TY - JOUR
T1 - Hemodynamic alternations following stent deployment and post-dilation in a heavily calcified coronary artery
T2 - In silico and ex-vivo approaches
AU - Gamage, Peshala T.
AU - Dong, Pengfei
AU - Lee, Juhwan
AU - Gharaibeh, Yazan
AU - Zimin, Vladislav N.
AU - Dallan, Luis A.P.
AU - Bezerra, Hiram G.
AU - Wilson, David L.
AU - Gu, Linxia
N1 - Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/12
Y1 - 2021/12
N2 - In this work, hemodynamic alterations in a patient-specific, heavily calcified coronary artery following stent deployment and post-dilations are quantified using in silico and ex-vivo approaches. Three-dimensional artery models were reconstructed from OCT images. Stent deployment and post-dilation with various inflation pressures were performed through both the finite element method (FEM) and ex vivo experiments. Results from FEM agreed very well with the ex-vivo measurements, interms of lumen areas, stent underexpansion, and strut malapposition. In addition, computational fluid dynamics (CFD) simulations were performed to delineate the hemodynamic alterations after stent deployment and post-dilations. A pressure time history at the inlet and a lumped parameter model (LPM) at the outlet were adopted to mimic the aortic pressure and the distal arterial tree, respectively. The pressure drop across the lesion, pertaining to the clinical measure of instantaneous wave-free flow ratio (iFR), was investigated. Results have shown that post-dilations are necessary for the lumen gain as well as the hemodynamic restoration towards hemostasis. Malapposed struts induced much higher shear rate, flow disturbances and lower time-averaged wall shear stress (TAWSS) around struts. Post-dilations mitigated the strut malapposition, and thus the shear rate. Moreover, stenting induced larger area of low TAWSS (<0.4 Pa) and lager volume of high shear rate (>2000 s−1), indicating higher risks of in-stent restenosis (ISR) and stent thrombosis (ST), respectively. Oscillatory shear index (OSI) and relative residence time (RRT) indicated the wall regions more prone to ISR are located near the malapposed stent struts.
AB - In this work, hemodynamic alterations in a patient-specific, heavily calcified coronary artery following stent deployment and post-dilations are quantified using in silico and ex-vivo approaches. Three-dimensional artery models were reconstructed from OCT images. Stent deployment and post-dilation with various inflation pressures were performed through both the finite element method (FEM) and ex vivo experiments. Results from FEM agreed very well with the ex-vivo measurements, interms of lumen areas, stent underexpansion, and strut malapposition. In addition, computational fluid dynamics (CFD) simulations were performed to delineate the hemodynamic alterations after stent deployment and post-dilations. A pressure time history at the inlet and a lumped parameter model (LPM) at the outlet were adopted to mimic the aortic pressure and the distal arterial tree, respectively. The pressure drop across the lesion, pertaining to the clinical measure of instantaneous wave-free flow ratio (iFR), was investigated. Results have shown that post-dilations are necessary for the lumen gain as well as the hemodynamic restoration towards hemostasis. Malapposed struts induced much higher shear rate, flow disturbances and lower time-averaged wall shear stress (TAWSS) around struts. Post-dilations mitigated the strut malapposition, and thus the shear rate. Moreover, stenting induced larger area of low TAWSS (<0.4 Pa) and lager volume of high shear rate (>2000 s−1), indicating higher risks of in-stent restenosis (ISR) and stent thrombosis (ST), respectively. Oscillatory shear index (OSI) and relative residence time (RRT) indicated the wall regions more prone to ISR are located near the malapposed stent struts.
KW - Calcified artery
KW - Computational fluid dynamics (CFD)
KW - Finite element method (FEM)
KW - Hemodynamics
KW - Optical coherence tomography (OCT)
KW - Oscillatory shear index
KW - Percutaneous coronary intervention (PCI)
KW - Post-dilation
KW - Relative residence time
KW - Restenosis
KW - Shear rate
KW - Stent expansion
KW - Stent thrombosis
KW - Wall shear stress
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U2 - 10.1016/j.compbiomed.2021.104962
DO - 10.1016/j.compbiomed.2021.104962
M3 - Article
C2 - 34715552
AN - SCOPUS:85117928041
SN - 0010-4825
VL - 139
JO - Computers in Biology and Medicine
JF - Computers in Biology and Medicine
M1 - 104962
ER -