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Related Experiment Video

Updated: Feb 16, 2026

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis
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Computational fluid dynamic comparison between patch-based and primary closure techniques after carotid

Maurizio Domanin1, Daniele Bissacco2, Davide Le Van3

  • 1Department of Clinical Sciences and Community Health, Università di Milano, Milan, Italy; Unità Operativa di Chirurgia Vascolare, Fondazione I.R.C.C.S. Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.

Journal of Vascular Surgery
|December 17, 2017
PubMed
Summary

Computational fluid dynamics analysis revealed that patch graft (PG) closure after carotid endarterectomy (CEA) leads to significantly higher disturbed blood flow conditions, indicated by oscillatory shear index (OSI) and relative residence time (RRT), compared to primary closure (PC). These findings suggest that elective use of patch grafts may increase the risk of restenosis.

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Area of Science:

  • Biomedical Engineering
  • Cardiovascular Surgery
  • Medical Imaging

Background:

  • Carotid endarterectomy (CEA) is a surgical procedure to remove plaque from carotid arteries.
  • Restenosis, or re-narrowing of the artery, is a potential complication after CEA.
  • The choice of closure technique, patch graft (PG) or primary closure (PC), may influence postoperative hemodynamics and restenosis risk.

Purpose of the Study:

  • To comparatively analyze blood flow conditions after CEA using computational fluid dynamics (CFD).
  • To evaluate hemodynamic differences between patch graft (PG) and primary closure (PC) techniques in real carotid geometries.
  • To identify disturbed flow patterns potentially linked to restenosis development.

Main Methods:

  • Reconstruction of eight 3D carotid geometries from postoperative magnetic resonance angiography (MRA) in seven patients.
  • Performance of CFD analysis to assess hemodynamic parameters: oscillatory shear index (OSI) and relative residence time (RRT).
  • Creation of virtual scenarios to compare PG and PC closure techniques within the same patient geometries.

Main Results:

  • Patch graft (PG) closure demonstrated significantly higher mean averaged-in-space OSI and percentage of area (%A) with OSI >0.2 compared to virtual primary closure (PC) (P < .01).
  • Similarly, PG cases showed higher mean averaged-in-space RRT and %A RRT >4.0 1/Pa than virtual PC cases (P < .05).
  • Disturbed flow indicators (OSI and RRT) were generally elevated in PG configurations, particularly in specific anatomical regions.

Conclusions:

  • Patch graft (PG) closure after CEA is associated with increased disturbed flow conditions compared to primary closure (PC).
  • Elevated OSI and RRT values in PG cases suggest a higher potential for hemodynamic stress and restenosis development.
  • Consideration of elective use of primary closure (PC) may be warranted to mitigate disturbed flows post-CEA.