Extended Eversion Carotid Endarterectomy: Computation of Hemodynamics
Tomislav Ištvanić1, Zvonimir Vrselja2, Hrvoje Brkić3
1Department of Vascular Surgery of Clinic for Surgery, University Hospital Osijek, Osijek, Croatia.
Annals of Vascular Surgery
|August 31, 2015
Summary
Extended-eversion carotid endarterectomy (exeCEA) shows improved hemodynamics compared to eversion carotid endarterectomy (eCEA). This novel surgical approach may enhance brain perfusion for stroke prevention.
Area of Science:
- Biomedical Engineering
- Cardiovascular Surgery
- Computational Fluid Dynamics
Background:
- Stroke prevention often requires surgery for significant internal carotid artery (ICA) stenosis.
- Eversion carotid endarterectomy (eCEA) is an alternative approach, but has disadvantages.
- Extended-eversion carotid endarterectomy (exeCEA) was developed to address these limitations.
Purpose of the Study:
- To investigate and compare hemodynamics after exeCEA and eCEA surgical approaches.
- To model restenosis progression at the incision line using computational fluid dynamics (CFD).
Main Methods:
- CFD models of exeCEA and eCEA were created, incorporating increasing groove sizes (1-2.5 mm) to simulate restenosis.
- Blood flow velocities, volume flow rates, and wall shear stress (WSS) were analyzed.
- Simulations were performed under input pressures of 120 and 150 mm Hg.
Main Results:
- exeCEA models exhibited a larger orifice toward the ICA and lower blood flow velocities.
- exeCEA models demonstrated higher volume flow rates in the ICA but lower rates in the external carotid artery.
- WSS values in the ICA were lower in exeCEA models, delaying the onset of the thrombotic range.
Conclusions:
- CFD analysis revealed superior hemodynamic properties for exeCEA compared to eCEA.
- The exeCEA approach shows potential for improved brain perfusion in stroke prevention strategies.
