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Research ArticleExtracranial Vascular

Flow Patterns in Carotid Webs: A Patient-Based Computational Fluid Dynamics Study

K.C.J. Compagne, K. Dilba, E.J. Postema, A.C.G.M. van Es, B.J. Emmer, C.B.L.M. Majoie, W.H. van Zwam, D.W.J. Dippel, J.J. Wentzel, A. van der Lugt and F.J.H. Gijsen for the MR CLEAN investigators
American Journal of Neuroradiology April 2019, 40 (4) 703-708; DOI: https://doi.org/10.3174/ajnr.A6012
K.C.J. Compagne
aFrom the Departments of Radiology and Nuclear Medicine (K.C.J.C., K.D., A.C.G.M.v.E., A.v.d.L.)
bNeurology (K.C.J.C., D.W.J.D.)
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K. Dilba
aFrom the Departments of Radiology and Nuclear Medicine (K.C.J.C., K.D., A.C.G.M.v.E., A.v.d.L.)
cBiomedical Engineering (K.D., E.J.P., J.J.W., F.J.H.G.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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E.J. Postema
cBiomedical Engineering (K.D., E.J.P., J.J.W., F.J.H.G.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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A.C.G.M. van Es
aFrom the Departments of Radiology and Nuclear Medicine (K.C.J.C., K.D., A.C.G.M.v.E., A.v.d.L.)
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B.J. Emmer
dDepartment of Radiology (B.J.E., C.B.L.M.M.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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C.B.L.M. Majoie
dDepartment of Radiology (B.J.E., C.B.L.M.M.), Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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W.H. van Zwam
eDepartment of Radiology (W.H.v.Z.), Maastricht University Medical Center, Maastricht, the Netherlands
fCardiovascular Research Institute Maastricht (W.H.v.Z.), Maastricht, the Netherlands.
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D.W.J. Dippel
bNeurology (K.C.J.C., D.W.J.D.)
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J.J. Wentzel
cBiomedical Engineering (K.D., E.J.P., J.J.W., F.J.H.G.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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A. van der Lugt
aFrom the Departments of Radiology and Nuclear Medicine (K.C.J.C., K.D., A.C.G.M.v.E., A.v.d.L.)
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F.J.H. Gijsen
cBiomedical Engineering (K.D., E.J.P., J.J.W., F.J.H.G.), Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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    Fig 1.

    A case with a carotid web in the ipsilateral carotid bifurcation of a patient with ischemic stroke. Images of CTA (A1) and CFD simulations (A2, streamlines; A3, wall shear stress). Focused on the region distal from the carotid web, a large recirculation zone is observed with low time-averaged WSS values. At the minimal lumen area at the location of the web, a high TAWSS is observed. Streamlines were based on the time-averaged velocity field.

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    Fig 2.

    Boxplots showing the distribution of the total surface of the recirculation zone, TransWSS, OSI, and TAWSS for the carotid bifurcation with a web and the contralateral bifurcation. P values were obtained from a paired Wilcoxon signed rank test. A, Distribution of the total surface of the recirculation area, which was statistically significant (P = .02) larger in carotid bifurcations with a web compared with the contralateral carotid bifurcation (control group) within patients. B, Distribution of TransWSS in the recirculation zone, which was statistically significant (P = .02) larger in carotid bifurcations with a web compared with the contralateral carotid bifurcation (control group) within patients. C, Distribution of maximum OSI in the recirculation zone, which was statistically significant (P = .04) larger in carotid bifurcations with a web compared with the contralateral carotid bifurcation (control group) within patients. D, Distribution of maximum time-averaged wall shear stress (Pascal) at the level of the carotid bulb, which was statistically significant (P = .01) larger in carotid bifurcations with a web compared with the contralateral carotid bifurcation (control group) within patients.

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    Table 1:

    Baseline characteristics of included patients

    Pt.Sex, Age (yr)Carotid Web in Symptomatic BifurcationLocation Intracranial OcclusionPrevious StrokeSmokingDiabetesAtrial FibrillationMyocardial Infarction
    1F, 45YesM1 rightYesNoNoNoNo
    2M, 77YesM1 rightNoNoNoYesNo
    3F, 67YesM1 rightNoNoNoNoNo
    4F, 44YesICA-T rightNoNoNoNoNo
    5F, 66YesM2 rightNoNoNoNoNo
    6F, 45YesICA-T rightNoNoNoNoNo
    7F, 59YesM1 rightNoNoNoNoNo
    8F, 46YesM1 rightNoNoNoNoNo
    9F, 73NoM1 leftNoNoNoNoNo
    • Note:—Pt. indicates patient; ICA-T, ICA terminus.

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    Table 2:

    Results of hemodynamic parameters between the carotid web and the contralateral carotid bifurcation

    Carotid WebContralateral Carotid BifurcationP Valuea
    Recirculation zone
        Area (median) (IQR) (mm2)63.61 (50.60–99.38)43.0 (36.46–50.34).02
        Length (median) (IQR) (mm)6.90 (5.60–8.60)1.80 (1.40–2.10).01
        Mean TAWSS (median) (IQR) (Pa)0.27 (0.23–0.34)0.27 (0.22–0.28).30
        Maximum TransWSS (median) (IQR) (Pa)0.25 (0.20–0.31)0.21 (0.10–0.23).02
        Maximum OSI (median) (IQR)0.39 (0.36–0.43)0.30 (0.19–0.33).04
    At level of minimum lumen area
        Maximum TAWSS (median) (IQR) (Pa)0.58 (0.51–0.61)0.45 (0.34–0.47).01
    • ↵a P values were obtained from a paired Wilcoxon signed rank test.

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American Journal of Neuroradiology: 40 (4)
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K.C.J. Compagne, K. Dilba, E.J. Postema, A.C.G.M. van Es, B.J. Emmer, C.B.L.M. Majoie, W.H. van Zwam, D.W.J. Dippel, J.J. Wentzel, A. van der Lugt, F.J.H. Gijsen
Flow Patterns in Carotid Webs: A Patient-Based Computational Fluid Dynamics Study
American Journal of Neuroradiology Apr 2019, 40 (4) 703-708; DOI: 10.3174/ajnr.A6012

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Flow Patterns in Carotid Webs: A Patient-Based Computational Fluid Dynamics Study
K.C.J. Compagne, K. Dilba, E.J. Postema, A.C.G.M. van Es, B.J. Emmer, C.B.L.M. Majoie, W.H. van Zwam, D.W.J. Dippel, J.J. Wentzel, A. van der Lugt, F.J.H. Gijsen
American Journal of Neuroradiology Apr 2019, 40 (4) 703-708; DOI: 10.3174/ajnr.A6012
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