Numerical study of biomechanical characteristics of plaque rupture at stenosed carotid bifurcation:a stenosis mechanical property-specific guide for blood pressure control in daily activities

Acute stress concentration plays an important role in plaque rupture and may cause stroke or myocardial infarction.Quantitative evaluation of the relation between in vivo plaque stress and variations in blood pressure and flow rates is valuable to optimize daily monitoring of the cardiovascular system for high-risk patients as well as to set a safe physical exercise intensity for better quality of life.In this study,we constructed an in vivo stress model for a human carotid bifurcation with atherosclerotic plaque,and analyzed the effects of blood pressure,flow rates,plaque stiffness,and stenosis on the elastic stress and fluid viscous stress around the plaque.According to the maximum values of the mechanical stress,we define a risk index to predict the risk level of plaque rupture under different exercise intensities.For a carotid bifurcation where the blood flow divides,the results suggest that the stenosis ratio determines the ratio of the contributions of elastic shear stress and viscous shear stress to plaque rupture.A n increase of the plaque stiffness enhances the maximum elastic shear stress in the plaque,indicating that a high-stiffness plaque is more prone to rupture for given stenosis ratio.High stress co-localization at the shoulder of plaques agrees with the region of plaque injury in clinical observations.It is demonstrated that,due to the stress-shield effect,the rupture risk of a high-stiffness plaque tends to decrease under high-stenosis conditions,suggesting the existence of a specific stenosis corresponding to the maximum risk.This study may help to complement risk stratification of vulnerable plaques in clinical practice and provides a stenosis mechanical property-specific guide for blood pressure control in cardiovascular health management.

HEMODYNAMICS FOR ASYMMETRIC INLET AXIAL VELOCITY PROFILE IN CAROTID BIFURCATION MODEL

The asymmetric inlet velocity profile has been observed in phantom model using LDA and in health subjects using Magnet Resonance （MR）. The effects of asymmetric inlet axial velocity profile on the flow field and the Wall Shear Stress （WSS） of carotid bifurcation were numerically studied herein with the TF-AHCB model, The results show that the Wall Shear Stress Gradient （WSSG） in the front part of the sinus for inward-tilting inlet axial velocity profile is nearly 2 times of that for the symmetric one in the beginning of systole, the end of systole, and diastole, respectively. The area of WSS below 5× 10^-3 Pa at the outer wall of the sinus for outward-tilting inlet axial velocity profile is 1.5 times of that for the inward-tilting one during diastole of the cardiac cycle. The asymmetric inlet velocity profiles can reduce the flow velocity near the inner wall of the sinus, which has been normally considered a high velocity region. It is concluded that besides bifurcation geometry and flow waveform, the asymmetry of inlet velocity profile is probably a factor influencing atherosclerosis.

Lattice Boltzmann method simulating hemodynamics in the three-dimensional stenosed and recanalized human carotid bifurcations

By using the lattice Boltzmann method(LBM)pulsatile blood flows were simulated in three-dimensional moderate stenosed and recanalized carotid bifurcations to understand local hemodynamics and its relevance in arterial atherosclerosis formation and progression.The helical flow patterns,secondary flow and wall dynamical pressure spatiotemporal distributions were investigated,which leads to the disturbed shear forces in the carotid artery bifurcations.The wall shear stress distributions indicated by time-averaged wall shear stress(TAWSS),oscillatory shear index(OSI),and the relative residence time(RRT)in a cardiac cycle revealed the regions where atherosclerotic plaques are prone to form,extend or rupture.This study also illustrates the point that locally disturbed flow may be considered as an indicator for early atherosclerosis diagnosis.Additionally the present work demonstrates the robust and highly efficient advantages of the LBM for the hemodynamics study of the human blood vessel system.

THE EFFECTS OF PHYSIOLOGICAL FLOW WAVEFORM ON WALL SHEAR STRESS IN CAROTID BIFURCATION MODEL

Numerical models of carotid bifurcation were constructed using a combination of tuning-fork bifurcation and straight or curved common carotid. The different inlet velocity profiles of the common carotid were generated for Bloch flow waveform and Holdsworth flow waveform, respectively. The effects of the different flow waveform for the common carotid on Wall Shear Stress （WSS） and Oscillatory Shear Index （OSI） of carotid bifurcation were studied by CFD method. The results show that the physiological flow waveform of curved common carotid has a significant effect on OSI. In particular, the OSI on the outer walls of carotid sinus and external carotid becomes higher in the inward-curved common carotid for Holdsworth flow waveform. But, in both cases of low WSS and high OSI, the effects of flow waveforms are smaller than those of the curved common carotid. The study reveals that the exact knowledge of the physiological flow waveform, vascular geometry and inlet velocity profile is important for hemodynamic numerical simulation of artery bifurcation.

Numerical simulation of pulsatile non-Newtonian flow in the carotid artery bifurcation

Both clinical and post mortem studies indicate that, in humans, the carotid sinus of the carotid artery bifurcation is one of the favored sites for the genesis and development of atherosclerotic lesions. Hemodynamic factors have been suggested to be important in atherogenesis. To understand the correlation between atherogenesis and fluid dynamics in the carotid sinus, the blood flow in artery was simulated numerically. In those studies, the property of blood was treated as an incompressible, Newtonian fluid. In fact, however, the blood is a complicated non-Newtonian fluid with shear thinning and viscoelastic properties, especially when the shear rate is low. A variety of non-Newtonian models have been applied in the numerical studies. Among them, the Casson equation was widely used. However, the Casson equation agrees well only when the shear rate is less than 10 s-1. The flow field of the carotid bifurcation usually covers a wide range of shear rate. We therefore believe that it may not be sufficient to describe the property of blood only using the Casson equation in the whole flow field of the carotid bifurcation. In the present study, three different blood constitutive models, namely, the Newtonian, the Casson and the hybrid fluid constitutive models were used in the flow simulation of the human carotid bifurcation. The results were compared among the three models. The results showed that the Newtonian model and the hybrid model had verysimilar distributions of the axial velocity, secondary flow and wall shear stress, but the Casson model resulted in significant differences in these distributions from the other two models. This study suggests that it is not appropriate to only use the Casson equation to simulate the whole flow field of the carotid bifurcation, and on the other hand, Newtonian fluid is a good approximation to blood for flow simulations in the carotid artery bifurcation.

Multidimensional modeling of the stenosed carotid artery: A novel CAD approach accompanied by an extensive lumped model

This study describes a multidimensional 3D/lumped parameter（LP） model which contains appropriate inflow/outflow boundary conditions in order to model the entire human arterial trees. A new extensive LP model of the entire arterial network（48 arteries） was developed including the effect of vessel diameter tapering and the parameterization of resistance, conductor and inductor variables. A computer aided-design（CAD） algorithm was proposed to effciently handle the coupling of two or more 3D models with the LP model, and substantially lessen the coupling processing time. Realistic boundary conditions and Navier-Stokes equations in healthy and stenosed models of carotid artery bifurcation（CAB） were used to investigate the unsteady Newtonian blood flow velocity distribution in the internal carotid artery（ICA）. The present simulation results agree well with previous experimental and numerical studies. The outcomes of a pure LP model and those of the coupled 3D healthy model were found to be nearly the same in both cases. Concerning the various analyzed 3D zones, the stenosis growth in the ICA was not found as a crucial factor in determining the absorbing boundary conditions.This paper demonstrates the advantages of coupling local and systemic models to comprehend physiological diseases of the cardiovascular system.

NUMERICAL ANALYSIS OF THE NON-NEWTONIAN BLOOD FLOW IN THE NON-PLANAR ARTERY WITH BIFURCATION

A numerical analysis of non-Newtonian fluid flow in non-planar artery withbifurcation was performed by using a finite element method to solve the three-dimensionalNavier-Stokes equations coupled with the non-Newtonian constitutive models, including Carreau, Crossand Bingham models. The objective of this study is to investigate the effects of . thenon-Newtonian properties of blood as well as curvature and out-of-plane geometry in the non-planardaughter vessels on the velocity distribution and wall shear stress. The results of this studysupport the view that the non-planarity of blood vessels and the non-Newtonian properties of bloodare of important in hemodynamics and play a significant role in vascular biology andpathophysiology.

Histological examination of carotid artery tissue in cases of ligature strangulation and hanging

Violence against the neck can result in a range of macromorphological and micromorphological findings.However,the forensic relevance of the carotid sinus in cases of violence against the neck remains controversial.In this follow-up study of 22 cases of suicidal and accidental strangulations,carotid bifurcations were examined histologically for morphological changes implying direct trauma,including haemorrhage and immunohistochemical expression of heat-shock proteins 27,60,and 70 and aquaporin-3.These cases were compared with a control group(82 cases)without neck compression or head trauma and with variable causes of death.No relevant histopathological findings implying direct trauma of the carotid bifurcation were found.No cases showed positive aquaporin-3 staining and only five cases showed positive heat-shock protein-27 staining,all of which were hangings.Without massive trauma of the carotid bifurcation,histological alterations cannot be expected.Without signs of rapid death,findings of acute circulatory failure,macromorphological and micromorphological findings of neck compression,and reliable markers indicating relevant impact on the carotid bifurcation the diagnosis of a lethal reflex cannot be verified.