Internal carotid artery (CA) stenosis is a primary etiological factor for stroke and transient ischemic attack. The severity of arterial stenosis significantly impacts patient health and treatment decisions. Therefore, we conducted computational fluid dynamics analyses on five carotid arteries (CAs) of severe stenosis and compared them with five CAs in the control group. We improved the three-element Windkessel model method by pre-calculating the constant-pressure outlet simulation of the first cardiac cycle, which accelerated the stability of the model. The research results show that vortices were observed at the bifurcation of the CAs in the control group, whereas in the severe stenosis group, vortices predominantly occurred within the carotid sinus downstream of the stenotic segment. Notably, the vortex flow in the carotid aneurysm downstream of the stenotic segment arises due to the cross-sectional constriction induced by stenosis, which always flows in a clockwise direction and may contribute to the formation of aneurysms distal to the stenotic region. A high time-averaged wall shear stress value can effectively identify the stenosis site of CAs, while a high relative residence time value marks the protrusion near the stenosis segment. This study delved into the hemodynamic parameters between the CAs of the severe stenosis group and the control group and provided robust clinical evidence for carotid atherosclerotic disease.

1.
R.
Matsui
,
T.
Nakagawa
,
H.
Takayoshi
,
K.
Onoda
,
H.
Oguro
,
A.
Nagai
, and
S.
Yamaguchi
, “
A prospective study of asymptomatic intracranial atherosclerotic stenosis in neurologically normal volunteers in a Japanese cohort
,”
Front. Neurol.
7
,
39
(
2016
).
2.
R.
Arasu
,
A.
Arasu
, and
J.
Muller
, “
Carotid artery stenosis: An approach to its diagnosis and management
,”
Aust. J. Gen. Pract.
50
,
821
825
(
2021
).
3.
A. I.
Qureshi
and
L. R.
Caplan
, “
Intracranial atherosclerosis
,”
Lancet (London, England)
383
,
984
998
(
2014
).
4.
M. P.
Krasteva
,
K. K.
Lau
,
P.
Mordasini
,
A. C. O.
Tsang
, and
M. R.
Heldner
, “
Intracranial atherosclerotic stenoses: Pathophysiology, epidemiology, risk factors and current therapy options
,”
Adv. Ther.
37
,
1829
1865
(
2020
).
5.
C. K.
Zarins
,
D. P.
Giddens
,
B. K.
Bharadvaj
,
V. S.
Sottiurai
,
R. F.
Mabon
, and
S.
Glagov
, “
Carotid bifurcation atherosclerosis. Quantitative correlation of plaque localization with flow velocity profiles and wall shear stress
,”
Circ. Res.
53
,
502
514
(
1983
).
6.
C. K.
Zarins
,
E.
Weisenberg
,
G.
Kolettis
,
R.
Stankunavicius
, and
S.
Glagov
, “
Differential enlargement of artery segments in response to enlarging atherosclerotic plaques
,”
J. Vasc. Surg.
7
,
386
394
(
1988
).
7.
Y.-T.
Liu
,
Z.-M.-Y.
Zhang
,
M.-L.
Li
,
S.
Gao
,
F.
Feng
, and
W.-H.
Xu
, “
Association of carotid artery geometries with middle cerebral artery atherosclerosis
,”
Atherosclerosis
352
,
27
34
(
2022
).
8.
Y.
Liu
,
G.
Jiang
,
X.
Wang
,
X.
An
, and
F.
Wang
, “
The relationship between geometry and hemodynamics of the stenotic carotid artery based on computational fluid dynamics
,”
Clin. Neurol. Neurosurg.
231
,
107860
(
2023
).
9.
X.
Liu
,
P.
Song
,
Q.
Gao
,
M.
Dai
,
J.
Rao
, and
J.
Wen
, “
Impact on hemodynamics in carotid arteries with carotid webs at different locations: A numerical study integrating thrombus growth model
,”
Comput. Methods Prog. Biomed.
243
,
107926
(
2024
).
10.
A. M.
Malek
,
S. L.
Alper
, and
S.
Izumo
, “
Hemodynamic shear stress and its role in atherosclerosis
,”
JAMA
282
,
2035
2042
(
1999
).
11.
H.
Sun
,
B.
Li
,
L.
Zhang
,
Y.
Zhang
,
J.
Liu
,
S.
Huang
,
X.
Xi
, and
Y.
Liu
, “
Numerical study of hemodynamic changes in the Circle of Willis after stenosis of the internal carotid artery
,”
Comput. Methods Prog. Biomed.
243
,
107881
(
2024
).
12.
M.
Albadawi
,
Y.
Abuouf
,
S.
Elsagheer
,
S.
Ookawara
, and
M.
Ahmed
, “
Predicting the onset of consequent stenotic regions in carotid arteries using computational fluid dynamics
,”
Phys. Fluids
33
,
123106
(
2021
).
13.
X.
Zhou
,
L.
Yin
,
L.
Xu
, and
F.
Liang
, “
Non-periodicity of blood flow and its influence on wall shear stress in the carotid artery bifurcation: An in vivo measurement-based computational study
,”
J. Biomech.
101
,
109617
(
2020
).
14.
M.
Nagargoje
and
R.
Gupta
, “
Effect of sinus size and position on hemodynamics during pulsatile flow in a carotid artery bifurcation
,”
Comput. Methods Programs Biomed.
192
,
105440
(
2020
).
15.
M. S.
Nagargoje
,
D. K.
Mishra
, and
R.
Gupta
, “
Pulsatile flow dynamics in symmetric and asymmetric bifurcating vessels
,”
Phys. Fluids
33
,
071904
(
2021
).
16.
J. J.
Wentzel
,
Y. S.
Chatzizisis
,
F. J. H.
Gijsen
,
G. D.
Giannoglou
,
C. L.
Feldman
, and
P. H.
Stone
, “
Endothelial shear stress in the evolution of coronary atherosclerotic plaque and vascular remodelling: Current understanding and remaining questions
,”
Cardiovasc. Res.
96
,
234
243
(
2012
).
17.
P.
Gallo
,
P. B.
Bijari
,
U.
Morbiducci
,
Y.
Qiao
,
Y. J.
Xie
,
M.
Etesami
,
D.
Habets
,
E. G.
Lakatta
,
B. A.
Wasserman
, and
D. A.
Steinman
, “
Segment-specific associations between local haemodynamic and imaging markers of early atherosclerosis at the carotid artery: An in vivo human study
,”
J. R. Soc. Interface
15
,
20180352
(
2018
).
18.
S.-W.
Lee
,
L.
Antiga
,
J. D.
Spence
, and
D. A.
Steinman
, “
Geometry of the carotid bifurcation predicts its exposure to disturbed flow
,”
Stroke
39
,
2341
2347
(
2008
).
19.
H.
Jung
,
T.
Kang
,
C.-H.
Lee
,
S.-Y.
Woo
,
S.-S.
Yang
,
D.
Mukherjee
,
D.-I.
Kim
, and
J.
Ryu
, “
Comparison of haemodynamics in carotid endarterectomy: Primary closure versus patch angioplasty
,”
Eng. Appl. Comput. Fluid Mech.
16
,
1601
1618
(
2022
).
20.
G.
De Nisco
,
A. M.
Kok
,
C.
Chiastra
,
D.
Gallo
,
A.
Hoogendoorn
,
F.
Migliavacca
,
J. J.
Wentzel
, and
U.
Morbiducci
, “
The atheroprotective nature of helical flow in coronary arteries
,”
Ann. Biomed. Eng.
47
,
425
438
(
2019
).
21.
N.
Hadi Johari
,
M.
Hamady
, and
X. Y.
Xu
, “
A computational study of the effect of stent design on local hemodynamic factors at the carotid artery bifurcation
,”
Artery Res.
26
,
161
(
2020
).
22.
H.
Sun
,
B.
Li
,
J.
Liu
,
X.
Xi
,
L.
Zhang
,
Y.
Zhang
,
G.
Li
,
H.
Guo
,
K.
Gu
,
T.
Wang
,
C.
Wen
, and
Y.
Liu
, “
Real-time model-based cerebral perfusion calculation for ischemic stroke
,”
Comput. Methods Prog. Biomed.
243
,
107916
(
2024
).
23.
D. M.
Martin
,
E. A.
Murphy
, and
F. J.
Boyle
, “
Computational fluid dynamics analysis of balloon-expandable coronary stents: Influence of stent and vessel deformation
,”
Med. Eng. Phys.
36
,
1047
1056
(
2014
).
24.
S.
Pirola
,
Z.
Cheng
,
O.
Jarral
,
D.
O'Regan
,
J.
Pepper
,
T.
Athanasiou
, and
X.
Xu
, “
On the choice of outlet boundary conditions for patient-specific analysis of aortic flow using computational fluid dynamics
,”
J. Biomech.
60
,
15
21
(
2017
).
25.
Y.
Mei
,
H.
Xu
,
W.
Ma
,
Z.
Li
,
R.
Yang
,
H.
Yuan
,
Y.
Peng
,
M.
Wu
,
Z.
Chen
,
W.
Guo
,
T.
Gao
,
J.
Xiong
, and
D.
Chen
, “
Retrograde branched extension limb assembling stent of pararenal abdominal aortic aneurysm: A longitudinal hemodynamic analysis for stent graft migration
,”
Numer. Methods Biomed. Eng.
36
,
e3394
(
2020
).
26.
Y.
Chen
,
B.
Xu
,
Y.
Cheng
,
K.
Luo
,
J.
Fan
, and
M.
Xiang
, “
Hemodynamic differences caused by left atrial appendage modeling contours
,”
Phys. Fluids
35
,
111904
(
2023
).
27.
A.
Martínez
,
M.
Hoeijmakers
,
L.
Geronzi
,
V.
Morgenthaler
,
J.
Tomasi
,
M.
Rochette
, and
M. E.
Biancolini
, “
Effect of turbulence and viscosity models on wall shear stress derived biomarkers for aorta simulations
,”
Comput. Biol. Med.
167
,
107603
(
2023
).
28.
A.
Bantwal
,
A.
Singh
,
A. R.
Menon
, and
N.
Kumar
, “
Pathogenesis of atherosclerosis and its influence on local hemodynamics: A comparative FSI study in healthy and mildly stenosed carotid arteries
,”
Int. J. Eng. Sci.
167
,
103525
(
2021
).
29.
U.
Morbiducci
,
R.
Ponzini
,
M.
Grigioni
, and
A.
Redaelli
, “
Helical flow as fluid dynamic signature for atherogenesis risk in aortocoronary bypass. A numeric study
,”
J. Biomech.
40
,
519
534
(
2007
).
30.
U.
Morbiducci
,
D.
Gallo
,
R.
Ponzini
,
D.
Massai
,
L.
Antiga
,
F. M.
Montevecchi
, and
A.
Redaelli
, “
Quantitative analysis of bulk flow in image-based hemodynamic models of the carotid bifurcation: The influence of outflow conditions as test case
,”
Ann. Biomed. Eng.
38
,
3688
3705
(
2010
).
31.
S.
Sengupta
,
M.
Hamady
, and
X.-Y.
Xu
, “
Haemodynamic analysis of branched endografts for complex aortic arch repair
,”
Bioengineering
9
,
45
(
2022
).
32.
R.
Shenoy
,
H. N.
Abhilash
,
A. A.
Basri
,
A. B. V.
Barboza
,
G.
Shenoy B
,
R.
Pai
, and
A.
Khader
, “
Study of bio-fluid dynamics in carotid artery system using numerical methods
,”
Malays. J. Sci. Adv. Technol.
2
,
16
21
(
2023
).
33.
A.
Raptis
,
P.
Tasso
,
K.
Batzalexis
,
D.
Gallo
,
M.
Xenos
,
U.
Morbiducci
, and
A.
Giannoukas
, “
Remodeling effects of carotid artery stenting versus endarterectomy with patch angioplasty in terms of morphology and hemodynamics
,”
Comput. Biol. Med.
140
,
105072
(
2022
).
34.
Y.
Ling
,
T.
Schenkel
,
J.
Tang
, and
H.
Liu
, “
Computational fluid dynamics investigation on aortic hemodynamics in double aortic arch before and after ligation surgery
,”
J. Biomech.
141
,
111231
(
2022
).
35.
P. M.
Khan
,
S. D.
Sharma
,
S.
Chakraborty
, and
S.
Roy
, “
Effect of heart rate on the hemodynamics in healthy and stenosed carotid arteries
,”
Phys. Fluids
35
,
061906
(
2023
).
36.
D.
Azar
,
W. M.
Torres
,
L. A.
Davis
,
T.
Shaw
,
J. F.
Eberth
,
V. B.
Kolachalama
,
S. M.
Lessner
, and
T.
Shazly
, “
Geometric determinants of local hemodynamics in severe carotid artery stenosis
,”
Comput. Biol. Med.
114
,
103436
(
2019
).
37.
T.
Karino
and
H. L.
Goldsmith
, “
Flow behaviour of blood cells and rigid spheres in an annular vortex
,”
Philos. Trans. R. Soc. London B
279
,
413
445
(
1997
).
38.
M.
Ameenuddin
and
M.
Anand
, “
A mixture theory model for blood combined with low-density lipoprotein transport to predict early atherosclerosis regions in idealized and patient-derived abdominal aorta
,”
J. Biomech. Eng.
142
,
101008
(
2020
).
39.
K. E.
Hoque
,
M.
Ferdows
,
S.
Sawall
,
E. E.
Tzirtzilakis
, and
M. A.
Xenos
, “
The impact of hemodynamic factors in a coronary main artery to detect the atherosclerotic severity: Single and multiple sequential stenosis cases
,”
Phys. Fluids
33
,
031903
(
2021
).
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