DIAGNOSTIC AND THERAPEUTIC TREATMENTS OF PLAQUES IN THE CAROTID BIFURCATION — STUDIES IN MODELS WITH STENTS AND FILTERS

Abstract

Fluid dynamics, especially forces and velocity distribution, influence the development of plaques. Flow parameters: pulsatility, the non-Newtonian flow behavior of blood and wall elasticity are considered. Flow visualization techniques (dyes and birefringent solution with a photo-elasticity apparatus) and LDA measurements demonstrate the importance of the flow. Accurate in vivo velocity measurements are necessary to calculate shear stresses. Different bifurcation angles and flow rate ratios were tested in true to life artery models. The most important fluid dynamic factors at bifurcations are the flow rate ratio and the geometry which create flow separation regions which are responsible for platelet aggregation and intima damage. It is necessary to measure all three velocity components to calculate the velocity vector. The highest shear stresses in a healthy carotid artery are 16 Pa and are found just at the apex. In artery models with 90% stenosis, shear stresses up to 250 Pa were found. Distally, vortices were created where particles remained over several pulse cycles. Measurements show that stents must be selected carefully and placed precisely. Filters must be closed during the systolic phase before removal, so that no trapped particles can escape.