A recent study demonstrated that certain geometric features of young adult carotid bifurcations are surrogate markers of disturbed flow [1]. However, as the carotid bifurcation ages, the bifurcation and flow waveform changes its geometry and dynamics, respectively [2, 3]. In addition to confounding systemic risk factors, such changes may interrupt homeostasis, potentially altering the likelihood of disturbed flow and atherosclerotic disease in the aging carotid bifurcation. Despite this, disturbed flow in aged bifurcations is typically inferred from image-based computational fluid dynamics (CFD) approaches using representative young and healthy adult flow waveforms.

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