Effect of exercise rehabilitation on hemodynamic performance after 5 carotid artery stenting: a numerical study

Abstract

Purpose A high in-stent restenosis rate and thrombosis have compromised clinical benefits after vascular stent placement. Exercise rehabilitation after stenting emerges as a promising and practical therapeutic strategy to improve the clinical performance of this therapy, although it remains controversial. The present study aims to explore the impact of exercise training on hemodynamic performance after vascular stent implantation. Methods Different 3-dimensional computational models based on the patient-specific carotids were constructed to calculate hemodynamic parameters, including flow velocity, time-averaged wall shear (TAWSS), oscillatory shear index (OSI), and relative residence time (RRT). Results The results demonstrated that exercise training increased TAWSS but decreased OSI and RRT in some cases after the intervention, and high-intensity exercise would further suppress the adverse blood flow. However, exercise training would remarkably reduce TAWSS and elevate OSI and RRT in patients with mild stenosis at upstream of stented segment. Additionally, we discovered that the hemodynamic environment change induced by exercise training was not significant compared to the stent position in some cases. Exercise would have a less beneficial impact on the disturbed blood flow after the distal common carotid artery (CCA) stenting. Conclusions These findings highlight that exercise-induced hemodynamic changes differ under different conditions. The exercise training for the intervention patients should only be performed after a comprehensive vascular function assessment.