颈动脉窦内压的变化速率对反射性降压效应的影响

在成年狗身上制备右侧孤离颈动脉窦,借助灌流装置用饱和氧的任氏液对其进行灌流。灌流压为搏动性的。通过改变每搏泵出量、灌流管道的阻力和弹性来调节灌流压及其变化速率。用多导生理记录仪同步记录股动脉血压、窦内灌流压及其变化速率。本文主要观察窦内压的变化速率对降压反射的影响。在8只狗身上共进行了93次实验。结果表明,在窦内压相同的情况下,灌流压的上升速率愈快,降压效应愈明显,而其下降速率则无显著作用。已有资料证明搏动性窦内压所引起的降压效应较非搏动性压力更为明显。由此可见,狗的颈动脉窦压力感受器不仅对搏动性压力而且对其上升的变化速率也很敏感。     

Mechanical remodeling of small-intestine submucosa small-diameter vascular grafts--a preliminary report

Small-intestine submucosa (SIS) is cell-free, 100-mu-thick collagen derived from the small intestine. It has been used as a vascular graft and has the highly desirable ability to be remodeled to become histologically indistinguishable from native adjacent artery. To date there has been limited reporting of its preimplantation and explant mechanical properties as a vascular graft. In this study, compliance, elastic modulus, and burst pressure were measured on preimplant-tested 5- and 8-mm SIS grafts and two 60-day remodeled grafts. Seven prefabricated grafts were implanted in the carotid (n = 7) in dogs, which were sacrificed after 55-63 days. The animals (n = 4) weighed from 22 to 27 kg. One dog received a unilateral carotid graft, and 3 dogs received bilateral carotid grafts. The fabrication technique employed hand-suturing with either nonresorbable or resorbable sutures. None of the grafts had a patency failure. Angiograms taken at 1 month and just before explantation showed uniform flow and no dilation. At the time of explantation, all carotid grafts were found to be encased in fibrous tissue. The grafts made with nonresorbable sutures showed thicker tissue growth at the suture line compared with those made with the resorbable sutures. Along the suture line, the grafts made with resorbable sutures exhibited a more natural color than those sutured with nonresorbable sutures. When the explanted carotid grafts were slit open, the lumen was white, shiny, and glistening. The grafts sutured with nonresorbable sutures exhibited small areas of fibrin and red blood cells when the suture was within the lumen. The resorbable-sutured grafts did not exhibit this response. The mean compliance (percent diameter increase for a pressure rise from 80 to 120 mm Hg) was on average 4.6% (range, 2.9%-8.6%) for the 5-mm preimplant-tested grafts. For the 8-mm preimplant-tested grafts, the increase in diameter for the same pressure rise was 8.7%, on average (range, 7.2% to 9.5%). For comparison, the small-diameter SIS graft at the time of implantation was about one half as compliant as the adjacent dog carotid artery, about 4 times more compliant than a typical vein graft, and more than 10 times more compliant than synthetic vascular grafts. The compliance measured on two 60-day carotid grafts was 10.5% and 7.2%, respectively. This is midway between the original compliance value and the compliance of a typical canine carotid artery (14%), indicating that mechanical remodeling occurred. The modulus of elasticity (E) increased exponentially with increasing pressure according to E = E0e alpha P, where E0 is the zero-pressure modulus and alpha is the exponent that describes the rate of increase in E with pressure; the unit of measure for variables E, E0, and P is g/cm2. The mean value for E0 was 4106 gm/cm2 (range, 1348-5601). The mean value for alpha was 0.0059 (range, 0.0028-0.0125). At 100 mm Hg, the mean value for E was 8.03 x 10(6) dynes/cm2 (range, 4.95-15.7 x 10(6)). For a 60-day SIS graft implant, the elastic modulus at 100 mm Hg decreased from a high value at implant time to twice that of a typical native canine carotid artery. The mean burst pressure for 5.5-mm grafts was 3517 mm Hg (range, 2069-4654). The burst pressure of the remodeled carotid grafts averaged 5660 mm Hg. The burst pressure for a typical carotid artery is about 5000 mm Hg. The results of this preliminary study complement those of previous SIS-vascular-graft studies and add a new factor, namely that the mechanical properties of the remodeled graft approach those of the vessel it replaces.     

Unloading arterial baroreceptors causes neurogenic hypertension

We developed a new model to examine the role of arterial baroreceptors in the long-term control of mean arterial pressure (MAP) in dogs. Baroreceptors in the aortic arch and one carotid sinus were denervated, and catheters were implanted in the descending aorta and common carotid arteries. MAP and carotid sinus pressure (CSP) averaged 104 +/- 2 and 102 +/- 2 mmHg (means +/- 1 SE), respectively, during a 5-day control period. Baroreceptor unloading was induced by ligation of the common carotid artery proximal to the innervated sinus (n = 6 dogs). MAP and CSP averaged 127 +/- 7 and 100 +/- 3 mmHg, respectively, during the 7-day period of baroreceptor unloading. MAP was significantly elevated (P < 0.01) compared to control, but CSP was unchanged. Heart rate and plasma renin activity increased significantly in response to baroreceptor unloading. Removal of the ligature to restore normal flow through the carotid resulted in normalization of all variables. Ligation of the carotid below a denervated sinus (n = 4) caused a significant decrease in CSP but no systemic hypertension. These results indicate that chronic unloading of carotid baroreceptors can produce neurogenic hypertension and provide strong evidence that arterial baroreceptors are involved in the long-term control of blood pressure.     

Reflex mechanisms for changes in renal nerve activity during positive end-expiratory pressure

This study was designed to investigate the interaction between carotid sinus baroreceptors and cardiopulmonary receptors in the reflex control of renal nerve activity (RNA) during positive end-expiratory pressure (PEEP) in anesthetized dogs. PEEP at two different levels (10 and 20 cmH2O) was applied to the following groups: animals with neuraxis intact (I group, n = 12); vagal and aortic nerve denervated animals with carotid sinus nerves intact (V group, n = 6); carotid sinus denervated animals with vagal and aortic nerves intact (SD group, n = 6); and carotid sinus denervated animals also having severed vagal and aortic nerves (SAV group, n = 12). Mean blood pressure (MBP), central venous pressure, and mean airway pressure were also simultaneously measured. In the I group, no significant alterations in RNA occurred during PEEP at both levels, even when MBP fell significantly. Although the drop in MBP in the SD group was similar to that in the I group, RNA decreased significantly 10 s after intervention at both PEEP levels, followed by a recovery of RNA toward the control level. In contrast, a significant increase in RNA, which continued until the end of PEEP, appeared in the V group immediately after each intervention. In the SAV group, RNA responses to PEEP, which were observed in the other groups, were abolished. These results provide evidence that during PEEP, renal nerve activity is modified by an interaction between carotid sinus baroreceptors and cardiopulmonary receptors; excitatory effects occur via carotid sinus nerves and inhibitory effects occur via vagal afferents.     

The influence of carotid sinus pressure on plasma atrial natriuretic peptide in anaesthetized rabbits

The effect of changes in carotid sinus perfusion pressure on plasma immunoreactive atrial natriuretic peptide (IR-ANP) was examined in anaesthetized rabbits, and the role of arterial pressure in mediating the changes in IR-ANP was assessed. Plasma IR-ANP was significantly greater (101.7 +/- 24.3 pg ml-1) when carotid sinus pressure was 60 mmHg than when it was 160 mmHg (27.1 +/- 8.6 pg ml-1). Mean arterial pressure (MAP) was significantly greater when carotid sinus pressure was controlled at 60 mmHg compared to when it was 160 mmHg, but right atrial pressure (RAP) was not significantly different at the two carotid sinus pressures. The administration of hexamethonium attenuated the changes in MAP and heart rate (HR) which occurred in response to alterations in carotid sinus pressure, and abolished the change in plasma IR-ANP. The results suggest that an inverse relationship exists between carotid sinus pressure and plasma IR-ANP, and that the release of ANP in response to a reduction of carotid sinus pressure is mediated by the associated haemodynamic changes.     

Baroreceptor control of pressure-flow relationships during hypoxemia

In the absence of peripheral chemoreceptors, the effects of graded hypoxemia on the carotid sinus control of central and regional hemodynamics were studied in anesthetized mongrel dogs. Baroreceptor stimulation was effected by carotid sinus isolation and perfusion under controlled pressure. Blood flows were measured in the aorta and the celiac, mesenteric, left renal, and right iliac arteries. Carotid sinus reflex set-point pressures were well maintained until hypoxemia was severe. Carotid sinus reflex set-point gain was maximal during mild hypoxemia. Reflex operating point regional flows were unaffected by hypoxemia. A factorial analysis of overall reflex increases in mean aortic pressure, flow, and power during reduced baroreceptor stimulation showed potentiation by increasing hypoxemia. Corresponding effects of baroreceptor stimulation and hypoxemia on aortic resistance and heart rate were additive. Celiac, renal, and iliac blood flows increased during both hypoxemia and reduced baroreceptor stimulation. Only in the celiac bed were blood flow changes independent of concomitant changes in cardiac output. Thus, at maximum sympathetic stimulation (low carotid sinus pressure) during hypoxemia, the cardiovascular system maintained both central and regional blood flows at high systemic blood pressures independent of the peripheral chemoreceptors.     

Baroreflex modulation of ultradian oscillations of blood pressure and heart rate in unanesthetized dogs

Telemetered, free-running dogs were studied to determine the role of cardiovascular control systems in modulation of ultradian oscillations of arterial pressure (MAP) and heart rate (HR). Data, aquired (2 Hz) by a stable telemetry system, was stored on a digital computer and analyzed for its harmonic content by a Fast Fourier Transform (FFT) algorithm. Both AP and HR consistently demonstrated rhythms having a period of from 0.6 to 1.0 h. Modulation of these rhythms by arterial pressure control systems was assessed in dogs studied before and carotid sinus baroreceptor denervation, before and after denervation of the aortic arch baroreceptors and before and after a combination of both these procedures. The data indicate the power spectral density (PSD) of MAP, but not HR, is increased (p less than 0.05) after denervation of the carotid sinuses alone, while the primary frequency of the oscillations was unchanged. On the other hand, denervation of the aortic arch baroreceptors alone was without effect on either the frequency or PSD of these oscillations. A combination of both carotid sinus and aortic arch denervation resulted in an increased (p less than 0.05) PSD of MAP oscillations but not in their frequency. These data indicate that the carotid sinuses modulate rhythmic behavior of MAP by buffering the magnitude, but not frequency, of the oscillations. Moreover, since oscillations were present in dogs after denervation of both the carotid sinus and aortic arch baroreceptors, these ultradian oscillations are not a result of a non-linear negative feedback mechanisms arising from these pressure sensitive regions.     

Left ventricular reflex control of venous return and systemic vascular capacitance in dogs

The reflex effects of left ventricular distension on venous return, vascular capacitance, vascular resistance, and sympathetic efferent nerve activity were examined in dogs anesthetized with sodium pentobarbital. In addition, the interaction of left ventricular distension and the carotid sinus baroreflex was examined. Vascular capacitance was assessed by measuring changes in systemic blood volume, using extracorporeal circulation with constant cardiac output and constant central venous pressure. Left ventricular distension produced by balloon inflation caused a transient biphasic change in venous return; an initial small increase was followed by a late relatively large decrease. Left ventricular distension increased systemic blood volume by 3.8 +/- 0.6 mL/kg and decreased systemic blood pressure by 27 +/- 2 mmHg (1 mmHg = 133.3 Pa) at an isolated carotid sinus pressure of 50 mmHg. These changes were accompanied by a simultaneous decrease in sympathetic efferent nerve activity. When the carotid sinus pressure was increased to 125 and 200 mmHg, these responses were attenuated. It is suggested that left ventricular mechanoreceptors and carotid baroreceptors contribute importantly to the control of venous return and vascular capacitance.     

Influence of substance P on carotid sinus nerve baro- and chemoreceptor activity in rabbits.

Substance P (SP) is abundant in the carotid sinus nerve (CSN) and has been implicated in baro- and chemoreceptor reflexes. We examined the effect of SP on blood pressure, heart rate, phrenic nerve activity, hindlimb perfusion pressure, and cardiac contractile strength in urethane-anesthetized rabbits with bilaterally cut cervical sympathetic, vagus, and aortic depressor nerves. Retrograde simultaneous injection of SP (0.5-2.7 micrograms/kg in 0.2-0.3 ml saline) into both carotid sinus areas via the internal carotid arteries decreased blood pressure (by 56%), heart rate (by 13%), cardiac contractility (by 25%) and phrenic nerve activity (by 77%). The effect on hindlimb perfusion pressure was variable. There was both a reflex effect and direct hindlimb vasodilation. In another group of rabbits, the carotid sinus areas were vascularly isolated and perfused with SP (0.19 micrograms/min dissolved in Locke's solution) or Locke's solution alone for 5 min. While carotid sinus perfusion pressure was maintained in the range of 80-120 mmHg, mean arterial blood pressure, heart rate, and unit activity from the CSN were recorded. SP increased the activity of 11 of 18 baroreceptor fibers and inhibited all of 20 chemoreceptor fibers. SP decreased mean arterial blood pressure and heart rate, but the changes were less than those obtained with injection of SP into nonisolated carotid sinus arteries because systemic effects of SP, which in some cases counteracted the reflex effects, were eliminated.     

Observations on the structure and innervation of the carotid sinus complex in the African porcupine (Hystrix cristata)

The carotid arterial system of the porcupine Hysitrix cristota has been studied using light and electron microscopy. Emphasis has been placed on describing the structure and innervation of the carotid sinus area located at the origin of the internal carotid artery. The sinus wall has a largely elastic structure and a reduced smooth muscle content. A functional relationship is proposed between the elastic structure of the sinus wall and baroreceptor mechanisms.     

The inhibition of efferent sympathetic activity by means of pressure stimulation of the carotid sinus pressoreceptors]

The influence of pressure stimulation of a barorecptor upon the activity of the sympathetic nerve branch terminating in the wall of the contralateral carotid bifurcation was studied on narcotized dogs. The potential activity of this branch is of efferent nature. On the average, 570 msec after the pressure load applied to the opposite carotid sinus preparation, a silent period occurred. The duration of this silent period and the activity of the sympathetic nerve branch depend on the internal pressure of the preparation. The influence of different structures (central and peripheral) on latency, total and partial inhibition of the sympathetic activity are discussed.     

Relative influence of carotid baroreceptors and muscle receptors in the control of renal and hindlimb circulations.

In vagotomized dogs, a comparison was made of the relative ability of the carotid baroreceptors and of the receptors in skeletal muscles to cause constriction of the renal and hindlimb resistance vessels. With kidney and hindlimb perfused at constant pressure a decrease in pressure in the carotid sinuses from 250 to 40-45 mm Hg (1 mm Hg = 133 N/m2) caused the respective blood flows to increase by 19 +/- 6% and 80 +/- 4% (mean +/- SE), and stimulating muscle receptors with capsaicin caused a further decrease of 49 +/- 9% and 4 +/- 2%, respectively. With perfusion at constant flow, the baroreflex caused an increase of 34 +/- 4 mm Hg in the renal perfusion pressure and of 99 +/- 10 mm Hg in the hindlimb; capsaicin caused further increases of 203 +/- 17 and 35 +/- 9 mm Hg; respectively. These responses were abolished by sympathectomy. Capsaicin injection increased mean renal sympathetic nerve activity by 111 +/- 16% over the maximal impulse frequency recorded when the carotid sinus pressure was 40-45 mm Hg. Thus, withdrawal of the restraint exerted by the carotid baroreceptors on the pool of central neurons controlling the vascular beds of the hindlimb and kidney leads to near maximal constriction of the resistance vessels in the former bu not the latter; with strong activation of muscle receptors, near maximal constriction occurs in both beds.     

Baroreceptor influence on a spinal cardiovascular reflex

A stretch of the walls of the thoracic aorta, performed in vagotomized cats without obstructing aortic flow, induces increases in heart rate, myocardial contractility, and arterial pressure. These reflex responses are still present after high spinal section. Cats under chloralose-urethane anesthesia were vagotomized and one carotid sinus was isolated and perfused with arterial blood at constant flow. The contralateral carotid sinus nerve and both aortic nerves were sectioned. A stretch of the walls of the thoracic aorta between the 7th and 10th intercostal arteries induced a reflex increase in mean arterial pressure 29 +/- 2 mmHg (mean +/- SE). Stepwise increases of carotid sinus pressure (CSP) or electrical stimulation of the carotid sinus nerve induced stepwise decreases of this reflex response. At maximal baroreceptor stimulation (CSP 212 +/- 9 mmHg) the reflex response to aortic stretch was reduced by 42%. These experiments show that this spinal cardiovascular reflex is at least partially under the inhibitory control of the baroreceptor input.     

Ca^2＋参链霉素对大鼠颈动脉窦压力感受器反射影响中的作用

在２３只隔离灌流颈动脉窦区的麻醉大鼠上,观察了链霉素（ｓｔｒｅｐｔｏｍｙｃｉｎ,ＳＭ）对动脉压力感受器反射影响的离子机制。结果：（１）用ＳＭ（２００μｍｏｌ／Ｌ）隔离灌流大鼠颈动脉窦区时,压力感受器机能曲线向右上方移位,曲线最大斜率及反射性血压下降幅度均减小（Ｐ〈０．０１）,提示ＳＭ对压力感受器反射的抑制作用;（２）预先灌流高Ｃａ＾２＋溶液（４ｍｍｏｌ／Ｌ）后,可部分消除ＳＭ（２００μｍｏｌ／Ｌ）     

Head Turning-Induced Hypotension in Elderly People

Carotid sinus hypersensitivity has a high prevalence in the elderly and is a possible cause of falls. In carotid sinus hypersensitivity, external triggers cause sudden reductions in blood pressure, leading to dizziness or syncope, resulting in falls. Turning of the head is considered an important example of such an external trigger in everyday life, wherein rotation of the neck is thought to manipulate the hypersensitive carotid sinus. However, direct evidence for this is lacking. The aim of this study was to investigate the effects of head turning in elderly with carotid sinus hypersensitivity. We performed a prospective, observational study in 105 elderly patients who visited a geriatric falls clinic in a university teaching hospital and in 25 community dwelling healthy elderly subjects. Continuous measurements of blood pressure and heart rate (Finapres) were performed before, during, and after head turning. Head turning-induced hypotension was defined as a drop in systolic blood pressure of at least 20 mmHg during head turning. Carotid sinus hypersensitivity was examined with carotid sinus massage. We also tested for two other common geriatric hypotensive syndromes, orthostatic hypotension and post prandial hypotension, using active standing and a meal test. All three hypotensive syndromes were defined using consensus definitions. Head turning resulted in hypotension in 39% of patients (mean systolic blood pressure drop 36 mm Hg) and in 44% of the healthy elderly, irrespective of the direction of the head movement. Carotid sinus hypersensitivity was associated with head-turning induced hypotension (OR= 3.5, 95% CI= 1.48 to 8.35). We conclude that head turning is indeed an important cause of sudden drops in blood pressure in elderly with carotid sinus hypersensitivity.     

Magnesium supplementation and deoxycorticosterone acetate--salt hypertension: effect on arterial mechanical properties and on activity of endothelin-1

The aim of this study was to show whether the decrease in blood pressure induced by Mg supplementation in deoxycorticosterone acetate - salt (DOCA-salt) hypertensive rats is associated with mechanical modifications of blood vessels and (or) changes in tissular production and (or) vasoconstrictor activity to endothelin-1. DOCA-salt treatment increased blood pressure, media thickness, cross-sectional area, and lumen diameter of carotid arteries. Distensibility and incremental elastic modulus versus stress were not altered in carotid arteries, suggesting that the DOCA-salt vessel wall adapts structurally to preserve its blood pressure buffering capacity. Magnesium supplementation attenuated DOCA-salt hypertension. In comparison with normotensive rats, systolic, mean, and pulse pressures were higher whereas diastolic pressure was not different in Mg-supplemented DOCA-salt rats. Magnesium supplementation did not significantly modify the elastic parameters of carotid arteries. In resistance mesenteric arteries, DOCA-salt hypertension induces an inward hypertrophic remodeling. Magnesium supplementation attenuates wall hypertrophy and increases lumen diameter to the normotensive diameter, suggesting a decrease in peripheral resistance. Magnesium supplementation normalizes the altered vasoconstrictor activity of endothelin-1 in mesenteric arteries and attenuates endothelin-1 overproduction in kidney, left ventricle, and aorta of DOCA-salt rats. These findings suggest that Mg supplementation prevents blood pressure elevation by attenuating peripheral resistance and by decreasing hypertrophic effect of endothelin-1 via inhibition of endothelin-1 production.     

Measurement of oscillatory flow pressure gradient in an elastic artery model

In vitro experiments were conducted to measure the oscillatory flow pressure gradient along an elastic tube in order to assess the recent nonlinear theory of Wang and Tarbell. According to this theory, in an elastic tube with oscillatory flow, the mean (time-averaged) pressure gradient cannot be calculated using Poiseuille's law. The effect of wall motion creates a nonlinear convective acceleration, and an induced mean pressure gradient is required to balance the convective acceleration. The induced mean pressure gradient depends on the diameter variation over a cycle, the pulsatility and unsteadiness of the flow, and the phase difference between the pressure wave form and the flow wave form. The amplitude of the pressure gradient also depends on these parameters and may deviate significantly from Womersley's rigid tube theory. A flow loop was constructed to produce oscillatory flow in an elastic tube. Flow wave forms were measured with an ultrasonic flow probe, and ultrasonic diameter crystals were used to measure wall movement. A special device for pressure drop measurement was constructed using Millar catheter tip transducers to obtain both forward and backward pressure drops that were then averaged. This averaging method eliminated the static error of the pressure transducers. The pressure-flow phase angle was varied by clamping a distal elastic section at various locations. Pressure gradients were obtained for a range of phase angles between −55 ° and +49 °. The mean and amplitude of the measured pressure gradient were compared to theoretical values. Both positive and negative induced mean pressure gradients were measured over the range of phase angles. The measured pressure gradient amplitudes were always lower than predicted by Womersley's rigid tube theory. The experimental means and amplitudes are in good agreement with the elastic tube theoretical values. Thus, the experiments verify the theory of Wang and Tarbell.     

链霉素对颈动脉窦压力感受器反射的抑制作用

在 2 3只隔离灌流颈动脉窦区的麻醉大鼠 ,观察了链霉素对颈动脉窦压力感受器反射的影响。结果如下 :(1)以链霉素 (10 0 μmol/L)隔离灌流大鼠左侧颈动脉窦区时 ,压力感受器反射机能曲线向左下方移位 ,曲线最大斜率 (PS)由 0 40± 0 0 1kPa降至 0 33± 0 0 1kPa (P <0 0 0 1) ,血压反射性下降 (reflexdecrease ,RD)幅度由 6 2 2±0 13kPa降至 5 0 2± 0 11kPa (P <0 0 0 1) ,阈压 (TP)、平衡压 (EP)和饱和压 (SP)则分别从 8 2 7± 0 2 5 ,12 71± 0 2 1和 2 4 41± 0 14kPa增至 10 33± 0 32 (P <0 0 1) ,13 33± 0 30 (P <0 0 1)和 2 6 11± 0 2 8kPa (P <0 0 1)。其中RD ,PS和TP的变化呈明显的剂量依赖性。 (2 )应用腺苷隔离灌流大鼠颈动脉窦区 ,引起颈动脉窦压力感受器反射的易化 ;在用链霉素预处理后 ,此易化效应不仅完全被阻断 ,且可使反射效应小于应用腺苷前的对照值。以上结果表明 ,链霉素对大鼠颈动脉窦压力感受器反射有明显的抑制作用。     

Laser Doppler anemometer measurements of pulsatile flow in a model carotid bifurcation

Hemodynamics at the human carotid bifurcation is important to the understanding of atherosclerotic plaque initiation and progression as well as to the diagnosis of clinically important disease. Laser Doppler anemometry was performed in a large scale model of an average human carotid. Pulsatile waveforms and physiologic flow divisions were incorporated. Disturbance levels and shear stresses were computed from ensemble averages of the velocity waveform measurements. Flow in the common carotid was laminar and symmetric. Flow patterns in the sinus, however, were complex and varied considerably during the cycle. Strong helical patterns and outer wall flow separation waxed and waned during each systole. The changing flow patterns resulted in an oscillatory shear stress at the outer wall ranging from -13 to 9 dyn cm-2 during systole with a time-averaged mean of only -0.5 dyn cm-2. This contrasts markedly with an inner wall shear stress range of 17-50, (mean 26) dyn cm-2. The region of transient separation was confined to the carotid sinus outer wall with no reverse velocities detected in the distal internal carotid. Notable disturbance velocities were also time-dependent, occurring only during the deceleration phase of systole and the beginning of diastole. The present pulsatile flow studies have aided in identifying hemodynamic conditions which correlate with early intimal thickening and predict the physiologic level of flow disturbances in the bulb of undiseased internal carotid arteries.     

Flow field and oscillatory shear stress in a tuning-fork-shaped model of the average human carotid bifurcation

The oscillatory shear index (OSI) was developed based on the hypothesis that intimal hyperplasia was correlated with oscillatory shear stresses. However, the validity of the OSI was in question since the correlation between intimal thickness and the OSI at the side walls of the sinus in the Y-shaped model of the average human carotid bifurcation (Y-AHCB) was weak. The objectives of this paper are to examine whether the reason for the weak correlation lies in the deviation in geometry of Y-AHCB from real human carotid bifurcation, and whether this correlation is clearly improved in the tuning-fork-shaped model of the average human carotid bifurcation (TF-AHCB). The geometry of the TF-AHCB model was based on observation and statistical analysis of specimens from 74 cadavers. The flow fields in both models were studied and compared by using flow visualization methods under steady flow conditions and by using laser Doppler anemometer (LDA) under pulsatile flow conditions. The TF-shaped geometry leads to a more complex flow field than the Y-shaped geometry. This added complexity includes strengthened helical movements in the sinus, new flow separation zone, and directional changes in the secondary flow patterns. The results show that the OSI-values at the side walls of the sinus in the TF-shaped model were more than two times as large as those in the Y-shaped model. This study confirmed the stronger correlation between the OSI and intimal thickness in the tuning-fork geometry of human carotid bifurcation, and the TF-AHCB model is a significant improvement over the traditional Y-shaped model.