Abstract
BackgroundThe process of restenosis after a stenting procedure is related to local biomechanical environment. Arterial wall stresses caused by the interaction of the stent with the vascular wall and possibly stress induced stent strut fracture are two important parameters. The knowledge of these parameters after stent deployment in a patient derived 3D reconstruction of a diseased coronary artery might give insights in the understanding of the process of restenosis.Methods3D reconstruction of a mildly stenosed coronary artery was carried out based on a combination of biplane angiography and intravascular ultrasound. Finite element method computations were performed to simulate the deployment of a stent inside the reconstructed coronary artery model at inflation pressure of 1.0 MPa. Strut thickness of the stent was varied to investigate stresses in the stent and the vessel wall.ResultsDeformed configurations, pressure-lumen area relationship and stress distribution in the arterial wall and stent struts were studied. The simulations show how the stent pushes the arterial wall towards the outside allowing the expansion of the occluded artery. Higher stresses in the arterial wall are present behind the stent struts and in regions where the arterial wall was thin. Values of 200 MPa for the peak stresses in the stent strut were detected near the connecting parts between the stent struts, and they were only just below the fatigue stress. Decreasing strut thickness might reduce arterial damage without increasing stresses in the struts significantly.ConclusionThe method presented in this paper can be used to predict stresses in the stent struts and the vessel wall, and thus evaluate whether a specific stent design is optimal for a specific patient.
Highlights
The process of restenosis after a stenting procedure is related to local biomechanical environment
In-stent restenosis is caused by neointimal hyperplasia and the process consists of various phases, including an inflammatory phase, a granulation or cellular proliferation phase, and a phase of remodelling involving extracellular matrix protein synthesis [2]
In this work we study the deployment of a stent in a patient derived 3D reconstruction of a mildly stenosed coronary artery by means of the finite element method
Summary
The process of restenosis after a stenting procedure is related to local biomechanical environment. Arterial wall stresses caused by the interaction of the stent with the vascular wall and possibly stress induced stent strut fracture are two important parameters. The arterial injury, in terms of medial disruption, intimal denudation and the presence of stent struts, trigger a cascade of processes. These include production of growth factors and cytokines, which trigger proliferation and migration of smooth muscle cell and allow production of extracellular matrix. Together these processes significantly compromise intra-arterial lumen leading to restenosis
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