Abstract
Stent induced hemodynamic changes in the coronary arteries are associated with higher risk of adverse clinical outcome. The purpose of this study was to evaluate the impact of stent design on wall shear stress (WSS), time average WSS, and WSS gradient (WSSG), in idealized stent geometries using computational fluid dynamics. Strut spacing, thickness, luminal protrusion, and malapposition were systematically investigated and a comparison made between two commercially available stents (Omega and Biomatrix). Narrower strut spacing led to larger areas of adverse low WSS and high WSSG but these effects were mitigated when strut size was reduced, particularly for WSSG. Local hemodynamics worsened with luminal protrusion of the stent and with stent malapposition, adverse high WSS and WSSG were identified around peak flow and throughout the cardiac cycle respectively. For the Biomatrix stent, the adverse effect of thicker struts was mitigated by greater strut spacing, radial cell offset and flow-aligned struts. In conclusion, adverse hemodynamic effects of specific design features (such as strut size and narrow spacing) can be mitigated when combined with other hemodynamically beneficial design features but increased luminal protrusion can worsen the stent’s hemodynamic profile significantly.
Highlights
Percutaneous coronary intervention (PCI) with stents is a widely used treatment for atheromatous coronary artery disease, a leading cause of death in the Western world.[42]
Our results suggest that a critical strut-size to strutspacing relationship exists and previous studies show this may be linked to vessel size.[14,18,25]
This study describes the effect of major stent design considerations including strut spacing, stent size and luminal protrusion on hemodynamic stress and extends this analysis to compare two commercially available stent designs
Summary
Percutaneous coronary intervention (PCI) with stents is a widely used treatment for atheromatous coronary artery disease, a leading cause of death in the Western world.[42]. A link between stent design and adverse clinical outcome was first established in stented rabbit iliac arteries,[9] and this was followed by changes in WSS being associated with neointimal hyperplasia.[24] Further investigations using simplified numerical[14] and experimental methods,[2,7] revealed that narrow strut spacing lead to undesirable flow stagnation zones and application of these concepts to 2D single stent units[8] subsequently guided several computational studies. These found that strut spacing,[14] stent connectors,[36] strut peak angle,[12] and strut thickness[15] were all important hemodynamic considerations in stent design
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