Path-Dependent Hemodynamics of the Stenosed Carotid Bifurcation

AbstractPrevious work using computational simulations and experimental flow visualizations has demonstrated marked differences in local flow patterns between stenosed carotid bifurcation models having the same stenosis severity but different stenosis geometries. Since local blood flow patterns are known to influence thrombosis and atherosclerotic plaque development and rupture, such differences may in turn reflect differences in thromboembolic and atherosclerotic potential, and hence risk of ischemic stroke. Towards testing this hypothesis, we tracked point particles, representing uniformly distributed blood elements, through concentrically and eccentrically stenosed carotid bifurcation models, and computed and compared various path-dependent hemodynamic parameters between the models. Our results suggest that residence time alone is not sensitive to stenosis geometry; however, notable differences between the stenosis models were observed with residence time indicators that incorporate shear-related phenomena, such as the transit times and levels of activation of platelets that exceed a given shear threshold. Specifically, these and other indicators, including the magnitude of platelet shear exposure and the size and density of local platelet and monocyte deposition, were found to be higher in the eccentric model. Experimental work is now required to assess the significance of these differences. © 2003 Biomedical Engineering Society. PAC2003: 8719Uv

[1]  U. Heinzmann,et al.  Flow mediated fibrin thrombus formation in an endothelium-lined model of arterial branching. , 1994, Thrombosis research.

[2]  Y Komiyama,et al.  High shear stress can initiate both platelet aggregation and shedding of procoagulant containing microparticles. , 1996, Blood.

[3]  L. Badimón,et al.  Thrombus formation on ruptured atherosclerotic plaques and rethrombosis on evolving thrombi. , 1992, Circulation.

[4]  D J Phillips,et al.  Hemodynamics of the normal human carotid bifurcation: in vitro and in vivo studies. , 1985, Ultrasound in medicine & biology.

[5]  P. Holme,et al.  Shear-induced platelet activation and platelet microparticle formation in native human blood. , 1998, Thrombosis research.

[6]  P Constantinides,et al.  Cause of thrombosis in human atherosclerotic arteries. , 1990, The American journal of cardiology.

[7]  C. R. Ethier,et al.  Steady flow separation patterns in a 45 degree junction , 2000, Journal of Fluid Mechanics.

[8]  D. Holdsworth,et al.  Flow Patterns at the Stenosed Carotid Bifurcation: Effect of Concentric versus Eccentric Stenosis , 2000, Annals of Biomedical Engineering.

[9]  C. R. Ethier,et al.  A characteristic/finite element algorithm for the 3-D Navier–Stokes equations using unstructured grids , 1999 .

[10]  Clement Kleinstreuer,et al.  Computational particle-hemodynamics analysis and geometric reconstruction after carotid endarterectomy , 2001, Comput. Biol. Medicine.

[11]  E. Falk.  Why do plaques rupture? , 1992, Circulation.

[12]  A. Gear,et al.  Platelet adhesion, shape change, and aggregation: rapid initiation and signal transduction events. , 1994, Canadian journal of physiology and pharmacology.

[13]  D. Holdsworth,et al.  Characterization of common carotid artery blood-flow waveforms in normal human subjects , 1999, Physiological measurement.

[14]  V. Fuster,et al.  Synergistic action of severe wall injury and shear forces on thrombus formation in arterial stenosis: definition of a thrombotic shear rate threshold. , 1994, Journal of the American College of Cardiology.

[15]  D A Steinman,et al.  Particle volumetric residence time calculations in arterial geometries. , 1996, Journal of biomechanical engineering.

[16]  E. Falk,et al.  Coronary thrombosis: pathogenesis and clinical manifestations. , 1991, The American journal of cardiology.

[17]  D. Ku,et al.  Pulsatile flow in the human left coronary artery bifurcation: average conditions. , 1996, Journal of biomechanical engineering.

[18]  David A Steinman,et al.  On assessing the quality of particle tracking through computational fluid dynamic models. , 2002, Journal of biomechanical engineering.

[19]  J. Moake,et al.  Platelets and shear stress. , 1996, Blood.

[20]  E L Bolson,et al.  Incomplete lysis of thrombus in the moderate underlying atherosclerotic lesion during intracoronary infusion of streptokinase for acute myocardial infarction: quantitative angiographic observations. , 1986, Circulation.

[21]  Robert Plonsey,et al.  An Outline of Cardiovascular Structure and Function , 2003 .

[22]  H. Goldsmith,et al.  Rheological Aspects of Thrombosis and Haemostasis: Basic Principles and Applications , 1986, Thrombosis and Haemostasis.

[23]  J. D. Hellums,et al.  A New Role for P-Selectin in Shear-Induced Platelet Aggregation , 2000, Circulation.

[24]  宮崎 泰彦.  High shear stress can initiate both platelet aggregation and shedding of procoagulant containing microparticles , 1999 .

[25]  H Schmid-Schönbein,et al.  Platelet and Coagulation Parameters Following Millisecond Exposure to Laminar Shear Stress , 1985, Thrombosis and Haemostasis.

[26]  P. Kierulf,et al.  Collagen Induced Thrombus Formation at the Apex of Eccentric Stenoses - A Time Course Study with Non-Anticoagulated Human Blood , 1996, Thrombosis and Haemostasis.

[27]  C. Warlow,et al.  MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis , 1991, The Lancet.

[28]  C Kleinstreuer,et al.  Computer simulation and geometric design of endarterectomized carotid artery bifurcations. , 2000, Critical reviews in biomedical engineering.

[29]  C. Ross Ethier,et al.  Enhanced error estimator for adaptive finite element analysis of 3D incompressible flow , 2001 .

[30]  D. Steinman,et al.  Calculating particle-to-wall distances in unstructured computational fluid dynamic models , 2001 .

[31]  A H Davies,et al.  The symptomatic carotid plaque. , 2000, Stroke.

[32]  V. Dzau.  Pathobiology of atherosclerosis and plaque complications. , 1994, American heart journal.

[33]  Emmanuel Larbi,et al.  Stroke in a Saudi Arabian National Guard Community: Analysis of 500 Consecutive Cases From a Population‐Based Hospital , 1993, Stroke.

[34]  S. Berger,et al.  Flows in Stenotic Vessels , 2000 .

[35]  D. Giddens,et al.  Effects of wall shear stress and fluid recirculation on the localization of circulating monocytes in a three-dimensional flow model. , 1995, Journal of biomechanics.

[36]  K S Sakariassen,et al.  Shear-induced platelet activation and platelet microparticle formation at blood flow conditions as in arteries with a severe stenosis. , 1997, Arteriosclerosis, thrombosis, and vascular biology.

[37]  M. Gharib,et al.  Vortex shedding as a mechanism for free emboli formation in mechanical heart valves. , 2000, Journal of biomechanical engineering.

[38]  Stanley E. Rittgers,et al.  Particle Motion Within In Vitro Models of Stenosed Internal Carotid and Left Anterior Descending Coronary Arteries , 1998, Annals of Biomedical Engineering.

[39]  J. D. Hellums,et al.  1993 Whitaker lecture: Biorheology in thrombosis research , 1994, Annals of Biomedical Engineering.

[40]  D. Leys,et al.  Atherothrombosis: A Major Health Burden , 2001, Cerebrovascular Diseases.

[41]  C. R. Ethier,et al.  Requirements for mesh resolution in 3D computational hemodynamics. , 2001, Journal of biomechanical engineering.

[42]  S. Sutera,et al.  A programmable, computer-controlled cone-plate viscometer for the application of pulsatile shear stress to platelet suspensions. , 1988, Biorheology.

[43]  J. Badimón,et al.  Mechanisms of arterial thrombosis in nonparallel streamlines: platelet thrombi grow on the apex of stenotic severely injured vessel wall. Experimental study in the pig model. , 1989, The Journal of clinical investigation.

[44]  Mehmet Toner,et al.  An Outline of Cardiovascular Structure and Function , 2003 .

[45]  D. Pelz,et al.  Stenosis of the carotid bifurcation: subjective assessment compared with strict measurement guidelines. , 1993, Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes.

[46]  M. Chassin,et al.  Appropriate use of carotid endarterectomy. , 1998, The New England journal of medicine.

[47]  G. Truskey,et al.  Hemodynamic parameters and early intimal thickening in branching blood vessels. , 2001, Critical reviews in biomedical engineering.

[48]  J.,et al.  Whitaker Lecture : Biorheology in Thrombosis Research , 2022 .

[49]  U. Heinzmann,et al.  Residence Time in Niches of Stagnant Flow Determines Fibrin Clot Formation in an Arterial Branching Model - Detailed Flow Analysis and Experimental Results , 1995, Thrombosis and Haemostasis.

[50]  A. Reininger,et al.  Occlusive Thrombus Formation on Indwelling Catheters: In Vitro Investigation and Computational Analysis , 1995, Thrombosis and Haemostasis.

[51]  R. F. Smith,et al.  Geometric characterization of stenosed human carotid arteries. , 1996, Academic radiology.

[52]  Carotid endarterectomy for patients with asymptomatic internal carotid artery stenosis. , 1995, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[53]  R T Schoephoerster,et al.  Effects of local geometry and fluid dynamics on regional platelet deposition on artificial surfaces. , 1993, Arteriosclerosis and thrombosis : a journal of vascular biology.