P u l s a t i l e F l o w T h r o u g h the C a r o t i d B i f u r c a t i o n

L. D. Jou and S. A. Berger Department of Mechanical Engineering University of California at Berkeley Berkeley, California 94720 Introduction

It has long been speculated that fluid dyaamlcs might play an important role in atherosclerotic diseases. Low and high shear stress, oscillatory shear stress, and the shear stress gradient [1-4] have all been proposed to relate fluid dynamics and atherosclerosis. Because of the geometry and importance of the carotid bifurcation, it has been a focus of research for more than a decade. In the carotid, the bifurcation results in very high shear stresses, while the widening of the carotid sinus leads to very low shear stresses. Both of these features are si~ificant in the search to identify the sites and mechanisms of atherosclerosis. It appears that geometrical factors and the pulsatility of the flow are both very important to the initiation of atherosclerosis and the growth of the plaque. H o w separation is an important aspect of flow in the carotid bifurcation. Plaque is often found in this low shear stress region. How separation also causes diagnostic problems in Magnetic Resonance Angiography (MRA) [5], which is a widely used modality to determine the degree of the stenosis. Therefore, an understanding of the extent of the separation region and its implication for the magnetization saturation in MRA is essential to accurate clinical diagnosis.
Method

In the present study, the pseudo-compressibility method, in which the continuity equation is written as

b ~-p + 13 V-u =0,

is used for steady flow [6] and for unsteady flow [7]. An implicit f'mite difference formulation was employed. A third-order flux-splitting procedure was used for the convection term, and a secondorder one for the viscous term [ 7]. After linearization, the Navier-Stokes equations are of the form:

which may be rewritten as I + 3- 1 Im +~=:-- / I (Dnl'm+l - D n+l'm) / \019/ 2 JAt = - ~nl,m _ Im (1.5Dn+l,m _ 2 D n + 0.5 Dn-l), J At

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where I is the transformation Jacobian, At the physical time step, A'~ the artificial time step, I tbe identity matrix, D -- [p u v w]T, R the residue, ~ the convection flux, and ffiiv the viscous flux. In the formula, n is the physical time and m is the iteration number of the pseudo-time. Therefore, it is second-order accurate both in space and in time. To increase the efficiency of the numerical scheme, the parameter 6, which is related to the pseudo-wave propagation speed, needs to be optimized. While a formula for optimum 13 has been established [8], numerical experiments showed that 1<~<500. The vessel wall is assumed to be rigid, and the fluid incompressible and Newtonian. Laminar flow is also assumed. At the wall, the no-slip condition is imposed, as well as zero normal pressure gradient. The velocity.profiles, which are functions of time, are specified at the entrance of the common carotid (CCA) and the exit of the external carotid (ECA), and the pressure at the exit of the internal carotid CICA). Point relaxation is used for the iteration with 1<6<100, and ~ increases with lulz. Several relaxation schemes have been evaluated. Our simulations indicated that the conjugate gradient with incomplete LU preconditioning was quite efficient for steady flow, but not for unsteady flow. In the simulations, the residues are reduced three orders of magnitude within 40 iterations for steady flow. Therefore, a simulation advances to the next time step whenever the maximum residue is less than 10-4 or after 40 iterations. The calculation for one cardiac period, consisting of 120 time steps, takes 50 hours on an IBM RISC 340 workstation. Systole takes up only 25 percent of the cardiac cycle, and the flow rate at the peak of systole is 2.5 times the mean flow rate. The Womersley number is 7.3 and the Reynolds number is 300.
Results The geometry of the carotid bifurcation varies from individual to individual. It can be charactedz~ by: the angle between the ICA and C C A , the angle between the E C A and CCA, the diameters of the CCA, ICA and E C A and the diameter of the carotidsinus. The flow depends on the Reynolds number, the flow-rateratio(the ratio of the flow ram in the ICA to thatin the C C A ) and the pulsatile wave form. The geometry used in this study (Fig. I) was obtained from averaging 67 anglograms [9]. The bifurcation magic between the ICA and E C A is 50". The diameter of the ICA and E C A am 0.7 and 0.6 of the diamcter of the CCA, respectively. The widening of the ICA is 1.06 of the diameter of the CCA. The code was validatedby comparing the simulation resultswith the steady and unsteady flows through a 90" curved duct [I0]. High wall shears can be found on the divider wall and near the bifurcation,and the flow separates from the main flow close to the non-divider wails. The maximum wall shear for pulsatile flow is 10 N / m 2 in the 3D simulation and 8.9 N / m 2 in the 2 D simulation;in contrast,in steady flow the m a x i m u m wall shear is 4.5 N / m 2 in the 31) simulation and 3.5 N / m 2 in the 21) simulation, all for a Reynolds number of 300 and flow-ram ratio0.6. Compared with 1.5 N / m 2 [lI] as the value above which the blood vessel dilatesand below which the vessel lumen decreases, our simulations indicate that the wall shear is below this level in most of the flow region except near the bifurcation.

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Several carotid bifurcations with different bifurcation angles were studied. Although their flow patterns vary slightly (Fig. 3), the distributions of the wall shear change dramatically (Fig. 2). For example, the wall shear decreases at the bifurcation-internal wall when the angle of the ICA decreases. This clearly demonstrates the effect of the centrifugal force. In pulsatile flow, the flow pattern and shear stress distribution in the carotid bifurcation are affected more by inertia than by geometry (Fig. 4-5). In addition, flow separation appears in both the ICA and ECA. Once the flow decelerates, the secondary flow becomes stronger immediately. Figure 6 shows the velocity contours and the secondary flow at the widening of the ICA.

Discussion
The carotid bifurcation generates very strong secondary flows in the ICA and ECA, and these secondary flows remain strong until they exit the carotid sinus. The secondary flow is weak within the separation region, which may cause saturation of magnetization in MRA [5]. The instantaneous streamlines are more complicated for pulsatile flow than for steady flow with the same flow rate and Reynolds number (Figs. 3,5). The flow always separates in the carotid sinus except for very low Reynolds numbers (<100); the extent of the separation is affected more by the flow-rate ratio than by the Reynolds number. Our simulations indicate that the separation region is not closed even for steady flow, and this greatly affects both the particle residence time in the carotid sinus and the saturation of magnetization. The separation region grows during deceleration and shrinks during acceleration. Several different pulse-wave forms have been studied. The shear stress in the separation region remains low throughout the pulse cycle despite changes in the flow rate. In addition, the mean wall shear stress is determined principally by the mean flow rather than by the pulsatility~

References
[1] C. G. Caro, J. M. Fitzgerald, R. C. Schroter:. Proc. Royal Soc. London, Ser. B, Vol. 177, 109 (1971) [2] D. L. Fry: Circ. Res. Vol. 24, 93 (1969) [3] D. N. Ku, D. P. Giddens: Atherosclerosis Vol. 3, 31 (1983) [4] M. Li, C. Kleinstreuer, G. A. Truskey: J. Biomech. Eng. Vol. 117, 350 (1995) [5] R. van Tyen, D. Saloner, L. D. Jou, S. A. Berger: Magn. Reson. Med. Vol. 31, 184 (1994) [6] A. J. Chorin: J. Comp. Phys. Vol. 2, 12 (1967) [7] S. E. Rogers, D. Kwak, C. Kids: A/AA J. Vol. 29, 603 (1991) [8] C. L. Merkle, Y. H. Choi: Int. J. Numer. Methods Eng. Vol. 25, 293 (1988) [9] B. K. Bharadvaj: J. Biomech. Eng. Vol. 15,349 (1982) [10] J. A. C. Humphrey, A. M. K. Taylor, J. H. Whitelaw: J. FluidMech. Vol. 83,509 (1979) [11] D. P. Giddens: Appl. Mech. Rev. Vol. 43, $98 (1990)

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Figure 1. The grid representation of the carotid bifurcation

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Figure 3. The streamlines in the carotid bifurcation for different bifurcation angles (ICA/ECA) (a) 10"/40", (b) 25*/25*, (c) 40"/10 at Re = 300 and Q~/Qc = 0.65.
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Figure 4. The wall shear in the ICA under physiological wave form

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Figure 5. The streamlines in the carotid bifurcation under the physiological wave form (a) t = 0.09"I", Co) t = 0.22T (end systole), (c) t = 0.45T, (d) t = 0.59T (diastole)

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Figure 6. The velocity contours and vector plot in the ICA Steady flow: (a) 10"/40", (b) 25"/25", (c) 40/10 Pulsatile flow: (d) t = 0.09T, (e) t = 0.22T, (f) t = 0.45T, (g) t = 0.59T