Vous êtes sur la page 1sur 9

ARTICLE IN PRESS

Journal of Biomechanics 41 (2008) 11–19


www.elsevier.com/locate/jbiomech
www.JBiomech.com

Carotid geometry effects on blood flow and on risk for vascular disease
Kien T. Nguyena, Christopher D. Clarka,
Thomas J. Chancellora, Dimitrios V. Papavassilioua,b,
a
School of Chemical, Biological and Materials Engineering, The University of Oklahoma, 100 East Boyd, SEC T-335, Norman, OK 73019, USA
b
Sarkeys Energy Center, The University of Oklahoma, 100 East Boyd, SEC T-335, Norman, OK 73019, USA
Accepted 7 August 2007

Abstract

It has been widely observed that atherosclerotic diseases occur at sites with complex hemodynamics, such as artery bifurcations,
junctions, and regions of high curvature. These regions usually have very low or highly oscillatory wall shear stress (WSS). In the present
work, 3D pulsatile blood flow through a model of the carotid artery bifurcation was simulated using a finite volume numerical method.
The goal was to quantify the risk of atherogenesis associated with different carotid artery geometries. A risk scale based on the average
WSS on the sinus wall of the internal carotid artery was proposed—a scale that can be used to quantify the effect of the carotid geometry
on the relative risk for developing vascular disease. It was found that the bifurcation angle and the out-of-plane angle of the internal
carotid artery affect the formation of low stress regions on the carotid walls. The main conclusions are: (a) larger internal carotid artery
angles (yIC) generally increase the frequency and the area of blood recirculation and lower the WSS on the sinus wall, hence increasing
the risk of plaque build-up; (b) off-plane angles were found to lower the WSS on the sinus for geometries with yICX251. Larger off-plane
angles generally increase the danger of plague build-up; (c) for yICo251, the off-plane angle does not have an obvious effect on the
hemodynamic WSS; (d) symmetric bifurcations were found to increase the WSS on the sinus wall and ease the risk of vascular disease.
r 2007 Elsevier Ltd. All rights reserved.

Keywords: Carotid bifurcation; Pulsatile blood flow; Vascular disease risk

1. Introduction (MRI), multislice CT, or positron emission tomography


(PET) scanning (Poli et al., 1988; Kato et al., 2003;
Serious cardiovascular diseases (e.g., atherosclerosis, Laurberg et al., 2007). These tools have been used to detect
thrombosis) have been observed on the carotid artery. In the initial structural atherosclerotic changes of the arterial
addition to factors like lack of exercise or bad diet, the walls, and to monitor in vivo the progression and/or the
unique geometry of each person’s carotid artery can affect regression of early atherosclerosis in man.
the blood flow pattern through the artery, which, in turn, In terms of hemodynamics, it has been found that low or
affects the risk of having plaque build-up and athero- oscillatory shear stress, rather than high shear stress,
sclerosis. Understanding blood flow patterns in different contributes to atherogenesis (Ku et al., 1985; Ku, 1997;
carotid geometries can, therefore, lead to the identification Malek et al., 1999; Younis et al., 2004). Low or oscillating
of people vulnerable to atherosclerosis. Recent clinical wall shear stress (WSS) usually occurs at complex
predictive tools of atherosclerosis include invasive proce- geometries, like bifurcating vessels or high curvature
dures such as X-ray contrast angiography and non-invasive vessels. Atherogenic phenotype was found to be stimulated
tools like ultrasonography, magnetic resonance imaging when carotid artery WSS was below 0.4 Pa (Malek et al.,
1999).
Corresponding author. School of Chemical, Biological and Materials Flow in a carotid artery bifurcation has been investi-
Engineering, The University of Oklahoma, 100 East Boyd, SEC T-335,
gated computationally by Nazemi et al. (1990), who
Norman, OK 73019, USA. Tel.: +1 405 325 5811; fax: +1 405 325 5813. modeled 2D, steady, pulsatile flow in a carotid artery
E-mail address: dvpapava@ou.edu (D.V. Papavassiliou). segment. Perktold et al. (1991) developed a 3D carotid

0021-9290/$ - see front matter r 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jbiomech.2007.08.012
ARTICLE IN PRESS
12 K.T. Nguyen et al. / Journal of Biomechanics 41 (2008) 11–19

artery model using a pressure correction finite element dynamic viscosity of m ¼ 0.004 kg/(m s). Previous investi-
method. Velocity and WSS values in the carotid sinus were gators have used several different models for flow in the
calculated and compared with experimental data with good carotid artery. Even though the physical properties of
agreement. Rindt and van Steehoven (1996) simulated blood, the velocity profiles, and the flow rates were
blood flow in the carotid artery bifurcation and found modeled similar to our study (based on realistic measure-
that lowering the angle between the main branch and ments), several recent studies employ geometry images of
the carotid sinus could reduce the risk of having reversed the carotid artery obtained directly from the laboratory.
axial flow. Some of these models offer a realistic description of the
Experimental measurements of fluid velocities in a scale carotid artery geometry, since it is reconstructed from
model of the human carotid bifurcation have been patient-specific data from MRI images (e.g., Steinman
conducted using laser-Doppler anemometry (Ku et al., et al., 2002 used data from two patients and Younis et al.,
1985; Ku and Giddens, 1987; Gijsen et al., 1999) and MRI 2004 used data from four patients). However, none of these
(Stokholm et al., 2000; Fayad and Fuster, 2001; Marshall previous models has been used to systematically study a
et al., 2004). Even though MRI does not usually give data wide range of different carotid geometry characteristics
over an extended area of the artery, 3D data acquired by and their effects on atherosclerosis, like the present work.
MRI have been used to guide computational fluid Abstraction of the carotid artery geometry to a simpler,
dynamics (CFD) studies. Papathanasopoulou et al. (2003)
calculated WSS vectors from time-resolved, 3D phase-
contrast MRI measurements of the velocity field, and
compared them to CFD predictions based on MR-derived common carotid
geometry and velocity measurements. Regions of low WSS artery, CCA
(defined as WSSo1 Pa) were found along the outer wall of
the carotid bulb and regions of higher WSS were found
downstream in the internal carotid artery (ICA). Younis
et al. (2004) used a 3D finite element analysis based on
MRI flow measurements to find that the largest region of
outer ICA s urface
low WSS (o0.5 Pa) occurred at the sinus of the ICA, while inner ICA surface
regions of high WSS (6–10 Pa) occurred at the apex and the
inner wall of the external carotid artery (ECA).
The present study systematically examines the effects of sinus
the 3D carotid geometry on the blood flow pattern and external carotid
artery, ECA
suggests a methodology for quantifying the risk of internal carotid
developing atherosclerosis. Pulsatile, 3D blood flow in artery, ICA
Y X
the carotid artery was simulated, using a finite volume
numerical method for a wide range of carotid artery Z
geometries, including cases that the bifurcating arteries are
not both on the same plane as the main carotid. Realistic
flow profiles, obtained by MRI measurements from healthy
humans, were used as boundary conditions.

2. Model development

In large blood vessels (such as the carotid artery), where


the size of blood cells is small compared to the diameter of
the tubes, blood behaves like a Newtonian fluid (Ku, 1997).
Therefore, most investigators have modeled blood in
carotid artery as a Newtonian fluid (Perktold and Hilbert,
1986; Rindt and van Steehoven, 1996; Steinman et al.,
2002; Papathanasopoulou et al., 2003; Younis et al., 2004). Y
X
Even though blood properties are unique for each person,
Z
its density ranges from 1020 to 1150 kg/m3 and its viscosity
is about four times that of water. Blood flow in the carotid Fig. 1. Typical carotid artery geometry used in this study (the CCA, the
artery has a mean Reynolds number of around 300 ICA, and the ECA are co-planar, and the bifurcation angle is 401). The
(Wootton and Ku, 1999), the flow rate varies with time, numerical grid used for the flow simulations is shown. The computational
cell size decreased gradually from 1.0 mm at the inlet of the CCA to
and the period of a pulse is roughly 1 s. In the present 0.5 mm at the outlet of the ECA and the ICA, and the volume of the sinus
work, the flow was modeled as pulsatile laminar flow of a and the bifurcation were resolved with a finer resolution: (a) full geometry
Newtonian fluid with a density of 1030 kg/m3 and a and (b) magnification of the bifurcation region.
ARTICLE IN PRESS
K.T. Nguyen et al. / Journal of Biomechanics 41 (2008) 11–19 13

better defined, but still very close to reality, model is then axis of 8 mm. The sinus had the same axis as the ICA, and
necessary. its center was located 20 mm away from the point of
The human carotid artery consists of the common bifurcation.
carotid artery (CCA) that bifurcates into the ECA and The bifurcation angle was defined as the angle between
the ICA. The diameter of an adult’s CCA ranges between 7 the ECA and the projection of the ICA on the plane
and 9 mm. Smith et al. (1996) digitized film angiograms of defined by the CCA and the ECA. The off-plane angle, f,
62 patients and developed a carotid bifurcation model, in was defined as the angle of the ICA with the CCA–ECA
which the diameter of the CCA is 8 mm and the radii of plane. The angle defined by the axes of the CCA and the
ECA and ICA are related to the radius of the CCA by ICA is called the ICA angle, yIC. The angle defined by the
axes of the CCA and the ECA is called the ECA angle, yEC.
RICA ¼ 0:6942RCCA , (1)
Clinical data have demonstrated major variations in
carotid bifurcation geometry. Furthermore, the geometry
RECA ¼ 0:5778RCCA , (2)
of the carotid artery changes with age. Thomas et al. (2005)
where RECA, RICA, and RCCA are the radii of the ECA, the found that the average bifurcation angle was 48.51 in one
ICA, and the CCA, respectively. A sinus is usually present population group (aged 2474 years) and 63.61 in another
in the ICA, right after the bifurcation. The size and shape population group (aged 63710 years). The average off-
of the sinus are also unique to each person. plane angle was 7.01 for the younger and 8.51 for the older
Specifically in our carotid model, the arteries were group. Based on these measurements, the bifurcation
modeled by cylindrical pipes, the sinus with an ellipsoid, angles investigated herein were varied from 401 to 601
and the bifurcation area with a sphere. A model of a and the off-plane angles from 01 to 201.
carotid artery with a 401 bifurcation angle is shown in The CCA inflow boundary condition was a time-
Fig. 1. The CCA was modeled by a cylinder with length of dependent mass flow rate, which was generated by a fit
41 mm and diameter of 8 mm. The ECA cylinder had a to the experimental data of Marshall et al. (2004) (see
length of 47 mm and a diameter of 4.6224 mm, and the ICA Fig. 2). No-slip boundary conditions were used on the
cylinder had a length of 47 mm and a diameter of carotid walls. The pressure at the ICA and the ECA outlets
5.5536 mm, as calculated using Eqs. (1) and (2). In order was set to be equal to 1 atm. The volumetric flow rates
to make the carotid bifurcation more realistic in 3D (and to through the external and internal carotids were calculated
avoid sharp edges at the intersections of cylindrical pipes), as a function of time, and were found to agree qualitatively
a sphere was created to connect the cylinders representing well with the measurements of Marshall et al. (2004), as
the carotid arteries and to smooth the bifurcation shown in Fig. 2. The measured peak flow rate of the
region. The sphere had a radius of 4 mm, equal to the ICA is significantly lower than the computed value, while
radius of the CCA. The ICA sinus was represented by the measured and computed values of the flow rate of the
an ellipsoid with a major axis equal to 22 mm and a minor ECA are close during the pulse. This agreement, even

10

6
flowrate (ml/s)

ICA Flow
Computed

Measured
4

Computed
ECA Flow Measured
0
0 0.2 0.4 0.6 0.8 1
time (s)

Fig. 2. Comparison between computed and experimentally measured values (from Marshall et al., 2004) for the ICA and the ECA outflows. The flow rate
at the entrance of the CCA in ml/s, F(t), was fitted with the piece-wise function shown on the figure to describe the inlet flow rate for the computations,
assuming that a cardiac pulse is 1 s.
ARTICLE IN PRESS
14 K.T. Nguyen et al. / Journal of Biomechanics 41 (2008) 11–19

Table 1
Simulation conditions for all the runs conducted

Run no. Bifurcation angle ICA angle yIC (1) ECA angle yEC Off-plane angle f ICA/CCA flow (ICA, ECA) angle
yIC+yEC (1) (1) (1) ratio (1)

1 40 20 20 0 0.630 40.00
2 40 20 20 5 0.626 40.26
3 40 20 20 10 0.624 41.03
4 40 20 20 20 0.624 43.96
5 50 20 30 0 0.626 50.00
6 50 20 30 5 0.626 50.18
7 50 20 30 10 0.626 50.73
8 50 20 30 20 0.621 52.84
9 60 20 40 0 0.626 60.00
10 60 20 40 5 0.623 60.13
11 60 20 40 10 0.622 60.50
12 60 20 40 20 0.618 61.98

13 50 25 25 0 0.625 50.00
14 50 25 25 5 0.624 50.18
15 50 25 25 10 0.623 50.73
16 50 25 25 20 0.623 52.84
17 50 30 20 0 0.621 50.00
18 50 30 20 5 0.621 50.18
19 50 30 20 10 0.621 50.73
20 50 30 20 20 0.623 52.84
21 60 30 30 0 0.618 60.00
22 60 30 30 5 0.618 60.13
23 60 30 30 10 0.619 60.50
24 60 30 30 20 0.621 61.98
25 50 40 10 0 0.615 50.00
26 50 40 10 5 0.617 50.18
27 50 40 10 10 0.616 50.73
28 50 40 10 20 0.616 52.84
29 60 40 20 0 0.624 60.00
30 60 40 20 5 0.625 60.13
31 60 40 20 10 0.625 60.50
32 60 40 20 20 0.628 61.98

The resulting ICA/CCA flow rate ratio, and the actual angle between the ICA and the ECA are also shown.

though qualitative, can serve as a validation for our constant flow rate of 0.0125 kg/s at the inlet of the CCA
model, because (as pointed out in the work of Marshall (this value is the peak flow rate in the CCA from the MRI
et al. 2004, in Fig. 5) the mass balance obtained measurements of Marshall et al., 2004).1 Grid indepen-
through their measurements was not satisfied. The dence was obtained when the number of cells were larger or
measured sum of the ICA and ECA flow rates was up to equal to 337,151. In this grid, which was chosen for the rest
20% different than the CCA flow rate, due to experimental of the simulations, the cell size decreased gradually from
errors. 1.0 mm at the CCA inlet to 0.5 mm at the ICA and the
ECA outlets, with subsequent refining of the section
3. Computational methodology between z ¼ 35 and 65 mm of the grid (see Fig. 1).
A time-step independence study was also conducted to
Flow in the carotid artery was simulated with the finite determine that a time step smaller or equal to 1/40 s is
volume-based software package FluentTM and using a sufficient for this type of flow.
second-order unsteady solver. The computational mesh
consisted of tetrahedral cells and was generated using the
software GambitTM. A typical mesh for a symmetric 401 1
Details of the grid independence study and the time-step independence
bifurcation angle and no off-plane angle is shown in Fig. 1. study can be found on the website supplementary material that
A grid independence study was performed for the case of a accompanies this paper.
ARTICLE IN PRESS
K.T. Nguyen et al. / Journal of Biomechanics 41 (2008) 11–19 15

4. Results
0.5
t=0.2s
Simulations and analysis were performed for a t=0.3s
wide range of bifurcation angles and off-plane angles 0.4 t=0.4s
(see Table 1). t=0.5s
t=0.6s
Twelve locations on the sinus wall were chosen as 0.3 t=0.7s

Vax (m/s)
representative measuring stations. These locations, which t=0.8s
were the intersections of six lines that ran across the sinus t=0.9s
0.2 t=1.0s
and perpendicular to the axis of the sinus, lay in the region t=0.1s
that frequently has low WSS, as shown in Fig. 3. The lines
0.1

0
Starting point of 0.002 0.004 0.006 0.008 0.01
Internal carotid
x (m)

10 mm 0.4
t=0.2s
line 1 t=0.3s
0.3 t=0.4s
line 2 t=0.5s
t=0.6s
line 3 Vax (m/s) t=0.7s
0.2 t=0.8s
line 4 t=0.9s
t=1.0s
line 5 t=0.1s
0.1
line 6

0.002 0.004 0.006 0.008 0.01 0.012


x (m)
Y X
Fig. 5. Axial velocity profiles at different time instances for Run 1:
Z
(a) velocity along line 2, which is on the plane that cuts through the edge
Fig. 3. Lines and planes defined on representative locations of the ICA separating the sinus bulb and the ICA upper tube; (b) velocity along line 4,
sinus on which the velocity is calculated. which is 4 mm downstream from line 2. Both lines 2 and 4 cross the ICA
axis and are perpendicular to it. The points at which Vax ¼ 0 indicate the
sinus wall.

Fig. 4. Velocity contour plots at different locations of the ICA sinus at t ¼ 0.3 s for Run 1: (a) plane 1, (b) plane 2, (c) plane 3, (d) plane 4, (e) plane 5, and
(f) plane 6. The color scale is in m/s.
ARTICLE IN PRESS
16 K.T. Nguyen et al. / Journal of Biomechanics 41 (2008) 11–19

Fig. 6. Shear stress on the ICA sinus wall at different time instances for Run 1: (a) t ¼ 0.1 s, (b) t ¼ 0.3 s, (c) t ¼ 0.5 s, (d) t ¼ 0.7 s, (e) t ¼ 0.9 s, and
(f) t ¼ 1.1 s. The color scale is in Pa.

were spaced 2 mm apart from each other along the sinus time instant after maximum velocity) for the case of a
axis. The first line, line 1, was located 10 mm away from the symmetric 401 bifurcation angle with no off-plane angle
origin of the ICA. In addition, six planes were created that (Run 1, Table 1). These cross-sections are the intersections
were perpendicular to the axis of the ICA. These planes of planes 1–6 with the sinus volume. Negative velocity
were named ‘‘plane 1’’ to ‘‘plane 6’’; plane 1 being closer to (designated by dark blue color) indicates flow recirculation
the origin of the ICA and plane 6 being the farthest. Lines areas. Although the peak of axial velocity is generally at
1–6 were located on planes 1–6, respectively. Below, we the center of the cross-sections investigated, some velocity
present simulation results on these planes and lines. skewing is observed (the maximum velocity does not occur
Velocity profiles have been calculated at any location at the center, as was also observed by Ku, 1997), most
and time.2 It was observed that the axial velocity is the clearly at planes 1 and 2. The skewing is caused by the
highest at the region right upstream and downstream of the changes in the vessel geometry as blood flows from the
sinus. Regions of flow recirculation formed near the sinus CCA to the bifurcation area and to the sinus.
wall due to the rapid changes in the flow rate, low fluid The profile of the component of the velocity vector that
viscosity, and the curvature of the sinus. Within such is parallel to the ICA axis (axial velocity, Vax) is shown in
recirculation regions, blood moves in the direction opposite Fig. 5 along lines 2 and 4 from time t ¼ 0.1 to 1.0 s. As
to the mean flow increasing the probability of plaque described above, these two lines cut through and are
deposition. Fig. 4 shows axial velocity contours over perpendicular to the axis of the ICA. As shown in Fig. 3,
different cross-sections of the sinus at time 0.3 s (i.e., the line 2 crosses the edge separating the sinus bulb and the
ICA upper tube. Line 4 is 4 mm downstream from line 2.
2
Typical vector plots of the velocity can be found on the website The data are for the case of Run 1, but are typical of all
supplementary material that accompanies this paper. runs. At the beginning of the cycle, the blood flow rate
ARTICLE IN PRESS
K.T. Nguyen et al. / Journal of Biomechanics 41 (2008) 11–19 17

Table 2
Time-averaged WSS on surfaces A and B (defined in Fig. 7) and the associated risk based on Eq. (3)

Case no. Average WSS on Average WSS on Sum Risk scale Incidents on Incidents on Sum
surface A (Pa) surface B (Pa) surface A surface B

1 0.2265 0.2797 0.5062 1.00 0 8 8


2 0.1568 0.2412 0.398 7.10 3 9 12
3 0.1644 0.2437 0.4081 6.53 3 9 12
4 0.1626 0.2441 0.4066 6.61 3 9 12
5 0.161 0.259 0.4199 5.86 3 8 11
6 0.1668 0.2612 0.428 5.41 3 9 12
7 0.1674 0.2417 0.4091 6.47 4 8 12
8 0.1735 0.2415 0.415 6.14 6 7 13
9 0.1868 0.2691 0.4559 3.83 4 7 11
10 0.1855 0.264 0.4495 4.20 4 9 13
11 0.2012 0.2715 0.4727 2.89 2 9 11
12 0.2099 0.2552 0.4651 3.32 6 7 13

13 0.1686 0.2555 0.4241 5.63 4 8 12


14 0.169 0.2439 0.4129 6.26 5 8 13
15 0.1664 0.2375 0.4039 6.77 6 6 12
16 0.1654 0.2375 0.403 6.82 6 7 13
17 0.1565 0.2291 0.3855 7.80 6 8 14
18 0.1525 0.217 0.3695 8.70 6 7 13
19 0.1493 0.2047 0.354 9.58 6 7 13
20 0.1509 0.207 0.3579 9.36 7 5 12
21 0.162 0.2554 0.4174 6.00 7 3 10
22 0.1646 0.2306 0.3952 7.26 7 4 11
23 0.1607 0.239 0.3998 7.00 7 4 11
24 0.1639 0.2326 0.3964 7.19 8 4 12
25 0.1529 0.2017 0.3545 9.55 9 4 13
26 0.1583 0.1946 0.3529 9.64 9 5 14
27 0.1535 0.1954 0.349 9.86 8 4 12
28 0.16 0.1909 0.3509 9.75 8 4 12
29 0.1554 0.2088 0.3642 9.00 9 4 13
30 0.1577 0.2056 0.3633 9.05 9 4 13
31 0.1546 0.2069 0.3615 9.15 7 3 10
32 0.1503 0.1962 0.3465 10.00 8 5 13

The number of instances with negative axial WSS on surfaces A and B is also presented, which could also be viewed as a measure of risk.

starts rising and reaches a maximum level at around 0.2 s rate gradually decreases from the peak level (t ¼ 0.5–0.9 s).
and then decreases gradually to the lowest level at the end The WSS is lower at the entry of the sinus and higher at the
of the cycle (t ¼ 1.0 s). The velocity gradients near the exit of the sinus.
intersections of line 2 and the sinus wall are much higher
than those near the intersections of line 4 and the sinus 5. Risk quantification—discussion
wall. The velocity profiles along line 4 flatten out at the
center and the velocity becomes negative near the sinus The risk for atherosclerotic disease is directly related to
wall. This indicates very low WSS and flow recirculation the WSS on the carotid walls, and the area of most interest
near the sinus wall. The points at which Vax is equal to zero is the area of the ICA sinus. In this study, the area-
are coincident with the walls of the sinus. weighted average WSS on two different surfaces covering
Fig. 6 shows contours of the WSS magnitude along the the inner and the outer wall of the sinus close to the
sinus wall as a function of time for Run 1. The region bifurcation were calculated every 0.1 s of a pulse. The time-
indicated by dark blue color has WSS less than 0.15 Pa averaged WSS magnitude was then calculated and tabu-
(much lower than the critical point of 0.4 Pa). At lated in Table 2 for every simulation case. In addition,
the beginning of the cycle (t ¼ 0.1 and 1.1 s), there is only occurrences of axial WSSp0 Pa were counted and included
a small dark blue region on the inner wall near the in Table 2. (A negative axial WSS, which implies a blood
bifurcation. When the blood flow rate peaks (t ¼ 0.2–0.3 s), recirculation area close to the carotid wall, is conducive to
several dark blue areas appear. These regions become more the formation of plaque. It is also a cause of very low WSS
widespread, especially on the outer sinus wall, as the flow on the carotid walls.) The locations of these two surfaces
ARTICLE IN PRESS
18 K.T. Nguyen et al. / Journal of Biomechanics 41 (2008) 11–19

where r is the sum of the average WSS on surfaces A and B


given in Table 2; rmin is the smallest sum and rmax is the
largest sum. Eq. (3) ensures that the relative risk factor
Surface A
takes values between 1 and 10, avoiding the case that a
person can have zero risk for plaque formation
(or cardiovascular disease).
The relative risk was examined in order to determine the
Surface B most important factors of the carotid artery geometry that
can contribute to the risk of vascular disease. Fig. 8 is a
histogram presenting the risk factor for all the carotid
geometries investigated as a function of yIC and yEC. It can
be seen that yIC is a major contributor—higher yIC results
in higher risk. Even though the effect of off-plane angle is
not obvious when yIC ¼ 201, higher f generally increases
the risk for yICX251.
Fig. 9 shows the relative risk for all geometries with
Y X f ¼ 0. It can be seen that the (20, 30) case is of higher risk
than the (25, 25) case, even though the latter has higher yIC
Z and both have the same yIC+yEC. From this comparison,
Fig. 7. Surfaces A and B on the sinus wall used to define a relative risk one may argue that symmetry (yIC ¼ yEC) reduces disease
scale associated with low WSS. risk. This risk-lowering effect of symmetry can also be
seen when comparing the (30, 20) case with the (30, 30).
Both geometries have the same yIC but the symmetric
are shown in Fig. 7. Surface A was defined as the part of one has lower risk. Also, the (40, 10) has higher risk
the sinus surface between two planes. The first plane is
parallel to the x ¼ 0 axis and intersects the sinus surface at
the starting point of the sinus inner edge (i.e., the edge
closer to the ECA). The second plane is parallel to the 10
φ = 0°
z ¼ 0 axis and intersects the sinus surface through the φ = 5°
8
middle point of the sinus inner edge. Surface B was also φ = 10°
defined as the part of the sinus surface between a plane φ = 20°
risk factor

6
parallel to the x ¼ 0 axis that cuts through the middle point
of the sinus outer edge and a second plane parallel to the 4
z ¼ 0 axis that cuts through the starting point of the sinus
outer edge. These two surfaces were chosen because our 2
results show that the WSS on these locations is usually
0
lower than 0.4 Pa (i.e., the critical WSS value for the 20,20 20,30 20,40 25,25 30,20 30,30 40,10 40,20
development of atherosclerotic disease according to Malek different geometries
et al., 1999) and fluctuates in direction.
Since very low hemodynamic WSS acting on the sinus Fig. 8. Histograms of relative risk for all geometries investigated. On the
x-axis, each geometry is designated with the pair (yIC, yEC).
wall is the main cause of plaque build-up, the risk of the
disease was correlated to the time-averaged WSS acting on
surfaces A and B. Although negative WSS implies
secondary flow and blood recirculation close to the sinus
10
wall, if it has a high absolute value it will not contribute to
atherosclerosis. Therefore, the risk of the disease was not 8 φ = 0°
correlated to the incidents of negative axial WSS, but it was
correlated to the absolute value of the WSS. As shown in
risk factor

6
Table 2, the case of a symmetric 401 bifurcation angle with
no off-plane has the lowest WSS and the case of yIC ¼ 401, 4
yEC ¼ 201, and f ¼ 201 has the highest WSS. A quantita-
tive relative risk scale was developed using the following 2
equation, where a value of risk factor equal to one indicates
0
the lowest risk and a value of 10 indicates the highest risk: 20,20 20,30 20,40 25,25 30,20 30,30 40,10 40,20
  different geometries
r  rmin
risk factor ¼ 1 þ 9 , (3)
rmax  rmin Fig. 9. Relative risk of all geometries with no off-plane angle.
ARTICLE IN PRESS
K.T. Nguyen et al. / Journal of Biomechanics 41 (2008) 11–19 19

than the (40, 20) because the first geometry is more correlation between plaque location and low oscillating shear stress.
asymmetric. Arteriosclerosis 5, 293–302.
Laurberg, J.M., Olsen, A.K., Hansen, S.B., Bottcher, M., Morrison, M.,
Table 1 shows the ratio (flow rate out of the ICA)/
Ricketts, S.A., Falk, E., 2007. Imaging of vulnerable atherosclerotic
(flow rate at the inlet of CCA) and the angle between the plagues with FDG-micro PET: no FDG accumulation. Atherosclerosis
ICA and the ECA on the plane defined by the axes of these 192, 275–282.
two arteries for simulated geometries. There is no obvious Malek, A.M., Alper, S.L., Izumo, S., 1999. Hemodynamic shear stress and
or systematic dependence of the risk of the disease on these its role in atherosclerosis. Journal of the American Medical Associa-
two parameters. tion 282, 2035–2042.
Marshall, I., Papathanasopoulou, P., Wartolowska, K., 2004. Carotid
The focus of the present study was on the flow in the sinus, flow rates and flow division at the bifurcation in healthy volunteers.
where plaque builds up, and on the effects of the bifurcation Physiological Measurement 25 (3), 691–697.
angles. However, the risk of atherogenesis associated with the Nazemi, M., Kleinstreuer, C., Archie, J.P., 1990. Pulsatile 2-dimensional
flow in the ECA and at the bifurcation area may be flow and plaque-formation in a carotid-artery bifurcation. Journal of
significant. Also, the shape and the location of the sinus, Biomechanics 23 (10), 1031–1037.
Papathanasopoulou, P., Zhao, S., Kohler, U., Robertson, M.B., Long, Q.,
which is fixed in this study, may significantly affect the flow Hoskins, P., Xu, X.Y., Marshall, I., 2003. MRI measurement of time-
patterns and the risk of the disease. The procedure established resolved wall shear stress vectors in a carotid bifurcation model, and
in this work, however, can be used to quantify risk from low comparison with CFD predictions. Journal of Magnetic Resonance
WSS irrespective of the location and shape of the sinus. Imaging 17, 153–162.
Perktold, K., Hilbert, D., 1986. Numerical simulation of pulsatile flow in a
carotid bifurcation model. Journal of Biomedical Engineering 8,
Conflict of interest 193–199.
Perktold, K., Resch, M., Peter, R.O., 1991. 3-Dimensional numerical
There are no financial or personal relationships of any of analysis of pulsatile flow and wall shear stress in the carotid artery
the co-authors with other people or organizations that bifurcation. Journal of Biomechanics 24 (6), 409–420.
Poli, A., Tremoli, E., Colombo, A., Sirtor, M., Pignoli, P., Paoletti, R.,
could inappropriately influence (bias) this work. 1988. Ultrasonographic measurement of the common carotid artery
wall thickness in hypercholesterolemic patients. A new model for the
Appendix A. Supplementary data quantitation and follow-up of preclinical atherosclerosis in living
human subjects. Atherosclerosis 70 (3), 253–261.
Rindt, C.C.M., van Steehoven, A.A., 1996. Unsteady flow in a rigid 3-D
Supplementary data associated with this article can be
model of the carotid artery bifurcation. Journal of Biomechanical
found in the online version at doi:10.1016/j.jbiomech. Engineering 118 (1), 90–96.
2007.08.012. Smith, R.F., Rutt, B.K., Fox, A.J., Rankin, R.N., 1996. Geometric
characterization of stenosed human carotid arteries. Academic
Radiology 3 (11), 898–911.
Steinman, D.A., Thomas, J.B., Ladak, H.M., Milner, J.S., Rutt, B.K.,
References Spence, J.D., 2002. Reconstruction of carotid bifurcation hemodyna-
mices and wall thickness using computational fluid dynamics and
Fayad, Z.A., Fuster, V., 2001. The human high-risk plaque and its MRI. Magnetic Resonance in Medicine 47 (1), 149–159.
detection by magnetic resonance imaging. American Journal of Stokholm, R., Oyre, S., Ringgaard, S., Flaagoy, H., Paaske, W.P.,
Cardiology 88 (2A), 42E–45E. Pedersen, E.M., 2000. Determination of wall shear rate in the human
Gijsen, F.J.H., van de Vosse, F.N., Janssen, J.D., 1999. The influence of carotid artery by magnetic resonance techniques. European Journal of
the non-Newtonian properties of blood on the flow in large arteries: Vascular and Endovascular Surgery 20 (5), 427–433.
steady flow in a carotid bifurcation model. Journal of Biomechanics 32 Thomas, J.B., Antiga, L., Che, S.L., Milner, J.S., Steinman, D.A.H.,
(6), 601–608. Spence, J.D., Rutt, B.K., Steinman, D.A., 2005. Variation in the
Kato, M., Dote, K., Habara, S., Takemoto, H., Goto, K., Nakanoka, K., carotid bifurcation geometry of young versus older adults-implications
2003. Clinical implications of carotid artery remodeling in acute for geometric risk of atherosclerosis. Stroke 36 (11), 2450–2456.
coronary syndrome. Ultrasonographic assessment of positive remodel- Wootton, D.M., Ku, D.N., 1999. Fluid mechanics of vascular systems,
ing. Journal of the American College of Cardiology 42 (6), 1026–1032. diseases and thrombosis. Annual Review of Biomedical Engineering 1,
Ku, D.N., 1997. Blood flow in arteries. Annual Review of Biomedical 299–329.
Engineering 29, 399–434. Younis, H.F., Kaazempur-Mofrad, M.R., Chan, R.C., Isasi, A.G.,
Ku, D.N., Giddens, D.P., 1987. Laser Doppler anemometer measure- Hinton, D.P., Chau, A.H., Kim, L.A., Kamm, R.D., 2004. Hemody-
ments of pulsatile flow in a model carotid bifurcation. Journal of namics and wall mechanics in human carotid bifurcation and its
Biomechanics 20 (4), 407–421. consequences for atherogenesis: investigation of inter-individual
Ku, D.N., Giddens, D.P., Zarins, C.K., Glagov, S., 1985. Pulsatile flow variation. Biomechanics and Modeling in Mechanobiology 3 (1),
and atherosclerosis in the human carotid bifurcation—positive 17–32.

Vous aimerez peut-être aussi