Association Between Targeted Aortic Segment Tortuosity and Stent-Graft–Induced New Entry After Thoracic Endovascular Aortic Repair for Aortic Dissection or Intramural Hematoma

A computational approach is used to investigate potential risk factors for distal stent graft-induced new entry (dSINE) in aortic dissection (AD) patients. Patient-specific simulations were performed based on computed tomography images acquired from six AD patients (three dSINE and three non-dSINE) to analyze the correlation between anatomical characteristics and stress/strain distributions. Sensitivity analysis was carried out using idealized models to independently assess the effect of stent graft length, stent tortuosity and wedge apposition angle at the landing zone on key biomechanical variables. Mismatch of biomechanical properties between the stented and nonstented regions led to high stress at the distal stent graft-vessel interface in all patients, as well as shear strain in the neighbouring region, which coincides with the location of tear formation. Stress was observed to increase with the increase of stent tortuosity (from 263kPa at a tortuosity angle of 50o to 313 kPa at 30o). It was further amplified by stent graft landing at the inflection point of a curve. Malapposition of the stent graft led to an asymmetrical segment within the aorta, therefore changing the location and magnitude of the maximum von Mises stress substantially (up to +25.9% with a +25o change in the distal wedge apposition angle). In conclusion, stent tortuosity and wedge apposition angle serve as important risk predictors for dSINE formation in AD patients.

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Early Prediction of Distal Stent Graft-Induced New Entry after Thoracic Endovascular Aortic Repair with Computational Fluid Dynamics

Tang,

Zhang,

Chen

2024

Proceedings of the 2024 9th International Conference on Biomedical Signal and Image Processing

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Association Between Targeted Aortic Segment Tortuosity and Stent-Graft–Induced New Entry After Thoracic Endovascular Aortic Repair for Aortic Dissection or Intramural Hematoma

Cited by 3 publications

References 24 publications

A CT-based predictive model for stent-induced vessel damage: application to type B aortic dissection

A CT-based predictive model for stent-induced vessel damage: application to type B aortic dissection

Effect of Vessel Tortuosity on Stress Concentration at the Distal Stent–Vessel Interface: Possible Link With New Entry Formation Through Biomechanical Simulation

Early Prediction of Distal Stent Graft-Induced New Entry after Thoracic Endovascular Aortic Repair with Computational Fluid Dynamics

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