Stented Coronary Arteries Research Articles

Three-dimensional evaluation of the spatial morphology of stented coronary artery segments in relation to restenosis

To investigate the correlations between the three-dimensional (3D) parameters of target coronary artery segments and restenosis after stent implantation. Sixty-four patients after single, cobalt chromium platform stent (27 BM stents and 37 DES) implantation were investigated retrospectively 12 ± 6 months after the index procedure. 3D coronary artery reconstruction was performed before and after the stent implantation using appropriate projections by a dedicated reconstruction software. The curve of the target segment was characterized by the ratio of the vessel length measured at midline (arc: A) and the distance between the edge points of the stent (chord: C): A/C ratio (ACr). Age, diabetes and hyperlipidaemia were taken into account for the statistical evaluation. 22 patients were diagnosed with ISR, while 42 patients without any restenosis served as controls. The two groups did not differ regarding major cardiovascular risk factors, proportion of the treated vessels or the type of stents. Higher initial ACr values were associated with greater straightening of the vessel curvature in all groups (p < 0.001). Significant negative correlations were found in cases of proximal or distal edge bending angles (p < 0.001). Pre-stent edge bending angles < 7° often showed an increase after the stent implantation, while in case of higher initial values, the bending angles generally decreased. Using multivariate logistic regression modelling we found that the pre-stent ACr was an independent predictor of in-stent restenosis (odds ratio for 1% increase of the ACr: 1.08; p = 0.012). Changes of angles at the stent edges following stent implantation correlate with the initial local bending angles. The ACr predispose to chronic shear stress in the vessel wall, which may contribute to the pathological intimal proliferation.

Fluid–structure interaction between pulsatile blood flow and a curved stented coronary artery on a beating heart: A four stent computational study

This work focuses on fluid–structure interaction (FSI) between a curved (tortuous) coronary artery with an implanted stent, pulsatile blood flow, and heart contractions. The goal is to understand which geometric distribution of stent struts, given by four different, commercially available stent geometries, is least likely to be associated with parameters correlated with pathobiologic responses leading to restenosis, in the case of curved coronary arteries, whose curvature changes significantly with each heart contraction. The stent geometries considered in this study correspond to a Palmaz-like stent, an Express-like stent, a Cypher-like stent, and a Xience-like stent. The biomechanical environment induced by each implanted stent is evaluated in terms of displacement magnitude, Von Mises stress, normal stress experienced by the intimal layer with implanted stent, and wall shear stress. Arterial walls are modeled as multi-layered structures: the intimal layer with the internal elastic laminae is modeled as a nonlinearly elastic membrane, while the media–adventitia complex is modeled as a 3D linearly elastic material. The Navier–Stokes equations for an incompressible, viscous fluid, are used to model the blood flow. Full, two-way coupling between the fluid and the structure, and between the thin and thick structure, is considered. To include the effects of the force exerted by the pericardium and heart muscle contractions, external force is applied to the coronary artery walls. Pulsatile boundary conditions were imposed at the inlet and outlet of the coronary segment, approximating measured diastolic coronary flow. The presence of an implanted stent was modeled by its impact on the mass and elasticity properties of the intimal layer where the stent is located. The stent material is modeled as a 316L stainless steel. A novel, loosely coupled partitioned scheme combined with an ALE approach was used to solve this nonlinear FSI problem. It was found that the Cypher-like stent geometry outperforms the other three stent geometries. The ranking from best to worst is as follows: Cypher-like stent, Express-like stent, Xience-like stent, Palmaz-like stent. It is conjectured that the sinusoidal horizontal stent struts and large cells associated with open-cell design, give rise to a stent geometry that conforms best to the native curved coronary artery, with smallest deviations in Von Mises stress and displacement from the nonstented curved coronary artery both during systole and diastole. To the best of our knowledge, this is the first computational study in which the behavior of different stent geometries implanted in curved coronary arteries is studied using full FSI capturing the behavior of multi-layered, curved, stented coronary arteries contracting on a beating heart.

Патогенетические механизмы развития рестеноза стентированных коронарных артерий и роль васкулоэндотелиального фактора роста А

Патогенетические механизмы развития рестеноза стентированных коронарных артерий и роль васкулоэндотелиального фактора роста А

Bending Analysis of Stented Coronary Artery: the Interaction Between Stent and Vessel

ABSTRACTVessel flexure can be triggered naturally by surgical operation, heart pulsation and body movement. It may affect the mechanical behavior of the stent and the existence of a stent may in turn cause vessel injury. In the present study, the finite element method is employed to study the interaction between stent and vessel during vessel flexure. Two- and four-link stents made of stainless steel 316L and magnesium alloy WE43 are considered. Results indicate that longitudinal deformation of the stent can be caused by vessel flexure, and the higher levels of stress exist in the link struts. The existence of the stent could induce significant stress concentration and straightened deformation on vessel wall in the course of vessel flexure. Stents with more links or made of harder materials show greater anti-deformation capability, thus inducing a more severe stress concentration and straightened deformation on the vessel wall. The bending direction also affects the mechanical performance of the vessel-stent system. The results obtained could provide useful information for better stent designs and clinical decisions.

Tissue Stresses in Stented Coronary Arteries with Different Geometries: Effect of the Relation Between Stent Length and Lesion Length

In-stent restenosis after stent deployment remains an obstruction in the long-term benefits of stenting. This study sought to investigate the influence of the relation between stent length and lesion length on the mechanics of the arterial wall with different geometries, including straight and tapered vessels. Results showed that when the length of the stent was longer than the lesion length, the maximum stress in plaque and vessel increased as the length of stent increased. When the length of the stent was shorter than the lesion length, the vessel stress induced by stent inflation was lower; both ends of the stenosis plaque could not be fully expanded. When the length of the stent was equal to the lesion length, the plaque and vessel stress induced by stent inflation was minimal, and stent foreshortening was minimal. Compared with the straight vessel, the stent implantation in the tapered vessel with the same stent length resulted in greater stress in vessel and plaque, an increased stent recoil, and a decreased stent foreshortening. When the length of the stent is equal to lesion length, it may be the reasonable choice for straight vessels and tapered vessels. Conclusions drawn from this article can help surgeons to choose appropriate stent lengths.

Patient-Specific Modeling of Stented Coronary Arteries Reconstructed from Optical Coherence Tomography: Towards a Widespread Clinical Use of Fluid Dynamics Analyses

The recent widespread application of optical coherence tomography (OCT) in interventional cardiology has improved patient-specific modeling of stented coronary arteries for the investigation of local hemodynamics. In this review, the workflow for the creation of fluid dynamics models of stented coronary arteries from OCT images is presented. The algorithms for lumen contours and stent strut detection from OCT as well as the reconstruction methods of stented geometries are discussed. Furthermore, the state of the art of studies that investigate the hemodynamics of OCT-based stented coronary artery geometries is reported. Although those studies analyzed few patient-specific cases, the application of the current reconstruction methods of stented geometries to large populations is possible. However, the improvement of these methods and the reduction of the time needed for the entire modeling process are crucial for a widespread clinical use of the OCT-based models and future in silico clinical trials.

Fusion of optical coherence tomography and angiography for numerical simulation of hemodynamics in bioresorbable stented coronary artery based on patient-specific model

Three-dimensional simulations of coronary artery using finite element analysis are considered as effective means to understand the biomechanical properties after the stent was deployed. Bioresorbable vascular scaffolds are new-generation stents used by people. Intravascular optical coherence tomography is an emerging technique for detecting struts. The common 3 D reconstruction methods are using Intravascular Ultrasound (IVUS) or angiographies. However, it loses the details about geometry model. Fusing of optical coherence tomography and angiography to reconstruct the bioresorbable stented coronary artery based on patient-specific mode is an innovative method to reconstruct the high fidelity geometry. This study aimed to use computer-aided design models and computational fluid dynamics research tools to conduct a systematic investigation of blood flow in an isolated artery with realistically deployed coronary stents. Some important hemodynamic factors such as wall shear stress, wall pressure and streamline were calculated. The doctors could evaluate the local hemodynamic alterations within coronary arteries after stent deployment by reconstructing the high-fidelity geometry about each clinical case.

Continuous Assessment of a Stented Coronary Artery Using a Pressure Wire During Percutaneous Pulmonary Valve Implantation

Continuous Assessment of a Stented Coronary Artery Using a Pressure Wire During Percutaneous Pulmonary Valve Implantation

Coronary artery rotation in native and stented porcine coronary arteries.

Coronary arteries are exposed to several complex biomechanical forces during the cardiac cycle. These biomechanical forces potentially contribute to both native coronary artery disease, development of atherosclerosis and eventual stent failure. The aim of the present study was to characterize and define coronary artery axial rotation and the effect of stent implantation on this biomechanical factor. Intravascular ultrasound (IVUS) images were obtained from porcine coronary arteries and analyzed in ultrasound analysis software used to evaluate myocardial strain and torsion in echocardiography. In this study the software was utilized for a novel application to evaluate coronary artery rotation and time-to-peak (TTP) rotation in porcine coronary arteries. Clockwise (CW) and counterclockwise (CCW) rotation of coronary arteries during the cardiac cycle and (TTP) rotation were measured. A total of 11 (4 LAD, 4 LCX, 3 RCA) coronary artery segments were independently analyzed pre- and post-stent implantation for a total of 22 IVUS runs. CW and CCW rotation and TTP varied widely within coronary artery segments and between different coronary arteries. Stent implantation impacted degree, direction and TTP of coronary rotation. Measurement reliability was assessed and the intraclass correlation coefficient for maximum average CCW was 0.990 (95% confidence interval 0.980-0.996, P < 0.0001), indicating excellent agreement. Coronary arteries display wide spectrum of CW and CCW rotation during the cardiac cycle. Coronary stents impact the degree and direction of coronary artery rotation. The implications of these findings on development of atherosclerosis and stent failure require further investigation.

Polymer-free dual drug-eluting stents evaluated in a porcine model

BackgroundAlthough drug-eluting stents have dramatically reduced the rates of restenosis and target lesion revascularization, they are associated with stent thrombosis (ST), a catastrophic event likely due to delayed endothelialization and chronic inflammation caused by the polymer and the metal scaffolds. To increase the safety and efficacy of stents, polymer-free dual drug-eluting stents (DDES) have been developed.MethodsA total 160 stents (Bare-metal stents (BMS), polymer-free probucol stents (PrES), sirolimus-eluting stents (SES) and DDES) were randomly implanted in the coronary arteries of 80 pigs. 14, 28, 90 and 191 days after implantation, QCA and OCT evaluations were performed in 20 pigs respectively, and the arteries were harvested for scanning electron microscope (SEM), histomorphology, histopathology analyses and for the relative expression of CD31, CD34 and CD133 on mRNA and protein levels.ResultsAt the 14-day time point, there were significant differences in the strut rate coverage (p = 0.011), with greater coverage in the PrES than in the SES group (53.2%vs. 20.3%, p = 0.002). As well, there were no significant differences in the expression of CD31, CD34 and CD133 between groups in mRNA and protein level.ConclusionsDDES were as safe as BMS and SES, but they did not further improve the endothelialization of the stented coronary arteries in the porcine model.

Immunohistochemical evaluation of remodeling of coronary artery restenosis

Aim: The aim of this study was to investigate the process of remodeling the walls of the coronary artery restenosis in the stented and non-stented coronary arteries.

Correlation between Angiographic in-Stent Restenosis and Post-procedural Glycosylated Hemoglobin Level in Diabetic Patients underwent Percutaneous Coronary Intervention with Drug eluting Stent

Background: Diabetes mellitus is a common, complex, and chronic metabolic disorder act as an important modifiable risk factor for cardiovascular disease and has been shown to be an independent predictor for in-stent restenosis after percutaneous coronary intervention.Objectives: To determine the influence of HbA1c level on the frequency of in-stent restenosis in diabetic patients after elective percutaneous coronary intervention.Patients and Methods: 89 diabetic patients with recurrent ischemia had history of previous percutaneous coronary intervention and stented coronary arteries with drug eluting stent were admitted to the Iraqi Center for Heart Diseases for elective coronary catheterization with or without percutaneous coronary intervention in period between April 2013 and March 2014. All patients were evaluated thoroughly. 26 patients were excluded for different reasons. 63 patients were assessing for stent patency during catheterization. 29 patients with patent stents. 34 patients with in-stent restenosis were investigated with HbA1c level. Diabetes mellitus was defined as fasting blood sugar concentration ≥126 mg/dl, random blood sugar ≥200 mg/dl with suggestive symptoms or positive history of diabetes mellitus with diet control or use an oral hypoglycemic agent(s) or insulin at the time of admission. Patients with in-stent restenosis were categorized into two groups based on their HbA1c level, good glycemic control (HbA1c ≤ 7%) and poor glycemic control (HbA1c&gt;7%).Results: Males represent 19 (55.9%) and females represent 15 (44.1%) of diabetic patients with in-stent restenosis. In table 2, 27 (79.45%) diabetic patients with poor glycemic control more likely to have in-stent restenosis than 7 (20.6%) patients with good glycemic control, P.value &lt; 0.005. In table 4 in-stent restenosis more likely to occur in non-proximal left anterior descending artery after elective PCI in 20 out of 27 patients with poor glycemic control, P.value &lt; 0.005.Conclusions: Our study reveals that there is a correlation between poor glycemic control and increased frequency of in-stent restenosis of drug eluting stents in diabetic patients. Poor glycemic controlled diabetic patients are more liable for in-stent restenosis of drug eluting stents after intervention in non-proximal left anterior descending artery.

A framework for computational fluid dynamic analyses of patient-specific stented coronary arteries from optical coherence tomography images

The clinical challenge of percutaneous coronary interventions (PCI) is highly dependent on the recognition of the coronary anatomy of each individual. The classic imaging modality used for PCI is angiography, but advanced imaging techniques that are routinely performed during PCI, like optical coherence tomography (OCT), may provide detailed knowledge of the pre-intervention vessel anatomy as well as the post-procedural assessment of the specific stent-to-vessel interactions. Computational fluid dynamics (CFD) is an emerging investigational tool in the setting of optimization of PCI results. In this study, an OCT-based reconstruction method was developed for the execution of CFD simulations of patient-specific coronary artery models which include the actual geometry of the implanted stent.The method was applied to a rigid phantom resembling a stented segment of the left anterior descending coronary artery. The segmentation algorithm was validated against manual segmentation. A strong correlation was found between automatic and manual segmentation of lumen in terms of area values. Similarity indices resulted >96% for the lumen segmentation and >77% for the stent strut segmentation. The 3D reconstruction achieved for the stented phantom was also assessed with the geometry provided by X-ray computed micro tomography scan, used as ground truth, and showed the incidence of distortion from catheter-based imaging techniques. The 3D reconstruction was successfully used to perform CFD analyses, demonstrating a great potential for patient-specific investigations.In conclusion, OCT may represent a reliable source for patient-specific CFD analyses which may be optimized using dedicated automatic segmentation algorithms.

Usefulness of the CHA2DS2-VASc Score in Predicting In-Stent Restenosis Among Patients Undergoing Revascularization With Bare-Metal Stents.

In-stent restenosis (ISR) is a limitation of percutaneous coronary intervention and has been linked to specific clinical and angiographic variables. The aim of the present study was to investigate the predictive value of preprocedural CHA2DS2-VASc score on ISR in patients undergoing revascularization with bare-metal stent (BMS) implantation for stable coronary artery disease or acute coronary syndrome. In the years 2012 to 2014, a total of 358 consecutive patients (mean age: 62.36 ± 11.28 years and 62.2% men) who had undergone successful BMS implantation were included in the study. All patients underwent stent implantation at admission to our center and had another coronary angiography performed due to recurrence of the symptoms consistent with myocardial ischemia and/or a stress test indicating ischemia. The patients were divided into 2 groups-ISR (n = 166) and non-ISR (n = 192). Angiographic ISR was defined as narrowing ≥50% in the stented coronary artery segment at follow-up angiography. The mean CHA2DS2-VASc score was 3.42 ± 1.35 (range 1-7). The CHA2DS2-VASc scores and high-sensitivity C-reactive protein (hs-CRP) levels were higher in the ISR group compared to the non-ISR group. At multivariable analysis, CHA2DS2-VASc score (odds ratio [OR]: 2.004, 95% confidence interval: 1.361-2.949, P < .001), total stent length (OR: 1.093, P = .001), stent diameter (OR: 0.129, P < .001), and hs-CRP (OR: 1.224, P < .001) emerged as independent risk factors for ISR. In conclusion, preprocedural CHA2DS2-VASc is an easily calculated score that provides an additional level of risk stratification beyond that provided by conventional risk factors. Thus, this score can be used as a simple and effective tool to predict ISR in patients undergoing BMS implantation.

Reconstruction of stented coronary arteries from optical coherence tomography images: Feasibility, validation, and repeatability of a segmentation method.

Optical coherence tomography (OCT) is an established catheter-based imaging modality for the assessment of coronary artery disease and the guidance of stent placement during percutaneous coronary intervention. Manual analysis of large OCT datasets for vessel contours or stent struts detection is time-consuming and unsuitable for real-time applications. In this study, a fully automatic method was developed for detection of both vessel contours and stent struts. The method was applied to in vitro OCT scans of eight stented silicone bifurcation phantoms for validation purposes. The proposed algorithm comprised four main steps, namely pre-processing, lumen border detection, stent strut detection, and three-dimensional point cloud creation. The algorithm was validated against manual segmentation performed by two independent image readers. Linear regression showed good agreement between automatic and manual segmentations in terms of lumen area (r>0.99). No statistically significant differences in the number of detected struts were found between the segmentations. Mean values of similarity indexes were >95% and >85% for the lumen and stent detection, respectively. Stent point clouds of two selected cases, obtained after OCT image processing, were compared to the centerline points of the corresponding stent reconstructions from micro computed tomography, used as ground-truth. Quantitative comparison between the corresponding stent points resulted in median values of ~150 μm and ~40 μm for the total and radial distances of both cases, respectively. The repeatability of the detection method was investigated by calculating the lumen volume and the mean number of detected struts per frame for seven repeated OCT scans of one selected case. Results showed low deviation of values from the median for both analyzed quantities. In conclusion, this study presents a robust automatic method for detection of lumen contours and stent struts from OCT as supported by focused validation against both manual segmentation and micro computed tomography and by good repeatability.

Endothelial progenitor cells and plaque burden in stented coronary artery segments: an optical coherence tomography study six months after elective PCI

BackgroundEndothelial progenitor cells (EPC) are involved in neovascularization and endothelial integrity. They might be protective in atherosclerosis. Optical coherence tomography (OCT) is a precise intracoronary imaging modality that allows assessment of subintimal plaque development. We evaluated the influence of EPC on coronary plaque burden in stable disease and implemented a novel computational plaque analysis algorithm using OCT.MethodsForty-three patients (69.8% males, 69.6 ± 7.7 years) were investigated by OCT during re-angiography 6 months after elective stent implantation. Different subpopulations of EPCs were identified by flow cytometry according to their co-expression of antigens (CD34+, CD133+, kinase domain receptor, KDR+). An algorithm was applied to calculate the underlying total plaque burden of the stented segments from OCT images. Plaque morphology was assessed according to international consensus in OCT imaging.ResultsA cumulative sub-strut plaque volume of 10.87 ± 12.7 mm3 and a sub-stent plaque area of 16.23 ± 17.0 mm2 were found within the stented vessel segments with no significant differences between different stent types. All EPC subpopulations (mean of EPC levels: CD34+/CD133+: 2.66 ± 2.0%; CD34+/KDR+: 7.50 ± 5.0%; CD34+/CD133+/KDR+: 1.12 ± 1.0%) inversely correlated with the identified underlying total plaque volume and plaque area (p ≤ 0.012).ConclusionsThis novel analysis algorithm allows for the first time comprehensive quantification of coronary plaque burden by OCT and illustration as spread out vessel charts. Increased EPC levels are associated with less sub-stent coronary plaque burden which adds to previous findings of their protective role in atherosclerosis.

Degradation of poly(L‐lactic acid) coating on permanent coronary metal stent investigated ex vivo by micro Raman spectroscopy

Poly(lactic acid) (PLA) is a biodegradable polymer with a variety of applications, such as functional coatings on implants, due to its biodegradability, good biocompatibility and very low toxicity. In this study, the degradation behavior of high molecular weight poly(L‐lactic acid) (L‐PLA), which was used as polymer coating on permanent coronary metal stent, was investigated ex vivo. Poly(methyl methacrylate) (PMMA)‐embedded histological specimens of stented porcine coronary arteries (left anterior descending artery, left circumflex artery and right coronary artery) were used to follow the degradation at various implantation times (6, 12, 24 and 36 months). Micro Raman spectroscopy was applied as an alternative technique for the determination of the residual content of the L‐PLA coating. For this purpose, the PMMA‐embedded cross sections of stented porcine coronary arteries were characterized through a previously developed Raman method for in situ quantitative analysis of PLA in a PMMA matrix. The residual content of L‐PLA coating on the surface of the coronary metal stent was determined through the relative Raman band area ratio of the C–COO stretching band of PLA at 873 cm−1 and the C–O–C symmetric stretching band of PMMA at 813 cm−1. This study demonstrated that Raman spectroscopy provides an alternative, non‐destructive technique for quantification of L‐PLA coating on permanent coronary metal stent in an animal model. The results suggest that the complete absorption of the L‐PLA coating required more than 24 months for the layer thickness applied in this study and that the degradation of high molecular weight L‐PLA in a porcine model is carried out by a hydrolytic degradation through the bulk erosion mode. Copyright © 2017 John Wiley &amp; Sons, Ltd.

Pathology of Chronic Total Occlusion in Bare-Metal Versus Drug-Eluting Stents: Implications for Revascularization

ObjectivesThe aim of this study was to explore the pathology of in-stent chronic total occlusion (IS-CTO) in bare-metal (BMS) versus drug-eluting stents (DES). BackgroundDespite a relatively high prevalence of IS-CTO, little is known about the underlying etiology and histopathologic characteristics of the occlusion. MethodsFrom CVPath Institute’s stent registry of human native coronary arteries, the authors identified 56 lesions (32 BMS and 24 DES) from 54 patients with IS-CTO. Sections of stented coronary arteries were examined for histological features of IS-CTO. The underlying mechanisms of IS-CTO were determined along with the histopathological characteristics. ResultsThe pathological prevalence of IS-CTO was significantly higher in BMS versus DES cases at autopsy (11.7% vs. 5.9%; p = 0.01). The most frequent etiology of IS-CTO was acute thrombotic occlusion (51% in BMS vs. 67% in DES), followed by restenosis (31% vs. 8%) and neoatherosclerotic rupture (9% vs. 4%). The proximal lumen pattern was abrupt in 67% of BMS and in 57% of DES, whereas the distal lumen was tapered in 68% of BMS and in 74% of DES. BMS showed longer fibrous cap of IS-CTO than DES in both proximal (4.6 mm vs. 1.6 mm; p = 0.06) and distal (5.3 mm vs. 2.0 mm; p = 0.06). ConclusionsAt autopsy, IS-CTO was observed more frequently in BMS versus DES, with acute thrombotic occlusion being the most frequent cause, followed by restenosis (especially in BMS) and neoatherosclerotic rupture. Our findings shed new light upon the frequency, mechanisms, and pathology of IS-CTO.

Improved diagnostic accuracy when combining computed tomography angiography and corrected coronary opacification in patients with coronary stents

Background The accuracy of coronary computed tomography angiography (CCTA) is sub-optimal in patients with coronary stents. Methods that can increase its diagnostic accuracy are desirable.Objective A proof-of-concept study was undertaken to determine if corrected coronary opacification (CCO) differences can improve the accuracy of CCTA in stented coronary arteries.Methods PCI patients who underwent both CCTA and invasive coronary angiography (ICA) within 3 months were analyzed. Coronary luminal attenuation values (normalized to the aorta) were measured proximally and distally to coronary stents. CCO differences were evaluated for ability to predict (i) stenosis on invasive angiography, (ii) abnormal resting coronary flow as measured by the corrected thrombolysis in myocardial infarction (TIMI) frame count (cTFC), and (iii) the combination of abnormal resting flow and significant stenosis on invasive angiography.Results Twenty-nine stented coronary arteries (n = 25, mean age =61.4 years, men =80.0%) were assessed. In stented coronary vessels, CCO identified stenosis (≥ 70%) with an area under the curve of 0.767 (P = 0.021). CCO predicted abnormal resting coronary flow with high accuracy (AUC =0.867, P = 0.002). Combined CCTA/CCO identified both abnormal cTFC and stenosis ≥70% on ICA (functionally significant stenosis) with diagnostic accuracy of 92.3%. In contrast, CCTA visual assessment alone had lower diagnostic accuracy of 66.7% for identifying functionally significant stenosis.Conclusion CCO differences are predictive of abnormal resting flow and consequently, in-stent restenosis. Incorporation of this technique may improve the specificity of CCTA in PCI patients.

Coupled Analysis of Blood Flow and Deformation of Stented Coronary Artery

Coupled Analysis of Blood Flow and Deformation of Stented Coronary Artery