Model Of Carotid Bifurcation Research Articles

Vortex dynamics in healthy and pro-atherogenic carotid artery bifurcation models

Vortex dynamics in healthy and pro-atherogenic carotid artery bifurcation models

Mathematical modeling in assessing the risk of restenosis after carotid endarterectomy

Carotid endarterectomy is the main way to combat atherosclerosis of the carotid arteries, which disrupts cerebral circulation. The generally accepted marker of atherogenesis risk are hemodynamic indices associated with near-wall shear stress. The purpose of the work is to conduct a comparative analysis of hemodynamic indices in various carotid bifurcation models. The influence of a virtual change in the geometric shape of the model in order to optimize hemodynamic indices is also being studied. On the basis of computed angiography data, carotid bifurcation models are constructed, in which critical zones of hemodynamic indices are built using computational fluid dynamics. A comparative analysis of the critical zones for different classes of models is carried out. Comparison of averaged indices for critical zones between ‘normal’ and post-operative groups gave more than 5-x worse results for the latter. The same results for the near-bifurcation parts of the zones give a 25% better result for postoperative models. Virtual ‘removal’ of insignificant plaques leads to a deterioration of the indices of up to 40% in the places of the plaque’s former location. The described method makes it possible to build the indices critical zones and compare them for various types of models. A technique for virtual changing the shape of a vessel (virtual surgery) is proposed. The novelty of the approach lies in the use for comparative analysis both real vessel models and hypothetical ‘improved’ virtual ones, as well in the proposed division of post-operative model’s critical zones into subzones of different genesis.

The influence of inlet flow asymmetry on the carotid bifurcation hemodynamics

Arterial bifurcations are known to be high-risk areas for the initiation of atherosclerosis. The appearance and growth of atherosclerotic plaques in the bifurcation of the carotid artery can result in severe consequences such as cerebrovascular accidents. The common signs of an atherogenic risk center around the surpassing critical values by certain hemodynamic indices, which are distributed over the artery wall. These indices are related to the effect of blood flow on the arterial wall, and their distribution is influenced by both the bifurcation’s geometric shape and the flow structure at its inlet. The objective of this study is to carry out a comparative analysis of hemodynamic indices in personal-specific models of carotid bifurcation with centrally symmetric and asymmetric input flows. The examined geometric models of bifurcation are based on computed angiography data obtained from the individuals free of apparent pathology. By using computational fluid dynamics within these models, the distribution of hemodynamic indices in a steady periodic flow is calculated and critical zones are determined for them. All the models are divided into two groups – those with symmetric and those with asymmetric input flows. For each model with asymmetric input flow, an alternative geometry is designed to ensure inlet flow symmetry, and comparative numerical calculations of the blood flow are carried out. The results of comparative analysis reveal that the distribution of hemodynamic indices is simpler for the group with symmetric input flow. A comparison of the averages between these two groups with symmetrical and natural asymmetric input flows indicates a 55% better result for the latter group. Furthermore, for almost all models with asymmetric input flow, their alternative models give worse hemodynamic results. Thus, hemodynamic indices in simpler models with symmetrical input flow can serve as an upper estimate for indices in models with natural asymmetric flow. A total of 89 models are included in the study.

Computational modeling of low-density lipoprotein accumulation at the carotid artery bifurcation after stenting.

Restenosis typically occurs in regions of low and oscillating wall shear stress, which also favor the accumulation of atherogenic macromolecules such as low-density lipoprotein (LDL). This study aims to evaluate LDL transport and accumulation at the carotid artery bifurcation following carotid artery stenting (CAS) by means of computational simulation. The computational model consists of coupled blood flow and LDL transport, with the latter being modeled as a dilute substance dissolved in the blood and transported by the flow through a convection-diffusion transport equation. The endothelial layer was assumed to be permeable to LDL, and the hydraulic conductivity of LDL was shear-dependent. Anatomically realistic geometric models of the carotid bifurcation were built based on pre- and post-stent computed tomography (CT) scans. The influence of stent design was investigated by virtually deploying two different types of stents (open- and closed-cell stents) into the same carotid bifurcation model. Predicted LDL concentrations were compared between the post-stent carotid models and the relatively normal contralateral model reconstructed from patient-specific CT images. Our results show elevated LDL concentration in the distal section of the stent in all post-stent models, where LDL concentration is 20 times higher than that in the contralateral carotid. Compared with the open-cell stents, the closed-cell stents have larger areas exposed to high LDL concentration, suggesting an increased risk of stent restenosis. This computational approach is readily applicable to multiple patient studies and, once fully validated against follow-up data, it can help elucidate the role of stent strut design in the development of in-stent restenosis after CAS.

Vortical Structures Promote Atheroprotective Wall Shear Stress Distributions in a Carotid Artery Bifurcation Model.

Carotid artery diseases, such as atherosclerosis, are a major cause of death in the United States. Wall shear stresses are known to prompt plaque formation, but there is limited understanding of the complex flow structures underlying these stresses and how they differ in a pre-disposed high-risk patient cohort. A 'healthy' and a novel 'pre-disposed' carotid artery bifurcation model was determined based on patient-averaged clinical data, where the 'pre-disposed' model represents a pathological anatomy. Computational fluid dynamic simulations were performed using a physiological flow based on healthy human subjects. A main hairpin vortical structure in the internal carotid artery sinus was observed, which locally increased instantaneous wall shear stress. In the pre-disposed geometry, this vortical structure starts at an earlier instance in the cardiac flow cycle and persists over a much shorter period, where the second half of the cardiac cycle is dominated by perturbed secondary flow structures and vortices. This coincides with weaker favorable axial pressure gradient peaks over the sinus for the 'pre-disposed' geometry. The findings reveal a strong correlation between vortical structures and wall shear stress and imply that an intact internal carotid artery sinus hairpin vortical structure has a physiologically beneficial role by increasing local wall shear stresses. The deterioration of this beneficial vortical structure is expected to play a significant role in atherosclerotic plaque formation.

Optimization of 4D Flow MRI Spatial and Temporal Resolution for Examining Complex Hemodynamics in the Carotid Artery Bifurcation.

Three-dimensional, ECG-gated, time-resolved, three-directional, velocity-encoded phase-contrast MRI (4D flow MRI) has been applied extensively to measure blood velocity in great vessels but has been much less used in diseased carotid arteries. Carotid artery webs (CaW) are non-inflammatory intraluminal shelf-like projections into the internal carotid artery (ICA) bulb that are associated with complex flow and cryptogenic stroke. Optimize 4D flow MRI for measuring the velocity field of complex flow in the carotid artery bifurcation model that contains a CaW. A 3D printed phantom model created from computed tomography angiography (CTA) of a subject with CaW was placed in a pulsatile flow loop within the MRI scanner. 4D Flow MRI images of the phantom were acquired with five different spatial resolutions (0.50-2.00 mm3) and four different temporal resolutions (23-96ms) and compared to a computational fluid dynamics (CFD) solution of the flow field as a reference. We examined four planes perpendicular to the vessel centerline, one in the common carotid artery (CCA) and three in the internal carotid artery (ICA) where complex flow was expected. At these four planes pixel-by-pixel velocity values, flow, and time average wall shear stress (TAWSS) were compared between 4D flow MRI and CFD. An optimized 4D flow MRI protocol will provide a good correlation with CFD velocity and TAWSS values in areas of complex flow within a clinically feasible scan time (~ 10min). Spatial resolution affected the velocity values, time average flow, and TAWSS measurements. Qualitatively, a spatial resolution of 0.50 mm3 resulted in higher noise, while a lower spatial resolution of 1.50-2.00 mm3 did not adequately resolve the velocity profile. Isotropic spatial resolutions of 0.50-1.00 mm3 showed no significant difference in total flow compared to CFD. Pixel-by-pixel velocity correlation coefficients between 4D flow MRI and CFD were > 0.75 for 0.50-1.00 mm3 but were < 0.5 for 1.50 and 2.00 mm3. Regional TAWSS values determined from 4D flow MRI were generally lower than CFD and decreased at lower spatial resolutions (larger pixel sizes). TAWSS differences between 4D flow and CFD were not statistically significant at spatial resolutions of 0.50-1.00 mm3 but were different at 1.50 and 2.00 mm3. Differences in temporal resolution only affected the flow values when temporal resolution was > 48.4ms; temporal resolution did not affect TAWSS values. A spatial resolution of 0.74-1.00 mm3 and a temporal resolution of 23-48ms (1-2k-space segments) provides a 4D flow MRI protocol capable of imaging velocity and TAWSS in regions of complex flow within the carotid bifurcation at a clinically acceptable scan time.

Variation of Shear Stresses and Flow Dynamics in Stented Patient Specific Carotid Bifurcation Model using Numerical Investigation

The carotid artery is a clinically important site in the human circulatory system as the consequences of its disease results in adverse outcomes like ischemic strokes, or death for too prolonged ischemia. Understanding the hemodynamics of this artery and its bifurcation are important. A method of treating the stenosis of this artery is Carotid Angioplasty and Stenting (CAS). This procedure results in a heavily modified hemodynamics or state of flow. To understand and predict this flow field modification Computational Fluid Dynamics (CFD) is an important computational tool. Further, the presence of a stent would affect hemodynamics. The aim of this work is to study these effects in patient-specific cases. The reconstructed patient-specific models will form the basis of the construction of the post-stenting carotid bifurcation models. A transient analysis was carried out to estimate the time-varying parameters in the fluid domains over a cardiac cycle as well as to gauge time average values over a cardiac cycle. Results are obtained for hemodynamic parameters, like wall shear stress, velocity, pressure, vorticity, and helicity, in both the prepared stenosed and stented geometries. It is seen that the stenting procedure leads to the renewal of the CCA to ICA flow path. But simultaneously the region in which the stent is present becomes a region of low TAWSS and contains areas of high OSI. These areas of low TAWSS and high OSI within the stented portions of the carotid bifurcations are indications for regions of possible restenosis. Therefore, the investigation demonstrates the likely region for future plaque growth. Further, the effects of widening of the lumen are also noted in comparison to the pre-stent cases

Shear stress metrics associated with pro-atherogenic high-risk anatomical features in a carotid artery bifurcation model

BackgroundDiseases associated with atherosclerotic plaques in the carotid artery are a major cause of deaths in the United States. Blood-flow-induced shear-stresses are known to trigger plaque formation. Prior literature suggests that the internal carotid artery sinus is prone to atherosclerosis, but there is limited understanding of why only certain patients are predisposed towards plaque formation. MethodsWe computationally investigate the effect of vessel geometry on wall-shear-stress distribution by comparing flowfields and wall-shear-stress-metrics between a low-risk and a novel predisposed high-risk carotid artery bifurcation anatomy. Both models were developed based on clinical risk estimations and patient-averaged anatomical features. The high-risk geometry has a larger internal carotid artery branching angle and a lower internal-to-carotid-artery-diameter-ratio. A patient-averaged physiological carotid artery inflow waveform is used. FindingsThe high-risk geometry experiences stronger flow separation in the sinus. Furthermore, it experiences a more equal flow split at the bifurcation, thereby reducing internal carotid artery flowrate and increasing atherosclerosis-prone low-velocity areas. Lowest time-averaged-wall-shear-stresses are present at the sinus outer wall, where plaques are often found, for both geometries. The high-risk geometry has significantly high, unfavorable oscillatory-shear-index values not found in the low-risk geometry. High oscillatory-shear-index areas are located at the vessels outside walls distal to the bifurcation and on the sinus wall. InterpretationThese results highlight the effectiveness of oscillatory-shear-index, to augment classical time-averaged-wall-shear-stress, in evaluating pro-atherogenic geometry features. Furthermore, the flow split at the bifurcation is a promising clinical indicator for atherosclerosis risk as it can be directly accessed using clinical imaging, whereas shear-stress-metrics cannot.

Hemodynamic Impact of Snoring on Carotid Artery after Stent Implantation: The Role of Oscillation

Purpose Snoring is common in overweight and old patients treated by endovascular stenting. Studies have proved a correlation between snoring and carotid stenosis, thus, snoring after carotid artery stenting (CAS) might promote or worsen clinical performance. Methods This study tested this hypothesis by constructing a patient-specific carotid bifurcation model and numerically analyzing hemodynamic changes of the carotid artery under different snoring conditions. These conditions included small and large amplitude, low and high frequency, and different age groups. Results The results found that high amplitude snoring suppressed the disturbed flow at the stented segment, while the downstream region of ICA became more chaotic, accounting for in-stent intimal restenosis and thrombosis. Furthermore, local blood flow patterns of elder groups with snoring symptoms were more likely to be changed due to low-speed flow, increasing the possibility of vascular remodeling and thrombosis. Besides, increased snoring frequency hardly influenced the local disturbed flow. Conclusions Therefore, older adults should receive medical treatment actively after stenting for high amplitude snoring as soon as possible to avoid potential adverse events.

Comparison of blood flow analysis in stenosed and stented carotid artery bifurcation models

Comparison of blood flow analysis in stenosed and stented carotid artery bifurcation models

Time-Resolved Wall Shear Rate Mapping Using High-Frame-Rate Ultrasound Imaging.

In atherosclerosis, low wall shear stress (WSS) is known to favor plaque development, while high WSS increases plaque rupture risk. To improve plaque diagnostics, WSS monitoring is crucial. Here, we propose wall shear imaging (WASHI), a noninvasive contrast-free framework that leverages high-frame-rate ultrasound (HiFRUS) to map the wall shear rate (WSR) that relates to WSS by the blood viscosity coefficient. Our method measures WSR as the tangential flow velocity gradient along the arterial wall from the flow vector field derived using a multi-angle vector Doppler technique. To improve the WSR estimation performance, WASHI semiautomatically tracks the wall position throughout the cardiac cycle. WASHI was first evaluated with an in vitro linear WSR gradient model; the estimated WSR was consistent with theoretical values (an average error of 4.6% ± 12.4 %). The framework was then tested on healthy and diseased carotid bifurcation models. In both scenarios, key spatiotemporal dynamics of WSR were noted: 1) oscillating shear patterns were present in the carotid bulb and downstream to the internal carotid artery (ICA) where retrograde flow occurs; and 2) high WSR was observed particularly in the diseased model where the measured WSR peaked at 810 [Formula: see text] due to flow jetting. We also showed that WASHI could consistently track arterial wall motion to map its WSR. Overall, WASHI enables high temporal resolution mapping of WSR that could facilitate investigations on causal effects between WSS and atherosclerosis.

Influence of Altered Pressures on Flow Dynamics in Carotid Bifurcation System Using Numerical Methods

The application of numerical methods like CFD to understand hemodynamics in arteries has excellent potential to solve complex flow problems. In recent years, CFD has been primarily used in the hemodynamics of the carotid artery due to advances in computational resources. This technique is widely used to obtain knowledge on hemodynamics, predict the risk factors for the development and progression of the atherosclerotic lesion, and analyze local flow profiles due to changes in the carotid artery geometry. This fundamental study will be supportive in observing the blood flow behavior through arteries and studying arterial diseases. The present study investigates three different subject-specific carotid bifurcation models under altered blood pressure conditions. Subject-specific 3D carotid bifurcation modeling is carried out using Materialize software. Unsteady flow simulation is conducted in ANSYS Fluent under the rigid wall and Newtonian conditions. The haemodynamic parameters such as vorticity, helicity, and time-averaged wall shear stress (TAWSS) were evaluated to understand better the beginning and progression of atherosclerotic plaques in the bifurcation. Also, the influence of geometric variation in the bifurcation region was investigated, and it was observed that this region causes significant vortex formation zones. A noticeable reduction in velocity and backflow formation was observed, which reduced the shear stress. It is established that the regions of low TAWSS along the bifurcation region are likely to develop atherosclerosis.

A comparison of Newtonian and non-Newtonian pulsatile blood rheology in carotid bifurcation through fluid–solid interaction hemodynamic assessment based on experimental data

Endothelial cells play a crucial role in the arterial homeostasis. In addition to physiological risk factors, abnormal levels of hemodynamic parameters induced by the pulsatile flow contribute to atherosclerotic plaque formation and development. In this study, we used an experimental setup to study the hemodynamics of Newtonian and non-Newtonian blood flow on a deformable model of human carotid bifurcation. The flow/pressure pulses of the experimental model were fed into a fluid–structure interaction numerical model, and respective hemodynamic parameters were obtained and compared between the two flow regimes. Results revealed noticeable differences among the two flow regimes when the pulsatile nature of blood flow and pressure were considered, with more distinct differences near junction sites. Velocity profiles of the non-Newtonian model were more flattened with higher back flow during the diastole. The shear stress waves as well as shear-dependent parameters, such as oscillatory shear index, relative residence time, and vorticity, as well as wall stress and strain, also indicated significant differences among the two models. Regardless of flow regime, results showed a good agreement with clinical outcomes in human carotid bifurcation, especially the carotid sinus. Near the bifurcation, marked fluctuations of shear stress are evident. Around the junction site, wall pulsation experienced variations up to five times of the normal pulse span. The quantified hemodynamic parameters obtained from proposed accurate model of carotid bifurcation may help to achieve technological solutions to adjust the out of biological ranges of these parameters, and avoid atheroma formation or treat the diseased artery.

3D modeling of generalized Newtonian fluid flow with data assimilation using the least-squares finite element method

In this contribution we present a least-squares finite element formulation to model steady-state flow of incompressible, non-Newtonian fluids in three dimensions including data assimilation. The approach is based on the incompressible Navier–Stokes equations and the nonlinear viscosity is considered by means of the Carreau–Yasuda viscosity model, which can account for shear-thickening and shear-thinning behavior of generalized Newtonian fluids. We outline the procedure how to integrate given data into the numerical solution of flow problems without additional computational cost using the least-squares FEM. Assimilation of experimental data provides the opportunity to reduce model errors resulting in a solution which more closely approximates reality. Furthermore, the preprocessing of the available data using Kriging interpolation is also described briefly.The presented formulation is first validated by investigating the flow in a cube with an exact solution without data assimilation. Convergence is evaluated based on the error in velocities and pressure compared to the exact solution. Then the effect of data assimilation is shown by modeling blood flow through a carotid bifurcation model and integrating data either along lines or over entire cross-sectional areas. The improvement of the numerical solution by means of data assimilation is revealed by comparing the calculated velocity profiles with experimental and numerical reference values.

Computer modeling of the area of carotid endarterectomy with patches of various forms

To describe geometric models of carotid artery bifurcation and computer modeling of carotid endarterectomy (CEA) with patches of various configurations. The method was demonstrated on a reconstructed model of intact vessel based on preoperative CT of the affected vessel in a certain patient. Blood flow is modeled by computational fluid dynamics using Doppler ultrasound data. Risk factors were assessed considering hemodynamic parameters of vascular wall associated with WSS. We studied hemodynamic results of 10 virtual CEA with patches of various shapes on the example of a reconstructed intact artery in a particular patient. Patch implantation is aimed at prevention of carotid artery narrowing since simple suture without a patch can reduce circumference of the artery by 4-5 mm. This result adversely affects blood flow. On the other hand, too wide a patch creates aneurysm-like deformation of internal carotid artery bulb. It is not optimal due to a large recirculation zone. It was found that patch width approximately equal to 3 mm ensures an optimal hemodynamic result. Deviations from this median value, both upward and downward, impair hemodynamics while the absence of a patch results the worst result. The proposed computer modeling technique is able to provide a personalized patch selection for CEA with low risk of restenosis in long-term follow-up period.

Computer modeling of different shaped patches in classical carotid endarterectomy

Objective: to construct geometric models of carotid bifurcation and build a computer modeling for carotid endarterectomy (CEA) operations with patches of various configurations.Materials and methods. The method uses reconstructed models of a healthy blood vessel obtained from a preoperative computed tomography (CT) study of the affected blood vessel of a particular patient. Flow in the vessel is simulated by computational fluid dynamics using data from the patient's ultrasonic Doppler velocimetry and CT angiography. Risk factors are assessed by hemodynamic indices at the vessel wall associated with Wall Shear Stress (WSS).Results. We used the proposed method to study the hemodynamic results of 10 virtual CEA operations with patches of various shapes on a reconstructed healthy artery of a particular patient. The reason for patch implantation was to ensure that the vessel lumen is not narrowed as a result of the surgery, since closing the incision without a patch can reduce the vessel lumen circumference by 4–5 mm, which adversely affects blood flow. On the other hand, too wide a patch creates aneurysmorphic deformation of the internal carotid artery (ICA) mouth, which is not optimal due to formation of a large recirculation zone. In this case, it was found that the implanted patch width of about 3 mm provides an optimal hemodynamic outcome. Deviations from this median value, both upward and downward, impair hemodynamics. The absence of a patch gives the worst of the results considered.Conclusion: The proposed computer modeling technique is able to provide a personalized patch selection for classical CEA with low risk of restenosis in the long-term follow-up.

Comparative study on hemodynamic environments around patient-specific carotid atherosclerotic plaques with different symmetrical features

Atherosclerotic plaque near the carotid sinus is a key risk factor for ischemic stroke. Although disturbed hemodynamic environments around atherosclerotic plaque had been investigated in many studies, the effect of their symmetrical features, especially longitudinal asymmetrical characteristics, had not been comparatively studied. In this study, three-dimensional carotid bifurcation models were established based on CT images of three patients with 50% stenosis and with different symmetrical features of carotid atherosclerotic plaques including concentric plaque, eccentric plaque, or eccentric longitudinal asymmetrical plaque. A healthy subject was chosen as the control. Wall shear stress (WSS) and oscillating shear index in the regions of upstream, downstream, downstream shoulders and regions around the point of maximum stenosis were analyzed. The results indicated that the maximum WSS around the eccentric longitudinal asymmetrical plaque were 8.6 times larger than that of the eccentric plaque and 1.9 times larger than that of the concentric plaque. And the distributions of WSS and OSI around the eccentric longitudinal asymmetric plaque were more disordered than those of the others. Our results highlighted the risk of the eccentric longitudinal asymmetrical plaque on plaque development and rupture and might provide a new index for evaluating the development of atherosclerosis.

Adaptive Spectral Doppler Estimation Based on the Modified Amplitude Spectrum Capon.

In conventional ultrasound systems, the compromise between frequency and temporal resolution limits the quality of the spectrograms and the ability to track fast blood flows. The main objective of this study was to identify a method that could reduce spectral broadening over time by reducing the observations and improving the spectral resolution and contrast. This problem is more pronounced in the process of imaging at higher blood velocities when using a short Doppler signal observation window (OW) in adaptive methods. The proposed adaptive technique, which is based on the covariance matrix Eigen space and the amplitude spectrum Capon (ASC) algorithm, managed to improve the spectral resolution and contrast compared with other adaptive algorithms within a shorter observation time, and it offered a narrower power spectrum and a more accurate spectrogram over time in combination with a coherence-based post filter. All methods were tested through various simulations. First, an analysis was carried out by simulating the femoral artery flow and the time-independent parabolic flow using the Field II simulator. Then, the performance of the proposed method was evaluated under more realistic conditions using a computational fluid dynamics simulation of complex flow fields in a carotid bifurcation model. Afterward, in vivo clinical data on the hepatic vein were used to validate the proposed method. Finally, the accuracy of the velocity estimated by different methods was evaluated through a mean-square-error assessment. Not only could the proposed method show significant improvements using extreme small OWs, N=[2, 4] , in the simulated data in terms of frequency resolution and contrast, but it also managed to offer an improvement of 74%, 73.3%, 22.2%, and 50% in frequency resolution, and an increase of 96.5, 90.2, 49, and 31.5 dB in contrast using in vivo clinical data compared with the Capon, amplitude and phase estimation (APES), projection-based Capon, and projection-based APES, respectively, for the OW of N=4 .

Contribution of atherosclerotic plaque location and severity to the near-wall hemodynamics of the carotid bifurcation: an experimental study and FSI modeling.

Atherosclerosis is initiated by endothelial injury that is related to abnormal values of hemodynamic parameters such as wall shear stress (WSS), oscillatory shear index (OSI) and stress phase angle (SPA), which are more common in arterial bifurcations due to the complex structure. An experimental model of human carotid bifurcation with accurate geometrical and mechanical features was set up, and using realistic pulsatile flow rates, the inlet and outlet pressure pulses were measured for normal and stenosed models with 40% and 80% severities at common carotid (CCA), internal carotid (ICA) and external carotid (ECA) arteries. Based on the obtained experimental data, fluid-structure models were developed to obtain WSS, OSI, and SPA and evaluate pathological consequences at different locations. Mild severity had minor impact, however, inducing severe 80% stenosis in each branch led to considerable localized changes of hemodynamic parameters both in the stenosis site and other locations. This included sharp increases in WSS values accompanied by very low values close to zero before and after the peaks. Severe stenosis not only caused significant changes in the local artery, but also in other branches. OSI and SPA were less sensitive to stenosis, although high peaks were observed on bifurcation site for the stenosis at ECA. The interconnection of arteries at carotid bifurcation results in altered pressure/flow patterns in all branches when a stenosis is applied in any site. Such effect confirms pathological findings that atherosclerotic plaques are observed simultaneously in different carotid branches, although with different degrees of plaque growth and severity.

Numerical study on the energy cascade of pulsatile Newtonian and power-law flow models in an ICA bifurcation

The complex physics and biology underlying intracranial hemodynamics are yet to be fully revealed. A fully resolved direct numerical simulation (DNS) study has been performed to identify the intrinsic flow dynamics in an idealized carotid bifurcation model. To shed the light on the significance of considering blood shear-thinning properties, the power-law model is compared to the commonly used Newtonian viscosity hypothesis. We scrutinize the kinetic energy cascade (KEC) rates in the Fourier domain and the vortex structure of both fluid models and examine the impact of the power-law viscosity model. The flow intrinsically contains coherent structures which has frequencies corresponding to the boundary frequency, which could be associated with the regulation of endothelial cells. From the proposed comparative study, it is found that KEC rates and the vortex-identification are significantly influenced by the shear-thinning blood properties. Conclusively, from the obtained results, it is found that neglecting the non-Newtonian behavior could lead to underestimation of the hemodynamic parameters at low Reynolds number and overestimation of the hemodynamic parameters by increasing the Reynolds number. In addition, we provide physical insight and discussion onto the hemodynamics associated with endothelial dysfunction which plays significant role in the pathogenesis of intracranial aneurysms.