A Computational Test-Bed to Assess Coronary Stent Implantation Mechanics Using a Population-Specific Approach
- 543 Downloads
The implantation behaviour of coronary stents is of great interest to clinicians and engineers alike as in-stent restenosis (ISR) remains a critical issue with the community. ISR is hypothesized to occur for reasons that include injury to the vessel wall caused by stent placement. To reduce the incidence of ISR, improved design and testing of coronary stents is needed. This research aims to facilitate more comprehensive evaluation of stents in the design phase, by generating more realistic arterial environments and corresponding stress states than have been considered heretofore, as a step towards reducing the prevalence of ISR. Furthermore it proposes improvements to the current requirements for coronary stent computational stress analyses as set out by the Food and Drug Administration (FDA). A systematic geometric test-bed with varying levels of arterial curvature and stenosis severity is developed and used to evaluate the implantation behaviour of two stent designs using finite element analysis. A parameter study on atherosclerotic tissue behaviour is also carried out. Results are analysed using tissue damage estimates and lumen gain comparisons for each design. Results indicate that stent design does not have a major impact on lumen gain behaviour but may have an influence on the potential for tissue damage. The level of stenosis in the arterial segments is seen to have a strong impact on the results while the effects of arterial curvature appear to be design dependent.
KeywordsFinite element analysis Coronary artery Atherosclerosis Stent
The authors would like to acknowledge funding from the Irish Research Council for Science, Engineering and Technology under the Embark Initiative (C. Conway) and the SFI/HEA Irish Centre for High-End Computing for the provision of computational facilities and support.
- 7.Dassault Systemes. Abaqus V6.10 Documentation. 2010.Google Scholar
- 9.de Feyter, P., J. Vos, and B. Rensing. Anti-restenosis trials. Curr. Interv. Cardiol. Rep. 2:326–331, 2000.Google Scholar
- 12.FDA. Non-Clinical Engineering Tests and Recommended Labeling for Intravascular Stents and Associated Delivery Systems. http://www.fda.gov/medicaldevices/deviceregulationandguidance/guidancedocuments/ucm071863.htm. Accessed 25 Jun 2012.
- 16.Gijsen, F., F. Migliavacca, S. Schievano, et al. Simulation of stent deployment in a realistic human coronary artery. BioMed. Eng. Oncoll. 7, 2008. doi: 10.1186/1475-925X-7-23.
- 18.Gu, L., S. Zhao, A. K. Muttyam, et al. The relation between the arterial stress and restenosis rate after coronary stenting. J. Med. Dev., Trans. ASME. 4, 2010.Google Scholar
- 21.Holzapfel, G. A., G. Sommer, C. T. Gasser, et al. Determination of layer-specific mechanical properties of human coronary arteries with nonatherosclerotic intimal thickening and related constitutive modeling. Am. J. Physiol. Heart Circ. Physiol. 289:H2048–H2058, 2005.Google Scholar
- 26.Kasiri, S., and D. J. Kelly. An argument for the use of multiple segment stents in curved arteries. J. Biomech. Eng. 133, 2011.Google Scholar
- 38.Migliavacca, F., L. Petrini, P. Massarotti, et al. Stainless and shape memory alloy coronary stents: a computational study on the interaction with the vascular wall. Biomech. Model. Mechanobiol. 2, 2004. doi: 10.1007/s10237-004-0039-6.
- 43.Ong, A. T. L., R. T. Van Domburg, J. Aoki, et al. Sirolimus-eluting stents remain superior to bare-metal stents at two years: medium-term results from the Rapamycin-Eluting Stent Evaluated at Rotterdam Cardiology Hospital (RESEARCH) registry. J. Am. Coll. Cardiol. 47:1356–1360, 2006.CrossRefGoogle Scholar
- 44.Pant, S., N. W. Bressloff, and G. Limbert. Geometry parameterization and multidisciplinary constrained optimization of coronary stents. Biomech. Model. Mechanobiol. 2011Google Scholar
- 46.Petrini, L., F. Migliavacc, and S. Schievano, et al. Computational analyses of intravascular stents. Biomech. Appl. Comput. Asst. Surg. 61–76, 2005.Google Scholar
- 48.Serruys, P. W. CAAS 2D/3D QCA Bifurcation analysis approach. In: European Bifurcation Club, EBC. Prague: 2008.Google Scholar
- 57.WHO. World Health Report 2004: Changing History. Published Online First: 2004.internal-pdf://World Health Report 2004-1247297536/World Health Report 2004.pdf.Google Scholar