{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T14:02:24Z","timestamp":1789912944911,"version":"4.0.1"},"reference-count":26,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Region V\u00e4sterbotten","award":["Centrala ALF"],"award-info":[{"award-number":["Centrala ALF"]}]},{"name":"Region V\u00e4sterbotten","award":["Spjutspetsmedel"],"award-info":[{"award-number":["Spjutspetsmedel"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Perfusion"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In aortic arch surgery, bilateral selective antegrade cerebral perfusion (bSACP) maintains cerebral blood flow during circulatory arrest. bSACP is often delivered using a single pump with a Y-connector, dividing the flow. Current practice has veered towards perfusion of the left common carotid artery by cannula and the right subclavian artery by a vascular graft. Flow distribution may therefore depend on left-sided cannula resistance, particularly in patients with limited collateral circulation. We investigated how cannula design influences perfusion pressure and flow distribution during bSACP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Four clinically available carotid perfusion cannulas were characterized using bench measurements (40\u2013200\u00a0mL\/min) and computational fluid dynamics (CFD). The resulting resistance models were integrated into patient-specific CFD models of the cerebral circulation in three patients with varying collateral capacity. Both flow- and pressure-targeted perfusion strategies were simulated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Bench testing demonstrated a 3-4-fold difference in flow resistance between the lowest- and highest-resistance cannulas, which was accurately reproduced in CFD simulations. Importantly, resistance did not correlate with nominal French size. In the patient-specific CFD models, increasing left side cannula resistance roughly doubled the pressure laterality (7\u20139 to 14\u201323\u00a0mmHg) and halved the left side inflow (135\u2013160 to 70\u2013100\u00a0mL\/min) for the cannulas tested. Effects were most pronounced in patients with limited collateral circulation. Sensitivity analyses confirmed robustness across physiological and geometric perturbations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Cannula resistance does not correlate with nominal French size. Cannula design may influence cerebral perfusion pressure and flow distribution during bSACP and may warrant increased attention.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02676591261489044","type":"journal-article","created":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T00:34:40Z","timestamp":1789778080000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of left common carotid cannula design on flow distribution and cerebral perfusion pressure during bilateral selective antegrade cerebral perfusion: An experimental and computational study"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1141-5143","authenticated-orcid":false,"given":"Petter","family":"Holmlund","sequence":"first","affiliation":[{"name":"Ume\u00e5 University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Servin","sequence":"additional","affiliation":[{"name":"Ume\u00e5 University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axel","family":"Vikstr\u00f6m","sequence":"additional","affiliation":[{"name":"Ume\u00e5 University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martha","family":"Johannesdottir","sequence":"additional","affiliation":[{"name":"Ume\u00e5 University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laleh","family":"Zarrinkoob","sequence":"additional","affiliation":[{"name":"Ume\u00e5 University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Hellstr\u00f6m","sequence":"additional","affiliation":[{"name":"Ume\u00e5 University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8171-7227","authenticated-orcid":false,"given":"Micael","family":"Appelblad","sequence":"additional","affiliation":[{"name":"Ume\u00e5 University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"issue":"23","key":"e_1_3_7_2_2","first-page":"1096","article-title":"[A new technic of cerebral protection. 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Best strategy for cerebral protection in arch surgery - antegrade selective cerebral perfusion and adequate hypothermia. Ann Cardiothorac Surg 2013; 2(3): 331\u2013338. https:\/\/doi.org\/10.3978\/j.issn.2225-319X.2013.02.05","journal-title":"Ann Cardiothorac Surg"},{"key":"e_1_3_7_5_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11748-025-02214-2"},{"key":"e_1_3_7_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2019.01.007"},{"key":"e_1_3_7_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12062271"},{"issue":"3","key":"e_1_3_7_8_2","first-page":"310","article-title":"Direct versus side-graft cannulation of the right axillary artery for antegrade cerebral perfusion","volume":"33","author":"Yilik L","year":"2006","unstructured":"Yilik L, Emrecan B, Kestelli M, et al. Direct versus side-graft cannulation of the right axillary artery for antegrade cerebral perfusion. 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