Shear Stress Regions Research Articles

Analysis of Blood Stasis for Stent Thrombosis Using an Advection-Diffusion Lattice Boltzmann Scheme

An advection-diffusion solver was applied to assess how stent strut shape and position impact the development of a pro-thrombotic region within the stented human artery. Presented here is a suitably parameterised advection-diffusion equation with a source term that is spatially uniform within a certain sub-domain of interest to compute a “time concentration”. The latter will serve as a surrogate quantity for the “age” of fluid parcels, i.e., the time the fluid parcel has spent in the sub-domain. This is a particularly useful concept in the context of coronary artery haemodynamics, where “stasis of blood” (or residence time) is recognized as the most important factor in thrombotic initiation. The novel method presented in this work has a very straightforward and convenient single lattice Boltzmann simulation framework encapsulation. A residence time surrogate is computed, presented and correlated with a range of traditional haemodynamic metrics (wall shear stress, shear rate and re-circulation region shapes) and finally, the role of these data to quantify the risk of thrombus formation is assessed.

Alterations in nasal airflow and air conditioning after endoscopic nasopharyngectomy for recurrent nasopharyngeal carcinoma: a pilot computational fluid dynamics study

Endoscopic nasopharyngectomy represents a significant intervention for recurrent nasopharyngeal carcinoma (NPC). Various surgical techniques, including transnasal and transoral approaches, are employed. However, the impact of these procedures on nasal airflow dynamics is not well understood. This computational fluid dynamics (CFD) study aimed to investigate alterations in nasal airflow and air conditioning following endoscopic nasopharyngectomy. A 55-year-old male patient with recurrent NPC was selected, whose CT data were utilized for image reconstruction. A preoperative model and two postoperative models, including the transnasal and transoral approach models, were established. The airflow patterns and various CFD parameters were analyzed. In the postoperative models, the high-speed airflow went along the soft palate and into the nasopharyngeal outlet, and there was the low-speed turbulence in the expanded nasopharyngeal cavity. Compared to the preoperative model, the postoperative models exhibited reductions in surface-to-volume ratio, nasal resistance, airflow velocity and proportion of high wall shear stress regions in nasopharynx. The changing trends of nasopharyngeal air temperature and humidity in the preoperative and transoral models were consistent. The heating and humidification efficiency decreased in the transnasal model compared to the transoral model. The endoscopic nasopharyngectomy for recurrent NPC affects the nasal airflow and warming and humidification function. The transoral approach has less influence on aerodynamics of the upper airway compared to the transnasal approach. From a CFD perspective, the endoscopic nasopharyngectomy does not increase the risk of postoperative complications, including the empty nose syndrome and the carotid blowout syndrome.

Computational model-based hemodynamic comparisons of traditional and modified idealized models of autologous radiocephalic fistula.

Autologous arteriovenous fistula (AVF) is a commonly used vascular access (VA) for hemodialysis, and hemodynamic changes are one of the main factors for its failure. To explore the effect of geometry on the hemodynamics in the AVF, a modified model is built with a gradual and smooth turn at the anastomosis and is compared with the traditional model, which has an abrupt sharp turn at the anastomisis. Transient computational fluid dynamics (CFD) simulations were performed for the comparison and analysis of the hemodynamic fields of the two models at different stages of the pulse cycle. The results showed that the low shear stress region and high oscillatory shear stress region in the modified AVF model coincided with regions of intimal hyperplasia that have been identified by previous studies. A comparison with the blood flow velocities measured in vivo was performed, and the error between the simulation results and the medical data was reduced by 22% in the modified model, which verifies the rationality and utility of the modified model.

Preparation and Application of Decanoic Acid/Arginine Hydrogels to a Transdermal Formulation.

We prepared a supramolecular hydrogel composed of decanoic acid and arginine (C10/Arg gel) and evaluated its application to a transdermal formulation. C10/Arg gel adjusted to pH 7 with 1 M NaOH aq or 1 M HCl aq provided a translucent hydrogel with a lamellar liquid crystal structure in the concentration region of decanoic acid ≥12% and arginine ≤9%. Rheological measurements showed that C10/Arg gel is a viscoelastic material with both solid and liquid properties, with elasticity being dominant over viscosity in the low shear stress region. The skin permeability of hydrocortisone (HC) and indomethacin (IM) from C10/Arg gels was investigated in vitro using hairless mouse skin and compared to control formulation drug suspensions (IM or HC) in water. The cumulative permeation amount of HC and IM from the C10/Arg gel at 10 h after application was approximately 16 and 11 times higher than that of the control, respectively. On the other hand, the flux of IM decreased with increasing arginine concentration, likely due to the acid-base interaction between Arg and IM in C10/Arg gel. Adequate drug skin permeation enhancement by C10/Arg gel requires optimizing the gel composition for each specific drug.

Biomechanical Effects of Seizures on Cerebral Dynamics and Brain Stress.

Epilepsy is one of the most common neurological disorders globally, affecting about 50 million people, with nearly 80% of those affected residing in low- and middle-income countries. It is characterized by recurrent seizures that result from abnormal electrical brain activity, with seizures varying widely in manifestation. The exploration of the biomechanical effects that seizures have on brain dynamics and stress levels is relevant for the development of more effective treatments and protective strategies. This study uses a blend of experimental data and computational simulations to assess the brain's physical response during seizures, particularly focusing on the behavior of cerebrospinal fluid and the resulting mechanical stresses on different brain regions. Notable findings show increases in stress, predominantly in the posterior gyri and brainstem, during seizures and an evidence of brain displacement relative to the skull. These observations suggest a dynamic and complex interaction between the brain and skull, with maximum shear stress regions demonstrating the limited yet essential protective role of the CSF. By providing a deeper understanding of the mechanical changes occurring during seizures, this research supports the goal of advancing diagnostic tools, informing more targeted treatment interventions, and guiding the creation of customized therapeutic strategies to enhance neurological care and protect against the adverse effects of seizures.

Ultrasonic irrigation flows in root canals: effects of ultrasound power and file insertion depth

Ultrasonic irrigation during root canal treatment can enhance biofilm disruption. The challenge is to improve the fluid flow so that the irrigant reaches areas inaccessible to hand instrumentation. The aim of this study is to experimentally investigate how the flow field and hydrodynamic forces induced by ultrasonic irrigation are influenced by the ultrasound power and file insertion depth. A root canal phantom was 3D printed and used as a mold for the fabrication of a PDMS channel. An ultrasonic instrument with a #15K-file provided the irrigation. The flow field was studied by means of Particle Image Velocimetry (PIV). The time averaged velocity and shear stress distributions were found to vary significantly with ultrasound power. Their maximum values increase sharply for low powers and up to a critical power level. At and above this setting, the flow pattern changes, from the high velocity and shear stress region confined in the vicinity of the tip, to one covering the whole root canal domain. Exceeding this threshold also induces a moderate increase in the maximum velocities and shear stresses. The insertion depth was found to have a smaller effect on the measured velocity and shear stresses. Due to the oscillating nature of the flow, instantaneous maximum velocities and shear stresses can reach much higher values than the mean, especially for high powers. Ultrasonic irrigation will benefit from using a higher power setting as this does produce greater shear stresses near the walls of the root canal leading to the potential for increased biofilm removal.

Flow accelerated corrosion and thinning mechanism of the pipeline after the butterfly valve based on CFD

Severe thinning was found on the pipeline after the butterfly valve of a hydrogenation unit, gravely threatening the safety and reliability of the unit. The mechanism of pipeline thinning was fully investigated in this work. The results of microstructure analysis showed that the corrosion products of thinned pipeline were mainly FeS2. The CFD results showed that flow accelerated corrosion was the main cause of pipeline thinning. The fluid behind the valve was violently disturbed due to the flow restriction of the valve disc. As a result, the pipeline suffered from erosive effect from high velocity flow with a very large wall shear stress. The region of high velocity and high wall shear stress was basically the same as the actual thinning region. The thinning mechanism of the pipeline was systematically dissected and described.

Numerical Simulation of Transonic Compressors with Different Turbulence Models

One of the most commonly used techniques in aerospace engineering is the RANS (Reynolds average Navier–Stokes) approach for calculating the transonic compressor flow field, where the accuracy of the computation is significantly affected by the turbulence model used. In this work, we use SA, SST, k-ɛ, and the PAFV turbulence model developed based on the side-biased mean fluctuations velocity and the mean strain rate tensor to numerically simulate the transonic compressor NASA Rotor 67 to evaluate the accuracy of turbulence modeling in numerical calculations of transonic compressors. The simulation results demonstrate that the four turbulence models are generally superior in the numerical computation of NASA Rotor 67, which essentially satisfies the requirements of the accuracy of engineering calculations; by comparing and analyzing the ability of the four turbulence models to predict the aerodynamic performance of transonic compressors and to capture the details of the flow inside the rotor. The errors of the Rotor 67 clogging flow rate calculated by the SA, SST, k-ɛ, and PAFV turbulence models with the experimental data are 0.9%, 0.8%, 0.7%, and 0.6%, respectively. The errors of the calculated peak efficiencies are 2.2%, 1.6%, 0.9%, and 4.9%. The SA and SST turbulence models were developed for the computational characteristics of the aerospace industry. Their computational stability is better and their outputs for Rotor 67 are comparable. The k-ɛ turbulence model calculates the pressure ratio and efficiency that are closest to the experimental data, but the computation of its details of the flow field near the wall surface is not ideal because the k-ɛ turbulence model cannot accurately capture the flow characteristics of the region of high shear stresses. The PAFV turbulence model has a better prediction of complex phenomena such as rotor internal shock wave location, shock–boundary layer interaction, etc., due to the use of a turbulent velocity scale in vector form, but the calculated rotor efficiency is small.

Knockdown of TRPV2 inhibits the migration of RAW264.7 cells toward low fluid shear stress region.

Our previous studies have demonstrated that macrophages (RAW264.7) have a special ability for sensing the gradient of fluid shear stress (FSS) and migrate toward the low-FSS region. However, the molecular mechanism regulating this phenomenon is still unclear. In this study, we examined the transcriptome genes in RAW264.7 cells, MC3T3-E1 osteoblasts, mesenchymal stem cells, canine renal epithelial cells, and periodontal ligament cells. The expression levels of genes related to cell migration, force transfer, and force sensitivity in the Ca2+ signaling pathway were analyzed. We observed that the transient receptor potential cation channel type 2 (TRPV2) was highly expressed in RAW264.7 cells. Furthermore, we used lentiviral transfection to knockdown TRPV2 expression in RAW264.7 cells and studied the effect of TRPV2 on the migration of RAW264.7 cells under a gradient FSS field. The results showed that compared with normal cells, TRPV2-knockdown cells had impaired ability for sensing FSS gradient to migrate toward the low-FSS region and lower intracellular calcium response to FSS stimulation. This study may reveal the molecular mechanism of regulating the directional migration of macrophages under a gradient FSS field.

Failure analysis of the collection pipeline at the outlet of air cooler in the distillation column

Severe leakage occurs in the collection pipeline at the outlet of air cooler in the distillation column, which leads to an unplanned shutdown. In order to reveal the root cause of the leakage, the corrosion process under oil–water two-phase flow in the horizontal-vertical pipeline was investigated by macroscopic observation, thickness measurement, microscopic analysis, and computational fluid dynamic (CFD) simulation. The results show that flow-accelerated corrosion (FAC) is the main reason for the leakage in the pipeline. The water volume fraction and wall shear stress are the crucial parameters in the corrosion process. The water volume fraction determines whether corrosion occurs by influencing the process of water wetting the wall of the pipeline. Fluid flow in the corrosion acceleration process is represented by the wall shear stress. The region of high water volume fraction and high wall shear stress is basically the same as the region of actual leakage. When the water cut inside the pipeline decreases by half, the corrosion risk of the pipeline is greatly reduced.

The Shear Stress-Regulated Expression of Glypican-4 in Endothelial Dysfunction In Vitro and Its Clinical Significance in Atherosclerosis.

Retention of circulating lipoproteins by their interaction with extracellular matrix molecules has been suggested as an underlying mechanism for atherosclerosis. We investigated the role of glypican-4 (GPC4), a heparan sulfate (HS) proteoglycan, in the development of endothelial dysfunction and plaque progression; Expression of GPC4 and HS was investigated in human umbilical vein/artery endothelial cells (HUVECs/HUAECs) using flow cytometry, qPCR, and immunofluorescent staining. Leukocyte adhesion was determined in HUVECs in bifurcation chamber slides under dynamic flow. The association between the degree of inflammation and GPC4, HS, and syndecan-4 expressions was analyzed in human carotid plaques; GPC4 was expressed in HUVECs/HUAECs. In HUVECs, GPC4 protein expression was higher in laminar than in non-uniform shear stress regions after a 1-day or 10-day flow (p < 0.01 each). The HS expression was higher under laminar flow after a 1 day (p < 0.001). Monocytic THP-1 cell adhesion to HUVECs was facilitated by GPC4 knock-down (p < 0.001) without affecting adhesion molecule expression. GPC4 and HS expression was lower in more-inflamed than in less-inflamed plaque shoulders (p < 0.05, each), especially in vulnerable plaque sections; Reduced expression of GPC4 was associated with atherogenic conditions, suggesting the involvement of GPC4 in both early and advanced stages of atherosclerosis.

A study on the rolling contact fatigue mechanism of ZC-L cast wheel steel

In this paper, the rolling contact fatigue (RCF) failure mechanism of ZC-L cast steel wheels was analyzed by optical microscope (OM), scanning electron microscope (SEM) and transmission electron microscope (TEM). The results show that obvious fatigue flaking is formed on the macroscopic surface of the wheel tread after RCF failure. The RCF cracks are formed at the maximum shear stress region of the sun-surface of the wheel (1–5 mm below the tread). There are a lot of subsurface white etching microstructure (WEM) and obvious casting defects in the subsurface of the wheel tread. The RCF cracks are mainly formed at the interface between the subsurface WEM and the matrix and at the edge of the casting defects. The subsurface WEM is composed of nano-ferrite grains and residual cementite, and its hardness is about 920HV, which is much higher than that of the matrix structure. During the wear process, the plastic deformation of the subsurface WEM and the matrix is not coordinated, resulting in the formation of RCF cracks. As a hard phase, the hardness of casting defects is much higher than that of matrix. In the process of wear, under the action of subsurface stress, the casting defects can cause obvious plastic deformation in the soft orientation region at the edge of the casting defects. When the plastic deformation reaches the plastic limit, the RCF cracks are formed at the edge of the inclusions due to ratchet failure. The stress at the crack tip is caused by the RCF crack propagation at the edge of inclusions will further lead to the refinement of the microstructure at the edge of the RCF crack. Under the action of the subsurface contact stress, the subsurface WEM and casting defects are the main reasons leading to the RCF failure of the ZC-L casting wheel. Improving the microstructure uniformity and reducing casting defects are the main methods to improve the fatigue property of casting wheels.

Structural aspects of the attached turbulent boundary layer flow over a hill

Three-dimensional turbulent boundary layers under strong pressure gradients and curvature are the rule in real-world flow applications but are typically not well predicted by turbulence models due to isotropic eddy viscosity or equilibrium assumptions. Validation-quality data in complex 3D flows is necessary for continued efforts to improve simulation accuracy. The Benchmark Validation Experiments for RANS/LES Investigations (BeVERLI) Hill bump model, designed specifically for validation experiments, was tested in the Virginia Tech Stability Wind Tunnel to collect validation experiment data on the three-dimensional (3D) boundary layer flow over a 3D hill. Laser Doppler velocimetry measurements on the bump model were used to study the mean flow and turbulence structure and evaluate the impact of pressure gradient and curvature upon the total shear stress in the boundary layer and evaluate the impact of pressure gradient and curvature upon the total shear stress behavior in the near-wall region. From analysis of the BeVERLI Hill flow, including the boundary layer just upstream of the hill, and comparison with the 3D flow around a wing-body junction of Ölçmen et al. (Exp Fluids 31:219–228, 2001), it is shown that none of the stations studied exhibit a constant shear stress region over any significant region of the boundary layer.Graphical abstract

Prediction of vortex structures in pulsatile flow through S-bend arterial geometry with different stenosis levels

Arterial stenosis poses a high cardiovascular risk, and clinical intervention is needed when these stenoses grow beyond a specific limit. The study of vortex dynamics in these diseased arteries can be beneficial to understand its severity. Therefore, in the present work, we have investigated the flow structures in an S-bend arterial geometry with different levels of stenosis using a sharp interface immersed boundary method. We have observed an onset of Kelvin-Helmholtz-type vortex roll-up for higher degrees of stenoses. Fluctuations in the wall shear stress are observed for higher stenosis degrees. However, these fluctuations depend on the position and length of the stenosis. Newtonian and non-Newtonian Carreau fluids predict similar vortex structures, although minor differences in the Kelvin-Helmholtz vortex structures and associated fluctuations are observed in the diastolic phase. The Newtonian fluid predicts a slightly longer low time-averaged wall shear stress (≤0.5 Pa) region immediately after the stenosis compared with the Carreau fluid in the 58 % blockage S-bend artery.

Dynamical influences of different aneurysm sizes on rupture risk of abdominal aorta

The current clinical index for surgical intervention of abdominal aortic aneurysms (AAA) is mainly based on measuring its maximum diameter. However, ruptures in AAAs do not necessarily occur at this location and conditions of rupture are still unclear. This study focuses on the understanding of the aneurysms rupture mechanisms. A set of fluid-structure interaction (FSI) models is developed to investigate the AAAs expansion into low wall shear stress (WSS) regions. 3D model geometries for different clinical stages are acquired from the literature including the final stage just before rupture. Blood is simulated as non-Newtonian fluid and dymanic boundary conditions are enforced to simulate blood pulsations. Local and averaged WSS, which are the critical parameters affecting rupture conditions, are evaluated based on the computational results. It is demonstrated that both averaged and local WSS correlate well with the rapid expansion of AAA as well as with rupture locations. From the present FSI study, blood recirculation is one of the main mechanism leading to a decrease in the WSS, which significantly increase the risk of rupture. The latter agrees with the outcomes of previous studies.

Biphasic flow dynamics and polarized mass transportation in branched hepatic sinusoids.

In fatty liver diseases, such as liver fibrosis and liver cirrhosis, blood flow in hepatic sinusoids, an elementary building block of the liver lobule, tends to bypass through collateral vessels inside sinusoids and presents distinct sinusoidal flows compared to normal physiological flows. It remains unclear in those flow characteristics in branched sinusoids and the correlation of pathological flows with liver lesions, mainly due to the difficulty of direct hemodynamics measurements in the sinusoids. Here, we developed a dual-branched theoretical model of hepatic sinusoidal flow to elucidate the relevant flow dynamics and mass transport. Numerical simulations, based on the lattice Boltzmann method, indicated that the flow velocity distribution in hepatic sinusoids is mainly dominated by endothelium permeability and presents a non-monotonic variation with the permeability at the fusion segment of these branched sinusoids. Flow-induced shear stress on the endothelium at the side of the Disse space exhibited a biphasic pattern, yielding a low shear stress region at the junctional site. Meanwhile, a highly polarized distribution of lipoproteins concentration was also presented at the low shear stress region, indicating a localized accumulation of typical hepatic serum proteins. Thus, this work provides the basic understanding of blood flow features and mass transport regulations in branched hepatic sinusoids.

A Hemodynamic Analysis of the Thrombosis Within Occluded Coronary Arterial Fistulas With Terminal Aneurysms Using a Blood Stasis Model.

Objective: The aim of this study is to numerically evaluate thrombosis risk within occluded coronary arterial fistulas (CAF) with terminal aneurysms, and provide guidance in choosing occlusion positions, with clinical observations as reference. Method: Four patients with CAF were studied, with different occlusion positions in actual treatments. Hemodynamics simulations were conducted, with blood residue predicted using the blood stasis model. Three types of models (untreated model, aneurysm-reserved model and aneurysm-removed model) were studeid for each patient. Four metrics, i.e., proportion of high oscillatory shear index (OSI), area of high OSI, old blood volume fraction (OBVF)) and old blood volume (OBV) was obtained to distinguish the thrombosis risk of different treatments (proximal or distal occlusion), comparing with the follow-up CTA. Results: For all the postopertive models, the high OBVF, high OSI(>0.3) and low time-averaged wall shear stress (TAWSS) regions were mainly at the distal fistula, indicating these regions were prone to thrombosis. The regions where blood residue remains are roughly regions of high OSI, corresponding well with clinical observations. In contrast, TAWSS failed to distinguish the difference in thrombosis risk. Absolute values (area of high OSI, OBV) can better reflect the degree of thrombosis risk between treatment types compared with percentage values (proportion of high OSI, OBVF). By comparing with the actual clinical treatments and observations, the OBV is superior to the area of high OSI in determining treatment type. Conclusion: The OBV, a volumetric parameter for blood stasis, can better account for the CAF thrombosis and reflect the degree of blood stasis compared with OSI or TAWSS, is a more appropriate metric for thrombosis in the fistula. Together with morphological parameters, the OBV could guide clinicians to formulate more appropriate surgical plans, which is of great significance for the preoperative evaluation and treatment prognosis of CAF patients.

A computational study of the effects of polycrystalline structure on residual stress-strain concentrations and fracture in metal-matrix composites

Deformation and fracture of metal-matrix composites are numerically investigated. Composite microstructures with a single ceramic particle in a homogeneous or polycrystalline matrix are generated by the step-by-step packing method. The thermoelastic-plastic reaction of the matrices is described using isotropic and anisotropic relations, including the associated plastic flow rule and crystal plasticity theory. The thermoelastic response of a ceramic particle is isotropic. In order to describe the crack initiation and propagation in the matrix and particle, two fracture criteria with the limiting values of the equivalent plastic strain and stress are developed. During cooling both pure shear and volumetric tension stress regions are formed in the matrix around the particle. The polycrystalline structure of the matrix prevents through-the-thickness crack formation during subsequent mechanical loading of the composite. Grain boundaries cause multiple stress concentrations and plastic strain localizations all over the matrix material, which delays fracture near the matrix-particle interface.

Comprehensive Evaluation of Rock Mechanical Properties and in-situ Stress in Tight Sandstone Oil Reservoirs

Comprehensive research on reservoir rock mechanics and in-situ stress properties combined with petrophysical experiments, logging models and numerical simulation is an important means to achieve efficient development of tight sandstone oil reservoirs. In this study, a large number of rock mechanics and acoustic experiments, full-wave train array acoustic wave tests, hydraulic fracturing data and three-dimensional finite element simulations were used to study the rock mechanical properties and in-situ stress characteristics of continental tight oil reservoirs in the Yanchang Formation. The results show that under uniaxial conditions, the tight sandstone samples mainly suffer from tensional ruptures. With the increase of confining pressure, the tight sandstone samples undergo obvious shear ruptures. When the confining pressure is loaded to 35 MPa, a typical vertical shear fracture will be formed. The hydraulic fracturing calculation results show that the in-situ stress state of the target layer satisfies σv (vertical principal stress)&amp;gt;σH (maximum horizontal principal stress)&amp;gt;σh (minimum horizontal principal stress). Based on the results of rock mechanics and acoustic tests, we have constructed the dynamic and static mechanical parameter conversion models of tight oil reservoirs and the logging interpretation model of current in-situ stress. Furthermore, the finite element method is used to simulate the three-dimensional structural stress field of the target layer. The simulations show that the horizontal principal stress distribution in the work area is consistent with the applied environmental stress. The σH of the target layer is mainly distributed in 32–50 MPa, and the σh is mainly distributed in 20–34 MPa. Both σH and σh are relatively high in the southern uplift of the work area; among them, σH is usually greater than 44 MPa, and σh is usually greater than 24 MPa. The northern part of the study area developed several grooved areas with relatively low stress values. The regions with high stress values are often distributed in bands, which may be related to the compression caused by the deformation of the strata. For shear stress, left-handed and right-handed regions usually alternate with each other. However, the extent of the left-handed area in the southern uplift area is larger than that of the right-handed area, indicating that the tight oil reservoirs in the study area are mainly affected by left-handed activities.

Influence of bionic texture coronary stent on hemodynamics after implantation

To explore the influence of bionic texture coronary stents on hemodynamics, a type of bioabsorbable polylactic acid coronary stents was designed, for which a finite element analysis method was used to carry out simulation analysis on blood flow field after the implantation of bionic texture stents with three different shapes (rectangle, triangle and trapezoid), thus revealing the influence of groove shape and size on hemodynamics, and identifying the optimal solution of bionic texture groove. The results showed that the influence of bionic texture grooves of different shapes and sizes on the lower wall shear stress region had a certain regularity. Specifically, the improvement effect of grooves above 0.06 mm on blood flow characteristics was poor, and the effect of grooves below 0.06 mm was good. Furthermore, the smaller the size is, the better the improvement effect is, and the 0.02 mm triangular groove had the best improvement effect. Based on the results of this study, it is expected that bionic texture stents have provided a new method for reducing in-stent restenosis.