Hemodynamics and the interaction between the components of the cardiovascular system are complex and involve a structural/fluid flow interaction. During the cardiac cycle, changes to vascular pressure induce a compliant response in the vessels as they cyclically stretch and relax. The compliance influences the fluid flow throughout the system. The interaction is influenced by the disease state of the artery, and in particular, a plaque layer can reduce the compliance. In order to properly quantify the fluid-structural response, it is essential to consider whether the tissue surrounding the artery provides a support to the vessel wall. Here, a series of calculations are provided to determine what role the supporting tissue plays in the vessel wall and how much tissue must be included to properly carry out future fluid-structure calculations. Additionally, we calculate the sensitivity of the compliance to material properties such as the Young's modulus or to the transmural pressure difference.

Simulations were made of the pressure and velocity fields throughout an artery before and after removal of plaque using orbital atherectomy plus adjunctive balloon angioplasty or stenting. The calculations were carried out with an unsteady computational fluid dynamic solver that allows the fluid to naturally transition to turbulence. The results of the atherectomy procedure leads to an increased flow through the stenotic zone with a coincident decrease in pressure drop across the stenosis. The measured effect of atherectomy and adjunctive treatment showed decrease the systolic pressure drop by a factor of 2.3. Waveforms obtained from a measurements were input into a numerical simulation of blood flow through geometry obtained from medical imaging. From the numerical simulations, a detailed investigation of the sources of pressure loss was obtained. It is found that the major sources of pressure drop are related to the acceleration of blood through heavily occluded cross sections and the imperfect flow recovery downstream. This finding suggests that targeting only the most occluded parts of a stenosis would benefit the hemodynamics. The calculated change in systolic pressure drop through the lesion was a factor of 2.4, in excellent agreement with the measured improvement. The systolic and cardiac-cycle-average pressure results were compared with measurements made in a multi-patient study treated with orbital atherectomy and adjunctive treatment. The agreements between the measured and calculated systolic pressure drop before and after the treatment were within 3%. This excellent agreement adds further confidence to the results. This research demonstrates the use of orbital atherectomy to facilitate balloon expansion to restore blood flow and how pressure measurements can be utilized to optimize revascularization of occluded peripheral vessels.