Effect of continuous arterial blood flow in patients with rotary cardiac assist device on the washout of a stenosis wake in the carotid bifurcation: a computer simulation study.

In recipients of rotary blood pumps for cardiac assist, the pulsatility of arterial flow is considerably diminished. This influences the shear stress patterns and streamlines in the arterial bed, with potential influence on washout and plaque growth. These effects may be aggravated in the recirculation area of stenoses, and therefore, exclude patients with atherosclerosis from the therapy with these devices. A numerical study was performed for the human carotid artery bifurcation with the assumption of a massive stenosis (75% reduction of cross-section area) in the carotid bulb. Four different flow time patterns (no support to full pump support) were applied. Flow patterns and particle residence time within the recirculation region were calculated, once within the relevant volume behind the stenosis and and once within a small region directly at the posterior heel of the stenosis. The flow patterns showed a considerable radial vorticity behind the stenosis. Mean particle residence time in the whole recirculation region was 15% less for high pump support (nearly continuous flow) compared to the natural flow pattern (0.19s compared to 0.22s), and nearly identical for the small heel region (0.28 to 0.27s). The flow simulation demonstrates, that even in the case of a pre-existing stenosis, the local effects of continuous flow on particle residence times are rather minimal (as was shown previously for intact arterial geometries). Therefore, from the point of macroscopic flow field analysis, continuous flow should not enhance the thromboembolic risk in ventricular assist device recipients.