Numerical simulation of carotid hemodynamics in patients with rotary blood pump cardiac assist

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 subsequent plaque growth. To study these effects, a three-dimensional computer simulation of the carotid bifurcation at various levels of flow pulsatility was performed. The results showed that as expected pulsatile shear stress varied considerably, whereas local mean shear stress levels were nearly identical for all degrees of pulsatility. Particle residence time in the carotid bulb did only increase for less than 15%, with secondary washout patterns contributing to good washout also in nonpulsatile conditions. It is concluded that also under continuous pump support the local flow patterns in the carotids provide sufficient washout and fluid exchange to prevent excessive plaque growth.