Background
Stroke prevention includes surgery for significant stenosis of internal carotid artery
(ICA). Consensus on a standard approach lacks and one alternative approach is eversion
carotid endarterectomy (eCEA). To overcome disadvantages of eCEA, we developed extended-eversion
carotid endarterectomy (exeCEA). Aiming to investigate hemodynamics after different
surgical approaches, we created computational fluid dynamics (CFD) models of exeCEA
and eCEA with included progressing lumen narrowing, representation of artery restenosis
at the incision line.
Methods
Blood flow velocities, volume flow rates, and wall shear stress (WSS) were established
in carotid arteries from models of eCEA and exeCEA with included increasing groove
(1, 1.5, 2, and 2.5 mm) at the “incision line”, under input pressure of 120 and 150 mm
Hg.
Results
For the corresponding restenosis grade, models of exeCEA had a larger orifice toward
ICA, lower blood flow velocities and higher volume flow rates in ICA, with lower volume
flow rates in external carotid artery. WSS values in ICA of exeCEA models were lower
than in eCEA models, later reaching the thrombotic range.
Conclusions
CFD showed better hemodynamic properties in exeCEA models, indicating presented approach
might be better at preserving brain perfusion.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Annals of Vascular SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Long-term survival and causes of death after stroke.Stroke. 2001; 32: 2131-2136
- Carotid endarterectomy by eversion technique: its safety and durability.Ann Surg. 1998; 228: 471
- A randomized study on eversion versus standard carotid endarterectomy: study design and preliminary results: the Everest Trial.J Vasc Surg. 1998; 27: 595-605
- Eversion versus conventional carotid endarterectomy: late results of a prospective multicenter randomized trial.J Vasc Surg. 2000; 31: 19-30
- Eversion vs conventional carotid endarterectomy: a systematic review.Eur J Vasc Endovasc Surg. 2002; 23: 195-201
- Restenosis after eversion vs patch closure carotid endarterectomy.J Vasc Surg. 2007; 46: 41-48
- Carotid endarterectomy. [UpToDate - Wolters Kluwer Health].June 2014 (Available at:) (Accessed June 30, 2014)
- Vessel wall and flow characteristics after carotid endarterectomy: eversion endarterectomy compared with Dacron patch plasty.Eur J Vasc Endovasc Surg. 1997; 13: 583-591
- Characteristic sonographic findings of early restenosis after carotid endarterectomy.Ultrasound Med. 2008; 27: 1345-1352
- Hemodynamic shear stress and its role in atherosclerosis.JAMA. 1999; 282: 2035-2042
- Closure technique after carotid endarterectomy influences local hemodynamics.J Vasc Surg. 2014; 60: 418-427
- 3D Slicer as an image computing platform for the Quantitative Imaging Network.Magn Reson Imaging. 2012; 30: 1323-1341
- Choice of in vivo versus idealized velocity boundary conditions influences physiologically relevant flow patterns in a subject-specific simulation of flow in the human carotid bifurcation.J Biomech Eng. 2009; 131: 021013
- Outflow conditions for image-based hemodynamic models of the carotid bifurcation: implications for indicators of abnormal flow.J Biomech Eng. 2010; 132: 091005
- Outflow boundary conditions for arterial networks with multiple outlets.Ann Biomed Eng. 2008; 36: 1496-1514
- NIH Image to ImageJ: 25 years of image analysis.Nat Methods. 2012; 9: 671-675
- Analysis of complex flow and the relationship between blood pressure, wall shear stress, and intima-media thickness in the human carotid artery.Am J Physiol Heart Circ Physiol. 2007; 293: H1031-H1037
- A mathematical evaluation of hemodynamic parameters after carotid eversion and conventional patch angioplasty.Am J Physiol Heart Circ Physiol. 2013; 305: H716-H724
- Carotid endarterectomy.Br J Anaesth. 2007; 99: 119-131
- When is carotid angioplasty and stenting the cost-effective alternative for revascularization of symptomatic carotid stenosis? A Canadian Health System perspective.AJNR Am J Neuroradiol. 2014; 35: 327-332
- Carotid endarterectomy: a review.Can J Neurol Sci. 2004; 31: 22-36
- Experience of 352 carotid endarterectomy cases operated on without any shunt and a technical modification: thirty-day results.Turkiye Klinikleri J Med Sci. 2013; 33: 1216-1223
- Modified eversion carotid endarterectomy.Ann Vasc Surg. 2013; 27: 178-185
- Hemodynamic effects of primary closure versus patch angioplasty of the carotid artery.Ann Vasc Surg. 1992; 6: 443-449
- Some atherosclerosis may be a consequence of the normal adaptive vascular response to shear.Atherosclerosis. 1990; 82: 193-196
- Comparison of blood flow velocity quantification by 4D flow MR imaging with ultrasound at the carotid bifurcation.AJNR Am J Neuroradiol. 2013; 34: 1407-1413
- Severe bilateral carotid stenosis: the impact of ipsilateral stenting on Doppler-defined contralateral stenosis.J Am Coll Cardiol. 2004; 43: 1358-1362
- Changes in internal carotid blood flow after CEA evaluated by transit-time flowmeter.Eur J Vasc Endovasc Surg. 2006; 31: 14-17
- Fluid shear stress and the vascular endothelium: for better and for worse.Prog Biophys Mol Biol. 2003; 81: 177-199
- Flow-mediated endothelial mechanotransduction.Physiol Rev. 1995; 75: 519-560
- Blood flow and coherent vortices in the normal and aneurysmatic aortas: a fluid dynamical approach to intra-luminal thrombus formation.J R Soc Interface. 2011; 8: 1449-1461
- Shear-induced platelet activation and platelet microparticle formation at blood flow conditions as in arteries with a severe stenosis.Arterioscler Thromb Vasc Biol. 1997; 17: 646-653
- Reduced effect of aspirin on thrombus formation at high shear and disturbed laminar blood flow.Thromb Haemost. 1996; 75: 827-832
- 1993 Whitaker Lecture: biorheology in thrombosis research.Ann Biomed Eng. 1994; 22: 445-455
- Fluid mechanics of arterial stenoses.J Biomech Eng. 1979; 101: 157-175
- Noninvasively and invasively measured pulsatile haemodynamics with graded arterial stenosis.Cardiovasc Res. 1979; 13: 45-57
- What happens to the external carotid artery following carotid endarterectomy?.BMC Surg. 2008; 8: 20
Article info
Publication history
Published online: August 26, 2015
Accepted:
May 26,
2015
Received:
February 13,
2015
Footnotes
Disclosure: The authors report no proprietary or commercial interest in any product mentioned or concept discussed in this article.
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
