Noninvasive assessment of carotid artery stenoses by the principle of multiscale modelling of non-Newtonian blood flow in patient-specific models

The concept of geometrical multiscale modelling of non-Newtonian blood flow in patient-specific models is presented with the aim to provide a methodology for the assessment of hemodynamic significance of carotid artery stenoses. The content of the paper is divided into two consequent parts. In the first one, the principle of the fractional flow reserve (FFR) as an indicator of ischemia-inducing arterial stenoses is tested on three large arterial models containing the aortic arch and both left and right carotid arteries. Using the three-element Windkessel model as an outflow boundary condition, the blood flow simulations are carried out on the basis of data taken from the literature due to unavailable information on patient-specific flow and pressure waveforms. In the second part of the paper, the incorporation of real in-vivo measurements into the multiscale simulations is addressed by presenting a sequential algorithm for the estimation of Windkessel parameters. The ability of the described estimation method, which employs a non-linear state estimator (unscented Kalman filter) on zero-dimensional flow models, is demonstrated on two different patient-specific carotid bifurcation models.