Advancements and Opportunities in Characterizing Patient-Specific Wall Shear Stress Imposed by Coronary Artery Stenting

Abstract

The success of drug-eluting stents (DES) is limited by restenosis and, to a lesser extent, late stent thrombosis. Mechanical stimuli have been implicated in these outcomes, with indices of wall shear stress (WSS) determined from computational simulations being reported most frequently. The current work summarizes state-of-the-art computational approaches applicable to patient-specific models aimed at further understanding changes in WSS indexes imposed by stent implantation. We begin with a review of best practices involved in the process and then summarize the literature related to stent-induced WSS alterations. Image-based reconstruction methods are also discussed, along with the latest generation boundary conditions that replicate cardiac physiology and downstream vasculature in the setting of coronary artery disease. The influence of existing material property data on WSS results obtained with geometries reconstructed from finite element modeling and fluid structure interaction (FSI) simulations is reviewed, along with the novel approaches being used to provide coronary artery plaque data that are currently missing from the literature. We also consider the use of machine learning tools that have the potential for impact when assessing the role of adverse stent-induced WSS in suboptimal clinical outcomes. We conclude by focusing on challenging cases that involve DES implantation, which may benefit from recent advancements in patient-specific computational modeling.

Aortic Remodeling Kinetics in Response to Coarctation-Induced Mechanical Perturbations

“…The current results should be interpreted relative to several potential limitations. In particular, high-fidelity hemodynamic simulation is challenging to perform longitudinally as 3D reconstruction of the aorta over the course of the disease requires multiple MRI acquisitions and often computationally heavy [46,47]. We, therefore, quantified WSS and IWS from the Hagen-Poiseuille law and force equilibrium using empirical measurements of local hemodynamics over the course of disease development.…”

Computational fluid dynamics as supporting technology for coronary artery disease diagnosis and treatment: an international survey

“…It has found widespread use in the functional assessment of CAD and in the elucidation of the role of hemodynamics in CAD initiation, progression, susceptibility and phenotype ( 4 , 11 , 12 ). Additionally, CFD has demonstrated its capability to describe and predict the hemodynamic responses before ( 13 , 14 ) and after cardiovascular interventional procedures ( 15 , 16 ), making it a valuable tool in the development and enhancement of intervention devices and treatment strategies ( 6 , 17 – 21 ). Furthermore, current literature has highlighted that basic modeling concepts are now ripe for incorporation into the knowledge base of interventional cardiologists.…”

“…In recent years, computational fluid dynamics (CFD) has emerged as a methodology ready to shift to technology for cardiovascular medicine, potentially enhancing the understanding of pathophysiology, by simulating interventional procedures, and improving decision making regarding CAD treatment (4)(5)(6)(7)(8). CFD utilizes numerical techniques to solve and analyze problems involving fluid flows, including blood flow (4).…”