Hemodynamic Simulation of Intra-stent Blood Flow

Abstract The stent has been a major breakthrough for the treatment of atherosclerotic vascular disease. The permanent vascular implant of a stent, however, changes the blood flow hemodynamics and may consequently affect the restenosis process. Computational Fluid Dynamics (CFD) has been widely used to analyze the hemodynamic behavior and wall shear stress (WSS) distribution in stented arteries. The objective of this study is to present a thorough comparison among various CFD models to investigate the effects of rheological properties and pulsatile flow on hemodynamic simulation of the intra-stent blood flow. Several CFD models were developed with various modeling setups – axisymmetric parallel ring vs. 3-D stented artery model, Newtonian vs. non-Newtonian flow, and steady-state vs. pulsatile flow. Simulated results show that the minimum WSS occurs at the recirculation zones located at the downstream or backside of each stent struts. The rheological effect on WWS is minor in the axisymmetric parallel ring model; however, it becomes slightly significant in the 3-D stented artery model, with Newtonian flow being a more conservative assumption. For given pulsatile waveforms, the steady-state and pulsatile flow resulted in fairly similar trends in the WSS distribution. Therefore, it is reasonable to simulate the intra-stent blood flow as a steady-state Newtonian flow, which could be beneficial in more complex simulations and drastically reduce the computational time. These findings will provide great insights for future stent design optimization to reduce restenosis.

[1]  B. Berk,et al.  Laminar shear stress: mechanisms by which endothelial cells transduce an atheroprotective force. , 1998, Arteriosclerosis, thrombosis, and vascular biology.

[2]  Abdul I. Barakat,et al.  Computational Study of Fluid Mechanical Disturbance Induced by Endovascular Stents , 2005, Annals of Biomedical Engineering.

[3]  K Ulm,et al.  Restenosis after coronary placement of various stent types. , 2001, The American journal of cardiology.

[4]  Y. Matsumoto,et al.  Does stent design affect probability of restenosis? A randomized trial comparing Multilink stents with GFX stents. , 2001, American heart journal.

[5]  J. Womersley Method for the calculation of velocity, rate of flow and viscous drag in arteries when the pressure gradient is known , 1955, The Journal of physiology.

[6]  J. Rodés-Cabau,et al.  Papel de la tensión de cizallamiento en la enfermedad aterosclerótica y la reestenosis tras implantación de stent coronario , 2006 .

[7]  John F LaDisa,et al.  Alterations in wall shear stress predict sites of neointimal hyperplasia after stent implantation in rabbit iliac arteries. , 2005, American journal of physiology. Heart and circulatory physiology.

[8]  A. Wahle,et al.  Effect of Endothelial Shear Stress on the Progression of Coronary Artery Disease, Vascular Remodeling, and In-Stent Restenosis in Humans: In Vivo 6-Month Follow-Up Study , 2003, Circulation.

[9]  S. Alper,et al.  Hemodynamic shear stress and its role in atherosclerosis. , 1999, JAMA.

[10]  Damien Coisne,et al.  Computational Approach to Estimating the Effects of Blood Properties on Changes in Intra-stent Flow , 2006, Annals of Biomedical Engineering.

[11]  C Bertolotti,et al.  Numerical and experimental models of post-operative realistic flows in stenosed coronary bypasses. , 2001, Journal of biomechanics.

[12]  S Chien,et al.  Effects of hematocrit and plasma proteins on human blood rheology at low shear rates. , 1966, Journal of applied physiology.

[13]  D. Lee,et al.  Intimal thickening under shear in a carotid bifurcation--a numerical study. , 1996, Journal of biomechanics.

[14]  Siamak Najarian,et al.  Analysis of wall shear stress in stented coronary artery using 3D computational fluid dynamics modeling , 2008 .

[15]  J J Wentzel,et al.  Relationship Between Neointimal Thickness and Shear Stress After Wallstent Implantation in Human Coronary Arteries , 2001, Circulation.