Influence of stenosis morphology on flow through severely stenotic vessels: implications for plaque rupture.

Flow patterns and flow-related stresses contribute to the characterization of health risks, particularly the risk of plaque rupture, posed by a particular atherosclerotic stenosis. Blood flow in the presence of significant plaque deposits is investigated, and the influence of factors such as stenosis morphology and surface irregularity is evaluated. Solutions for three-dimensional, unsteady flow in these stenotic vessels are obtained for an incompressible, Newtonian fluid. The equations of motion are solved numerically using a finite volume formulation. The resulting flow patterns and shear and normal stresses are interpreted with respect to diagnostic implications, including the possibility of plaque rupture. The inadequacy of "percent stenosis" to characterize the risks posed by a particular plaque is demonstrated. Surface irregularity, stenosis aspect ratio, and the shape of the pulsatile waveform all have considerable influence on the flow field and on the stresses on the plaque. A measure of surface irregularity or plaque symmetry, in particular, may complement percent stenosis in diagnosing the risk of plaque rupture.