Simulation of oxygen transfer in stented arteries and correlation with in‐stent restenosis

Published on Dec 1, 2013in International Journal for Numerical Methods in Biomedical Engineering2.097
· DOI :10.1002/CNM.2588
M. Caputo1
Estimated H-index: 1
(Polytechnic University of Milan),
Claudio Chiastra18
Estimated H-index: 18
(Polytechnic University of Milan)
+ 6 AuthorsPaolo Zunino28
Estimated H-index: 28
(Polytechnic University of Milan)
Sources
Abstract
SUMMARY Computational models are used to study the combined effect of biomechanical and biochemical factors on coronary in-stent restenosis, which is a postoperative remodeling and regrowth pathology of the stented arteries. More precisely, we address numerical simulations, on the basis of Navier–Stokes and mass transport equations, to study the role of perturbed wall shear stresses and reduced oxygen concentration in a geometrical model reconstructed from a real porcine artery treated with a stent. Joining in vivo and in silico tools of investigation has multiple benefits in this case. On one hand, the geometry of the arterial wall and of the stent closely correspond to a real implanted configuration. On the other hand, the inspection of histological tissue samples informs us on the location and intensity of in-stent restenosis. As a result, we are able to correlate geometrical factors, such as the axial variation of the artery diameter and its curvature; the numerical quantification of biochemical stimuli, such as wall shear stresses; and the availability of oxygen to the inner layers of the artery, with the appearance of in-stent restenosis. This study shows that the perturbation of the vessel curvature could induce hemodynamic conditions that stimulate undesired arterial remodeling. Copyright © 2013 John Wiley & Sons, Ltd.
📖 Papers frequently viewed together
23 Citations
45 Citations
21 Citations
References45
Newest
#1Elena Cutrì (Polytechnic University of Milan)H-Index: 7
#2Paolo Zunino (University of Pittsburgh)H-Index: 28
Last. Francesco Migliavacca (Polytechnic University of Milan)H-Index: 60
view all 5 authors...
The treatment of coronary bifurcation lesions represents a challenge for the interventional cardiologists due to the lower rate of procedural success and the higher risk of restenosis. The advent of drug-eluting stents (DES) has dramatically reduced restenosis and consequently the request for re-intervention. The aim of the present work is to provide further insight about the effectiveness of DES by means of a computational study that combines virtual stent implantation, fluid dynamics and drug ...
28 CitationsSource
#1Stefano Morlacchi (Polytechnic University of Milan)H-Index: 12
#2Francesco Migliavacca (Polytechnic University of Milan)H-Index: 60
In the last two decades, numerical models have become well-recognized and widely adopted tools to investigate stenting procedures. Due to limited computational resources and modeling capabilities, early numerical studies only involved simplified cases and idealized stented arteries. Nowadays, increased computational power allows for numerical models to meet clinical needs and include more complex cases such as the implantation of multiple stents in bifurcations or curved vessels. Interesting pro...
61 CitationsSource
#1Diego Gallo (Polytechnic University of Turin)H-Index: 23
#2David A. Steinman (U of T: University of Toronto)H-Index: 62
Last. Umberto Morbiducci (Polytechnic University of Turin)H-Index: 32
view all 4 authors...
Abstract The main purpose of the study is to verify if helical flow might be a surrogate marker of the exposure to disturbed shear in normal carotid bifurcations. Based on hemodynamic simulations data of 50 carotid bifurcations, we defined appropriate helicity-based bulk flow descriptors and multivariate linear regression analysis was performed to assess the potential for a combination of helicity-based indicators in describing the exposure to disturbed shear. To select the optimal combination o...
106 CitationsSource
#1Claudio Chiastra (Polytechnic University of Milan)H-Index: 18
#2Stefano Morlacchi (Polytechnic University of Milan)H-Index: 12
Last. Francesco Migliavacca (Polytechnic University of Milan)H-Index: 60
view all 5 authors...
Abstract Nowadays the provisional side branch (PSB) approach is the preferred coronary bifurcation stenting technique. It is usually concluded by the final kissing balloon (FKB) procedure which consists in the simultaneous expansion of two balloons in both the bifurcation branches. Several kinds of accesses to the side branch (SB) can be used to perform the FKB procedure resulting in different final geometrical configurations of both the artery and the implanted stent and, consequently, altered ...
38 CitationsSource
#1Stefano Morlacchi (Polytechnic University of Milan)H-Index: 12
#2Claudio Chiastra (Polytechnic University of Milan)H-Index: 18
Last. Francesco Migliavacca (Polytechnic University of Milan)H-Index: 60
view all 6 authors...
Abstract Despite their success, stenting procedures are still associated to some clinical problems like sub-acute thrombosis and in-stent restenosis. Several clinical studies associate these phenomena to a combination of both structural and hemodynamic alterations caused by stent implantation. Recently, numerical models have been widely used in the literature to investigate stenting procedures but always from either a purely structural or fluid dynamic point of view. The aim of this work is the ...
56 CitationsSource
#1Stefano Morlacchi (Polytechnic University of Milan)H-Index: 12
#2Brandis Keller (Polytechnic University of Milan)H-Index: 8
Last. Patricia V. Lawford (University of Sheffield)H-Index: 27
view all 11 authors...
A model that combines the results of in vivo experiment, 3D image data, and computer simulation has been developed. Twelve identical stents were implanted into six healthy pigs and explanted at a range of different post-recovery periods from 6 h to 28 days. The stented vessel segments were embedded in methacrylate resin for the preparation of transverse histological sections and imaged using ultra-high resolution micro-CT. The resulting CT data was used to reconstruct the 3D geometry of the sten...
61 CitationsSource
#1Jeng-Jiann Chiu (NHRI: National Health Research Institutes)H-Index: 1
#2Shu ChienH-Index: 128
Vascular endothelial cells (ECs) are exposed to hemodynamic forces, which modulate EC functions and vascular biology/pathobiology in health and disease. The flow patterns and hemodynamic forces are not uniform in the vascular system. In straight parts of the arterial tree, blood flow is generally laminar and wall shear stress is high and directed; in branches and curvatures, blood flow is disturbed with nonuniform and irregular distribution of low wall shear stress. Sustained laminar flow with h...
1,238 CitationsSource
This study investigates the oxygen mass transport in the region around the human carotid bifurcation, particularly addressing the effects of bifurcation geometry and pulsatile blood flow on the oxygen transport between the blood flow and artery wall tissue, coupled with the metabolic oxygen consumption and oxygen diffusion in the artery wall tissue. The temporal variations and spatial distributions of the oxygen tension are predicted quantitatively using a geometric model of the human carotid bi...
12 CitationsSource
#1Jonathan Murphy (DIT: Dublin Institute of Technology)H-Index: 5
#2Fergal Boyle (DIT: Dublin Institute of Technology)H-Index: 16
This paper reviews the recent literature regarding the time-dependant computational fluid dynamics (CFD) analyses of blood flow through implanted coronary stents. The in vivo processes which result in arterial restenosis are identified. The definition and range of the computationally predicted variables which are believed to stimulate the restenosis processes are evaluated. The reviewed literature is subdivided into effect-based in which the effects of altering the flow model are investigated an...
49 CitationsSource
#1Dario Gastaldi (Polytechnic University of Milan)H-Index: 20
#2Stefano Morlacchi (Polytechnic University of Milan)H-Index: 12
Last. Francesco Migliavacca (Polytechnic University of Milan)H-Index: 60
view all 7 authors...
The most common approach to treat atherosclerosis in coronary bifurcations is the provisional side-branch (PSB) stenting, which consists sequentially of the insertion of a stent in the main branch (MB) of the bifurcation and a dilatation of the side branch (SB) passing through the struts of the stent at the bifurcation. This approach can be followed by a redilatation of the MB only or by a Final Kissing Balloon (FKB) inflation, both strategies leading to a minor stent distortion in the MB. The p...
91 CitationsSource
Cited By23
Newest
#1Pavel Zun (Saint Petersburg State University of Information Technologies, Mechanics and Optics)H-Index: 5
#2Andrey Svitenkov (Saint Petersburg State University of Information Technologies, Mechanics and Optics)H-Index: 1
Last. Alfons G. Hoekstra (UvA: University of Amsterdam)H-Index: 57
view all 3 authors...
Abstract Computational models are increasingly used to study cardiovascular disease. However, models of coronary vessel remodelling usually make some strong assumptions about the effects of a local narrowing on the flow through the narrowed vessel. Here, we test the effects of local flow dynamics on the predictions of an in-stent restenosis (ISR) model. A previously developed 2D model of ISR is coupled to a 1D model of coronary blood flow. Then, two different assumptions are tested. The first as...
Source
#1Monika Colombo (Polytechnic University of Milan)H-Index: 4
#2Yong He (UF: University of Florida)H-Index: 7
Last. Claudio Chiastra (Polytechnic University of Milan)H-Index: 18
view all 10 authors...
In-stent restenosis (ISR) represents a major drawback of stented superficial femoral arteries (SFAs). Motivated by the high incidence and limited knowledge of ISR onset and development in human SFAs, this study aims to (i) analyze the lumen remodeling trajectory over 1-year follow-up period in human stented SFAs and (ii) investigate the impact of altered hemodynamics on ISR initiation and progression. Ten SFA lesions were reconstructed at four follow-ups from computed tomography to quantify the ...
Source
#1Javier Escuer (University of Zaragoza)H-Index: 2
#2Irene Aznar (University of Zaragoza)
Last. Miguel Ángel Martínez (Ciber)H-Index: 38
view all 6 authors...
In the last decade, many computational models have been developed to describe the transport of drug eluted from stents and the subsequent uptake into arterial tissue. Each of these models has its own set of limitations: for example, models typically employ simplified stent and arterial geometries, some models assume a homogeneous arterial wall, and others neglect the influence of blood flow and plasma filtration on the drug transport process. In this study, we focus on two common limitations. Sp...
Source
#1Rana Zakerzadeh (RMIT: RMIT University)H-Index: 6
#2Tanja Cupac (RMIT: RMIT University)H-Index: 1
Last. Michael J. Durka (University of Pittsburgh)H-Index: 5
view all 3 authors...
This paper reports on modelling and simulation of the coupled mass and momentum transport through the arterial lumen and the porous arterial wall of an abdominal aortic aneurysm (AAA). The effect o...
1 CitationsSource
#1Rana Zakerzadeh (RMIT: RMIT University)H-Index: 6
#2Tanja Cupac (RMIT: RMIT University)H-Index: 1
Last. Alexander Guy (RMIT: RMIT University)
view all 4 authors...
PURPOSE Abdominal Aortic Aneurysms (AAA) have extreme medical prevalence as an asymptomatic cause of death in developed countries. The probability of AAA rupture is promoted by the localized oxygen loss in the AAA wall which occurs in part because many AAAs contain a layer called intraluminal thrombus (ILT). Considering this strong clinical association, the purpose of this study is to investigate the key features that constitute to the oxygen diffusion, and therefore hypoxia in AAA. METHODS A th...
Source
#1Shicheng He (SEU: Southeast University)
#2Wanling Liu (Chongqing University)
Last. Guixue Wang (Chongqing University)H-Index: 28
view all 9 authors...
Abstract Percutaneous coronary intervention (PCI) has been widely used in the treatment of atherosclerosis, while in-stent restenosis (ISR) has not been completely resolved. Studies have shown that changes in intravascular mechanical environment are related to ISR. Hence, an in-depth understanding of the effects of stent intervention on vascular mechanics is important for clinically optimizing stent implantation and relieving ISR. Nine rabbits with stenotic carotid artery were collected by ballo...
Source
#1John M. Tarbell (CCNY: City College of New York)H-Index: 71
#2Marwa Mahmoud (CCNY: City College of New York)H-Index: 3
Last. Colin G. Caro (Imperial College London)H-Index: 25
view all 5 authors...
Atherosclerosis and vascular disease of larger arteries are often associated with hypoxia within the layers of the vascular wall. In this review, we begin with a brief overview of the molecular changes in vascular cells associated with hypoxia and then emphasize the transport mechanisms that bring oxygen to cells within the vascular wall. We focus on fluid mechanical factors that control oxygen transport from lumenal blood flow to the intima and inner media layers of the artery, and solid mechan...
6 CitationsSource
#1Susanna Migliori (Polytechnic University of Milan)H-Index: 4
#2Claudio Chiastra (Polytechnic University of Milan)H-Index: 18
Last. Francesco Migliavacca (Polytechnic University of Milan)H-Index: 60
view all 10 authors...
Abstract The rupture of a vulnerable plaque, known as ulceration, is the most common cause of myocardial infarction. It can be recognized by angiographic features, such as prolonged intraluminal filling and delayed clearance of the contrast liquid. The diagnosis of such an event is an open challenge due to the limited angiographic resolution and acquisition frequency. The treatment of ulcerated plaques is an open discussion, due to the high heterogeneity and the lack of evidences that support pa...
4 CitationsSource
#1Anna Corti (Polytechnic University of Milan)H-Index: 2
#2Claudio Chiastra (Polytechnic University of Milan)H-Index: 18
Last. Stefano Casarin (Houston Methodist Hospital)H-Index: 5
view all 6 authors...
Abstract Background Peripheral artery disease (PAD) is an atherosclerotic disorder that leads to unpaired lumen patency through intimal hyperplasia and the build-up of plaques, mainly localized in areas of disturbed flow. Computational models can provide valuable insights in the pathogenesis of atherosclerosis and act as a predictive tool to optimize current interventional techniques. Our hypothesis is that a reliable predictive model must include the atherosclerosis development history. Accordi...
6 CitationsSource
#1Monika Colombo (Polytechnic University of Milan)H-Index: 4
#2Marco Bologna (Polytechnic University of Milan)H-Index: 6
Last. Claudio Chiastra (Polytechnic University of Milan)H-Index: 18
view all 8 authors...
Abstract Patients with peripheral artery disease who undergo endovascular treatment are often inflicted by in-stent restenosis. The relation between restenosis and abnormal hemodynamics may be analyzed using patient-specific computational fluid dynamics (CFD) simulations. In this work, first a three-dimensional (3D) reconstruction method, based on an in-house semi-automatic segmentation algorithm of a patient's computed tomography (CT) images with calcification and metallic artifacts, and thromb...
13 CitationsSource