.3389\/fphys.2022.846404","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.12.17.21267944","asserted-by":"object"}]},"ISSN":["1664-042X"],"issn-type":[{"value":"1664-042X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,28]]},"article-number":"846404"}}