On the Importance of Assumptions for Bulk Flow in Hemodynamic Models of the Carotid Bifurcation

It is widely accepted that the local hemodynamics in the arterial system affects the atherogenic process. In particular the hemodynamic environment at the carotid artery bifurcation has been widely studied due to its predilection for atherosclerosis. Much effort has been spent in the past on image-based CFD carotid bifurcation models to assess the sensitivity to several assumptions of wall shear stress (WSS)-based parameters as indicators of abnormal flow. This luminal-surface-oriented approach was historically driven by histological observations on samples of the vessel wall. The consequence for this was that the reduction of the complexity of 4D flow fields focused mainly on WSS. However, few studies have provided adequate insights into the influence of these assumptions in order to confidently model the 4D hemodynamics within the bifurcation. Only recently the interest in the role played by the bulk flow in the development of the arterial disease has grown dramatically. This is the consequence of the emerging awareness that arterial hemodynamics, being an intricate process that involves interaction, reconnection and continuous re-organization of structures, could play a primary role in the regulation of mass transfer, and of its athero-protective/susceptible effect. Earlier works [1] pointed out the existence of a relationship between helical/vortical flow patterns and transport processes that could affect blood-vessel wall interaction, and might cause alterations in the residence time of atherogenic particles involved in the initiation of inflammatory response. Recently we introduced robust quantitative descriptors of bulk flow that can “reduce” the inherent complexity associated with 4D flow fields in arteries [1]. Here we present a study on the impact of assumptions on blood rheology and outflow boundary conditions (BCs) on bulk flow features within healthy carotid bifurcations, by using 4D flow descriptors. The final goal is to provide adequate insights not only to complement and to integrate, but also to extend with a quantitative characterization of the bulk flow the description currently adopted to classify altered hemodynamics.