Computational particle-hemodynamics analysis and geometric reconstruction after carotid endarterectomy.

Transient three-dimensional laminar incompressible dilute suspension flow in rigid in-plane carotid artery bifurcations has been solved with a user-enhanced finite-volume program. Instantaneous velocity vector and wall shear stress vector fields illustrate strong "disturbed flow" patterns. Implications of elevated surface contours of hemodynamic wall parameters, indicating such disturbed flows, and particle deposition sites are discussed and a relative comparison in terms of indicator functions between the endarterectomized carotid artery bifurcation and two design improvements is shown. Although the combined perioperative mortality and non-fatal stroke rate for carotid endarterectomy ranges only from 2% to 7%, the final geometric design recommendation presented merits consideration because it may significantly lower the chances of post-operative complications such as stroke, ischemic attack, or even death. The new carotid artery bifurcation design is based on the overall reduction of "disturbed flow" indicator functions, including the time-averaged wall shear stress angle deviation and a wall deposition parameter for critical blood particles, such as monocytes.