{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T18:06:10Z","timestamp":1779991570001,"version":"3.53.1"},"reference-count":54,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004530","name":"Universiti Putra Malaysia","doi-asserted-by":"publisher","award":["[IN-PUTRA\/2024\/9300498]"],"award-info":[{"award-number":["[IN-PUTRA\/2024\/9300498]"]}],"id":[{"id":"10.13039\/501100004530","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke, yet geometric stenosis alone may not fully reflect the functional hemodynamic burden of a lesion. This study used computational fluid dynamics (CFD) with a shear-thinning non-Newtonian Carreau viscosity model to quantify the combined effects of stenosis severity and blood viscosity on intracranial hemodynamics. A middle cerebral artery (MCA) stenosis model with an original ~70% narrowing was reconstructed from computed tomography angiography, and additional idealized stenosis variants (30%, 50%, and 90%) were generated on the same anatomical background to enable controlled comparisons. Three viscosity states (below-normal, normal, and high) were simulated under transient, incompressible, laminar flow with rigid walls and identical boundary conditions. Velocity, pressure, and wall shear stress (WSS), oscillatory shear index (OSI) and time-averaged wall shear stress (TAWSS) were evaluated. The results show that flow behavior is governed by the combined influence of geometry and rheology, rather than by stenosis severity alone. Severe stenosis produced a dual pathological shear environment, characterized by elevated WSS within the stenotic region and disturbed low-shear flow downstream. In addition, TAWSS showed a non-monotonic response, increasing up to 70% stenosis and then decreasing at 90% stenosis. OSI also showed viscosity-dependent elevation under severe stenosis, with values ranging from approximately 0.38 to 0.48, indicating enhanced oscillatory and disturbed flow.These findings support integrating non-Newtonian hemorheology and hemodynamic metrics with geometric assessment to improve ICAS risk stratification and inform hemodynamics-guided intervention timing.<\/jats:p>","DOI":"10.1371\/journal.pone.0342713","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T17:35:27Z","timestamp":1779989727000},"page":"e0342713","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hemodynamic impact of blood viscosity in intracranial atherosclerotic arteries with varying stenosis severity: A non-newtonian computational fluid dynamics patient specific study"],"prefix":"10.1371","volume":"21","author":[{"given":"Lei","family":"Zhengyao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Nor Ikmal","family":"Muhamad Nazri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6606-4582","authenticated-orcid":true,"given":"Adi Azriff","family":"Basri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masaaki","family":"Tamagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaito","family":"Sagara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8975-2174","authenticated-orcid":true,"given":"Abdul Hanif Khan Yusof","family":"Khan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0450-8832","authenticated-orcid":true,"given":"Eusni Rahayu","family":"Mohd Tohit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"pone.0342713.ref001","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1159\/000438779","article-title":"The Latest Information on Intracranial Atherosclerosis: Diagnosis and Treatment","volume":"4","author":"J Koo","year":"2015","journal-title":"Interv Neurol"},{"issue":"2","key":"pone.0342713.ref002","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2023.e13527","article-title":"Functional evaluation of intracranial atherosclerotic stenosis by pressure ratio measurements","volume":"9","author":"M Wang","year":"2023","journal-title":"Heliyon"},{"key":"pone.0342713.ref003","volume-title":"Biomechanics: mechanical properties of living tissues","author":"YC Fung"},{"key":"pone.0342713.ref004","volume-title":"Bifurcations in Flow Patterns. Nonlinear Topics in the Mathematical Sciences","author":"PG Bakker","year":"2023"},{"issue":"1","key":"pone.0342713.ref005","first-page":"1434832","article-title":"Non\u2010Newtonian Effects of Blood Flow on Hemodynamics in Pulmonary Stenosis: Numerical Simulation","volume":"2023","author":"F He","year":"2023","journal-title":"Appl Bionics Biomech"},{"issue":"4","key":"pone.0342713.ref006","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2024.e26622","article-title":"Hemodynamical behavior analysis of anemic, diabetic, and healthy blood flow in the carotid artery","volume":"10","author":"H Ahmed","year":"2024","journal-title":"Heliyon"},{"issue":"10","key":"pone.0342713.ref007","first-page":"1245","article-title":"Flow of a Casson fluid in a slightly curved tube","volume":"29","author":"RL Batra","year":"1991","journal-title":"Int J Eng Sci"},{"issue":"4","key":"pone.0342713.ref008","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/S1350-4533(00)00036-9","article-title":"Unsteady stenosis flow prediction: a comparative study of non-Newtonian models with operator splitting scheme","volume":"22","author":"WL Siauw","year":"2000","journal-title":"Med Eng Phys"},{"issue":"6","key":"pone.0342713.ref009","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1016\/j.jbiomech.2005.01.034","article-title":"Non-Newtonian blood flow in human right coronary arteries: transient simulations","volume":"39","author":"BM Johnston","year":"2006","journal-title":"J Biomech"},{"issue":"5","key":"pone.0342713.ref010","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1016\/j.jbiomech.2005.02.003","article-title":"Numerical investigation of the non-Newtonian pulsatile blood flow in a bifurcation model with a non-planar branch","volume":"39","author":"J Chen","year":"2006","journal-title":"J Biomech"},{"issue":"10","key":"pone.0342713.ref011","doi-asserted-by":"crossref","first-page":"106009","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.106009","article-title":"Computational Fluid Dynamics in Intracranial Atherosclerosis - Lessons from Cardiology: A Review of CFD in Intracranial Atherosclerosis.","volume":"30","author":"D Pavlin-Premrl","year":"2021","journal-title":"J Strok Cerebrovas Dis."},{"key":"pone.0342713.ref012","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/978-1-4471-3105-2_5","article-title":"The measurement of red blood cell deformability","volume-title":"Clinical aspects of blood viscosity and cell deformability","author":"JC Barbenel","year":"1981"},{"issue":"2","key":"pone.0342713.ref013","doi-asserted-by":"crossref","first-page":"488","DOI":"10.2337\/dc13-1374","article-title":"Blood viscosity in subjects with normoglycemia and prediabetes","volume":"37","author":"C Irace","year":"2014","journal-title":"Diabetes Care"},{"issue":"1","key":"pone.0342713.ref014","first-page":"1","article-title":"Mathematical modeling of non-Newtonian blood flow through artery in the presence of stenosis","volume":"4","author":"P Mathur","year":"2013","journal-title":"Adv Appl Math Biosci"},{"key":"pone.0342713.ref015","volume-title":"Blood viscosity and shock: The role of hemodilution, hemoconcentration and defibrination","author":"H Goslinga","year":"2012"},{"issue":"1","key":"pone.0342713.ref016","first-page":"682054","article-title":"Mechanisms linking red blood cell disorders and cardiovascular diseases","volume":"2015","author":"I Mozos","year":"2015","journal-title":"BioMed Res Int"},{"issue":"1","key":"pone.0342713.ref017","doi-asserted-by":"crossref","first-page":"9604","DOI":"10.1038\/s41598-025-94828-y","article-title":"Morphology and biomechanical index predict the rupture location and rupture risk of abdominal aortic aneurysm","volume":"15","author":"T Liu","year":"2025","journal-title":"Sci Rep"},{"key":"pone.0342713.ref018","doi-asserted-by":"crossref","unstructured":"Stokes GG. On the theories of the internal friction of fluids in motion, and of the equilibrium and motion of elastic solids. https:\/\/doi.org\/10.1190\/1.9781560801931.ch3e","DOI":"10.1190\/1.9781560801931.ch3e"},{"issue":"1823","key":"pone.0342713.ref019","first-page":"389","article-title":"M\u00e9moire sur les lois du mouvement des fluides","volume":"6","author":"CL Navier","year":"1823","journal-title":"Mem Acad Sci Inst France"},{"issue":"1","key":"pone.0342713.ref020","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1122\/1.549276","article-title":"Rheological Equations from Molecular Network Theories","volume":"16","author":"PJ Carreau","year":"1972","journal-title":"Trans Soc Rheol"},{"key":"pone.0342713.ref021","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-62703-380-0","volume-title":"Handbook of clinical nutrition and stroke","author":"ML Corrigan","year":"2013"},{"issue":"2","key":"pone.0342713.ref022","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1007\/BF01907921","article-title":"The measurement of blood density and its meaning","volume":"84","author":"T Kenner","year":"1989","journal-title":"Basic Res Cardiol"},{"key":"pone.0342713.ref023","unstructured":"Basri AA, Abdul Khader CJ, Raghuvir P, Mohammad Z, Zainludin A, Kamarul AA. Fluid structure interaction of renal arteries of Abdominal Aorta subjected to single and double stenosed complication. 2020."},{"issue":"5","key":"pone.0342713.ref024","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.pcad.2006.11.001","article-title":"Wall shear stress: theoretical considerations and methods of measurement","volume":"49","author":"D Katritsis","year":"2007","journal-title":"Prog Cardiovasc Dis"},{"issue":"7","key":"pone.0342713.ref025","doi-asserted-by":"crossref","first-page":"2173","DOI":"10.1007\/s11517-025-03311-3","article-title":"Rapid wall shear stress prediction for aortic aneurysms using deep learning: a fast alternative to CFD","volume":"63","author":"MAA Faisal","year":"2025","journal-title":"Med Biol Eng Comput"},{"issue":"4","key":"pone.0342713.ref026","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1007\/s10237-022-01586-1","article-title":"A longitudinal study of the arterio-venous fistula maturation of a single patient over 15 weeks","volume":"21","author":"E Colley","year":"2022","journal-title":"Biomech Model Mechanobiol"},{"key":"pone.0342713.ref027","doi-asserted-by":"crossref","first-page":"718540","DOI":"10.3389\/fphys.2021.718540","article-title":"Comparison of Newtonian and Non-newtonian Fluid Models in Blood Flow Simulation in Patients With Intracranial Arterial Stenosis","volume":"12","author":"H Liu","year":"2021","journal-title":"Front Physiol"},{"key":"pone.0342713.ref028","volume-title":"Fluid Mechanics","author":"FM White","year":"2011","edition":"7"},{"key":"pone.0342713.ref029","doi-asserted-by":"crossref","first-page":"1467257","DOI":"10.3389\/fbioe.2024.1467257","article-title":"Numerical study on the cerebral blood flow regulation in the circle of Willis with the vascular absence and internal carotid artery stenosis","volume":"12","author":"H Lv","year":"2024","journal-title":"Front Bioeng Biotechnol"},{"issue":"5","key":"pone.0342713.ref030","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0097531","article-title":"Computational fluid dynamics modeling of symptomatic intracranial atherosclerosis may predict risk of stroke recurrence","volume":"9","author":"X Leng","year":"2014","journal-title":"PLoS One"},{"issue":"6","key":"pone.0342713.ref031","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1093\/ons\/opz335","article-title":"Intracranial atherosclerosis: A disease of functional, not anatomic stenosis? How trans-stenotic pressure gradients can help guide treatment","volume":"18","author":"M Zanaty","year":"2020","journal-title":"Oper Neurosurg"},{"issue":"1","key":"pone.0342713.ref032","doi-asserted-by":"crossref","first-page":"4896","DOI":"10.1038\/s41598-025-89100-2","article-title":"Hemodynamic effects of stenosis with varying severity in different segments of the carotid artery using computational fluid dynamics","volume":"15","author":"J Yang","year":"2025","journal-title":"Sci Rep"},{"issue":"41","key":"pone.0342713.ref033","doi-asserted-by":"crossref","first-page":"3421","DOI":"10.1093\/eurheartj\/ehz551","article-title":"Expert recommendations on the assessment of wall shear stress in human coronary arteries: existing methodologies, technical considerations, and clinical applications","volume":"40","author":"F Gijsen","year":"2019","journal-title":"Eur Heart J"},{"issue":"1","key":"pone.0342713.ref034","first-page":"63","article-title":"Myocardial CT perfusion for the prediction of obstructive coronary artery disease, valuable or not?","volume":"5","author":"AR van Rosendael","year":"2015","journal-title":"Cardiovasc Diagn Ther"},{"issue":"6","key":"pone.0342713.ref035","article-title":"Intracranial atherosclerosis: A disease of functional, not anatomic, stenosis","volume":"11","author":"M Zanaty","year":"2018","journal-title":"Circ Cardiovasc Imaging"},{"issue":"2","key":"pone.0342713.ref036","first-page":"241","article-title":"Hemodynamic analysis of intracranial atherosclerotic stenosis using computational fluid dynamics","volume":"13","author":"X Zhao","year":"2023","journal-title":"Bioengineering"},{"issue":"6","key":"pone.0342713.ref037","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1097\/MAT.0000000000001296","article-title":"Dynamics of Blood Flows in Aortic Stenosis: Mild, Moderate, and Severe","volume":"67","author":"C-S Jhun","year":"2021","journal-title":"ASAIO J"},{"key":"pone.0342713.ref038","article-title":"Comparison of blood viscosity models in different degrees of carotid artery stenosis","volume":"13","author":"S Liu","year":"2025","journal-title":"PeerJ"},{"key":"pone.0342713.ref039","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/1742-4682-6-7","article-title":"Extension of Murray\u2019s law using a non-Newtonian model of blood flow","volume":"6","author":"R Revellin","year":"2009","journal-title":"Theor Biol Med Model"},{"key":"pone.0342713.ref040","article-title":"Does blood viscosity affect cerebral blood flow? A study in a population living in a high-altitude city","author":"C Huaman\u00ed","year":"2023","journal-title":"medRxiv"},{"key":"pone.0342713.ref041","doi-asserted-by":"crossref","first-page":"786","DOI":"10.3389\/fneur.2018.00786","article-title":"Effects of Dehydration on Brain Perfusion and Infarct Core After Acute Middle Cerebral Artery Occlusion in Rats: Evidence From High-Field Magnetic Resonance Imaging","volume":"9","author":"Y-H Tsai","year":"2018","journal-title":"Front Neurol"},{"issue":"3","key":"pone.0342713.ref042","article-title":"Hemodynamic simulation in the aortic arch under anemic, diabetic, and healthy blood flow conditions using computational fluid dynamics","volume":"21","author":"FA Tina","year":"2026","journal-title":"PLoS One"},{"issue":"1","key":"pone.0342713.ref043","article-title":"Wall shear stress distribution in intracranial atherosclerotic disease and associations with vessel and plaque morphology","volume":"32","author":"L Lan","year":"2026","journal-title":"CNS Neurosci Ther"},{"issue":"1","key":"pone.0342713.ref044","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1002\/brb3.25","article-title":"Computational fluid dynamic characterization of carotid bifurcation stenosis in patient-based geometries","volume":"2","author":"CM Schirmer","year":"2012","journal-title":"Brain Behav"},{"issue":"7","key":"pone.0342713.ref045","doi-asserted-by":"crossref","first-page":"1411","DOI":"10.1007\/s10439-012-0695-0","article-title":"High wall shear stress and spatial gradients in vascular pathology: a review","volume":"41","author":"JM Dolan","year":"2013","journal-title":"Ann Biomed Eng"},{"issue":"8","key":"pone.0342713.ref046","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.3390\/pharmaceutics17081028","article-title":"Reprogramming Atherosclerosis: Precision Drug Delivery, Nanomedicine, and Immune-Targeted Therapies for Cardiovascular Risk Reduction","volume":"17","author":"P Karakasis","year":"2025","journal-title":"Pharmaceutics"},{"issue":"1","key":"pone.0342713.ref047","doi-asserted-by":"crossref","first-page":"5493","DOI":"10.1038\/s41598-018-23842-0","article-title":"Retrospective Study of Hemodynamic Changes Before and After Carotid Stenosis Formation by Vessel Surface Repairing","volume":"8","author":"X Li","year":"2018","journal-title":"Sci Rep"},{"issue":"10","key":"pone.0342713.ref048","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.3390\/bioengineering12101042","article-title":"The Impact of Stenosis Severity on Hemodynamic Parameters in the Iliac Artery: A Fluid-Structure Interaction Study","volume":"12","author":"N Rahmati","year":"2025","journal-title":"Bioengineering (Basel)"},{"issue":"5","key":"pone.0342713.ref049","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1007\/s10237-019-01282-7","article-title":"The importance of blood rheology in patient-specific computational fluid dynamics simulation of stenotic carotid arteries.","volume":"19","author":"JB Mendieta","year":"2020","journal-title":"Biomech Model Mechanobio."},{"issue":"47","key":"pone.0342713.ref050","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1098\/rsif.2009.0476","article-title":"Flow instability and wall shear stress variation in intracranial aneurysms","volume":"7","author":"H Baek","year":"2010","journal-title":"J R Soc Interface"},{"key":"pone.0342713.ref051","doi-asserted-by":"crossref","first-page":"1705263","DOI":"10.3389\/fcvm.2025.1705263","article-title":"Multidirectional wall shear stress is associated with thrombotic risk in isolated coronary artery ectasia","volume":"12","author":"J Sun","year":"2025","journal-title":"Front Cardiovasc Med"},{"issue":"1","key":"pone.0342713.ref052","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s12572-016-0161-6","article-title":"Computational fluid dynamic simulation of human carotid artery bifurcation based on anatomy and volumetric blood flow rate measured with magnetic resonance imaging","volume":"8","author":"H Gharahi","year":"2016","journal-title":"Int J Adv Eng Sci Appl Math"},{"issue":"1","key":"pone.0342713.ref053","doi-asserted-by":"crossref","first-page":"37","DOI":"10.3390\/pr11010037","article-title":"The Numerical Analysis of Non-Newtonian Blood Flow in a Mechanical Heart Valve","volume":"11","author":"A Chen","year":"2022","journal-title":"Processes"},{"issue":"1","key":"pone.0342713.ref054","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1038\/s41598-025-30538-9","article-title":"Hemodynamic response to stent-induced aneurysm deformation in patient-specific internal carotid artery cases: A computational study","volume":"16","author":"W Rajhi","year":"2025","journal-title":"Sci Rep"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0342713","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T17:35:40Z","timestamp":1779989740000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0342713"}},"subtitle":[],"editor":[{"given":"Ad\u00e9lia","family":"Sequeira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,5,28]]},"references-count":54,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0342713","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,28]]}}}