The hemodynamic effects of in-tandem carotid artery stenosis: implications for carotid endarterectomy.

OBJECTIVES: It remains controversial whether patients with severe disease of the internal carotid artery and a coexisting stenotic lesion downstream would benefit from a carotid endarterectomy (CEA) of the proximal lesion. The aim of this study was to simulate the hemodynamic and wall shear effects of in-tandem internal carotid artery stenosis using a computational fluid dynamic (CFD) idealized model to give insight into the possible consequences of CEA on these lesions. METHODS: A CFD model of steady viscous flow in a rigid tube with two asymmetric stenoses was introduced to simulate blood flow in arteries with multiple constrictions. The effect of varying the distance between the two stenoses, and the severity of the upstream stenosis on the pressure and wall shear stress (WSS) distributions on the second plaque, was investigated. The influence of the relative positions of the two stenoses was also assessed. RESULTS: The distance between the plaques was found to have minimal influence on the overall hemodynamic effect except for the presence of a zone of low WSS (range -20 to 30 dyne/cm2) adjacent to both lesions when the two stenoses were sufficiently close (<4 times the arterial diameter). The upstream stenosis was protective if it was larger than the downstream stenosis. The relative positions of the stenoses were found to influence the WSS but not the pressure distribution. CONCLUSIONS: The geometry and positions of the lesions need to be considered when considering the hemodynamic effects of an in-tandem stenosis. Low WSS is thought to cause endothelial dysfunction and initiate atheroma formation. The fact that there was a flow recirculation zone with low WSS in between the two stenoses may demonstrate how two closely positioned plaques may merge into one larger lesion. Decision making for CEA may need to take into account the hemodynamic situation when an in-tandem stenosis is found. CFD may aid in the risk stratification of patients with this problem.

Non-aqueous phase liquid behavior in the subsurface: Transportation, source zone characterization and remediation

Contaminant behaviour in soils and fractured rock is very complex, not least because of the heterogeneity of the subsurface environment. For non-aqueous phase liquids (NAPLs), a liquid density contrast and interfacial tension between the contaminant and interstitial fluid adds to the complexity of behaviour, increasing the difficulty of predicting NAPL behaviour in the subsurface. This paper outlines the need for physical model tests that can improve fundamental understanding of NAPL behaviour in the subsurface, enhance risk assessments of NAPL contaminated sites, reduce uncertainty associated with NAPL source remediation and improve current technologies for NAPL plume remediation. Four case histories are presented to illustrate physical modelling approaches that have addressed problems associated with NAPL transport, remediation and source zone characterization. © 2006 Taylor & Francis Group, London.