Abstract
A definitive, quantitative investigation has been performed to determine whether orbital atherectomy gives rise to cavitation. The investigation encompassed a synergistic interaction between in vitro experimentation and numerical simulation. The experimentation was performed in two independent fluid environments: 1) a transparent tube having a diameter similar to that of the superficial femoral artery and 2) a large, fluid-filled, open-topped container. All of the experimental and simulation work was based on the geometric model of the Diamondback 360 atherectomy device (Cardiovascular Systems, Inc., St. Paul, MN). Rotational speeds ranged from 80,000 to 214,000 rpm. The presence or absence of cavitation in the experiments was assessed by means of high-speed photography. The photographic images clearly display the fact that there was no cavitation. Flow visualization revealed the presence of fluid flows driven by pressure gradients created by the geometry of the rotating crown. The numerical simulations encompassed the fluid environments and the operating conditions of the experiments. The key result of the numerical simulation is that the minimum fluid pressure due to the rotational motion was approximately 50 times greater than the saturation vapor pressure of the fluid. Since the onset of cavitation requires that the fluid pressure falls below the saturation vapor pressure, the computational outcome strongly supports the experimental findings.
Highlights
There are currently four types of in vivo devices for the debulking of plaque
If cavitation bubbles were to collapse in a blood vessel, substantial tissue damage might occur
The first result to be presented from the numerical simulations relates to the radial pressure variation created by the rotating atherectomy device positioned in a tube
Summary
There are currently four types of in vivo devices for the debulking of plaque. Among these, two are based on abrasive removal of the plaque while the others utilize a shaving technique. The presence of rotation gives rise to radial pressure variations across the cross section of the artery being debulked These pressure variations could lead to the creation of cavitation bubbles if the local pressure were to fall below the saturation vapor pressure of the fluid. The rotational velocities at the surface of the crown and at the surface of the bare shaft appear to differ by an order of magnitude, thereby giving rise to very different pressures adjacent to the bare shaft and the crown. In this light, it is difficult to justify comparable distributions of bubbles adjacent to the crown and the bare shaft. The mechanism for the creation of the latter-named bubbles is, unclear
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