Resulting Wall Shear Stress Research Articles

On the nonlinear relationship between wall shear stress topology and multi-directionality in coronary atherosclerosis

Background and ObjectiveIn this paper we investigate twelve multi-directional/topological wall shear stress (WSS) derived metrics and their relationships with the formation of coronary plaques in both computational fluid dynamics (CFD) and dynamic fluid-structure interaction (FSI) frameworks. While low WSS is one of the most established biomechanical markers associated with coronary atherosclerosis progression, alone it is limited. Multi-directional and topological WSS derived metrics have been shown to be important in atherosclerosis related mechanotransduction and near-wall transport processes. However, the relationships between these twelve WSS metrics and the influence of both FSI simulations and coronary dynamics is understudied. MethodsWe first investigate the relationships between these twelve WSS derived metrics, stenosis percentage and lesion length through a parametric, transient CFD study. Secondly, we extend the parametric study to FSI, both with and without the addition of coronary dynamics, and assess their correlations. Finally, we present the case of a patient who underwent invasive coronary angiography and optical coherence tomography imaging at two time points 18 months apart. Associations between each of the twelve WSS derived metrics in CFD, static FSI and dynamic FSI simulations were assessed against areas of positive/negative vessel remodelling, and changes in plaque morphology. Results22–32% stenosis was the threshold beyond which adverse multi-directional/topological WSS results. Each metric produced a different relationship with changing stenoses and lesion length. Transient haemodynamics was impacted by coronary dynamics, with the topological shear variation index suppressed by up to 94%. These changes appear more critical at smaller stenosis levels, suggesting coronary dynamics could play a role in the earlier stages of atherosclerosis development. In the patient case, both dynamics and FSI vs CFD changes altered associations with measured changes in plaque morphology. An appendix of the linear fits between the various FSI- and CFD-based simulations is provided to assist in scaling CFD-based results to resemble the compliant walled characteristics of FSI more accurately. ConclusionsThese results highlight the potential for coronary dynamics to alter multi-directional/topological WSS metrics which could impact associations with changes in coronary atherosclerosis over time. These results warrant further investigation in a wider range of morphological settings and longitudinal cohort studies in the future.

Boundary layer analysis of ventilated partial cavity for friction drag reduction

This paper describes the use of water tunnel plate experiments and large eddy simulations to understand ventilated partial cavity (VPC) flow, especially the mechanism of friction drag reduction. The different flow behaviors along the flow direction indicate that VPC can be divided into three regions: continuous cavity, transitional cavity, and mixing cavity. Specifically, in the continuous cavity region, the flow state can be regarded as laminar; the density and dynamic viscosity are close to those of the strictly gas phase; and the resulting wall shear stress reaches minimum level along the flow direction. In the transitional cavity region, the flow state is similar to the transition state of single-phase flow with density, viscosity, and wall shear stress along the flow direction all exhibiting exponential growth. In the mixing cavity region, the flow state is analogous to turbulence. The flow is in a phase mixed state. The dynamic viscosity is close to that of the strictly water phase. The resulting wall shear stress is stable with small fluctuations. Importantly, the analytical boundary layer equation for wall shear stress derived from the momentum equation remains applicable to the continuous cavity and the mixing cavity regions.

Non-Newtonian Blood Modeling in Intracranial Aneurysm Hemodynamics: Impact on the Wall Shear Stress and Oscillatory Shear Index Metrics for Ruptured and Unruptured Cases.

When simulating blood flow in intracranial aneurysms (IAs), the Newtonian model seems to be ubiquitous. However, analyzing the results from the few studies on this subject, the doubt remains on whether it is necessary to use non-Newtonian models in computational fluid dynamics (CFD) simulations of cerebral vascular flows. The objective of this study is to investigate whether different rheology models would influence the hemodynamic parameters related to the wall shear stress (WSS) for ruptured and unruptured IA cases, especially because ruptured aneurysms normally have morphological features, such as lobular regions and blebs, that could trigger non-Newtonian phenomena in the blood flow due to low shear rates. Using CFD in an open-source framework, we simulated four ruptured and four unruptured patient-specific aneurysms to assess the influence of the blood modeling on the main hemodynamic variables associated with aneurysm formation, growth, and rupture. Results for WSS and oscillatory shear index (OSI) and their metrics were obtained using Casson and Carreau-Yasuda non-Newtonian models and were compared with those obtained using the Newtonian model. We found that all differences between non-Newtonian and the Newtonian models were consistent among all cases irrespective of their rupture status. We further found that the WSS at peak systole is overestimated by more than 50% by using the non-Newtonian models, but its metrics based on time and surface averaged values are less affected-the maximum relative difference among the cases is 7% for the Casson model. On the other hand, the surface-averaged OSI is underestimated by more than 30% by the non-Newtonian models. These results suggest that it is recommended to investigate different blood rheology models in IAs simulations when specific parameters to characterize the flow are needed, such as peak-systole WSS and OSI.

An immersed boundary method with y+‐adaptive wall function for smooth wall shear

AbstractImmersed boundary (IB) method with a wall function for high Reynolds number flows is attractive when the boundary is complex and evolving. However, when combined with IB method, existing wall functions cannot produce smooth wall shear stress, which is important for many processes such as erosion. The root cause is the discontinuity between the log‐law and laminar layers in most wall functions. A wall function in IB methods is typically enforced through IB cells. However, for complex and evolving boundaries, IB cells can be located in either the log‐law layer or the laminar layer, which follow different laws. To remedy this, a new method is introduced with a y+‐adaptive strategy. The idea is that when an IB cell is too close to an IB, it is replaced by a neighboring fluid cell further away from the boundary. Consequently, all IB cells are in the log‐law layer. The resulting wall shear stress is much smoother. This adaptive strategy is a compromise between how accurate the location of an IB wall is represented and the smoothness of simulated wall shear. Example cases in 1D, 2D, and 3D show the y+‐adaptive wall function produces results compared well with theory and experiments.

A computational framework to investigate retinal haemodynamics and tissue stress

The process of vision begins in the retina, yet the role of biomechanical forces in the retina is relatively unknown and only recently being explored. This contribution describes a computational framework involving 3D fluid-structure interaction simulations derived from fundus images that work towards creating unique data on retinal biomechanics. We developed methods to convert 2D fundus photographs into 3D geometries that follow the curvature of the retina. Retina arterioles are embedded into a six-layer representation of the retinal tissue with varying material properties throughout the retinal tissue. Using three different human retinas (healthy, glaucoma, diabetic retinopathy) and by varying our simulation approaches, we report the effects of transient versus steady flow, viscosity assumptions (Newtonian, non-Newtonian and Fåhræus-Lindqvist effect) and rigid versus compliant retinal tissue, on resulting wall shear stress (WSS) and von Mises stress. In the retinal arterioles, the choice of viscosity model is important and WSS obtained from models with the Fåhræus-Lindqvist effect is markedly different from Newtonian and non-Newtonian models. We found little difference in WSS between steady-state and pulsatile simulations (< 5%) and show that WSS varies by about 7% between rigid and deformable models. Comparing the three geometries, we found notably different WSS in the healthy (3.3 ± 1.3Pa), glaucoma (5.7 ± 1.6Pa) and diabetic retinopathy cases (4.3 ± 1.1Pa). Conversely, von Mises stress was similar in each case. We have reported a novel biomechanical framework to explore the stresses in the retina. Despite current limitations and lack of complete subject-specific physiological inputs, we believe our framework is the first of its kind and with further improvements could be useful to better understand the biomechanics of the retina.

Post-operative wall shear stress in the superior mesenteric artery: Biomarker of long term outcome in patients with residual disease after incomplete cytoreductive surgery for pseudomyxoma peritonei

BackgroundAfter incomplete cytoreductive surgery (CRS), the assessment of pseudomyxoma peritonei (PMP) progression remains challenging. The objective was to assess the efficacy of wall shear stress (WSS) measured in superior mesenteric artery (SMA) to predict PMP progression in the postoperative setting to propose additional treatments. MethodsIn a prospective study, 52 patients with PMP had Doppler-ultrasound examination of the SMA with WSS calculation within one year after CRS with a mean follow-up of 43.3 ± 18.3 months. Patients were categorized according to the completeness of CRS and clinical outcome: Group-1 (n = 19): complete CRS and no recurrence, group-2 (n = 20): incomplete CRS with slowly progressive disease (alive at 2 years without severe clinical symptoms), group-3 (n = 13): incomplete CRS and severe clinical symptoms or dead within two years. Results of WSS were compared between groups and to 24 healthy subjects. ResultsWSS measured in the SMA was superior in Group-3 (19.6 ± 8.2 dynes/cm2) than in Group-2 (9.2 ± 1.8 dynes/cm2, p = 1.10−6), Group-1 (10.4 ± 2.8 dynes/cm2, p = 8.10−5), and healthy patients (8.7 ± 2.8 dynes/cm2, p = 9.10−7). One year after surgery, among patients with incomplete CRS a cut-off value of 12.1dynes/cm2 allowed distinguishing patients without from those with severe disease progression with a sensitivity of 100% and a specificity of 100% (p < 1.10−4) AUC = 1.000 [95%CI: 0.897–1.000]. ConclusionPost-operative assessment of the WSS in the SMA in patients with incomplete CRS for PMP should be considered as biomarker of tumor progression in the postoperative setting. Therefore, WSS could be useful to target patients needing adjuvant systemic chemotherapy one year after CRS.

Wall shear stress from jetting cavitation bubbles

The collapse of a cavitation bubble near a rigid boundary induces a high-speed transient jet accelerating liquid onto the boundary. The shear flow produced by this event has many applications, examples of which are surface cleaning, cell membrane poration and enhanced cooling. Yet the magnitude and spatio-temporal distribution of the wall shear stress are not well understood, neither experimentally nor by simulations. Here we solve the flow in the boundary layer using an axisymmetric compressible volume-of-fluid solver from the OpenFOAM framework and discuss the resulting wall shear stress generated for a non-dimensional distance, $\unicode[STIX]{x1D6FE}=1.0$ ($\unicode[STIX]{x1D6FE}=h/R_{max}$, where $h$ is the distance of the initial bubble centre to the boundary, and $R_{max}$ is the maximum spherical equivalent radius of the bubble). The calculation of the wall shear stress is found to be reliable once the flow region with constant shear rate in the boundary layer is determined. Very high wall shear stresses of 100 kPa are found during the early spreading of the jet, followed by complex flows composed of annular stagnation rings and secondary vortices. Although the simulated bubble dynamics agrees very well with experiments, we obtain only qualitative agreement with experiments due to inherent experimental challenges.

Mechanobiology in Cardiovascular Disease Management: Potential Strategies and Current Needs.

Mechanical forces are powerful regulators of biology and disease. In the vasculature, the expression of particular cellular phenotypes appears to depend not only on a combination of intrinsic genetically programed biology but also on local hemodynamic environmental factors induced by blood flow (Nerem and Girard, 1990). A major component in the spectrum of forces experienced by cardiovascular tissue is the friction force exerted by the blood flow on the endothelium. Through multiple dedicated receptors, endothelial cells are able to sense the magnitude and directionality of this force and of the resulting wall shear stress (WSS), and to transduce this mechanical signal into biochemical signals, altering in turn cellular function. Interestingly, while physiologic WSS maintains vascular homeostasis (Figure 1A), WSS abnormalities often correlate with disease states (Figure 1B). While hemodynamic pathways have been identified in some cardiovascular pathologies such as calcific aortic valve disease (CAVD) (Butcher et al., 2008), aneurysms (Humphrey et al., 2015), atherosclerosis (Cunningham and Gotlieb, 2005), and intimal hyperplasia (IH) (Haruguchi and Teraoka, 2003), the clinical management of these disorders remains focused on addressing their symptoms via aggressive modalities rather than blocking the flow-induced pathological cascade. As a result, current treatments are often palliative and ignore the driving biological processes. In this context, the elucidation of the cause-and-effect relationships between cardiovascular biology and hemodynamics has the potential to advance the understanding of disease progression and to enable new diagnosis and treatments.

A Numerical Study of the Impact of Wavy Walls on Steady Fluid Flow Through a Curved Tube

In this paper, we discuss the impact of a wavy-walled pipe cross-section on steady flow in a curved tube at moderate Dean numbers and small tube radius-to-radius-of-curvature ratios. Parameters investigated include the protrusion height, the number of protrusions around the tube circumference, and the pipe curvature. This work extends a previous analytical investigation that employed a double perturbation expansion to elucidate the flow field as a function of these parameters. Due to the rapid growth in the solution complexity as the number of terms in each expansion increases, the analytical work is relegated to small wall perturbations and low Dean numbers. These barriers are removed in the present study by numerically solving the Navier–Stokes equations at Dean numbers up to 2500. The impact on the axial and secondary flow structures are emphasized, along with the resulting wall shear stress distributions.

Influence of Bicuspid Valve Geometry on Ascending Aortic Fluid Dynamics: A Parametric Study

Bicuspid aortic valve (BAV) predisposes to aortic aneurysms with a high prevalence. A first hypothesis for this phenomenon is related to fibrillin deficiency (genetic hypothesis). The present article focused on a complementary, hemodynamic hypothesis stating that it is the peculiar fluid dynamics of blood in the ascending aorta of patients with BAV configurations that leads to aneurysm formation. To corroborate this hypothesis, a parametric study was performed based on numerical simulations of ascending aorta hemodynamics with different configurations of orifice area and valve orientation. The resulting wall shear stress (WSS) distributions and degree of asymmetry of the blood jet were investigated, and surrogate indices introduced. The results showed that WSS was more pronounced in subjects with BAV morphologies, also in the nonstenotic case. In particular, a maximum WSS of 3Pa was found (vs. 1.5Pa in subjects with a tricuspid configuration). It is localized at the mid-ascending aorta, the segment more prone to dilate as shown by the index related to maximum WSS (0.869 in BAV vs. 0.322 in tricuspid). Moreover, the asymmetry of the blood flow was found larger for decreasing valve area, the related index at mid-ascending aorta being more than three times higher than that found for tricuspid configuration (0.70 vs. 0.20). Further, WSS and flow asymmetry were higher also at the sinus of Valsalva and sinotubolar junction for a latero-lateral (LL) BAV configuration in keeping with the clinical observation on association between BAV configurations and different aortic aneurysm morphology. These findings may help explain the higher risk of aneurysm formation in BAV patients. The proposed indices will require validation prior to application in clinical settings.

Accurate Prediction of Wall Shear Stress in a Stented Artery: Newtonian Versus Non-Newtonian Models

A significant amount of evidence linking wall shear stress to neointimal hyperplasia has been reported in the literature. As a result, numerical and experimental models have been created to study the influence of stent design on wall shear stress. Traditionally, blood has been assumed to behave as a Newtonian fluid, but recently that assumption has been challenged. The use of a linear model; however, can reduce computational cost, and allow the use of Newtonian fluids (e.g., glycerine and water) instead of a blood analog fluid in an experimental setup. Therefore, it is of interest whether a linear model can be used to accurately predict the wall shear stress caused by a non-Newtonian fluid such as blood within a stented arterial segment. The present work compares the resulting wall shear stress obtained using two linear and one nonlinear model under the same flow waveform. All numerical models are fully three-dimensional, transient, and incorporate a realistic stent geometry. It is shown that traditional linear models (based on blood's lowest viscosity limit, 3.5 Pa s) underestimate the wall shear stress within a stented arterial segment, which can lead to an overestimation of the risk of restenosis. The second linear model, which uses a characteristic viscosity (based on an average strain rate, 4.7 Pa s), results in higher wall shear stress levels, but which are still substantially below those of the nonlinear model. It is therefore shown that nonlinear models result in more accurate predictions of wall shear stress within a stented arterial segment.

MR Image-Based Geometric and Hemodynamic Investigation of the Right Coronary Artery with Dynamic Vessel Motion

The aim of this study was to develop a fully subject-specific model of the right coronary artery (RCA), including dynamic vessel motion, for computational analysis to assess the effects of cardiac-induced motion on hemodynamics and resulting wall shear stress (WSS). Vascular geometries were acquired in the right coronary artery (RCA) of a healthy volunteer using a navigator-gated interleaved spiral sequence at 14 time points during the cardiac cycle. A high temporal resolution velocity waveform was also acquired in the proximal region. Cardiac-induced dynamic vessel motion was calculated by interpolating the geometries with an active contour model and a computational fluid dynamic (CFD) simulation with fully subject-specific information was carried out using this model. The results showed the expected variation of vessel radius and curvature throughout the cardiac cycle, and also revealed that dynamic motion of the right coronary artery consequent to cardiac motion had significant effects on instantaneous WSS and oscillatory shear index. Subject-specific MRI-based CFD is feasible and, if scan duration could be shortened, this method may have potential as a non-invasive tool to investigate the physiological and pathological role of hemodynamics in human coronary arteries.

The influence of aortic dimensions on calculated wall shear stress in the mouse aortic arch

In this paper, the influence of the aortic dimensions of an investigated mouse on its resulting wall shear stress (WSS) was studied. A numerical model of a mouse aortic arch was created based on a micro-CT scan of a vascular corrosion cast of an 8-week-old wild type mouse. This model was then rescaled to obtain five models with aortic root diameters corresponding to five different stages in the mouse life cycle varying from late fetal (0.7 mm) to old adult (1.5 mm). Consistent with literature, WSS values much higher than those normally encountered in humans were found. WSS was found to decrease rapidly in early life stages and to reach a plateau in adulthood, thus supporting a mediating role for WSS in arterial growth. Our results show that WSS values for mice should be interpreted very cautiously, and if possible an animal-specific geometry with animal-specific boundary conditions should be used.

Simulation of Flow through a Miller Cuff Bypass Graft

Unnatural temporal and spatial distributions of wall shear stress in the anastomosis of distal bypass grafts have been identified as possible factors in the development of anastomotic intimal hyperplasia in these grafts. Distal bypass graft anastomoses with an autologus vein cuff (a Miller cuff) interposed between the graft and artery have been shown to alleviate the effects of intimal hyperplasia. In this study, pulsatile flow through models of a standard end-to-side anastomosis and a Miller cuff anastomosis are computed and the resulting wall shear stress and pressure distributions analysed. The results are inconclusive, and could be taken to suggest that the unnatural distributions of shear stress that do occur along the anastomosis floor may not be particularly important in the development of intimal hyperplasia. However, it seems more likely that the positive effects of the biological and material properties of the vein cuff, which are not considered in this study, somehow outweigh the negative effects of the shear stress distributions predicted to occur on the floor of the Miller-cuff graft.

Extended Thermodynamics Derivation of Energy Dissipation in Unsteady Pipe Flow

Extended irreversible thermodynamics (EIT) provides a framework for deriving extensions to phenomenological equations (e.g., Newton's law of viscosity, Fick's law of mass transport, and Darcy's law for porous media flow) for problems involving high frequencies (i.e., rapid transients). In this paper, a phenomenological equation is derived for energy loss in 1D unsteady pipe flow using an EIT formalism. The resulting wall shear stress is equal to the sum of (1) the steady-state shear stress; (2) a term that is proportional to the local (i.e., temporal) acceleration; and (3) a term that is proportional to the product of the velocity and the convective (i.e., spatial) acceleration. The form of this EIT-based wall shear stress formula shows that EIT provides a physical basis for instantaneous acceleration based unsteady friction formulas. It also illustrates the limitations and underlying assumptions of these models. For example, instantaneous acceleration based unsteady friction formulas are limited to fast transients (i.e., transients in which the water hammer timescale is significantly smaller than the diffusion timescale). A characteristics solution for unsteady pipe flow is proposed in which the phenomenological equation is used to model energy dissipation. Comparison of numerical test results with measured data from upstream and downstream valve closure laboratory experiments shows excellent agreement.

Computational study of the effect of geometric and flow parameters on the steady flow field at the rabbit aorto-celiac bifurcation

Arterial hemodynamic forces may play a role in the localization of early atherosclerotic lesions. We have been developing numerical techniques based on overset or “Chimera” type formulations to solve the Navier-Stokes equations in complex geometries simulating arterial bifurcations. This paper presents three-dimensional steady flow computations in a model of the rabbit aorto-celiac bifurcation. The computational methods were validated by comparing the numerical results to previously-obtained flow visualization data. Once validated, the numerical algorithms were used to investigate the sensitivity of the computed flow field and resulting wall shear stress distribution to various geometric and hemodynamic parameters. The results demonstrated that a decrease in the extent of aortic taper downstream of the celiac artery induced looping fluid motion along the lateral walls of the aorta and shifted the peak wall shear stress from downstream of the celiac artery to upstream. Increasing the flow Reynolds number led to a sharp increase in spatial gradients of wall shear stress. The flow field was highly sensitive to the flow division ratio, i.e., the fraction of total flow rate that enters the celiac artery, with larger values of this ratio leading to the occurrence of flow separation along the dorsal wall of the aorta. Finally, skewness of the inlet velocity profile had a profound impact on the wall shear stress distribution near the celiac artery. While not physiological due to the assumption of steady flow, these results provide valuable insight into the fluid physics at geometries simulating arterial bifurcations.

Hemodynamics of human carotid artery bifurcations: Computational studies with models reconstructed from magnetic resonance imaging of normal subjects

Purpose: The precise role played by hemodynamics, particularly wall shear stress, in the development and progression of vascular disease remains unclear, in large part because of a lack of in vivo studies with humans. Although technical challenges remain for noninvasively imaging wall shear stresses in humans, vascular anatomy can be imaged with sufficiently high resolution to allow reconstruction of three-dimensional models for computational hemodynamic studies. In this paper we present an entirely noninvasive magnetic resonance imaging (MRI) protocol that provides carotid bifurcation geometry and flow rates from which the in vivo hemodynamics can be computed. Maps of average, oscillatory, and gradients of wall shear stress are presented for two normal human subjects, and their data are compared with those computed for an idealized carotid bifurcation model. Methods: An MRI protocol was developed to acquire all necessary image data in scan times suitable for patient studies. Three-dimensional models of the carotid bifurcation lumen were reconstructed from serial black blood MR images of two normal volunteers. Common and internal carotid artery flow rate waveforms were determined from MRI phase-contrast velocity imaging in the same subjects and were used to impose fully developed velocity boundary conditions for the computational model. Subject-specific time-resolved velocities and wall shear stresses were then computed with a finite element–based Navier-Stokes equation solver. Results: Models reconstructed from in vivo MRI of two subjects showed obvious differences in branch angle, bulb size and extent, and three-dimensional curvature. Maps of a variety of wall shear stress indices showed obvious qualitative differences in patterns between the in vivo models and between the in vivo models and the idealized model. Secondary, helical flow patterns, induced primarily by the asymmetric and curved in vivo geometries, were found to play a key role in determining the resulting wall shear stress patterns. The use of in vivo flow rate waveforms was found to play a minor but noticeable role in some of the wall shear stress behavior observed. Conclusions: Conventional “averaged” carotid bifurcation models mask interesting hemodynamic features observed in realistic models derived from noninvasive imaging of normal human subjects. Observation of intersubject variations in the in vivo wall shear stress patterns supports the notion that more conclusive evidence regarding the role of hemodynamics in vascular disease may be derived from such individual studies. The techniques presented here, when combined with subject-specific MRI measurements of carotid artery plaque thickness and composition, provide the tools necessary for entirely noninvasive, prospective, in vivo human studies of hemodynamics and the relationship of hemodynamics to vascular disease.(J Vasc Surg 1998;27:143-56.)

Simulation of non-Newtonian blood flow in an end-to-side anastomosis.

In order to quantify the importance of non-Newtonian blood rheology on anastomotic flow patterns, the characteristics of Newtonian and non-Newtonian blood flows were compared in a 2-D, 45 degree end-to-side anastomosis model under both steady and unsteady flow conditions. All flows were assumed to be two-dimensional, and were simulated numerically using parameters consistent with blood flow in the femoral artery. A novel, purely viscous constitutive relation, based on a generalized form of the power law relation, was developed to model the non-Newtonian rheology of blood. The resulting wall shear stress patterns indicate that for the parameter values under consideration, non-Newtonian blood rheology has a significant effect on steady flow wall shear stresses, but no significant effect on unsteady flow wall shear stresses. Based on these and other simulations, a parameter is formulated that gives an indication of the importance of non-Newtonian blood rheology under a given set of flow conditions. In addition, an argument is presented for allowing the conclusions from this two-dimensional study to be extended to three-dimensional blood flow.

Pulsatile non-newtonian blood flow in three-dimensional carotid bifurcation models: a numerical study of flow phenomena under different bifurcation angles

Flow and stress patterns in human carotid artery bifurcation models, which differ in the bifurcation angle, are analysed numerically under physiologically relevant flow conditions. The governing Navier-Stokes equations describing pulsatile, three-dimensional flow of an incompressible non-Newtonian fluid are approximated using a pressure correction finite element method, which has been developed recently. The non-Newtonian behaviour of blood is modelled using Casson's relation, based on measured dynamic viscosity. The study concentrates on flow and stress characteristics in the carotid sinus. The results show that the complex flow in the sinus is affected by the angle variation. The magnitude of reversed flow, the extension of the recirculation zone in the outer sinus region and the duration of flow separation during the pulse cycle as well as the resulting wall shear stress are clearly different in the small angle and in the large angle bifurcation. The haemodynamic phenomena, which are important in atherogenesis, are more pronounced in the large angle bifurcation.