Computational study of the fluid-dynamics in carotids before and after endarterectomy.

In this work, we provide a computational study of the effects of carotid endarterectomy (CEA) on the fluid-dynamics at internal carotid bifurcations. We perform numerical simulations in real geometries of the same patients before and after CEA, using patient-specific boundary data obtained by Echo-Color Doppler measurements. We analyze four patients with a primary closure and other four where a patch was used to close arteriotomies. The results show that (i) CEA is able to restore physiological fluid-dynamic conditions; (ii) among the post-operative cases, the presence of patch leads to local hemodynamic conditions which might imply a higher risk of restenosis in comparison with the cases without patch.

[1]  R. Mofidi,et al.  Increased Internal Carotid Artery Peak Systolic Velocity Is Associated with Presence of Significant Atherosclerotic Plaque Instability Independent of Degree of ICA Stenosis , 2011 .

[2]  M. Kaazempur-Mofrad,et al.  Hemodynamics and wall mechanics in human carotid bifurcation and its consequences for atherogenesis: investigation of inter-individual variation , 2004, Biomechanics and modeling in mechanobiology.

[3]  Jiyuan Tu,et al.  Hemodynamics analysis of patient‐specific carotid bifurcation: A CFD model of downstream peripheral vascular impedance , 2013, International journal for numerical methods in biomedical engineering.

[4]  Frans N van de Vosse,et al.  MRI-based quantification of outflow boundary conditions for computational fluid dynamics of stenosed human carotid arteries. , 2010, Journal of biomechanics.

[5]  R. Friedlander,et al.  Carotid endarterectomy with primary closure: analysis of outcomes and review of the literature. , 2012, Neurosurgery.

[6]  Hao Gao,et al.  Carotid arterial plaque stress analysis using fluid-structure interactive simulation based on in-vivo magnetic resonance images of four patients. , 2009, Journal of biomechanics.

[7]  P. Rothwell,et al.  Patch angioplasty versus primary closure for carotid endarterectomy. , 2000, The Cochrane database of systematic reviews.

[8]  Seongwon Kang,et al.  A fluid-structure interaction analysis on hemodynamics in carotid artery based on patient-specific clinical data , 2012, Journal of Mechanical Science and Technology.

[9]  R. T. Eppink,et al.  Pressure-induced mechanical stress in the carotid artery bifurcation: a possible correlation to atherosclerosis. , 1995, Journal of biomechanics.

[10]  A. Davies,et al.  Endarterectomy for asymptomatic carotid artery stenosis , 1995, BMJ.

[11]  C Kleinstreuer,et al.  Effect of carotid artery geometry on the magnitude and distribution of wall shear stress gradients. , 1996, Journal of vascular surgery.

[12]  T. Kenner,et al.  Flow and stress characteristics in rigid walled and compliant carotid artery bifurcation models , 2006, Medical and Biological Engineering and Computing.

[13]  Davide Ambrosi,et al.  BLOOD fLOw VeLOCITY fIeLD eSTIMATION VIA SPATIAL ReGReSSION wITh PDe PeNALIzATION , 2014 .

[14]  X. Y. Xu,et al.  Introduction to the biomechanics of carotid plaque pathogenesis and rupture: review of the clinical evidence. , 2010, The British journal of radiology.

[15]  W. Coulter Effect of Inlet Velocity Profiles on Patient-Specific Computational Fluid Dynamics Simulations of the Carotid Bifurcation , 2013 .

[16]  B. Rutt,et al.  Hemodynamics of human carotid artery bifurcations: computational studies with models reconstructed from magnetic resonance imaging of normal subjects. , 1998, Journal of vascular surgery.

[17]  D. Ku,et al.  Wall shear over high degree stenoses pertinent to atherothrombosis. , 2010, Journal of biomechanics.

[18]  A. Kamenskiy,et al.  Hemodynamically Motivated Choice of Patch Angioplasty for the Performance of Carotid Endarterectomy , 2012, Annals of Biomedical Engineering.

[19]  Daniel B Hier,et al.  Early Clinical Differentiation of Cerebral Infarction From Severe Atherosclerotic Stenosis and Cardioembolism , 1992, Stroke.

[20]  L. Antiga,et al.  Influence of bicuspid valve geometry on ascending aortic fluid dynamics: a parametric study. , 2012, Artificial organs.

[21]  P. Rothwell,et al.  Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy. , 2011, Asian journal of surgery.

[22]  E. Lakatta,et al.  Effect of common carotid artery inlet length on normal carotid bifurcation hemodynamics. , 2010, Journal of biomechanical engineering.

[23]  Luca Antiga,et al.  Impact of hemodynamics on lumen boundary displacements in abdominal aortic aneurysms by means of dynamic computed tomography and computational fluid dynamics , 2013, Biomechanics and modeling in mechanobiology.

[24]  L. Antiga,et al.  Comparative finite element model analysis of ascending aortic flow in bicuspid and tricuspid aortic valve. , 2010, Artificial organs.

[25]  A. Tannenbaum,et al.  Choice of in vivo versus idealized velocity boundary conditions influences physiologically relevant flow patterns in a subject-specific simulation of flow in the human carotid bifurcation. , 2009, Journal of biomechanical engineering.

[26]  Michael M. Resch,et al.  Numerical flow studies in human carotid artery bifurcations: basic discussion of the geometric factor in atherogenesis. , 1990, Journal of biomedical engineering.

[27]  D. Saloner,et al.  Numerical analysis of flow through a severely stenotic carotid artery bifurcation. , 2002, Journal of biomechanical engineering.

[28]  C. Vergara,et al.  Flow rate defective boundary conditions in haemodynamics simulations , 2005 .

[29]  C. Weiller,et al.  Wall shear stress distribution at the carotid bifurcation: influence of eversion carotid endarterectomy , 2013, European Radiology.

[30]  D. Ku,et al.  Fluid mechanics of vascular systems, diseases, and thrombosis. , 1999, Annual review of biomedical engineering.

[31]  Alfio Quarteroni,et al.  Cardiovascular mathematics : modeling and simulation of the circulatory system , 2009 .

[32]  P. Serruys,et al.  The role of shear stress in the destabilization of vulnerable plaques and related therapeutic implications , 2005, Nature Clinical Practice Cardiovascular Medicine.

[33]  D. Steinman,et al.  The effect of wall distensibility on flow in a two-dimensional end-to-side anastomosis. , 1994, Journal of biomechanical engineering.

[34]  M Markl,et al.  Comparison of Blood Flow Velocity Quantification by 4D Flow MR Imaging with Ultrasound at the Carotid Bifurcation , 2013, American Journal of Neuroradiology.

[35]  D. Ku,et al.  Pulsatile Flow and Atherosclerosis in the Human Carotid Bifurcation: Positive Correlation between Plaque Location and Low and Oscillating Shear Stress , 1985, Arteriosclerosis.

[36]  J. Archie,et al.  A fifteen-year experience with carotid endarterectomy after a formal operative protocol requiring highly frequent patch angioplasty. , 2000, Journal of vascular surgery.

[37]  Erling Falk,et al.  Mechanical stresses in carotid plaques using MRI-based fluid-structure interaction models. , 2008, Journal of biomechanics.

[38]  P. Rothwell,et al.  Systematic review of randomized controlled trials of patch angioplasty versus primary closure and different types of patch materials during carotid endarterectomy. , 2004, Journal of vascular surgery.

[39]  David A. Steinman,et al.  Path-Dependent Hemodynamics of the Stenosed Carotid Bifurcation , 2003, Annals of Biomedical Engineering.

[40]  J. Slattery,et al.  Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST) , 1998, The Lancet.

[41]  Dalin Tang,et al.  Planar biaxial characterization of diseased human coronary and carotid arteries for computational modeling. , 2012, Journal of biomechanics.

[42]  C. Yuan,et al.  Plaque Rupture in the Carotid Artery Is Localized at the High Shear Stress Region: A Case Report , 2007, Stroke.

[43]  M. Hennerici,et al.  Doppler colour flow imaging after carotid endarterectomy. , 1991, European journal of vascular surgery.

[44]  Cornelius Weiller,et al.  In Vivo Wall Shear Stress Distribution in the Carotid Artery: Effect of Bifurcation Geometry, Internal Carotid Artery Stenosis, and Recanalization Therapy , 2010, Circulation. Cardiovascular imaging.

[45]  P. Fischer,et al.  Direct numerical simulation of transitional flow in a stenosed carotid bifurcation. , 2008, Journal of biomechanics.

[46]  Alberto Redaelli,et al.  Womersley number-based estimation of flow rate with Doppler ultrasound: Sensitivity analysis and first clinical application , 2010, Comput. Methods Programs Biomed..

[47]  Alfio Quarteroni,et al.  Numerical Treatment of Defective Boundary Conditions for the Navier-Stokes Equations , 2002, SIAM J. Numer. Anal..

[48]  Dalin Tang,et al.  3D MRI-Based Multicomponent FSI Models for Atherosclerotic Plaques , 2004, Annals of Biomedical Engineering.

[49]  Piercesare Secchi,et al.  Spatial regression with PDE penalization: an application to blood velocity field estimation , 2013 .

[50]  Giovanna Rizzo,et al.  Womersley Number-Based Estimates of Blood Flow Rate in Doppler Analysis: In Vivo Validation by Means of Phase-Contrast MRI , 2010, IEEE Transactions on Biomedical Engineering.

[51]  Valentin Fuster,et al.  Thrombus Formation on Atherosclerotic Plaques: Pathogenesis and Clinical Consequences , 2001, Annals of Internal Medicine.

[52]  Giovanna Rizzo,et al.  Womersley number-based estimates of blood flow rate in Doppler analysis: In vivo validation by means of Phase Contrast Magnetic Resonance Imaging , 2010 .

[53]  A. Kamenskiy,et al.  A mathematical evaluation of hemodynamic parameters after carotid eversion and conventional patch angioplasty. , 2013, American Journal of Physiology. Heart and Circulatory Physiology.

[54]  D. Liepsch An introduction to biofluid mechanics--basic models and applications. , 2002, Journal of biomechanics.

[55]  Erling Falk,et al.  Pathogenesis of atherosclerosis. , 2006, Journal of the American College of Cardiology.

[56]  D. Ku BLOOD FLOW IN ARTERIES , 1997 .

[57]  R Eugene Zierler,et al.  Carotid artery stenosis: gray-scale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. , 2003, Radiology.

[58]  D. Sackett,et al.  Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. , 1998, The New England journal of medicine.

[59]  David A. Steinman,et al.  An Insight into the Mechanistic Role of the Common Carotid Artery on the Hemodynamics at the Carotid Bifurcation , 2014, Annals of Biomedical Engineering.

[60]  Alberto Redaelli,et al.  Reliable CFD-based estimation of flow rate in haemodynamics measures. , 2006, Ultrasound in medicine & biology.

[61]  R. Poole,et al.  Closure technique after carotid endarterectomy influences local hemodynamics. , 2014, Journal of vascular surgery.