Numerical Simulation of Stent Angioplasty with Predilation: An Investigation into Lesion Constitutive Representation and Calcification Influence
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It is acceptable clinical practice to predilate a severely occluded vessel to allow better positioning of endovascular stents, and while the impact of this intervention has been examined for aggregate response in animals there has been no means to examine whether there are specific vessels that might benefit. Finite element methods offer the singular ability to explore the mechanical response of arteries with specific pathologic alterations in mechanics to stenting and predilation. We examined varying representations of atherosclerotic tissue including homogeneous and heterogeneous dispersion of calcified particles, and elastic, pseudo-elastic, and elastic–plastic constitutive representations of bulk atherosclerotic tissue. The constitutive representations of the bulk atherosclerotic tissue were derived from experimental test data and highlight the importance of accounting for testing mode of loading. The impact of arterial predilation is presented and, in particular, its effect on intimal predicted damage, atherosclerotic tissue von Mises and maximum principal stresses, and luminal deformation was dependent on the type of constitutive representation of diseased tissue, particularly in the presence of calcifications.
KeywordsStent Atherosclerosis Predilation angioplasty Finite element analysis Pseudo-elasticity Calcification
The authors would like to acknowledge funding from the Irish Research Council/Irish Research Council for Science, Engineering and Technology (CC), the support of the Research Participation Program at US FDA administered by Oak Ridge Institute for Science and Education (CC), the US National Institutes of Health R01 GM 49039 (ERE), the SFI/HEA Irish Centre for High End Computing and the Massachusetts Institute of Technology Engaging Centre for the provision of computational facilities and support.
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