Hemodynamics of Stent Implantation Procedures in Coronary Bifurcations: An In Vitro Study

Brindise, Melissa C.; Chiastra, Claudio; Burzotta, Francesco; Migliavacca, Francesco; Vlachos, Pavlos P.

doi:10.1007/s10439-016-1699-y

Cited by 29 publications

(15 citation statements)

References 31 publications

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“…In a study by Brindise et al [39], three different stenting techniques were compared in four compliant coronary artery models with a 60° bifurcation: provisional, crush and culotte technique. Overall, the culotte technique resulted in minimal stent induced flow disturbances as compared with the crush technique.…”

Section: Fluid Dynamics In Two-stent Techniquesmentioning

confidence: 99%

Local fluid dynamics in patients with bifurcated coronary lesions undergoing percutaneous coronary interventions

et al. 2021

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Although the coronary arteries are uniformly exposed to systemic cardiovascular risk factors, atherosclerosis development has a non-random distribution, which follows the local mechanical stresses including flow-related hemodynamic forces. Among these, wall shear stress plays an essential role and it represents the major flow-related factor affecting the distribution of atherosclerosis in coronary bifurcations. Furthermore, an emerging body of evidence suggests that hemodynamic factors such as low and oscillating wall shear stress may facilitate the development of in-stent restenosis and stent thrombosis after successful drug-eluting stent implantation. Drug-eluting stent implantation represents the gold standard for bifurcation interventions. In this specific setting of interventions on bifurcated lesions, the impact of fluid dynamics is expected to play a major role and constitutes substantial opportunity for future technical improvement. In the present review, available data is summarized regarding the role of local fluid dynamics in the clinical outcome of patients with bifurcated lesions.

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Section: Fluid Dynamics In Two-stent Techniquesmentioning

confidence: 99%

Local fluid dynamics in patients with bifurcated coronary lesions undergoing percutaneous coronary interventions

et al. 2021

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“…The WSS and its related indices has been extensively used in human hemodynamics for studying the performance of coronary stents [40,41,[43][44][45][46][47][48][49]. Although they have been used as significant morphologic and hemodynamic parameters for assessing intracranial aneurysm rupture [50][51][52], their application for evaluating the performance of FDSs has been rarely performed.…”

Section: Hemodynamics Parametersmentioning

confidence: 99%

CFD-Based Comparison Study of a New Flow Diverting Stent and Commercially-Available Ones for the Treatment of Cerebral Aneurysms

et al. 2019

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Flow-diverting stents (FDSs) show considerable promise for the treatment of cerebral aneurysms by diverting blood flow away from the aneurysmal sacs, however, post-treatment complications such as failure of occlusion and subarachnoid haemorrhaging remain and vary with the FDS used. Based on computational fluid dynamics (CFD), this study aimed to investigate the performance of a new biodegradable stent as compared to two metallic commercially available FDSs. CFD models were developed for an idealized cerebral artery with a sidewall aneurysmal sac treated by deploying the aforementioned stents of different porosities (90, 80, and 70 % ) respectively. By using these models, the simulation and analysis were performed, with a focus on comparing the local hemodynamics or the blood flow in the stented arteries as compared to the one without the stent deployment. For the comparison, we computed and compared the flow velocity, wall shear stress (WSS) and pressure distributions, as well as the WSS related indices, all of which are of important parameters for studying the occlusion and potential rupture of the aneurysm. Our results illustrate that the WSS decreases within the aneurysmal sac on the treated arteries, which is more significant for the stents with lower porosity or finer mesh. Our results also show that the maximum WSS near the aneurysmal neck increases regardless of the stents used. In addition, the WSS related indices including the time-average WSS, oscillatory shear index and relative residence time show different distributions, depending on the FDSs. Together, we found that the finer mesh stents provide more flow reduction and smaller region characterized by high oscillatory shear index, while the new stent has a higher relative residence time.

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“…Largely undisturbed blood flow was found through the stents, with only a small recirculation zone at the ostium of the Cx [16,17]. This reflects the smooth curve between LMS and branch arteries, and contrasts with two-stent strategies with more angulation, such as 'T' [18,19]. The gaps in the LMS between the stents and the LMS wall matched our findings of SKS deployment in undiseased porcine arteries in our first publication [6], but have not been seen clinically, and none of our OCT images showed this.…”

Section: Discussionmentioning

confidence: 99%

Simultaneous kissing stents to treat unprotected left main stem coronary artery bifurcation disease; stent expansion, vessel injury, hemodynamics, tissue healing, restenosis, and repeat revascularization

Morris

Iqbal

Chiastra

et al. 2018

Cathet Cardio Intervent

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ObjectivesTo perform detailed analysis of stent expansion, vessel wall stress, hemodynamics, re‐endothelialization, restenosis, and repeat PCI in the simultaneous kissing stents (SKS) technique of bifurcation left main stem (LMS) stenting.BackgroundThe SKS technique is useful to treat patients with true bifurcation disease of the LMS but remains controversial.Methods and ResultsComputational structural analysis of SKS expansion demonstrated undistorted and evenly expanded stents. Computational fluid dynamics modelling revealed largely undisturbed blood flow. 239 PCI procedures were performed on 217 patients with unprotected bifurcation LMS disease with SKS using DES (2004‐2017). We electively studied 13 stable patients from baseline to 10 years post‐SKS with repeat angiography and optical coherence tomography, and demonstrated tissue coverage of the stent struts at the carina, with no evidence of lacunae behind the stents. We studied all patients with symptomatic recurrence. Target lesion revascularization rate was 3.2% at 1 year and 4.6% at 2 years. Of all 20 patients with restenosis, the site was the LMS‐Cx stent in 7, the LMS‐LAD stent in 2 and both in 11. Two‐year recurrence rate was 7/32 (5.3%) for first, and 4/108 (3.7%) for second generation DES. Treatment with repeat kissing techniques was undertaken in 19/20, with sustained clinical results with re‐SKS.ConclusionThe SKS technique for treating unprotected LMS bifurcation disease does not distort the stents, is associated with favorable hemodynamics, tissue coverage of the exposed struts, and a low restenosis rate when performed with contemporary stents. Re‐PCI with repeat SKS appears feasible, safe, and durable.

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Hemodynamics of Stent Implantation Procedures in Coronary Bifurcations: An In Vitro Study

Cited by 29 publications

References 31 publications

Local fluid dynamics in patients with bifurcated coronary lesions undergoing percutaneous coronary interventions

Local fluid dynamics in patients with bifurcated coronary lesions undergoing percutaneous coronary interventions

CFD-Based Comparison Study of a New Flow Diverting Stent and Commercially-Available Ones for the Treatment of Cerebral Aneurysms

Simultaneous kissing stents to treat unprotected left main stem coronary artery bifurcation disease; stent expansion, vessel injury, hemodynamics, tissue healing, restenosis, and repeat revascularization

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