Physiological significance of helical flow in the arterial system and its potential clinical applications

Helical flow in the human aorta is possibly a typical example of 'form follows function' in the vascular system. The helical blood flow may provide guaranties for the inner surface of the ascending aortic wall to get smooth and even washing by the blood so that atherosclerotic plaques can hardly form in the area of the ascending aorta. It has been documented that the phenomenon of helical flow of blood is not just localized in the ascending aorta, it also exists in several large arteries and veins as well. Preliminary studies demonstrated the widely existing helical flow might play positive physiological roles in facilitating blood flow transport, suppressing disturbed blood flow, preventing the accumulation of atherogenic low density lipoproteins on the luminal surfaces of arteries, enhancing oxygen transport from the blood to the arterial wall and reducing the adhesion of blood cells on the arterial surface. These roles of helical blood flow may lessen the burden of arteries and protect the arteries from the pathology of atherosclerosis, thrombosis, and intimal hyperplasia. The great development of time-resolved three-dimensional phase contrast MRI (flow-sensitive 4D-MRI) and the advent of dimensionless indices such as helical flow index proposed to characterize helical flow make clinic quantification of the helical flow in the human large arteries possible. Moreover, researchers probed into the possibility to apply the mechanism of helical flow to the design of vascular interventions to reduce thrombus formation and intimal hyperplasia caused by abnormal flow conditions.