Arterial wall mechanics and clinical implications after coronary stenting: Comparisons of three stent designs

The goal of this work is to quantitatively assess the relationship between the reported restenosis rates and stent induced arterial stress or strain parameters through finite element method. The impact of three stent designs (PalmazSchatz stent, Express stent, and Multilink Vision stent) on the arterial stress distributions were characterized. The influences of initial stent deployment location, stent-tissue friction, and plaque properties on the arterial stresses were also investigated. Higher arterial stresses were observed at the proximal end of the plaque. The MultilinkVision stent induced lesser stress concentrations due to the high stiffness of the Cobalt Chromium material and thinner strut thickness. The stent-induced arterial stress concentrations were positively correlated with the reported in-stent restenosis rates, with a correlation coefficient of 0.992. Stent deployment initiated at the center of the lumen led to less arterial stress variation, while deployment closer to the thinner edge of the plaque causes higher arterial stresses. The friction between the stent and tissue was found to contribute to larger stress alternations for the plaque only. Increased plaque stiffness resulted in a reduced arterial stress concentration and clinical restenosis rate. Results presented herein suggested that arterial stresses serve as a comprehensive index factor to predict the occurrence of in-stent restenosis, which will facilitate the new stent design and surgical planning.