Affiliations: McGill University Medical Clinic, Montreal General Hospital, Montreal, Quebec, Canada H3G 1A4
Abstract: The relationship between blood flow and the localization of thrombosis and atherosclerosis in vivo was investigated using the approach and techniques of microrheology. The flow patterns and wall-adhesion of platelets were studied in the captive annular vortex formed at a sudden tubular expansion at various hematocrits in steady and pulsatile flow. The adhesion density exhibited a peak within the vortex and just downstream of the reattachment point, which is also a stagnation point. The peaks flattened out with increasing Reynolds number in steady flow and also in pulsatile flow. Platelet adhesion increased markedly with increasing hematocrit. The localization of adhesion peaks was explained by curvature of the streamlines carrying platelets to the wall on either side of the reattachment point. The relevance of these results to the circulation is that stagnation points are found in regions of disturbed flow at various sites in the arterial and venous circulations. This was shown in experiments using a technique whereby flow was visualized in isolated transparent natural blood vessels prepared from dogs and humans postmortem. In dog saphenous vein bileaflet valves, there was a large primary spiral vortex as well as a smaller secondary vortex, the latter acting as a trap and generator of thrombi. Recirculation zones also existed in the dog aorta at T-junctions of the celiac, cranial mesenteric and renal arteries. Finally, in the human carotid bifurcation, a large standing recirculation zone consisting of spiral secondary flows formed in the carotid sinus at physiological flow conditions. In all these arterial flows there are streamlines impinging radially on the vessel wall which increase the local flux of platelets and plasma proteins and lipids and may lead to the genesis of thrombosis and atherosclerosis.
