Effects of Cardiovascular Stent Design on Wall Shear Stress Distribution in Straight and Curved Arteries

Abstract:

he stent is a major breakthrough in the treatment of coronary artery diseases. The permanent vascular implant of a stent, however, changes the intra-stent blood hemodynamics. There is a growing consensus that the stent implant may change the artery wall shear stress distribution and therefore trigger the restenosis process. Several studies have suggested that low shear stress, particularly the shear stress less than 5 dyne/cm2, may lead to endothelial proliferation of smooth muscle cells. Computational fluid dynamics (CFD) has been widely used to analyze hemodynamics in stented arteries. In this paper, CFD models were developed to investigate the effects of cardiovascular stent design on the wall shear stress distribution in straight and curved arteries. Results show that the stent design pattern alone did not have a significant impact on the stent hemodynamics; however, stenting in curved arteries increased the low shear stress area which may lead to higher restenosis rate. The low shear stress area was almost doubled when the degree of artery curvature increased from 0o to 90o. The proposed methodology and findings will provide great insight for future optimization of stent design to reduce the risk of restenosis.

• Periodical: Applied Mechanics and Materials (Volumes 284-287)
• Pages: 1642-1646
• DOI: https://doi.org/10.4028/www.scientific.net/AMM.284-287.1642
• Online since: January 2013
• Authors: Hao Ming Hsiao, Ying Chih Liao, Chien Han Lin, Fang Yu Liu, Yu Ming Tsuei
• Keywords: Cardiovascular Stent Design, Coronary Stented Artery, Curved Arteries, Hemodynamics, Restenosis, Wall Shear Stress (WSS)

References

[1] Kastrati A, et al, Restenosis after coronary placement of various stent types, Am J Cardiol, 87 (2001) 34-39.

[2] Yoshitomi Y, et al, Interventional cardiology - Does stent design affect probability of restenosis? A randomized trial comparing Multilink stents with GFX stents, Am Heart J, 142 (2001) 445-451.

DOI: 10.1067/mhj.2001.117321

[3] LaDisa JF, et al, Alterations in wall shear stress predict sites of neointimal hyperplasia after stent implantation in rabbit iliac arteries, Am J Physiol Heart Circ Physiol, 288 (2005), H2465-H2475.

DOI: 10.1152/ajpheart.01107.2004

[4] Lee D and Chiu JJ, Intimal thickening under shear in a carotid bifurcation - A numerical study, J Biomech, 29 (1996) 1-11.

DOI: 10.1016/0021-9290(95)00024-0

[5] Mongrain R and Rodes-Cabau J, Role of shear stress in atherosclerosis and restenosis after coronary stent implantation, Rev Esp Cardiol, 59(2006) 1-4.

DOI: 10.1016/s1885-5857(06)60040-6

[6] Stone PH, et al, Effect of endothelial shear stress on the progression of coronary artery disease, vascular remodeling, and in-stent restenosis in humans - In vivo 6-month follow-up study, Circulation, 108 (2003) 438-444.

DOI: 10.1161/01.cir.0000080882.35274.ad

[7] Wentzel, JJ, et al, Relationship between neointimal thickness and shear stress after wallstent implantation in human coronary arteries, Circulation, 103(2001) 1740-1745.

DOI: 10.1161/01.cir.103.13.1740

[8] Yao H., et al, Computational modelling of blood flow through curved stenosed arteries, J Med Eng Tech, 24 (2000) 163-168.

[9] Nosovitsky, V. A., et al. Effects of curvature and stenosis-like harrowing on wall shear stress in a coronary artery model with phasic flow, Comput Biomed Res, 30 (1997) 61-82.

DOI: 10.1006/cbmr.1997.1434

[10] Taewon Seo, et al, Computational Study of Fluid Mechanical Disturbance Induced by Endovascular Stents, Ann Biomed Eng, 33 (2005) 444-456.

DOI: 10.1007/s10439-005-2499-y

[11] Ofili EO, Labovitz AJ and Kern MJ, Coronary flow velocity dynamics in normal and diseased arteries, Am J Cardiol, 14 (1993) 71-78.

DOI: 10.1016/0002-9149(93)90128-y

[12] Chien S, et al, Effects of hematocrit and plasma proteins on human blood rheology at low shear rates, J Appl Physiol, Vol. 21(1966), pp.81-87.

DOI: 10.1152/jappl.1966.21.1.81

[13] Seo T, Schachter LG and Barakat AI, Computational study of fluid mechanical disturbance induced by endovascular stents, Ann Biomed Eng, 33(2005) 444-456.

DOI: 10.1007/s10439-005-2499-y

[14] Traub O and Berk BC, Laminar shear stress - Mechanisms by which endothelial cells transduce an atheroprotective force, Arterioscler Thromb Vasc Biol, 18 (1998) 677-685.

DOI: 10.1161/01.atv.18.5.677

[15] Malek AM, Alper SL and Izumo S, Hemodynamic shear stress and its role in atherosclerosis, JAMA, 282 (1999) 2035-(2042).

DOI: 10.1001/jama.282.21.2035