Cardiovascular stent design and wall shear stress distribution in coronary stented arteries

The stent is a major breakthrough in the treatment of coronary artery diseases. The permanent vascular implant of a stent, however, changes the intra-stent blood flow haemodynamics. There is a growing consensus that the stent implant may change the artery wall shear stress distribution and hence trigger the restenosis process. Computational fluid dynamics (CFD) has been widely used to analyse haemodynamics in stented arteries. In this Letter, CFD models were developed to investigate the effects of stent design pattern and strut geometry, respectively, on the wall shear stress distribution in coronary stented arteries. Assessment of the potential restenosis risk was primarily based on the wall shear stress distribution. Results show that the stent design pattern alone does not have a significant impact on the stent haemodynamic behaviour. Wall shear stress is very sensitive to strut thickness, while varying the strut width or crown radius has very little effect. The proposed methodology and findings will provide great insight for future optimisation of stent design to reduce the risk of restenosis.

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

[2]  D. Ku,et al.  Pulsatile Flow and Atherosclerosis in the Human Carotid Bifurcation: Positive Correlation between Plaque Location and Low and Oscillating Shear Stress , 1985, Arteriosclerosis.

[3]  M. Kern,et al.  Coronary flow velocity dynamics in normal and diseased arteries. , 1993, The American journal of cardiology.

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

[5]  D. Ku BLOOD FLOW IN ARTERIES , 1997 .

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

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

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

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

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

[11]  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.

[12]  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.

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

[14]  R. Mongrain,et al.  [Role of shear stress in atherosclerosis and restenosis after coronary stent implantation]. , 2006, Revista espanola de cardiologia.

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

[16]  David N. Ku,et al.  correlation between plaque location and low oscillating shear stress Pulsatile flow and atherosclerosis in the human carotid bifurcation. Positive , 2007 .

[17]  Hao-Ming Hsiao,et al.  Why similar stent designs cause new clinical issues. , 2012, JACC. Cardiovascular interventions.