Abstract
Coronary artery stenting is commonly used for the treatment of coronary stenosis, and different stent structures indeed have various impacts on the stress distribution within the plaque and artery as well as the local hemodynamic environment. This study aims to evaluate the performance of different stent structures by characterizing the mechanical parameters after coronary stenting. Six stent structures including three commercially-shaped stents (Palmaz-Schatz-shaped, Xience Prime-shaped, and Cypher-shaped) and three author-developed stents (C-Rlink, C-Rcrown, and C-Astrut) implanted into a curved stenotic coronary artery were investigated. Structural analyses of the balloon-stent-plaque-artery system were first performed, and then followed by hemodynamic analyses. The results showed that among the three commercially-shaped stents, the Palmaz-Schatz-shaped had the least stent dogboning and recoiling, corresponding to the greatest maximum plastic strain and the largest diameter change, nevertheless, it induced the highest maximum von Mises stress on plaque, arterial intima and media. From the viewpoint of hemodynamics, the Palmaz-Schatz-shaped displayed smaller areas of adverse low wall shear stress (<0.5 Pa), low time-averaged wall shear stress (<0.5 Pa), and high oscillating shear index (>0.1). Compared to the Cypher-shaped, the C-Rcrown and C-Astrut had smaller recoiling, greater maximum plastic stain and larger diameter change, which indicated the improved mechanical performance of the Cypher-shaped stent. Moreover, both C-Rcrown and C-Astrut exhibited smaller areas of adverse low wall shear stress, and low time-averaged wall shear stress, but only the C-Rcrown displayed a smaller area of adverse high oscillating shear index. The present study evaluated and compared the performance of six different stents deployed inside a curved artery, and could be potentially utilized as a guide for the selection of suitable commercially-shaped stent for clinical application, and to provide an approach to improve the performance of the commercial stents.
Highlights
Coronary artery disease (CAD) is one of the greatest threats to human health and life, and it usually occurs when cholesterol builds up inside the walls of arteries, eventually forming a plaque, narrowing the arteries and limiting the flow of oxygenrich blood to the heart
Serious clinical complications remain such as the in-stent restenosis (ISR), which is the reduction of the lumen size following the stent implantation (Park et al, 2012)
The primary process leading to ISR is neointimal hyperplasia (NH) that consists of excessive tissue growth in and around the implanted stent, and results in a decreased blood flow through the artery
Summary
Coronary artery disease (CAD) is one of the greatest threats to human health and life, and it usually occurs when cholesterol builds up inside the walls of arteries, eventually forming a plaque, narrowing the arteries and limiting the flow of oxygenrich blood to the heart. The primary process leading to ISR is neointimal hyperplasia (NH) that consists of excessive tissue growth in and around the implanted stent, and results in a decreased blood flow through the artery. It is reported that different stent structures caused varying stress levels within the plaque and artery (Colombo et al, 2002; Gu et al, 2010), and induced different levels and patterns of WSS and OSI on the artery wall (Balossino et al, 2008; Murphy and Boyle, 2010a; Pant et al, 2010; Gundert et al, 2013), so the stent structure plays a critical role in the post-operative effect of stenting. Different connection methods of struts such as peakto-peak (aligned stent strut) or peak-to-valley (offset stent strut) influenced the blood flow (Gundert et al, 2012a; Beier et al, 2016)
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