Hemodynamic alternations following stent deployment and post-dilation in a heavily calcified coronary artery: In silico and ex-vivo approaches
| Autor: | David L. Wilson, Vladislav Zimin, Hiram G. Bezerra, Linxia Gu, Luis Augusto Palma Dallan, Yazan Gharaibeh, Peshala P. T Gamage, Juhwan Lee, Pengfei Dong |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Lumen (anatomy) Hemodynamics Health Informatics Article Restenosis Internal medicine medicine Shear stress Humans Computer Simulation cardiovascular diseases business.industry Stent equipment and supplies medicine.disease Coronary Vessels Dilatation Arterial tree Computer Science Applications surgical procedures operative medicine.anatomical_structure Aortic pressure Cardiology Stents business Tomography Optical Coherence Artery |
| Zdroj: | Comput Biol Med |
| ISSN: | 1879-0534 |
| Popis: | In this work, the 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, including the lumen areas, stent underexpansion, and showed qualitative agreement with 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-dilation mitigated the strut malapposition, and thus the shear rate. Moreover, areas of low (TAWSS 2000 s(−1)) were quantified to estimate the risks of in-stent restenosis (ISR) and stent thrombosis (ST). Results of oscillatory shear index (OSI) and relative residence time (RRT) indicated the wall regions more prone to ISR are located near the malapposed stent struts. |
| Databáze: | OpenAIRE |
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