3 and ​and4D).4D). Three regions of interest were defined: the distal CCA, the stenosis proper, and the poststenotic region (PSR), where values were averaged spatially and temporally and over all cases in this study. The average WSS GDC-0199 magnitude at the throat of the stenosis was 107

± 73 dyn/cm2, significantly higher than 23 ± 11 dyn/cm2 in the healthy CCA segment upstream (P < 0.02). In the PSR, the average WSS magnitude was 19 ± 14 dyn/cm2 (Figs. 2 and ​and3).3). The area of maximal increased WSS was located slightly upstream to the maximum stenosis. All cases displayed a varying degree of increased WSS on a Inhibitors,research,lifescience,medical patch of the wall downstream from the stenosis away from the curvature of the vessel, more

prominent in highly stenotic cases where the resulting blood flow jet hits the vessel wall, for example, cases 2 and 4 (Fig. 2). Compared to ideal laminar flow in a healthy vessel with vanishing components Inhibitors,research,lifescience,medical of the WSS in directions other than the axial direction of the bulk flow, the models in this study predict average axial WSS components different from the averaged WSS magnitude: in the stenosis the axial WSS component was 71 ± 49 dyn/cm2, and in the PSR the axial component was 8.0 ± 5.1 dyn/cm2. Figure 3 Axial wall shear stress (WSS) magnitude along Inhibitors,research,lifescience,medical the line between points X and Y (see schematic on right of each panel) during five points of the cardiac cycle. Green arrows

demarcate the point of maximal shear reversal during the cardiac cycle. Figure 4 Contour plots of the wall shear Inhibitors,research,lifescience,medical stress gradient (WSSG) magnitude (A) and the axial WSSG component (B) averaged over the cardiac cycle. (C) Bargraph showing time-averaged and spatially averaged mean magnitudes of the WSSG and directional magnitudes of … Pulsatile migration of zones of alternating shear vector directions The temporal change of the WSS direction over the course of the cardiac cycle in response to the pulsatile flow Inhibitors,research,lifescience,medical conditions employed by our modeling approach was studied. Figure 2A–C shows three exemplary case types that are used to illustrate the highly complex and dynamic process that these was predicted by our model. In the concentric stenosis depicted in Figure 2A (case 3), the stenosis is located close to the bifurcation and is followed by a tapered PSR (similar to the situation found in case 2). A concentric stenosis located distal to the bifurcation with a prestenotic dilatation and a tapered PSR up- and downstream is shown in Figure 2B (case 5) and can also be found in cases 1, 4, and 7 (Fig. 2D). Figure 2C shows a long and eccentric stenosis that spans a longer distance (case 6, similar to case 8). The findings in the first two types of stenosis are similar: increased magnitude antegrade WSS vectors at the throat of the stenosis (area s, Fig.