Abstract
Stent implantation has been a primary treatment for stenosis and other intravascular diseases. However, the struts expansion procedure might cause endothelium lesion and the structure of the struts could disturb the blood flow environment near the wall of the blood vessel. These changes could damage the vascular innermost endothelial cell (EC) layer and pose risks of restenosis and post-deployment thrombosis. This research aims to investigate the effect of flow alterations on EC distribution in the presence of gap between two struts within the parallel flow chamber. To study how the gap presence impacts EC migration and the endothelialization effect on the surface of the struts, two struts were placed with specific orientations and positions on the EC layer in the flow chamber. After a 24-h exposure under wall shear stress (WSS), we observed the EC distribution conditons especially in the gap area. We also conducted computational fluid dynamics (CFD) simulations to calculate the WSS distribution. High EC-concentration areas on the bottom plate corresponded to the high WSS by the presence of gap between the two struts. To find the relation between the WSS and EC distributions on the fluorescence images, WSS condition by CFD simulation could be helpful for the EC distribution. The endothelialization rate, represented by EC density, on the downstream sides of both struts was higher than that on the upstream sides. These observations were made in the flow recirculation at the gap area between two struts. On two side surfaces between the gaps, meaning the downstream at the first and the upstream at the second struts, EC density differences on the downstream surfaces of the first strut were higher than on the upstream surfaces of the second strut. Finally, EC density varied along the struts when the struts were placed at tilted angles. These results indicate that, by the presence of gap between the struts, ECs distribution could be predicted in both perpendicular and tiled positions. And tiled placement affect ECs distribution on the strut side surfaces.
Highlights
Stent implantation is widely used to cure cardiovascular diseases such as stenosis or aneurysm (Borhani et al, 2018)
The objective of this study is to investigate the influence of gap between two struts on endothelial cell (EC) distribution at the dish surface and strut endothelialization process
In order to observe the EC distribution after the flow exposure with the presence of gap between two struts and the endothelialization effect on the surface of the strut, two struts were placed in a specific position and orientation on the EC monolayer inside the parallel flow chamber
Summary
Stent implantation is widely used to cure cardiovascular diseases such as stenosis or aneurysm (Borhani et al, 2018). During the stent deployment process, struts expansion could cause damage to the vascular endothelium. The endothelium lesion might induce first platelet aggregation to form a thrombus. The formation of thrombus and neointima caused by EC dysfunction could promote the re-blocking of the blood vessel. The negative effect of re-blockage of the blood vessel, such as restenosis and thrombosis, has become a severe complication after the stenting treatment (Liu et al, 1989; Foley et al, 1994; Bavry et al, 2005; Mauri et al, 2005; Finn et al, 2007). The complications by stent deployment could be considered as EC denudation around struts. To reduce the vessel re-blockage, accelerate the endothelialization, meaning covering the struts by ECs, is necessary as quick endothelialization on the strut could prevent platelet adhesion and inhibit SMC proliferation
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