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Mei J, Yan H, Zhao X, Yuan Y, Su H, Xue T, Jia Z. In-stent Restenosis After Stenting for Superior Mesenteric Artery Dissection Is Associated With Stent Landing Zone: From Clinical Prediction to Hemodynamic Mechanisms. J Endovasc Ther 2024:15266028241241494. [PMID: 38561992 DOI: 10.1177/15266028241241494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To identify risk factors for in-stent restenosis (ISR) in patients undergoing stent placement for superior mesenteric artery dissection (SMAD) and to determine the hemodynamic mechanism underlying ISR. METHODS For this retrospective study, patients with SMAD who had ISR after stent placement were included in the ISR group, and age- and sex-matched patients with SMAD who did not experience ISR after stent placement were included in the control group. Clinical, imaging, and hemodynamic data were assessed. Multivariable regression was used to identify independent ISR risk factors. Structural and fluid dynamics simulations were applied to determine the hemodynamic mechanism underlying the occurrence of ISR. RESULTS The study population included 26 patients with ISR and 26 control patients. Multivariate analysis demonstrated that stent-to-vascular (S/V) ratio (odds ratio [OR], 1.14; 95% confidence interval [CI]: 1.00-1.29; p=0.045), stent proximal position >10 mm away from the SMA root (OR, 108.67; 95% CI: 3.09-3816.42; p=0.010), and high oscillatory shear index (OSI) area (OR, 1.25; 95% CI: 1.02-1.52; p=0.029) were predictors of ISR. In structural and fluid dynamics simulations, a stent proximal position near the abdominal aorta (AA) or entering into the AA reduced the contact area between the proximal struts of the stent and the vascular wall, and alleviated the distal lumen overdilation. CONCLUSION The S/V ratio, stent proximal position away from the SMA root (>10 mm), and high OSI area are independent risk factors for ISR in patients with SMAD undergoing stent placement. Deploying the proximal end of the stent near the AA or entering into the AA appears to improve the hemodynamic environment in the SMA lumen and ultimately reduce the risk of ISR. CLINICAL IMPACT In-stent restenosis is an uncommon but potentially catastrophic complication after stent placement for the management of superior mesenteric artery dissection. This study identified risk factors for in-stent restenosis and demonstrated that, as long as the stent can fully cover the dissection range, deploying the proximal end of the stent near the abdominal aorta or less entering into the abdominal aorta may reduce the risk of in-stent restenosis in this patient population.
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Affiliation(s)
- Junhao Mei
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
| | - Hui Yan
- Department of Radiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Xi Zhao
- Central Research Institute, United Imaging Healthcare, Shanghai, China
| | - Yuan Yuan
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Haobo Su
- Department of Interventional Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tongqing Xue
- Department of Interventional Radiology, Huaian Hospital of Huai'an City, Huai'an, China
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
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Lungu CN, Creteanu A, Mehedinti MC. Endovascular Drug Delivery. Life (Basel) 2024; 14:451. [PMID: 38672722 PMCID: PMC11051410 DOI: 10.3390/life14040451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/12/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Drug-eluting stents (DES) and balloons revolutionize atherosclerosis treatment by targeting hyperplastic tissue responses through effective local drug delivery strategies. This review examines approved and emerging endovascular devices, discussing drug release mechanisms and their impacts on arterial drug distribution. It emphasizes the crucial role of drug delivery in modern cardiovascular care and highlights how device technologies influence vascular behavior based on lesion morphology. The future holds promise for lesion-specific treatments, particularly in the superficial femoral artery, with recent CE-marked devices showing encouraging results. Exciting strategies and new patents focus on local drug delivery to prevent restenosis, shaping the future of interventional outcomes. In summary, as we navigate the ever-evolving landscape of cardiovascular intervention, it becomes increasingly evident that the future lies in tailoring treatments to the specific characteristics of each lesion. By leveraging cutting-edge technologies and harnessing the potential of localized drug delivery, we stand poised to usher in a new era of precision medicine in vascular intervention.
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Affiliation(s)
- Claudiu N. Lungu
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
| | - Andreea Creteanu
- Department of Pharmaceutical Technology, University of Medicine and Pharmacy Grigore T Popa, 700115 Iași, Romania
| | - Mihaela C. Mehedinti
- Department of Functional and Morphological Science, Faculty of Medicine and Pharmacy, Dunarea de Jos University, 800010 Galati, Romania;
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Baek KI, Ryu K. Role of Flow-Sensitive Endothelial Genes in Atherosclerosis and Antiatherogenic Therapeutics Development. J Cardiovasc Transl Res 2023:10.1007/s12265-023-10463-w. [PMID: 38010480 DOI: 10.1007/s12265-023-10463-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
Atherosclerosis is a chronic inflammatory disease that is the underlying cause of cardiovascular disease which initiates from endothelial dysfunction from genetic and environmental risk factors, including biomechanical forces: blood flow. Endothelial cells (ECs) lining the inner arterial wall regions exposed to disturbed flow are prone to atherosclerosis development, whereas the straight regions exposed to stable flow are spared from the disease. These flow patterns induce genome- and epigenome-wide changes in gene expression in ECs. Through the sweeping changes in gene expression, disturbed flow reprograms ECs from athero-protected cell types under the stable flow condition to pro-atherogenic cell conditions. The pro-atherogenic changes induced by disturbed flow, in combination with additional risk factors such as hypercholesterolemia, lead to the progression of atherosclerosis. The flow-sensitive genes and proteins are critical in understanding the mechanisms and serve as novel targets for antiatherogenic therapeutics.
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Affiliation(s)
- Kyung In Baek
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Kitae Ryu
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
- Department of Biotechnology, The University of Suwon, 17, Wauan-Gil, Bongdam-Eup, Hwaseong-Si, Gyeonggi-Do, 18323, Republic of Korea.
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Ghorbannia A, LaDisa JF. Intravascular imaging of angioplasty balloon under-expansion during pre-dilation predicts hyperelastic behavior of coronary artery lesions. Front Bioeng Biotechnol 2023; 11:1192797. [PMID: 37284239 PMCID: PMC10240066 DOI: 10.3389/fbioe.2023.1192797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 05/08/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction: Stent-induced mechanical stimuli cause pathophysiological responses in the coronary artery post-treatment. These stimuli can be minimized through choice of stent, size, and deployment strategy. However, the lack of target lesion material characterization is a barrier to further personalizing treatment. A novel ex-vivo angioplasty-based intravascular imaging technique using optical coherence tomography (OCT) was developed to characterize local stiffness of the target lesion. Methods: After proper institutional oversight, atherosclerotic coronary arteries (n = 9) were dissected from human donor hearts for ex vivo material characterization <48 h post-mortem. Morphology was imaged at the diastolic blood pressure using common intravascular OCT protocols and at subsequent pressures using a specially fabricated perfusion balloon that accommodates the OCT imaging wire. Balloon under-expansion was quantified relative to the nominal balloon size at 8 ATM. Correlation to a constitutive hyperelastic model was empirically investigated (n = 13 plaques) using biaxial extension results fit to a mixed Neo-Hookean and Exponential constitutive model. Results and discussion: The average circumferential Cauchy stress was 66.5, 130.2, and 300.4 kPa for regions with <15, 15-30, and >30% balloon under-expansion at a 1.15 stretch ratio. Similarly, the average longitudinal Cauchy stress was 68.1, 172.6, and 412.7 kPa, respectively. Consequently, strong correlation coefficients >0.89 were observed between balloon under-expansion and stress-like constitutive parameters. These parameters allowed for visualization of stiffness and material heterogeneity for a range of atherosclerotic plaques. Balloon under-expansion is a strong predictor of target lesion stiffness. These findings are promising as stent deployment could now be further personalized via target lesion material characterization obtained pre-operatively.
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Affiliation(s)
- Arash Ghorbannia
- Section of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI, United States
- Department of Biomedical Engineering, Marquette University and The Medical College of Wisconsin, Milwaukee, WI, United States
| | - John F. LaDisa
- Section of Pediatric Cardiology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, United States
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, WI, United States
- Department of Biomedical Engineering, Marquette University and The Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Physiology, Milwaukee, WI, United States
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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Venn J, Larkee CE, Garcia GJM, Rayz VL, LaDisa JF. A workflow for viewing biomedical computational fluid dynamics results and corresponding data within virtual and augmented reality environments. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1096289. [PMID: 36908292 PMCID: PMC9996009 DOI: 10.3389/fmedt.2023.1096289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/26/2023] [Indexed: 02/25/2023] Open
Abstract
Researchers conducting computational fluid dynamics (CFD) modeling can spend weeks obtaining imaging data, determining boundary conditions, running simulations and post-processing files. However, results are typically viewed on a 2D display and often at one point in time thus reducing the dynamic and inherently three-dimensional data to a static image. Results from different pathologic states or cases are rarely compared in real-time, and supplementary data are seldom included. Therefore, only a fraction of CFD results are typically studied in detail, and associations between mechanical stimuli and biological response may be overlooked. Virtual and augmented reality facilitate stereoscopic viewing that may foster extraction of more information from CFD results by taking advantage of improved depth cues, as well as custom content development and interactivity, all within an immersive approach. Our objective was to develop a straightforward, semi-automated workflow for enhanced viewing of CFD results and associated data in an immersive virtual environment (IVE). The workflow supports common CFD software and has been successfully completed by novice users in about an hour, demonstrating its ease of use. Moreover, its utility is demonstrated across clinical research areas and IVE platforms spanning a range of cost and development considerations. We are optimistic that this advancement, which decreases and simplifies the steps to facilitate more widespread use of immersive CFD viewing, will foster more efficient collaboration between engineers and clinicians. Initial clinical feedback is presented, and instructional videos, manuals, templates and sample data are provided online to facilitate adoption by the community.
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Affiliation(s)
- John Venn
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, United States
| | | | - Guilherme J. M. Garcia
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, United States
| | - Vitaliy L. Rayz
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, United States
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - John F. LaDisa
- Department of Biomedical Engineering, Marquette University and Medical College of Wisconsin, Milwaukee, WI, United States
- Department of Pediatrics - Division of Cardiology, Herma Heart Institute, Children’s Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, United States
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Athani A, Ghazali NNN, Anjum Badruddin I, Kamangar S, Salman Ahmed NJ, Honnutagi A. Visualization of multiphase pulsatile blood over single phase blood flow in a patient specific stenosed left coronary artery using image processing technique. Biomed Mater Eng 2023; 34:13-35. [PMID: 36278331 DOI: 10.3233/bme-211333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Coronary arteries disease has been reported as one of the principal roots of deaths worldwide. OBJECTIVE The aim of this study is to analyze the multiphase pulsatile blood flow in the left coronary artery tree with stenosis. METHODS The 3D left coronary artery model was reconstructed using 2D computerized tomography (CT) scan images. The Red Blood Cell (RBC) and varying hemodynamic parameters for single and multiphase blood flow conditions were analyzed. RESULTS Results asserted that the multiphase blood flow modeling has a maximum velocity of 1.017 m/s and1.339 m/s at the stenosed region during the systolic and diastolic phases respectively. The increase in Wall Shear Stress (WSS) observed at the stenosed region during the diastole phase as compared during the systolic phase. It was also observed that the highest Oscillatory Shear Index (OSI) regions are found in the downstream area of stenosis and across the bifurcations. The increase in RBCs velocity from 0.45 m/s to 0.6 m/s across the stenosis was also noticed. CONCLUSION The computational multiphase blood flow analysis improves the understanding and accuracy of the complex flow conditions of blood elements (RBC and Plasma) and provides the progression of the disease development in the coronary arteries. This study helps to enhance the diagnosis of the blocked (stenosed) arteries more precisely compared to the single-phase blood flow modeling.
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Affiliation(s)
- Abdulgaphur Athani
- Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - N N N Ghazali
- Department of Mechanical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Irfan Anjum Badruddin
- Mechanical Engineering Department, College of Engineering, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Sarfaraz Kamangar
- Mechanical Engineering Department, College of Engineering, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - N J Salman Ahmed
- Department of Mechanical Engineering, HMS Institute of Technology, Tumkur, India
| | - Abdulrazak Honnutagi
- Department of Civil Engineering, Anjuman-I-islam's Kaleskar Technical Campus (AIKTC), New Mumbai, India
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7
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Geng Y, Wu X, Liu H, Zheng D, Xia L. Index of microcirculatory resistance: state-of-the-art and potential applications in computational simulation of coronary artery disease. J Zhejiang Univ Sci B 2022; 23:123-140. [PMID: 35187886 DOI: 10.1631/jzus.b2100425] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The dysfunction of coronary microcirculation is an important cause of coronary artery disease (CAD). The index of microcirculatory resistance (IMR) is a quantitative evaluation of coronary microcirculatory function, which provides a significant reference for the prediction, diagnosis, treatment, and prognosis of CAD. IMR also plays a key role in investigating the interaction between epicardial and microcirculatory dysfunctions, and is closely associated with coronary hemodynamic parameters such as flow rate, distal coronary pressure, and aortic pressure, which have been widely applied in computational studies of CAD. However, there is currently a lack of consensus across studies on the normal and pathological ranges of IMR. The relationships between IMR and coronary hemodynamic parameters have not been accurately quantified, which limits the application of IMR in computational CAD studies. In this paper, we discuss the research gaps between IMR and its potential applications in the computational simulation of CAD. Computational simulation based on the combination of IMR and other hemodynamic parameters is a promising technology to improve the diagnosis and guide clinical trials of CAD.
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Affiliation(s)
- Yingyi Geng
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Xintong Wu
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China
| | - Haipeng Liu
- Research Centre of Intelligent Healthcare, Faculty of Health and Life Science, Coventry University, Coventry CV1 5FB, UK
| | - Dingchang Zheng
- Research Centre of Intelligent Healthcare, Faculty of Health and Life Science, Coventry University, Coventry CV1 5FB, UK.
| | - Ling Xia
- Key Laboratory for Biomedical Engineering of Ministry of Education, Institute of Biomedical Engineering, Zhejiang University, Hangzhou 310027, China.
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8
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Kashyap V, Gharleghi R, Li DD, McGrath-Cadell L, Graham RM, Ellis C, Webster M, Beier S. Accuracy of vascular tortuosity measures using computational modelling. Sci Rep 2022; 12:865. [PMID: 35039557 PMCID: PMC8764056 DOI: 10.1038/s41598-022-04796-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022] Open
Abstract
Severe coronary tortuosity has previously been linked to low shear stresses at the luminal surface, yet this relationship is not fully understood. Several previous studies considered different tortuosity metrics when exploring its impact of on the wall shear stress (WSS), which has likely contributed to the ambiguous findings in the literature. Here, we aim to analyze different tortuosity metrics to determine a benchmark for the highest correlating metric with low time-averaged WSS (TAWSS). Using Computed Tomography Coronary Angiogram (CTCA) data from 127 patients without coronary artery disease, we applied all previously used tortuosity metrics to the left main coronary artery bifurcation, and to its left anterior descending and left circumflex branches, before modelling their TAWSS using computational fluid dynamics (CFD). The tortuosity measures included tortuosity index, average absolute-curvature, root-mean-squared (RMS) curvature, and average squared-derivative-curvature. Each tortuosity measure was then correlated with the percentage of vessel area that showed a < 0.4 Pa TAWSS, a threshold associated with altered endothelial cell cytoarchitecture and potentially higher disease risk. Our results showed a stronger correlation between curvature-based versus non-curvature-based tortuosity measures and low TAWSS, with the average-absolute-curvature showing the highest coefficient of determination across all left main branches (p < 0.001), followed by the average-squared-derivative-curvature (p = 0.001), and RMS-curvature (p = 0.002). The tortuosity index, the most widely used measure in literature, showed no significant correlation to low TAWSS (p = 0.86). We thus recommend the use of average-absolute-curvature as a tortuosity measure for future studies.
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Affiliation(s)
- Vishesh Kashyap
- Mechanical and Aerospace Engineering Department, Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, USA
| | - Ramtin Gharleghi
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW, Australia.
| | - Darson D Li
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW, Australia
| | - Lucy McGrath-Cadell
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | - Robert M Graham
- Molecular Cardiology and Biophysics Division, Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | | | | | - Susann Beier
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW, Australia
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9
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Camarda JA, Dholakia RJ, Wang H, Samyn MM, Cava JR, LaDisa JF. A Pilot Study Characterizing Flow Patterns in the Thoracic Aorta of Patients With Connective Tissue Disease: Comparison to Age- and Gender-Matched Controls via Fluid Structure Interaction. Front Pediatr 2022; 10:772142. [PMID: 35601426 PMCID: PMC9114664 DOI: 10.3389/fped.2022.772142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 03/25/2022] [Indexed: 12/02/2022] Open
Abstract
Prior computational and imaging studies described changes in flow patterns for patients with Marfan syndrome, but studies are lacking for related populations. This pilot study addresses this void by characterizing wall shear stress (WSS) indices for patients with Loeys-Dietz and undifferentiated connective tissue diseases. Using aortic valve-based velocity profiles from magnetic resonance imaging as input to patient-specific fluid structure interaction (FSI) models, we determined local flow patterns throughout the aorta for four patients with various connective tissue diseases (Loeys-Dietz with the native aorta, connective tissue disease of unclear etiology with native aorta in female and male patients, and an untreated patient with Marfan syndrome, as well as twin patients with Marfan syndrome who underwent valve-sparing root replacement). FSI simulations used physiological boundary conditions and material properties to replicate available measurements. Time-averaged WSS (TAWSS) and oscillatory shear index (OSI) results are presented with localized comparison to age- and gender-matched control participants. Ascending aortic dimensions were greater in almost all patients with connective tissue diseases relative to their respective control. Differences in TAWSS and OSI were driven by local morphological differences and cardiac output. For example, the model for one twin had a more pronounced proximal descending aorta in the vicinity of the ductus ligamentum that impacted WSS indices relative to the other. We are optimistic that the results of this study can serve as a foundation for larger future studies on the connective tissue disorders presented in this article.
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Affiliation(s)
- Joseph A Camarda
- Department of Pediatrics, Division of Cardiology, Herma Heart Institute, Children's Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Ronak J Dholakia
- Department of Biomedical Engineering, Marquette University the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Hongfeng Wang
- Department of Biomedical Engineering, Marquette University the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Margaret M Samyn
- Department of Pediatrics, Division of Cardiology, Herma Heart Institute, Children's Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Biomedical Engineering, Marquette University the Medical College of Wisconsin, Milwaukee, WI, United States
| | - Joseph R Cava
- Department of Pediatrics, Division of Cardiology, Herma Heart Institute, Children's Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, United States
| | - John F LaDisa
- Department of Pediatrics, Division of Cardiology, Herma Heart Institute, Children's Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Biomedical Engineering, Marquette University the Medical College of Wisconsin, Milwaukee, WI, United States.,Departments of Medicine, Division of Cardiovascular Medicine and Physiology, Medical College of Wisconsin, Milwaukee, WI, United States
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10
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Shen C, Gharleghi R, Li DD, Stevens M, Dokos S, Beier S. Secondary flow in bifurcations - Important effects of curvature, bifurcation angle and stents. J Biomech 2021; 129:110755. [PMID: 34601214 DOI: 10.1016/j.jbiomech.2021.110755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 09/01/2021] [Accepted: 09/16/2021] [Indexed: 12/27/2022]
Abstract
Coronary bifurcations have complex flow patterns including secondary flow zones and helical flow, which directly affect pathophysiological mechanisms such as the development of atherosclerosis. The objective of this study was to generate insights into the effects of curvature, bifurcation angle and the presence of stents on flow patterns and resulting haemodynamics in coronary left main bifurcations. The blood flow and associated metrics were modelled in both idealised and patient-specific bifurcations with varying curvature and bifurcation angles with and without stents, resulting in a total of 128 geometries considered. The results showed that larger curvature of bifurcating vessels has a significant influence on secondary flow, especially with distance to the bifurcation region, causing a skew, spin and asymmetry of Dean vortices, an increase in helical flow intensity with symmetry loss, and a decrease in adversely low time-average wall shear stress (TAWSS). Generally, asymmetric flow patterns coincided with adversely low TAWSS regions. In identical stented geometries, the presence of the stents induced local recirculation immediately adjacent to the stent struts, thus generating adversely low TAWSS in these areas, with some effect on the overall secondary flow. Overall, the effect of stents outweighed the effect of curvature and BA. This new knowledge contributes to a better understanding of the joint effects of curvature, bifurcation angle, and stents on flow patterns and haemodynamics in coronary bifurcations.
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Affiliation(s)
- C Shen
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia.
| | - R Gharleghi
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - D D Li
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - M Stevens
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - S Dokos
- Graduate School of Biomedical Engineering, University of New South Wales, Sydney NSW 2052, Australia
| | - S Beier
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney NSW 2052, Australia
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11
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Avril S, Gee MW, Hemmler A, Rugonyi S. Patient-specific computational modeling of endovascular aneurysm repair: State of the art and future directions. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3529. [PMID: 34490740 DOI: 10.1002/cnm.3529] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 06/13/2023]
Abstract
Endovascular aortic repair (EVAR) has become the preferred intervention option for aortic aneurysms and dissections. This is because EVAR is much less invasive than the alternative open surgery repair. While in-hospital mortality rates are smaller for EVAR than open repair (1%-2% vs. 3%-5%), the early benefits of EVAR are lost after 3 years due to larger rates of complications in the EVAR group. Clinicians follow instructions for use (IFU) when possible, but are left with personal experience on how to best proceed and what choices to make with respect to stent-graft (SG) model choice, sizing, procedural options, and their implications on long-term outcomes. Computational modeling of SG deployment in EVAR and tissue remodeling after intervention offers an alternative way of testing SG designs in silico, in a personalized way before intervention, to ultimately select the strategies leading to better outcomes. Further, computational modeling can be used in the optimal design of SGs in cases of complex geometries. In this review, we address some of the difficulties and successes associated with computational modeling of EVAR procedures. There is still work to be done in all areas of EVAR in silico modeling, including model validation, before models can be applied in the clinic, but much progress has already been made. Critical to clinical implementation are current efforts focusing on developing fast algorithms that can achieve (near) real-time solutions, as well as ways of dealing with inherent uncertainties related to patient aortic wall degradation on an individualized basis. We are optimistic that EVAR modeling in the clinic will soon become a reality to help clinicians optimize EVAR interventions and ultimately reduce EVAR-associated complications.
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Affiliation(s)
- Stéphane Avril
- Mines Saint-Étienne, Univ Lyon, Univ Jean Monnet, INSERM, Saint-Étienne, France
| | - Michael W Gee
- Mechanics & High Performance Computing Group, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany
| | - André Hemmler
- Mechanics & High Performance Computing Group, Department of Mechanical Engineering, Technical University of Munich, Garching, Germany
| | - Sandra Rugonyi
- Biomedical Engineering Department, Oregon Health & Science University, Portland, Oregon, USA
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12
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Assessment of Reflux From Needleless Connectors: Blinded Comparison of Category Designation to Benchtop Function Using a Venous Simulator. JOURNAL OF INFUSION NURSING 2021; 44:323-330. [PMID: 34753151 DOI: 10.1097/nan.0000000000000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Needleless connectors (NCs) for vascular access have limited needlestick injuries, but complications including occlusion, thrombosis, and infections have increased despite reduced needlestick injuries. These complications relate to the ability of an NC design to limit volume fluctuations that can lead to fluid reflux with potential for microbial contamination. Different NC designs requiring specific usage protocols and training, a lack of clarity in NC function relative to manufacturer-designated categories, and confounding results from a limited number of studies comparing different NCs have resulted in confusion, ultimately leading to complications from undesirable fluid movement within the vascular access. The authors therefore quantified the magnitude of reflux with current commercially available NCs using a venous stimulator. Thirteen blinded NC designs spanning the categories of negative and positive displacement, neutral, and antireflux were tested to quantify fluid movement upon disconnection and reconnection from a representative intravenous pressure (3 NCs per design; 10 trials per NC). Trials for each NC tested followed consistent displacement trends leading to tight error bars. Blinded NCs were then characterized according to their function and compared with their category designation after unblinding. All positive and negative NCs functioned in a manner consistent with their respective category designations. Conversely, all NCs categorized as neutral actually functioned with negative displacement (ie, reflux upon disconnection; 4/5 NCs) or positive displacement (1/5 NCs). Only NCs classified as antireflux functioned as neutral, which was confirmed in a blinded bidirectional flow test. These results suggest that the neutral NC-marketed category may be confusing to users unless the particular NC design has an integrated antireflux component.
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Gamage PT, Dong P, Lee J, Gharaibeh Y, Zimin VN, Dallan LAP, Bezerra HG, Wilson DL, Gu L. Hemodynamic alternations following stent deployment and post-dilation in a heavily calcified coronary artery: In silico and ex-vivo approaches. Comput Biol Med 2021; 139:104962. [PMID: 34715552 DOI: 10.1016/j.compbiomed.2021.104962] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 10/16/2021] [Accepted: 10/17/2021] [Indexed: 01/16/2023]
Abstract
In this work, hemodynamic alterations in a patient-specific, heavily calcified coronary artery following stent deployment and post-dilations are quantified using in silico and ex-vivo approaches. Three-dimensional artery models were reconstructed from OCT images. Stent deployment and post-dilation with various inflation pressures were performed through both the finite element method (FEM) and ex vivo experiments. Results from FEM agreed very well with the ex-vivo measurements, interms of lumen areas, stent underexpansion, and strut malapposition. In addition, computational fluid dynamics (CFD) simulations were performed to delineate the hemodynamic alterations after stent deployment and post-dilations. A pressure time history at the inlet and a lumped parameter model (LPM) at the outlet were adopted to mimic the aortic pressure and the distal arterial tree, respectively. The pressure drop across the lesion, pertaining to the clinical measure of instantaneous wave-free flow ratio (iFR), was investigated. Results have shown that post-dilations are necessary for the lumen gain as well as the hemodynamic restoration towards hemostasis. Malapposed struts induced much higher shear rate, flow disturbances and lower time-averaged wall shear stress (TAWSS) around struts. Post-dilations mitigated the strut malapposition, and thus the shear rate. Moreover, stenting induced larger area of low TAWSS (<0.4 Pa) and lager volume of high shear rate (>2000 s-1), indicating higher risks of in-stent restenosis (ISR) and stent thrombosis (ST), respectively. Oscillatory shear index (OSI) and relative residence time (RRT) indicated the wall regions more prone to ISR are located near the malapposed stent struts.
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Affiliation(s)
- Peshala T Gamage
- Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, FL, 32901, USA
| | - Pengfei Dong
- Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, FL, 32901, USA.
| | - Juhwan Lee
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Yazan Gharaibeh
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Vladislav N Zimin
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
| | - Luis A P Dallan
- Cardiovascular Imaging Core Laboratory, Harrington Heart & Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
| | - Hiram G Bezerra
- Interventional Cardiology Center, Heart and Vascular Institute, The University of South Florida, Tampa, FL, 33606, USA
| | - David L Wilson
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Linxia Gu
- Department of Biomedical and Chemical Engineering and Sciences, Florida Institute of Technology, Melbourne, FL, 32901, USA.
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Xue H, Saha SC, Beier S, Jepson N, Luo Z. Topological Optimization of Auxetic Coronary Stents Considering Hemodynamics. Front Bioeng Biotechnol 2021; 9:728914. [PMID: 34589473 PMCID: PMC8473832 DOI: 10.3389/fbioe.2021.728914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/27/2021] [Indexed: 12/05/2022] Open
Abstract
This paper is to design a new type of auxetic metamaterial-inspired structural architectures to innovate coronary stents under hemodynamics via a topological optimization method. The new architectures will low the occurrence of stent thrombosis (ST) and in-stent restenosis (ISR) associated with the mechanical factors and the adverse hemodynamics. A multiscale level-set approach with the numerical homogenization method and computational fluid dynamics is applied to implement auxetic microarchitectures and stenting structure. A homogenized effective modified fluid permeability (MFP) is proposed to efficiently connect design variables with motions of blood flow around the stent, and a Darcy-Stokes system is used to describe the coupling behavior of the stent structure and fluid. The optimization is formulated to include three objectives from different scales: MFP and auxetic property in the microscale and stenting stiffness in the macroscale. The design is numerically validated in the commercial software MATLAB and ANSYS, respectively. The simulation results show that the new design can not only supply desired auxetic behavior to benefit the deliverability and reduce incidence of the mechanical failure but also improve wall shear stress distribution to low the induced adverse hemodynamic changes. Hence, the proposed stenting architectures can help improve safety in stent implantation, to facilitate design of new generation of stents.
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Affiliation(s)
- Huipeng Xue
- School of Mechanical and Mechatronic Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | - Suvash C Saha
- School of Mechanical and Mechatronic Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | - Susann Beier
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Kensington, NSW, Australia
| | - Nigel Jepson
- Department Cardiology, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Zhen Luo
- School of Mechanical and Mechatronic Engineering, University of Technology Sydney, Sydney, NSW, Australia
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15
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The Role of Elevated Wall Shear Stress in Progression of Pulmonary Vein Stenosis: Evidence from Two Case Studies. CHILDREN-BASEL 2021; 8:children8090729. [PMID: 34572161 PMCID: PMC8470228 DOI: 10.3390/children8090729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 12/03/2022]
Abstract
Pulmonary vein stenosis is a serious condition characterized by restriction or blockage due to fibrotic tissue ingrowth that develops in the pulmonary veins of infants or children. It is often progressive and can lead to severe pulmonary hypertension and death. Efforts to halt or reverse disease progression include surgery and catheter-based balloon dilation and stent implantation. Its cause and mechanism of progression are unknown. In this pilot study, we propose and explore the hypothesis that elevated wall shear stress at discrete pulmonary venous sites triggers stenosis. To assess this theory, we retrospectively analyzed cardiac catheterization, lung scan, and X-ray computed tomography data to estimate wall shear stress in the pulmonary veins at multiple time points during disease progression in two patients. Results are consistent with the existence of a level of elevated wall shear stress above which the disease is progressive and below which progression is halted. The analysis also suggests the possibility of predicting the target lumen size necessary in a given vein to reduce wall shear stress to normal levels and remove the trigger for stenosis progression.
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Wang L, Jiao L, Pang S, Yan P, Wang X, Qiu T. The Development of Design and Manufacture Techniques for Bioresorbable Coronary Artery Stents. MICROMACHINES 2021; 12:mi12080990. [PMID: 34442612 PMCID: PMC8398368 DOI: 10.3390/mi12080990] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/18/2021] [Accepted: 08/18/2021] [Indexed: 02/02/2023]
Abstract
Coronary artery disease (CAD) is the leading killer of humans worldwide. Bioresorbable polymeric stents have attracted a great deal of interest because they can treat CAD without producing long-term complications. Bioresorbable polymeric stents (BMSs) have undergone a sustainable revolution in terms of material processing, mechanical performance, biodegradability and manufacture techniques. Biodegradable polymers and copolymers have been widely studied as potential material candidates for bioresorbable stents. It is a great challenge to find a reasonable balance between the mechanical properties and degradation behavior of bioresorbable polymeric stents. Surface modification and drug-coating methods are generally used to improve biocompatibility and drug loading performance, which are decisive factors for the safety and efficacy of bioresorbable stents. Traditional stent manufacture techniques include etching, micro-electro discharge machining, electroforming, die-casting and laser cutting. The rapid development of 3D printing has brought continuous innovation and the wide application of biodegradable materials, which provides a novel technique for the additive manufacture of bioresorbable stents. This review aims to describe the problems regarding and the achievements of biodegradable stents from their birth to the present and discuss potential difficulties and challenges in the future.
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Affiliation(s)
- Liang Wang
- School of Mechanical Engineering, Beijing Institute of Technology, No. 5 Zhongguancun South Street, Haidian District, Beijing 100081, China; (L.W.); (S.P.)
| | - Li Jiao
- Key Laboratory of Fundamental Science for Advanced Machining Beijing Institute of Technology, No. 5 Zhongguancun South Street, Haidian District, Beijing 100081, China; (L.J.); (P.Y.); (X.W.)
| | - Shuoshuo Pang
- School of Mechanical Engineering, Beijing Institute of Technology, No. 5 Zhongguancun South Street, Haidian District, Beijing 100081, China; (L.W.); (S.P.)
| | - Pei Yan
- Key Laboratory of Fundamental Science for Advanced Machining Beijing Institute of Technology, No. 5 Zhongguancun South Street, Haidian District, Beijing 100081, China; (L.J.); (P.Y.); (X.W.)
| | - Xibin Wang
- Key Laboratory of Fundamental Science for Advanced Machining Beijing Institute of Technology, No. 5 Zhongguancun South Street, Haidian District, Beijing 100081, China; (L.J.); (P.Y.); (X.W.)
| | - Tianyang Qiu
- Key Laboratory of Fundamental Science for Advanced Machining Beijing Institute of Technology, No. 5 Zhongguancun South Street, Haidian District, Beijing 100081, China; (L.J.); (P.Y.); (X.W.)
- Correspondence:
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Djukic T, Saveljic I, Pelosi G, Parodi O, Filipovic N. A study on the accuracy and efficiency of the improved numerical model for stent implantation using clinical data. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 207:106196. [PMID: 34091419 DOI: 10.1016/j.cmpb.2021.106196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/17/2021] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Stent implantation procedure should be carefully planned and adapted to the particular patient in order to minimize possible complications. Numerical simulations can provide useful quantitative data about the state of the artery after the implantation, as well as information about the benefits of the intervention from the hemodynamical point of view. METHODS In this paper, a numerical model for stent implantation is presented. This numerical model simulates the stent expansion, the interaction of the stent with arterial wall and the deformation of the arterial wall under the influence of the stent. FE method was used to perform CFD simulations and the effects of stenting were analyzed by comparing the hemodynamic parameters before and after stent implantation. RESULTS Clinical data for overall 34 patients was used for the simulations, and for 9 of them data from follow up examinations was used to validate the results of simulations of stent implantation. CONCLUSIONS The good agreement of results (less than 4.1% of SD error for all the 9 validation cases) demonstrated the accuracy of the presented numerical model. The developed approach can be a valuable tool for the improvement of pre-operative planning and patient-specific treatment optimization.
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Affiliation(s)
- Tijana Djukic
- Bioengineering Research and Development Center, BioIRC, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia; Institute for Information Technologies, University of Kragujevac, Jovana Cvijica bb, 34000 Kragujevac, Serbia.
| | - Igor Saveljic
- Bioengineering Research and Development Center, BioIRC, Prvoslava Stojanovica 6, 34000 Kragujevac, Serbia; Institute for Information Technologies, University of Kragujevac, Jovana Cvijica bb, 34000 Kragujevac, Serbia.
| | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy.
| | - Oberdan Parodi
- Institute of Clinical Physiology, National Research Council, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy.
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Nguyen DT, Smith AF, Jiménez JM. Stent strut streamlining and thickness reduction promote endothelialization. J R Soc Interface 2021; 18:20210023. [PMID: 34404229 PMCID: PMC8371379 DOI: 10.1098/rsif.2021.0023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/22/2021] [Indexed: 12/15/2022] Open
Abstract
Stent thrombosis (ST) carries a high risk of myocardial infarction and death. Lack of endothelial coverage is an important prognostic indicator of ST after stenting. While stent strut thickness is a critical factor in ST, a mechanistic understanding of its effect is limited and the role of haemodynamics is unclear. Endothelialization was tested using a wound-healing assay and five different stent strut models ranging in height between 50 and 150 µm for circular arc (CA) and rectangular (RT) geometries and a control without struts. Under static conditions, all stent strut surfaces were completely endothelialized. Reversing pulsatile disturbed flow caused full endothelialization, except for the stent strut surfaces of the 100 and 150 µm RT geometries, while fully antegrade pulsatile undisturbed flow with a higher mean wall shear stress caused only the control and the 50 µm CA geometries to be fully endothelialized. Modest streamlining and decrease in height of the stent struts improved endothelial coverage of the peri-strut and stent strut surfaces in a haemodynamics dependent manner. This study highlights the impact of the stent strut height (thickness) and geometry (shape) on the local haemodynamics, modulating reendothelialization after stenting, an important factor in reducing the risk of stent thrombosis.
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Affiliation(s)
- Duy T. Nguyen
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Alexander F. Smith
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA 01003, USA
| | - Juan M. Jiménez
- Department of Mechanical and Industrial Engineering, University of Massachusetts Amherst, Amherst, MA 01003, USA
- Department of Biomedical Engineering, University of Massachusetts Amherst, Amherst, MA 01003, USA
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Pan C, Han Y, Lu J. Structural Design of Vascular Stents: A Review. MICROMACHINES 2021; 12:mi12070770. [PMID: 34210099 PMCID: PMC8305143 DOI: 10.3390/mi12070770] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/18/2022]
Abstract
Percutaneous Coronary Intervention (PCI) is currently the most conventional and effective method for clinically treating cardiovascular diseases such as atherosclerosis. Stent implantation, as one of the ways of PCI in the treatment of coronary artery diseases, has become a hot spot in scientific research with more and more patients suffering from cardiovascular diseases. However, vascular stent implanted into vessels of patients often causes complications such as In-Stent Restenosis (ISR). The vascular stent is one of the sophisticated medical devices, a reasonable structure of stent can effectively reduce the complications. In this paper, we introduce the evolution, performance evaluation standards, delivery and deployment, and manufacturing methods of vascular stents. Based on a large number of literature pieces, this paper focuses on designing structures of vascular stents in terms of “bridge (or link)” type, representative volume unit (RVE)/representative unit cell (RUC), and patient-specific stent. Finally, this paper gives an outlook on the future development of designing vascular stents.
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Affiliation(s)
- Chen Pan
- School of Mechanical Engineering, Beijing Institute of Technology, Zhongguancun South Street No. 5, Haidian District, Beijing 100081, China; (C.P.); (J.L.)
- Institute of Engineering Medicine, Beijing Institute of Technology, Zhongguancun South Street No. 5, Haidian District, Beijing 100081, China
| | - Yafeng Han
- School of Mechanical Engineering, Beijing Institute of Technology, Zhongguancun South Street No. 5, Haidian District, Beijing 100081, China; (C.P.); (J.L.)
- Correspondence:
| | - Jiping Lu
- School of Mechanical Engineering, Beijing Institute of Technology, Zhongguancun South Street No. 5, Haidian District, Beijing 100081, China; (C.P.); (J.L.)
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20
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Vardhan M, Randles A. Application of physics-based flow models in cardiovascular medicine: Current practices and challenges. BIOPHYSICS REVIEWS 2021; 2:011302. [PMID: 38505399 PMCID: PMC10903374 DOI: 10.1063/5.0040315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/18/2021] [Indexed: 03/21/2024]
Abstract
Personalized physics-based flow models are becoming increasingly important in cardiovascular medicine. They are a powerful complement to traditional methods of clinical decision-making and offer a wealth of physiological information beyond conventional anatomic viewing using medical imaging data. These models have been used to identify key hemodynamic biomarkers, such as pressure gradient and wall shear stress, which are associated with determining the functional severity of cardiovascular diseases. Importantly, simulation-driven diagnostics can help researchers understand the complex interplay between geometric and fluid dynamic parameters, which can ultimately improve patient outcomes and treatment planning. The possibility to compute and predict diagnostic variables and hemodynamics biomarkers can therefore play a pivotal role in reducing adverse treatment outcomes and accelerate development of novel strategies for cardiovascular disease management.
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Affiliation(s)
- M. Vardhan
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
| | - A. Randles
- Department of Biomedical Engineering, Duke University, Durham, North Carolina 27708, USA
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21
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Tarrahi I, Colombo M, Hartman EMJ, Tovar Forero MN, Torii R, Chiastra C, Daemen J, Gijsen FJH. Impact of bioresorbable scaffold design characteristics on local haemodynamic forces: an ex vivo assessment with computational fluid dynamics simulations. EUROINTERVENTION 2020; 16:e930-e937. [PMID: 31951204 DOI: 10.4244/eij-d-19-00657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS Bioresorbable scaffold (BRS) regions exposed to flow recirculation, low time-averaged wall shear stress (TAWSS) and high oscillatory shear index (OSI) develop increased neointima tissue. We investigated haemodynamic features in four different BRSs. METHODS AND RESULTS Fantom (strut height [SH] = 125 µm), Fantom Encore (SH = 98 µm), Absorb (SH = 157 µm) and Magmaris (SH = 150 µm) BRSs were deployed in phantom tubes and imaged with microCT. Both 2D and 3D geometrical scaffold models were reconstructed. Computational fluid dynamics (CFD) simulation was performed to compute TAWSS and OSI. Thicker struts had larger recirculation zones and lower TAWSS in 2D. Absorb had the largest recirculation zone and the lowest TAWSS (240 µm and -0.18 Pa), followed by Magmaris (170 µm and -0.15 Pa), Fantom (140 µm and -0.14 Pa) and Fantom Encore (100 µm and -0.13 Pa). Besides strut size, stent design played a dominant role in 3D. The highest percentage area adverse TAWSS (<0.5 Pa) and OSI (>0.2) were found for Fantom (56% and 30%) and Absorb (53% and 33%), followed by Fantom Encore (30% and 25%) and Magmaris (25% and 20%). Magmaris had the smallest areas due to a small footprint and rounded struts. CONCLUSIONS Due to stent design, both Fantom Encore and Magmaris showed smaller TAWSS and OSI than Fantom and Absorb. This study quantifies which scaffold features are most important to reduce long-term restenosis.
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Affiliation(s)
- Imane Tarrahi
- Department of Biomedical Engineering, Erasmus MC, Rotterdam, the Netherlands
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Sharifzadeh B, Kalbasi R, Jahangiri M, Toghraie D, Karimipour A. Computer modeling of pulsatile blood flow in elastic artery using a software program for application in biomedical engineering. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 192:105442. [PMID: 32192998 DOI: 10.1016/j.cmpb.2020.105442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/05/2020] [Accepted: 03/07/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND OBJECTIVE Atherosclerosis-a condition in which an artery is constricted-alters blood flow in the artery, that can exacerbate the condition. Focusing on previous studies, it can be seen that the k-ε model has been used in the simulation. Therefore, the reverse flow on the back of stenosis is not well represented. In this study, the simulated results are much closer to clinical results, relying on the use of physiological pulses, and considering elasticity of the vessel wall, and the applying k-ω model. It can therefore be claimed that a much more accurate prediction will be made regarding the formation, development and progression of the disease. METHODS Modeling biological systems usually contain many parameters, which cannot be calculated experimentally, or are too costly and time consuming. In addition, it is occasionally required to examine the influence of different physical variables, which, given the complexity of the governing equations, make analytical methods feasible (or very limited). The present study is an attempt to investigate the turbulent pulsatile blood flow in an elastic artery with single and double stenoses using a finite element software program, ADINA 8.8. RESULTS According to the results, the k - ω turbulence model predicted a larger reverse flow in the post-stenotic region and between the two stenoses in comparison with the k - ε model. In other words, the k - ω model results suggest that a larger region is prone to atherosclerosis. In addition, that the k - ε model predicted a greater maximum shear stress at the throat and a shorter reverse flow region (Mean WSS < 0) in both stenosis scenarios. In other words, relative to the k - ε model, the k - ω model underestimated the damage to the plaque and the risk of its rupture though it predicted new stenosis developing behind the previous one. It was observed that the presence of a double stenosis causes the upstream pressure to reach the critical value in less time. Velocity profiles revealed that in the stenosis throat, the maximum velocity exceeds the normal biological state, which may cause disorders in the blood circulation. CONCLUSIONS The artery wall displacement results are suggestive of the greater difference between the two turbulence models in the case with double stenosis compared with single stenosis. Moreover, the difference between the two turbulence models in double stenosis is minimized in both post-stenotic and pre-stenotic regions.
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Affiliation(s)
- Bahador Sharifzadeh
- Department of Mechanical engineering, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Rasool Kalbasi
- Department of Mechanical engineering, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Mehdi Jahangiri
- Department of Mechanical Engineering, Shahrekord Branch, Islamic Azad University, Shahrekord, Iran
| | - Davood Toghraie
- Department of Mechanical Engineering, Khomeinishahr Branch, Islamic Azad University, Khomeinishahr, Iran
| | - Arash Karimipour
- Sustainable Management of Natural Resources and Environment Research Group, Faculty of Environment and Labour Safety, Ton Duc Thang University, Ho Chi Minh City, Vietnam.
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Influence of Artery Straightening on Local Hemodynamics in Left Anterior Descending (LAD) Artery after Stent Implantation. Cardiol Res Pract 2020; 2020:6970817. [PMID: 32550022 PMCID: PMC7261340 DOI: 10.1155/2020/6970817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 04/20/2020] [Indexed: 11/29/2022] Open
Abstract
Objectives The study investigates local hemodynamic environment changes caused by straightening phenomenon and the relationship between straightening phenomenon and in-stent restenosis. Background Intravascular intervention is an effective treatment in restoring the normal flow conditions and vascular lumen. Unfortunately, in-stent restenosis often occurs in a subset of patients after stent implantation and limits the success of stent implantation outcomes. The implanted stent usually causes artery straightening locally, rather than coinciding and adjusting to the physiological curve exactly. Artery straightening would apparently modify the artery geometry and therefore alter the local hemodynamic environment, which may result in intimal hyperplasia and restenosis after stenting implantation. Methods In the current investigation, we verify the hypothesis that the artery straightening influences the local hemodynamic state using the different 3D CT models. Flow analysis for blood in the left anterior descending coronary artery and the straightening model is simulated numerically. Result The current results reveal that the straightening phenomenon alters the distribution of wall shear stress and flow patterns, decreases the wall shear stress (WSS), and increases the oscillatory shear index (OSI) and the relative residence time (RRT), especially at the proximal and distal areas of stenting. Conclusions The local straightened geometry established after stent implantation was likely to generate portions of the stenting area to a high risk of neointimal hyperplasia and subsequent restenosis.
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Liu CD, Chen F. Increase of wall shear stress caused by arteriovenous fistula reduces neointimal hyperplasia after stent implantation in healthy arteries. Vascular 2020; 28:396-404. [PMID: 32228224 DOI: 10.1177/1708538120913748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Wall shear stress plays a critical role in neointimal hyperplasia after stent implantation. It has been found that there is an inverse relation between wall shear stress and neointimal hyperplasia. This study hypothesized that the increase of arterial wall shear stress caused by arteriovenous fistula could reduce neointimal hyperplasia after stents implantation. METHODS AND RESULTS Thirty-six male rabbits were randomly divided into three groups: STENT, rabbits received stent implantation into right common carotid artery; STENT/arteriovenous fistula, rabbits received stent implantation into right common carotid artery and carotid-jugular arteriovenous fistula; Control, rabbits received no treatment. After 21 days, stented common carotid artery specimens were harvested for histological staining and protein expression analysis. In STENT group, wall shear stress maintained at a low level from 43.2 to 48.9% of baseline. In STENT/arteriovenous fistula group, wall shear stress gradually increased to 86% over baseline. There was a more significant neointimal hyperplasia in group STENT compared with the STENT/arteriovenous fistula group (neointima area: 0.87 mm2 versus 0.19 mm2; neointima-to-media area ratio: 1.13 versus 0.18). Western blot analysis demonstrated that the protein level of endothelial nitric oxide synthase in STENT group was significantly lower than that in STENT/arteriovenous fistula group, but the protein levels of proliferating cell nuclear antigen, vascular cell adhesion molecule 1, phospho-p38 mitogen-activated protein kinase (Pp38), and phospho-c-Jun N-terminal kinase in STENT group were significantly higher than that in the STENT group. CONCLUSION High wall shear stress caused by arteriovenous fistula as associated with the induction in neointimal hyperplasia after stent implantation. The underlying mechanisms may be related to modulating the expression and activation of endothelial nitric oxide synthase, vascular cell adhesion molecule 1, p38, and c-Jun N-terminal kinase.
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Affiliation(s)
- Chong Dong Liu
- Department of Vascular Surgery, the Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Feng Chen
- Department of Vascular Surgery, the Second Affiliated Hospital, Nanchang University, Nanchang, China
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Migliori S, Chiastra C, Bologna M, Montin E, Dubini G, Genuardi L, Aurigemma C, Mainardi L, Burzotta F, Migliavacca F. Application of an OCT-based 3D reconstruction framework to the hemodynamic assessment of an ulcerated coronary artery plaque. Med Eng Phys 2020; 78:74-81. [PMID: 32037282 DOI: 10.1016/j.medengphy.2019.12.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 11/23/2019] [Accepted: 12/01/2019] [Indexed: 01/09/2023]
Abstract
The rupture of a vulnerable plaque, known as ulceration, is the most common cause of myocardial infarction. It can be recognized by angiographic features, such as prolonged intraluminal filling and delayed clearance of the contrast liquid. The diagnosis of such an event is an open challenge due to the limited angiographic resolution and acquisition frequency. The treatment of ulcerated plaques is an open discussion, due to the high heterogeneity and the lack of evidences that support particular strategies. Therefore, the therapeutic decision should follow a detailed investigation with angiography and intravascular imaging, such as optical coherence tomography (OCT), to locate the lesion, besides its geometric features and the lumen occlusion severity. The aim of this study is the application of a framework for the in-silico analysis of the disrupted hemodynamics due to an ulcerated lesion. The study employed a validated OCT-based reconstruction methodology and computational fluid dynamics (CFD) simulations for the computation of local hemodynamic quantities, such as wall shear stress. The reported findings, such as disrupted pre-operative flow conditions, proved the applicability of the developed framework for CFD analyses on complicated patient-specific anatomies that feature ulcerated plaques. The prediction of lesion expansion and the clinical decision making can benefit from a reliable computation of wall shear stress distributions that result from the peculiar anatomy of the lesion. The application of intravascular OCT imaging, high fidelity 3D reconstructions and CFD simulations might guide the treatment of such pathology.
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Affiliation(s)
- Susanna Migliori
- Research and Development Department, Caristo Diagnostics, Oxford, United Kingdom; Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy; PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Marco Bologna
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Eros Montin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy; Center for Advanced Imaging Innovation and Research (CAI2R), and the Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, United States
| | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Lorenzo Genuardi
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cristina Aurigemma
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Mainardi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
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Mendieta JB, Fontanarosa D, Wang J, Paritala PK, McGahan T, Lloyd T, Li Z. The importance of blood rheology in patient-specific computational fluid dynamics simulation of stenotic carotid arteries. Biomech Model Mechanobiol 2020; 19:1477-1490. [DOI: 10.1007/s10237-019-01282-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022]
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Wei L, Leo HL, Chen Q, Li Z. Structural and Hemodynamic Analyses of Different Stent Structures in Curved and Stenotic Coronary Artery. Front Bioeng Biotechnol 2019; 7:366. [PMID: 31867313 PMCID: PMC6908811 DOI: 10.3389/fbioe.2019.00366] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/12/2019] [Indexed: 12/30/2022] Open
Abstract
Coronary artery stenting is commonly used for the treatment of coronary stenosis, and different stent structures indeed have various impacts on the stress distribution within the plaque and artery as well as the local hemodynamic environment. This study aims to evaluate the performance of different stent structures by characterizing the mechanical parameters after coronary stenting. Six stent structures including three commercially-shaped stents (Palmaz-Schatz-shaped, Xience Prime-shaped, and Cypher-shaped) and three author-developed stents (C-Rlink, C-Rcrown, and C-Astrut) implanted into a curved stenotic coronary artery were investigated. Structural analyses of the balloon-stent-plaque-artery system were first performed, and then followed by hemodynamic analyses. The results showed that among the three commercially-shaped stents, the Palmaz-Schatz-shaped had the least stent dogboning and recoiling, corresponding to the greatest maximum plastic strain and the largest diameter change, nevertheless, it induced the highest maximum von Mises stress on plaque, arterial intima and media. From the viewpoint of hemodynamics, the Palmaz-Schatz-shaped displayed smaller areas of adverse low wall shear stress (<0.5 Pa), low time-averaged wall shear stress (<0.5 Pa), and high oscillating shear index (>0.1). Compared to the Cypher-shaped, the C-Rcrown and C-Astrut had smaller recoiling, greater maximum plastic stain and larger diameter change, which indicated the improved mechanical performance of the Cypher-shaped stent. Moreover, both C-Rcrown and C-Astrut exhibited smaller areas of adverse low wall shear stress, and low time-averaged wall shear stress, but only the C-Rcrown displayed a smaller area of adverse high oscillating shear index. The present study evaluated and compared the performance of six different stents deployed inside a curved artery, and could be potentially utilized as a guide for the selection of suitable commercially-shaped stent for clinical application, and to provide an approach to improve the performance of the commercial stents.
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Affiliation(s)
- Lingling Wei
- Biomechanics Laboratory, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Qiang Chen
- Biomechanics Laboratory, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China
| | - Zhiyong Li
- Biomechanics Laboratory, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China.,School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD, Australia
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Zun PS, Narracott AJ, Chiastra C, Gunn J, Hoekstra AG. Location-Specific Comparison Between a 3D In-Stent Restenosis Model and Micro-CT and Histology Data from Porcine In Vivo Experiments. Cardiovasc Eng Technol 2019; 10:568-582. [PMID: 31531821 PMCID: PMC6863796 DOI: 10.1007/s13239-019-00431-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 09/07/2019] [Indexed: 11/25/2022]
Abstract
Background Coronary artery restenosis is an important side effect of percutaneous coronary intervention. Computational models can be used to better understand this process. We report on an approach for validation of an in silico 3D model of in-stent restenosis in porcine coronary arteries and illustrate this approach by comparing the modelling results to in vivo data for 14 and 28 days post-stenting. Methods This multiscale model includes single-scale models for stent deployment, blood flow and tissue growth in the stented vessel, including smooth muscle cell (SMC) proliferation and extracellular matrix (ECM) production. The validation procedure uses data from porcine in vivo experiments, by simulating stent deployment using stent geometry obtained from micro computed tomography (micro-CT) of the stented vessel and directly comparing the simulation results of neointimal growth to histological sections taken at the same locations. Results Metrics for comparison are per-strut neointimal thickness and per-section neointimal area. The neointimal area predicted by the model demonstrates a good agreement with the detailed experimental data. For 14 days post-stenting the relative neointimal area, averaged over all vessel sections considered, was 20 ± 3% in vivo and 22 ± 4% in silico. For 28 days, the area was 42 ± 3% in vivo and 41 ± 3% in silico. Conclusions The approach presented here provides a very detailed, location-specific, validation methodology for in silico restenosis models. The model was able to closely match both histology datasets with a single set of parameters. Good agreement was obtained for both the overall amount of neointima produced and the local distribution. It should be noted that including vessel curvature and ECM production in the model was paramount to obtain a good agreement with the experimental data. Electronic supplementary material The online version of this article (10.1007/s13239-019-00431-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- P S Zun
- Institute for Informatics, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands.
- Biomechanics Laboratory, Department of Biomedical Engineering, Erasmus Medical Center, Rotterdam, The Netherlands.
- National Center for Cognitive Technologies, ITMO University, Saint Petersburg, Russia.
| | - A J Narracott
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - C Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - J Gunn
- Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
- Insigneo Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - A G Hoekstra
- Institute for Informatics, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
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Tenekecioglu E, Torii R, Katagiri Y, Asano T, Modolo R, Miyazaki Y, Chichareon P, Poon EKW, Gijsen FJH, Thondapu V, van Klaveren D, Jonker H, Ooi A, Barlis P, Collet C, Onuma Y, Bourantas CV, Serruys PW. Early strut protrusion and late neointima thickness in the Absorb bioresorbable scaffold: a serial wall shear stress analysis up to five years. EUROINTERVENTION 2019; 15:e370-e379. [PMID: 29969424 DOI: 10.4244/eij-d-18-00381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of the study was to evaluate the effect of strut protrusion (SP) on wall shear stress (WSS) and neointimal growth (NG) one and five years after implantation of an Absorb bioresorbable vascular scaffold. METHODS AND RESULTS Eight patients were selected from a first-in-man study. Following three-dimensional (3D) reconstruction of coronaries, WSS was quantified using Newtonian steady-flow simulation in each cross-section at 5° subunits (sectors) of the circumferential luminal surface. At one year, neointimal thickness (NT) was measured by optical coherence tomography (OCT) and correlated to WSS and SP post procedure. Median SP was 112.9 (90.8, 133.1) µm post implantation. Post procedure, a logarithmic inverse relationship between SP and post-implantation WSS (r=-0.425, p<0.001; correlation coefficients in a range from -0.143 to -0.553) was observed, whereas a correlation between baseline logarithm-transformed WSS (log-WSS) and NT (r=-0.451, p<0.001; correlation coefficients ranged from -0.140 to -0.662) was documented at one year. Mixed-effects analysis between baseline log-WSS and NT at follow-up yielded a slope of 30 µm/ln Pascal (Pa) and a y-intercept of 98 µm. As a result of NG, median flow area decreased from 6.91 (6.53, 7.48) mm2 post implantation to 5.65 (5.47, 6.02) mm2 at one-year follow-up (p=0.01) and to 5.75±1.37 mm2 at five-year follow-up (p=0.024). However, the vessel surface exposed to low WSS (<1 Pa) decreased significantly post procedure (42%) to one year (35.9%) and five years (15.2%) (p-overall <0.0001). CONCLUSIONS SP disturbs laminar flow, creates regions of low WSS (<1.0 Pa) that are associated with NG and lumen area reduction. Low WSS post implantation reduced significantly at long-term follow-up. Thin struts with effective embedment would substantially reduce NG and accelerate homogenisation of WSS towards physiological values.
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Affiliation(s)
- Erhan Tenekecioglu
- Department of Interventional Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, the Netherlands
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Vardhan M, Gounley J, Chen SJ, Kahn AM, Leopold JA, Randles A. The importance of side branches in modeling 3D hemodynamics from angiograms for patients with coronary artery disease. Sci Rep 2019; 9:8854. [PMID: 31222111 PMCID: PMC6586809 DOI: 10.1038/s41598-019-45342-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 06/05/2019] [Indexed: 12/21/2022] Open
Abstract
Genesis of atherosclerotic lesions in the human arterial system is critically influenced by the fluid mechanics. Applying computational fluid dynamic tools based on accurate coronary physiology derived from conventional biplane angiogram data may be useful in guiding percutaneous coronary interventions. The primary objective of this study is to build and validate a computational framework for accurate personalized 3-dimensional hemodynamic simulation across the complete coronary arterial tree and demonstrate the influence of side branches on coronary hemodynamics by comparing shear stress between coronary models with and without these included. The proposed novel computational framework based on biplane angiography enables significant arterial circulation analysis. This study shows that models that take into account flow through all side branches are required for precise computation of shear stress and pressure gradient whereas models that have only a subset of side branches are inadequate for biomechanical studies as they may overestimate volumetric outflow and shear stress. This study extends the ongoing computational efforts and demonstrates that models based on accurate coronary physiology can improve overall fidelity of biomechanical studies to compute hemodynamic risk-factors.
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Affiliation(s)
- Madhurima Vardhan
- Department of Biomedical Engineering, Duke University, Durham, 27708, USA
| | - John Gounley
- Department of Biomedical Engineering, Duke University, Durham, 27708, USA
| | - S James Chen
- Department of Medicine/Cardiology, University of Colorado AMC, Aurora, 80045, USA
| | - Andrew M Kahn
- Division of Cardiovascular Medicine, University of California San Diego, San Diego, 92103, USA
| | - Jane A Leopold
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, 02115, USA
| | - Amanda Randles
- Department of Biomedical Engineering, Duke University, Durham, 27708, USA.
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31
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Obiweluozor FO, Tiwari AP, Lee JH, Batgerel T, Kim JY, Lee D, Park CH, Kim CS. Thromboresistant semi-IPN hydrogel coating: Towards improvement of the hemocompatibility/biocompatibility of metallic stent implants. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2019; 99:1274-1288. [DOI: 10.1016/j.msec.2019.02.054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/29/2019] [Accepted: 02/15/2019] [Indexed: 02/09/2023]
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32
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Üveges Á, Jenei C, Kiss T, Szegedi Z, Tar B, Szabó GT, Czuriga D, Kőszegi Z. Three-dimensional evaluation of the spatial morphology of stented coronary artery segments in relation to restenosis. Int J Cardiovasc Imaging 2019; 35:1755-1763. [PMID: 31127455 PMCID: PMC6773821 DOI: 10.1007/s10554-019-01628-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/13/2019] [Indexed: 11/30/2022]
Abstract
To investigate the correlations between the three-dimensional (3D) parameters of target coronary artery segments and restenosis after stent implantation. Sixty-four patients after single, cobalt chromium platform stent (27 BM stents and 37 DES) implantation were investigated retrospectively 12 ± 6 months after the index procedure. 3D coronary artery reconstruction was performed before and after the stent implantation using appropriate projections by a dedicated reconstruction software. The curve of the target segment was characterized by the ratio of the vessel length measured at midline (arc: A) and the distance between the edge points of the stent (chord: C): A/C ratio (ACr). Age, diabetes and hyperlipidaemia were taken into account for the statistical evaluation. 22 patients were diagnosed with ISR, while 42 patients without any restenosis served as controls. The two groups did not differ regarding major cardiovascular risk factors, proportion of the treated vessels or the type of stents. Higher initial ACr values were associated with greater straightening of the vessel curvature in all groups (p < 0.001). Significant negative correlations were found in cases of proximal or distal edge bending angles (p < 0.001). Pre-stent edge bending angles < 7° often showed an increase after the stent implantation, while in case of higher initial values, the bending angles generally decreased. Using multivariate logistic regression modelling we found that the pre-stent ACr was an independent predictor of in-stent restenosis (odds ratio for 1% increase of the ACr: 1.08; p = 0.012). Changes of angles at the stent edges following stent implantation correlate with the initial local bending angles. The ACr predispose to chronic shear stress in the vessel wall, which may contribute to the pathological intimal proliferation.
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Affiliation(s)
- Áron Üveges
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary. .,Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary.
| | - Csaba Jenei
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Tibor Kiss
- Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
| | - Zoltán Szegedi
- Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
| | - Balázs Tar
- Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
| | - Gábor Tamás Szabó
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dániel Czuriga
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsolt Kőszegi
- Division of Cardiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Szabolcs - Szatmár - Bereg County Hospitals and University Teaching Hospital, Nyíregyháza, Hungary
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Abstract
Background and Objective Ostial LM stenting potentially induces turbulence in the aortic wall near the LM ostium, which might be correlated with aorta dilation and dissection. We investigated through a computational fluid dynamic analysis (CFD), the presence and potential consequences of flow turbulences both in the ascending aorta and arch after a stenting left main (LM) mid shaft or distal disease. Methods The model of the ascending aorta and left coronary artery was reconstructed reviewing both angiographic and echocardiographic measurements of 80 consecutive patients (43 males, mean age 75.1 ± 6.2 years) with significant LM mid shaft or distal disease treated in our institution. For stent simulation, a third-generation everolimus-eluting stent was reconstructed. Two stenting procedures (lesion 1:1 or ostial coverage) were investigated. Results The net area averaged WSS of the model resulted higher when the stent covered the lesion 1:1 compared to the ostial coverage (3.68 vs. 2.06 Pa, P=0.01 and 3.97 vs. 1.98 Pa, P < 0.001, respectively). LM ostial coverage generates more turbulences in the LM itself, in the aortic wall at ostium level, and at the sino-tubular junction compared with the stenting of the lesion 1:1. Conversely, in the ascending aorta, the WSS appears lower when stenting the lesion 1:1. Conclusion Extending the stent coverage up to the ostium, when the ostial region is not diseased, might induce unfavorable alterations of flow; not only both at the level of the LM lesion and ostium sites, but also in the ascending aorta and aortic arch, potentially predisposing the aortic wall to long-term damage.
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34
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Liu L, Zhang XB, Lu S, Liu ZJ, Zhu XJ. Plaque Distribution of Basilar Artery Fenestration by 3D High-Resolution MR Vessel Wall Imaging. Cell Transplant 2019; 28:851-855. [PMID: 30983405 PMCID: PMC6719492 DOI: 10.1177/0963689719843813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The association between fenestrations and neurovascular pathology is not well defined. The morphology of vessel wall plays an important role in the development of neurovascular pathology. We sought to explore the plaque distribution around basilar artery fenestration (BAF) by three-dimensional high-resolution MR vessel wall imaging (3D HRMRI). Patients with BAF on 3D HRMRI images were enrolled. All cross-sectional slices of basilar arteries were assessed and categorized based on the location of fenestration as proximal segment, in-bifurcation segment, and distal segment. Furthermore, plaques in the in-bifurcation segment were classified according to their orientation being centered on the lateral, interior, dorsal, or ventral wall of the vessel. In all, 12 cases with BAF involving 661 cross-sectional image slices in entire basilar arteries were included. Plaques were found in 190 image slices, with the distribution of 41 slices in the proximal segment, 144 slices in the in-bifurcation segment and 67 slices in the distal segment. Plaques were found more frequently in the proximal and in-bifurcation segments than in the distal segment (P < 0.001), but there was no statistical difference between the proximal and in-bifurcation segment (P = 0.11). In the in-bifurcation segment, plaques were more frequently located at the lateral (50.0%) than other interior (16.0%), dorsal (21.0%), and ventral (13.0%) wall (P < 0.001).Plaques of BAF tend to locate in the proximal and in-bifurcation segments, especially at the lateral wall of the in-bifurcation segment.
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Affiliation(s)
- Lei Liu
- 1 Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Xue-Bin Zhang
- 2 Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Shuo Lu
- 1 Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Zun-Jing Liu
- 1 Department of Neurology, China-Japan Friendship Hospital, Beijing, China
| | - Xian-Jin Zhu
- 2 Department of Radiology, China-Japan Friendship Hospital, Beijing, China
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Elliott MR, Kim D, Molony DS, Morris L, Samady H, Joshi S, Timmins LH. Establishment of an Automated Algorithm Utilizing Optical Coherence Tomography and Micro-Computed Tomography Imaging to Reconstruct the 3-D Deformed Stent Geometry. IEEE TRANSACTIONS ON MEDICAL IMAGING 2019; 38:710-720. [PMID: 30843790 PMCID: PMC6407623 DOI: 10.1109/tmi.2018.2870714] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Percutaneous coronary intervention (PCI) is the prevalent treatment for coronary artery disease, with hundreds of thousands of stents implanted annually. Computational studies have demonstrated the role of biomechanics in the failure of vascular stents, but clinical studies is this area are limited by a lack of understanding of the deployed stent geometry, which is required to accurately model and predict the stent-induced in vivo biomechanical environment. Herein, we present an automated method to reconstruct the 3-D deployed stent configuration through the fusion of optical coherence tomography (OCT) and micro-computed tomography ( μ CT) imaging data. In an experimental setup, OCT and μ CT data were collected in stents deployed in arterial phantoms ( n=4 ). A constrained iterative deformation process directed by diffeomorphic metric mapping was developed to deform μ CT data of a stent wireframe to the OCT-derived sparse point cloud of the deployed stent. Reconstructions of the deployed stents showed excellent agreement with the ground-truth configurations, with the distance between corresponding points on the reconstructed and ground-truth configurations of [Formula: see text]. Finally, reconstructions required <30 min of computational time. In conclusion, the developed and validated reconstruction algorithm provides a complete spatially resolved reconstruction of a deployed vascular stent from commercially available imaging modalities and has the potential, with further development, to provide more accurate computational models to evaluate the in vivo post-stent mechanical environment, as well as clinical visualization of the 3-D stent geometry immediately following PCI.
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Prithipaul PKM, Kokkolaras M, Pasini D. Assessment of structural and hemodynamic performance of vascular stents modelled as periodic lattices. Med Eng Phys 2018; 57:11-18. [PMID: 29759946 DOI: 10.1016/j.medengphy.2018.04.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 03/17/2018] [Accepted: 04/16/2018] [Indexed: 11/16/2022]
Abstract
This work considers vascular stents with tubular geometry assumed to follow a periodic arrangement of repeating unit cells. Structural and hemodynamic metrics are presented to assess alternative stent geometries, each defined by the topology of the unit cell. Structural metrics include foreshortening, elastic recoil and radial stiffness, whereas hemodynamic performance is described by a wall shear stress index quantifying the impact of in-stent restenosis. A representative volume element (RVE) modelling approach is used, and results are compared to those obtained from full simulations of entire stents. We demonstrate that the RVE approach can be used to quantify the impact of the topology of the repeating unit on the structural and hemodynamic properties of a stent, and thus support clinicians in making proper choices among alternative stent geometries.
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Affiliation(s)
- Purnendu K M Prithipaul
- Department of Mechanical Engineering, McGill University, 817 Sherbrook St. West, Montreal, Quebec, H3A 0C3, Canada.
| | - Michael Kokkolaras
- Department of Mechanical Engineering, McGill University, 817 Sherbrook St. West, Montreal, Quebec, H3A 0C3, Canada.
| | - Damiano Pasini
- Department of Mechanical Engineering, McGill University, 817 Sherbrook St. West, Montreal, Quebec, H3A 0C3, Canada.
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37
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Wang J, Jin X, Huang Y, Ran X, Luo D, Yang D, Jia D, Zhang K, Tong J, Deng X, Wang G. Endovascular stent-induced alterations in host artery mechanical environments and their roles in stent restenosis and late thrombosis. Regen Biomater 2018; 5:177-187. [PMID: 29942650 PMCID: PMC6007795 DOI: 10.1093/rb/rby006] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/11/2018] [Accepted: 03/08/2018] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular stent restenosis remains a major challenge in interventional treatment of cardiovascular occlusive disease. Although the changes in arterial mechanical environment due to stent implantation are the main causes of the initiation of restenosis and thrombosis, the mechanisms that cause this initiation are still not fully understood. In this article, we reviewed the studies on the issue of stent-induced alterations in arterial mechanical environment and discussed their roles in stent restenosis and late thrombosis from three aspects: (i) the interaction of the stent with host blood vessel, involve the response of vascular wall, the mechanism of mechanical signal transmission, the process of re-endothelialization and late thrombosis; (ii) the changes of hemodynamics in the lumen of the vascular segment and (iii) the changes of mechanical microenvironment within the vascular segment wall due to stent implantation. This review has summarized and analyzed current work in order to better solve the two main problems after stent implantation, namely in stent restenosis and late thrombosis, meanwhile propose the deficiencies of current work for future reference.
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Affiliation(s)
- Jinxuan Wang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education; State and Local Joint Engineering Laboratory for Vascular Implants; Bioengineering College of Chongqing University, Chongqing, China
| | - Xuepu Jin
- Key Laboratory of Biorheological Science and Technology, Ministry of Education; State and Local Joint Engineering Laboratory for Vascular Implants; Bioengineering College of Chongqing University, Chongqing, China
| | - Yuhua Huang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education; State and Local Joint Engineering Laboratory for Vascular Implants; Bioengineering College of Chongqing University, Chongqing, China
| | - Xiaolin Ran
- Key Laboratory of Biorheological Science and Technology, Ministry of Education; State and Local Joint Engineering Laboratory for Vascular Implants; Bioengineering College of Chongqing University, Chongqing, China
| | - Desha Luo
- Key Laboratory of Biorheological Science and Technology, Ministry of Education; State and Local Joint Engineering Laboratory for Vascular Implants; Bioengineering College of Chongqing University, Chongqing, China
| | - Dongchuan Yang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education; State and Local Joint Engineering Laboratory for Vascular Implants; Bioengineering College of Chongqing University, Chongqing, China
| | - Dongyu Jia
- Key Laboratory of Biorheological Science and Technology, Ministry of Education; State and Local Joint Engineering Laboratory for Vascular Implants; Bioengineering College of Chongqing University, Chongqing, China
| | - Kang Zhang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education; State and Local Joint Engineering Laboratory for Vascular Implants; Bioengineering College of Chongqing University, Chongqing, China
| | - Jianhua Tong
- Institute for Biomedical Engineering & Nano Science, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaoyan Deng
- Key Laboratory for Biomechanics and Mechanobiology of the Ministry of Education, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Guixue Wang
- Key Laboratory of Biorheological Science and Technology, Ministry of Education; State and Local Joint Engineering Laboratory for Vascular Implants; Bioengineering College of Chongqing University, Chongqing, China
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Fu Y, Zhang S, Du H, Li L, Wang C, Zheng G, Wang Y, Dong H, Jia H, Yu B. Impact of vessel curvature on neointimal healing after stent implantation as assessed by optical coherence tomography. Medicine (Baltimore) 2018; 97:e0518. [PMID: 29668639 PMCID: PMC5916689 DOI: 10.1097/md.0000000000010518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Previous studies have indicated that stent implantation could alter the vessel geometry, which may impact the neointimal healing process. Curvature is an important parameter for evaluating vessel geometry. The purpose of our study was to investigate the relationship between vessel curvature and neointimal healing after stent implantation. METHODS Fifty-nine patients with acute coronary syndrome (ACS) who underwent stent implantation were enrolled in the study. According to the post-percutaneous coronary intervention vessel curvature measured by quantitative coronary angiography, patients were divided into high (n = 30) and low (n = 29) curvature groups. Neointimal thickness and area together with the neointimal type were assessed by optical coherence tomography at a 6-month follow-up. RESULTS Baseline clinical characteristics were comparable between the 2 groups. The vessel curvature at pre- and 6-month follow-up was significantly higher in the high curvature group than the low curvature group. At 6-month follow-up, neointimal thickness (0.22 [0.08-0.32] mm vs. 0.10 [0.07-0.16] mm, P = .043) and neointimal area (1.86 [0.66-2.66] vs. 0.82 [0.60-1.41] mm, P = .030) were significantly higher in the high curvature group than the low curvature group. In the high curvature group, the incidence of the heterogeneous neointimal type was higher than that in the low curvature group (50.00% vs. 17.20%, respectively, P = .004), whereas the frequency of the homogeneous neointimal type was lower (43.30% vs. 82.80%, respectively, P = .004) in the high curvature group than the low curvature group. CONCLUSION Higher vessel curvature after stent implantation may potentially have an impact on the neointimal healing with a higher incidence of heterogeneous neointimal.
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Lin CY, Veneziani A, Ruthotto L. Numerical methods for polyline-to-point-cloud registration with applications to patient-specific stent reconstruction. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e2934. [PMID: 29073332 DOI: 10.1002/cnm.2934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 05/08/2017] [Accepted: 10/15/2017] [Indexed: 06/07/2023]
Abstract
We present novel numerical methods for polyline-to-point-cloud registration and their application to patient-specific modeling of deployed coronary artery stents from image data. Patient-specific coronary stent reconstruction is an important challenge in computational hemodynamics and relevant to the design and improvement of the prostheses. It is an invaluable tool in large-scale clinical trials that computationally investigate the effect of new generations of stents on hemodynamics and eventually tissue remodeling. Given a point cloud of strut positions, which can be extracted from images, our stent reconstruction method aims at finding a geometrical transformation that aligns a model of the undeployed stent to the point cloud. Mathematically, we describe the undeployed stent as a polyline, which is a piecewise linear object defined by its vertices and edges. We formulate the nonlinear registration as an optimization problem whose objective function consists of a similarity measure, quantifying the distance between the polyline and the point cloud, and a regularization functional, penalizing undesired transformations. Using projections of points onto the polyline structure, we derive novel distance measures. Our formulation supports most commonly used transformation models including very flexible nonlinear deformations. We also propose 2 regularization approaches ensuring the smoothness of the estimated nonlinear transformation. We demonstrate the potential of our methods using an academic 2D example and a real-life 3D bioabsorbable stent reconstruction problem. Our results show that the registration problem can be solved to sufficient accuracy within seconds using only a few number of Gauss-Newton iterations.
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Affiliation(s)
- Claire Yilin Lin
- Department of Mathematics, University of Michigan, Ann Arbor, 48109, MI, USA
| | - Alessandro Veneziani
- Department of Mathematics and Computer Science, Emory University, 400 Dowman Dr NE, Atlanta, 30322, GA, USA
- School of Advanced Studies IUSS Pavia, Piazza della Vittoria 15, 27100 Pavia, Italy
| | - Lars Ruthotto
- Department of Mathematics and Computer Science, Emory University, 400 Dowman Dr NE, Atlanta, 30322, GA, USA
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Zhang BC, Tu SX, Karanasos A, van Geuns RJ, de Jaegere P, Zijlstra F, Regar E. Association of stent-induced changes in coronary geometry with late stent failure: Insights from three-dimensional quantitative coronary angiographic analysis. Catheter Cardiovasc Interv 2018; 92:1040-1048. [PMID: 29399998 DOI: 10.1002/ccd.27520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 12/31/2017] [Accepted: 01/06/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND The relationship between vessel angulation and large changes in vessel geometry after stent implantation and the occurrence of stent failure still remains unclear. We sought to investigate the association of the change in the coronary bending angle after stenting and the risk for late stent failure by three-dimensional quantitative coronary angiography (3D QCA). METHODS The bending angle in coronary lesions that presented with late stent failure and those without stent failure was computed during the cardiac cycle, before and after stenting using a recently developed 3D QCA software. RESULTS A total of 40 lesions with stent failure (cases) were successfully matched to 47 lesions without stent failure (controls).The mean duration to follow-up coronary angiography was 1,011 days in cases and 1,109 days in the control group (P = 0.14). In stent failure, the systolic bending angle after stenting was smaller (14.45° [12.18, 17.68] versus 18.20° [14.00, 20.30], P = 0.01), while the stent-induced change in systolic bending angle was significantly larger (4.15° [1.13, 7.20] versus 1.80° [-1.90, 4.40], P = 0.004). Multivariable logistic regression analysis suggested that systolic bending angle after stenting (odds ratio: 0.88; 95% CI: 0.79-0.99; P = 0.03), and decrease in systolic bending angle after stenting (odds ratio: 1.13; 95% CI: 1.02-1.26; P = 0.03) were predictors of stent failure. CONCLUSIONS Our study suggests that a change in the natural tortuous course of the coronaries by stent implantation with the decrease in coronary bending angle is a potentially major contributor in stent failure.
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Affiliation(s)
- Bu Chun Zhang
- Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, People's Republic of China.,Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sheng Xian Tu
- Med-X Research Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Antonios Karanasos
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Cardiology, Hippokration Hospital, Athens, Greece
| | - Robert-Jan van Geuns
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Peter de Jaegere
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Evelyn Regar
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.,University Hospital of Zurich, Heart Center, Zurich, Switzerland
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Chiastra C, Migliori S, Burzotta F, Dubini G, Migliavacca F. Patient-Specific Modeling of Stented Coronary Arteries Reconstructed from Optical Coherence Tomography: Towards a Widespread Clinical Use of Fluid Dynamics Analyses. J Cardiovasc Transl Res 2017; 11:156-172. [PMID: 29282628 PMCID: PMC5908818 DOI: 10.1007/s12265-017-9777-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/18/2017] [Indexed: 11/30/2022]
Abstract
The recent widespread application of optical coherence tomography (OCT) in interventional cardiology has improved patient-specific modeling of stented coronary arteries for the investigation of local hemodynamics. In this review, the workflow for the creation of fluid dynamics models of stented coronary arteries from OCT images is presented. The algorithms for lumen contours and stent strut detection from OCT as well as the reconstruction methods of stented geometries are discussed. Furthermore, the state of the art of studies that investigate the hemodynamics of OCT-based stented coronary artery geometries is reported. Although those studies analyzed few patient-specific cases, the application of the current reconstruction methods of stented geometries to large populations is possible. However, the improvement of these methods and the reduction of the time needed for the entire modeling process are crucial for a widespread clinical use of the OCT-based models and future in silico clinical trials.
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Affiliation(s)
- Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy.
| | - Susanna Migliori
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriele Dubini
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy
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Hewlin RL, Kizito JP. Development of an Experimental and Digital Cardiovascular Arterial Model for Transient Hemodynamic and Postural Change Studies: "A Preliminary Framework Analysis". Cardiovasc Eng Technol 2017; 9:1-31. [PMID: 29124548 DOI: 10.1007/s13239-017-0332-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
Abstract
The ultimate goal of the present work is to aid in the development of tools to assist in the treatment of cardiovascular disease. Gaining an understanding of hemodynamic parameters for medical implants allow clinicians to have some patient-specific proposals for intervention planning. In the present work an experimental and digital computational fluid dynamics (CFD) arterial model consisting of a number of major arteries (aorta, carotid bifurcation, cranial, femoral, jejunal, and subclavian arteries) were fabricated to study: (1) the effects of local hemodynamics (flow parameters) on global hemodynamics (2) the effects of transition from bedrest to upright position (postural change) on hemodynamics, and (3) diffusion of dye (medical drug diffusion simulation) in the arterial system via experimental and numerical techniques. The experimental and digital arterial models used in the present study are the first 3-D systems reported in literature to incorporate the major arterial vessels that deliver blood from the heart to the cranial and femoral arteries. These models are also the first reported in literature to be used for flow parameter assessment via medical drug delivery and orthostatic postural change studies. The present work addresses the design of the experimental and digital arterial model in addition to the design of measuring tools used to measure hemodynamic parameters. The experimental and digital arterial model analyzed in the present study was developed from patient specific computed tomography angiography (CTA) scans and simplified geometric data. Segments such as the aorta (ascending and descending) and carotid bifurcation arteries of the experimental and digital arterial model was created from online available patient-specific CTA scan data provided by Charite' Clinical and Research Hospital. The cranial and coronary arteries were simplified arterial geometries developed from dimensional specification data used in previous work. For the patient specific geometries, a MATLAB code was written to upload the CTA scans of each artery, calculate the centroids, and produce surface splines at each discrete cross section along the lumen centerline to create the patient specific arterial geometries. The MATLAB code worked in conjunction with computer aided software (CAD) Solidworks to produce solid models of the patient specific geometries and united them with the simplified geometries to produce the full arterial model (CAD model). The CAD model was also used as a blueprint to fabricate the experimental model which was used for flow visualization via particle imaging velocimetry (PIV) and postural change studies. A custom pulse duplicator (pulsatile pump) was also designed and developed for the present work. The pulse duplicator is capable of producing patient-specific volumetric waveforms for inlet flow to the experimental arterial model. A simple fluid structure interaction (FSI) study was also conducted via optical techniques to establish the magnitude of vessel diameter change due to the pulsatile flow. A medical drug delivery (dye dispersion and tracing) case was simulated via a dye being dispersed into the pulsatile flow stream to measure the transit time of the dye front. Pressure waveforms for diseased cases (hypertension & stenotic cases) were also obtained from the experimental arterial model during postural changes from bedrest (0°) to upright position (90°). The postural changes were simulated via attaching the experimental model to a tile table the can transition from 0° to 90°. The PIV results obtained from the experimental model provided parametric data such as velocity and wall shear stress data. The medical drug delivery simulations (experimental and numerical) studies produce time dependent data which is useful for predicting flow trajectory and transit time of medical drug dispersion. In the case of postural change studies, pressure waveforms were obtained from the common carotid artery and the femoral sections to yield pressure difference data useful for orthostatic hypotension analysis. Flow parametric data such as vorticity (flow reversal), wall shear stress, normal stress, and medical drug transit data was also obtained from the digital arterial model CFD simulations. Although the present work is preliminary work, the experimental and digital models proves to be useful in providing flow parametric data of interest such as: (1) normal stress which is useful for predicting the magnitude of forces which could promote arterial rupture or dislodging of medical implants, (2) wall shear stress which is useful for analyzing the magnitude of drug transport at the arterial wall, (3) vorticity which is useful for predicting the magnitude of flow reversal, and (4) arterial compliance in the case of the experimental model which could be useful in the efforts of developing FSI numerical simulations that incorporates compliance which realistically models the flow in the arterial system.
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Affiliation(s)
- Rodward L Hewlin
- University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, USA.
| | - John P Kizito
- North Carolina Agricultural and Technical State University, 1601 East Market Street, Greensboro, NC, 27411, USA
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43
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Haemodynamic effects of incomplete stent apposition in curved coronary arteries. J Biomech 2017; 63:164-173. [DOI: 10.1016/j.jbiomech.2017.09.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 07/18/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023]
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Price MJ, Shlofmitz RA, Spriggs DJ, Haldis TA, Myers P, Popma Almonacid A, Maehara A, Dauler M, Peng Y, Mehran R. Safety and efficacy of the next generation Resolute Onyx zotarolimus-eluting stent: Primary outcome of the RESOLUTE ONYX core trial. Catheter Cardiovasc Interv 2017; 92:253-259. [DOI: 10.1002/ccd.27322] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/02/2017] [Accepted: 08/14/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Matthew J. Price
- Department of Cardiovascular Diseases; Scripps Clinic; La Jolla California USA
| | | | - Douglas J. Spriggs
- Department of Interventional Cardiology; Morton Plant Hospital; Clearwater Florida USA
| | - Thomas A. Haldis
- Department of Interventional Cardiology; Sanford Health; Fargo North Dakota USA
| | - Paul Myers
- Department of Interventional Cardiology; Tristar Centennial Medical Center; Nashville Tennessee USA
| | - Alexandra Popma Almonacid
- Cardiovascular Imaging Core Laboratory; Beth Israel Deaconess Medical Center; Boston Massachusetts USA
| | | | - Michelle Dauler
- Coronary Clinical Department; Medtronic; Santa Rosa California USA
| | - Yun Peng
- Coronary Clinical Department; Medtronic; Santa Rosa California USA
| | - Roxana Mehran
- Department of Cardiology; Mount Sinai Medical Center; New York USA
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Wong KKL, Wang D, Ko JKL, Mazumdar J, Le TT, Ghista D. Computational medical imaging and hemodynamics framework for functional analysis and assessment of cardiovascular structures. Biomed Eng Online 2017; 16:35. [PMID: 28327144 PMCID: PMC5359907 DOI: 10.1186/s12938-017-0326-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/13/2017] [Indexed: 11/10/2022] Open
Abstract
Cardiac dysfunction constitutes common cardiovascular health issues in the society, and has been an investigation topic of strong focus by researchers in the medical imaging community. Diagnostic modalities based on echocardiography, magnetic resonance imaging, chest radiography and computed tomography are common techniques that provide cardiovascular structural information to diagnose heart defects. However, functional information of cardiovascular flow, which can in fact be used to support the diagnosis of many cardiovascular diseases with a myriad of hemodynamics performance indicators, remains unexplored to its full potential. Some of these indicators constitute important cardiac functional parameters affecting the cardiovascular abnormalities. With the advancement of computer technology that facilitates high speed computational fluid dynamics, the realization of a support diagnostic platform of hemodynamics quantification and analysis can be achieved. This article reviews the state-of-the-art medical imaging and high fidelity multi-physics computational analyses that together enable reconstruction of cardiovascular structures and hemodynamic flow patterns within them, such as of the left ventricle (LV) and carotid bifurcations. The combined medical imaging and hemodynamic analysis enables us to study the mechanisms of cardiovascular disease-causing dysfunctions, such as how (1) cardiomyopathy causes left ventricular remodeling and loss of contractility leading to heart failure, and (2) modeling of LV construction and simulation of intra-LV hemodynamics can enable us to determine the optimum procedure of surgical ventriculation to restore its contractility and health This combined medical imaging and hemodynamics framework can potentially extend medical knowledge of cardiovascular defects and associated hemodynamic behavior and their surgical restoration, by means of an integrated medical image diagnostics and hemodynamic performance analysis framework.
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Affiliation(s)
- Kelvin K. L. Wong
- School of Medicine, University of Western Sydney, Campbelltown, Sydney, NSW 2560 Australia
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
| | - Defeng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong
| | - Jacky K. L. Ko
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, New Territories Hong Kong
| | - Jagannath Mazumdar
- Centre for Biomedical Engineering and School of Electrical and Electronics Engineering, University of Adelaide, Adelaide, SA 5005 Australia
| | - Thu-Thao Le
- National Heart Centre, Mistri Wing, 17 Third Hospital Avenue, Singapore, 168752 Singapore
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Effects of bifurcation-specific and conventional stents on coronary bifurcation flow. An experimental and numerical study. J Biomech 2017; 54:64-72. [DOI: 10.1016/j.jbiomech.2017.01.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 01/23/2017] [Accepted: 01/25/2017] [Indexed: 01/09/2023]
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47
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Affiliation(s)
- Daniel E. Heath
- Department of Chemical and Biomolecular Engineering; Particulate Fluids Processing Centre; The University of Melbourne; Parkville Victoria Australia
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48
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Hsiao ST, Spencer T, Boldock L, Prosseda SD, Xanthis I, Tovar-Lopez FJ, Van Beusekom HMM, Khamis RY, Foin N, Bowden N, Hussain A, Rothman A, Ridger V, Halliday I, Perrault C, Gunn J, Evans PC. Endothelial repair in stented arteries is accelerated by inhibition of Rho-associated protein kinase. Cardiovasc Res 2016; 112:689-701. [PMID: 27671802 PMCID: PMC5157135 DOI: 10.1093/cvr/cvw210] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 09/09/2016] [Accepted: 09/17/2016] [Indexed: 12/14/2022] Open
Abstract
Aims Stent deployment causes endothelial cells (EC) denudation, which promotes in-stent restenosis and thrombosis. Thus endothelial regrowth in stented arteries is an important therapeutic goal. Stent struts modify local hemodynamics, however the effects of flow perturbation on EC injury and repair are incompletely understood. By studying the effects of stent struts on flow and EC migration, we identified an intervention that promotes endothelial repair in stented arteries. Methods and Results In vitro and in vivo models were developed to monitor endothelialization under flow and the influence of stent struts. A 2D parallel-plate flow chamber with 100 μm ridges arranged perpendicular to the flow was used. Live cell imaging coupled to computational fluid dynamic simulations revealed that EC migrate in the direction of flow upstream from the ridges but subsequently accumulate downstream from ridges at sites of bidirectional flow. The mechanism of EC trapping by bidirectional flow involved reduced migratory polarity associated with altered actin dynamics. Inhibition of Rho-associated protein kinase (ROCK) enhanced endothelialization of ridged surfaces by promoting migratory polarity under bidirectional flow (P < 0.01). To more closely mimic the in vivo situation, we cultured EC on the inner surface of polydimethylsiloxane tubing containing Coroflex Blue stents (65 μm struts) and monitored migration. ROCK inhibition significantly enhanced EC accumulation downstream from struts under flow (P < 0.05). We investigated the effects of ROCK inhibition on re-endothelialization in vivo using a porcine model of EC denudation and stent placement. En face staining and confocal microscopy revealed that inhibition of ROCK using fasudil (30 mg/day via osmotic minipump) significantly increased re-endothelialization of stented carotid arteries (P < 0.05). Conclusions Stent struts delay endothelial repair by generating localized bidirectional flow which traps migrating EC. ROCK inhibitors accelerate endothelial repair of stented arteries by enhancing EC polarity and migration through regions of bidirectional flow.
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Affiliation(s)
- Sarah T Hsiao
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK.,INSIGNEO Institute of In Silico Medicine, University of Sheffield, Sheffield S10 2RX, UK
| | - Tim Spencer
- Materials and Engineering Research Institute, Sheffield Hallam University, Sheffield S1 4RF, UK
| | - Luke Boldock
- Department of Mechanical Engineering, University of Sheffield, Sheffield S10 2RX, UK.,INSIGNEO Institute of In Silico Medicine, University of Sheffield, Sheffield S10 2RX, UK
| | - Svenja Dannewitz Prosseda
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK.,INSIGNEO Institute of In Silico Medicine, University of Sheffield, Sheffield S10 2RX, UK
| | - Ioannis Xanthis
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK.,INSIGNEO Institute of In Silico Medicine, University of Sheffield, Sheffield S10 2RX, UK
| | - Francesco J Tovar-Lopez
- School of Electrical and Computer Engineering, RMIT University, Melbourne VIC 3001, Australia
| | | | - Ramzi Y Khamis
- Faculty of Medicine, National Heart and Lung Institute, Imperial College London WI2 0HS, UK
| | | | - Neil Bowden
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK.,INSIGNEO Institute of In Silico Medicine, University of Sheffield, Sheffield S10 2RX, UK
| | - Adil Hussain
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK.,INSIGNEO Institute of In Silico Medicine, University of Sheffield, Sheffield S10 2RX, UK
| | - Alex Rothman
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK.,INSIGNEO Institute of In Silico Medicine, University of Sheffield, Sheffield S10 2RX, UK
| | - Victoria Ridger
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK.,INSIGNEO Institute of In Silico Medicine, University of Sheffield, Sheffield S10 2RX, UK
| | - Ian Halliday
- Materials and Engineering Research Institute, Sheffield Hallam University, Sheffield S1 4RF, UK
| | - Cecile Perrault
- Department of Mechanical Engineering, University of Sheffield, Sheffield S10 2RX, UK.,INSIGNEO Institute of In Silico Medicine, University of Sheffield, Sheffield S10 2RX, UK
| | - Julian Gunn
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK.,INSIGNEO Institute of In Silico Medicine, University of Sheffield, Sheffield S10 2RX, UK
| | - Paul C Evans
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK .,INSIGNEO Institute of In Silico Medicine, University of Sheffield, Sheffield S10 2RX, UK.,Bateson Centre, University of Sheffield, Sheffield S10 2RX, UK
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Gaudry M, Bartoli JM, Bal L, Giorgi R, De Masi M, Magnan PE, Piquet P. Anatomical and Technical Factors Influence the Rate of In-Stent Restenosis following Carotid Artery Stenting for the Treatment of Post-Carotid Endarterectomy Stenosis. PLoS One 2016; 11:e0161716. [PMID: 27611997 PMCID: PMC5017627 DOI: 10.1371/journal.pone.0161716] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/10/2016] [Indexed: 12/03/2022] Open
Abstract
Background Carotid artery stenting (CAS) has been advocated as an alternative to redo surgery for the treatment of post-carotid endarterectomy (CEA) stenosis. This study analyzed the efficacy of CAS for post-CEA restenosis, focusing on an analysis of technical and anatomical predictive factors for in-stent restenosis. Methods We performed a retrospective monocentric study. We included all patients who underwent CAS for post-CEA restenosis at our institution from July 1997 to November 2013. The primary endpoints were the technical success, the presence of in-stent restenosis >50% or occlusion, either symptomatic or asymptomatic, during the follow-up period, and risk factors for restenosis. The secondary endpoints were early and late morbidity and mortality (TIA, stroke, myocardial infarction, or death). Results A total of 153 CAS procedures were performed for post-CEA restenosis, primarily because of asymptomatic lesions (137/153). The technical success rate was 98%. The 30-day perioperative stroke and death rate was 2.6% (two TIAs and two minor strokes), and rates of 2.2% (3/137) and 6.2% (1/16) were recorded for asymptomatic and symptomatic patients, respectively. The average follow-up time was 36 months (range, 6–171 months). In-stent restenosis or occlusion was observed in 16 patients (10.6%). Symptomatic restenosis was observed in only one patient. We found that young age (P = 0.002), stenosis > 85% (P = 0.018), and a lack of stent coverage of the common carotid artery (P = 0.006) were independent predictors of in-stent restenosis. Conclusion We identified new risk factors for in-stent restenosis that were specific to this population, and we propose a technical approach that may reduce this risk.
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Affiliation(s)
- Marine Gaudry
- APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France
- * E-mail:
| | | | - Laurence Bal
- APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France
| | - Roch Giorgi
- Aix-Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Marseille, France
- APHM, Hôpital Timone, Service Biostatistique et Technologies de l’Information et de la Communication, Marseille, France
| | - Mariangela De Masi
- APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France
| | | | - Philippe Piquet
- APHM, Hôpital Timone, Department of Vascular Surgery, 13005, Marseille, France
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Brindise MC, Chiastra C, Burzotta F, Migliavacca F, Vlachos PP. Hemodynamics of Stent Implantation Procedures in Coronary Bifurcations: An In Vitro Study. Ann Biomed Eng 2016; 45:542-553. [PMID: 27460012 DOI: 10.1007/s10439-016-1699-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 07/19/2016] [Indexed: 01/09/2023]
Abstract
Stent implantation in coronary bifurcations presents unique challenges and currently there is no universally accepted stent deployment approach. Despite clinical and computational studies, the effect of each stent implantation method on the coronary artery hemodynamics is not well understood. In this study the hemodynamics of stented coronary bifurcations under pulsatile flow conditions were investigated experimentally. Three implantation methods, provisional side branch (PSB), culotte (CUL), and crush (CRU), were investigated using time-resolved particle image velocimetry to measure the velocity fields. Subsequently, hemodynamic parameters including wall shear stress, oscillatory shear index (OSI), and relative residence time (RRT) were calculated. The pressure field through the vessel was non-invasively quantified and pressure wave speeds were computed. The effects of each stented case were evaluated and compared against an un-stented case. CRU provided the lowest compliance mismatch, but demonstrated detrimental stent interactions. PSB, the clinically preferred method, and CUL maintained many normal flow conditions. However, PSB provided about a 300% increase in both OSI and RRT. CUL yielded a 10 and 85% increase in OSI and RRT, respectively. The results of this study support the concept that different bifurcation stenting techniques result in hemodynamic environments that deviate from that of un-stented bifurcations, to varying degrees.
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Affiliation(s)
- Melissa C Brindise
- School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN, 47907, USA
| | - Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Chemistry, Materials and Chemical Engineering Department "Giulio Natta", Politecnico di Milano, Milan, Italy
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Francesco Burzotta
- Department of Cardiovascular Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Chemistry, Materials and Chemical Engineering Department "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Pavlos P Vlachos
- School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN, 47907, USA.
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