Hemodynamically Driven Stent Strut Design
Juan M. Jiménez,Peter F. Davies +1 more
190
TL;DR: A streamlined stent strut design is proposed that promotes the development of a local flow field free of recirculation zones, which is predicted to inhibit thrombosis and is more conducive for endothelialization.
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Abstract: Stents are deployed to physically reopen stenotic regions of arteries and to restore blood flow. However, inflammation and localized stent thrombosis remain a risk for all current commercial stent designs. Computational fluid dynamics results predict that nonstreamlined stent struts deployed at the arterial surface in contact with flowing blood, regardless of the strut height, promote the creation of proximal and distal flow conditions that are characterized by flow recirculation, low flow (shear) rates, and prolonged particle residence time. Furthermore, low shear rates yield an environment less conducive for endothelialization, while local flow recirculation zones can serve as micro-reaction chambers where procoagulant and pro-inflammatory elements from the blood and vessel wall accumulate. By merging aerodynamic theory with local hemodynamic conditions we propose a streamlined stent strut design that promotes the development of a local flow field free of recirculation zones, which is predicted to inhibit thrombosis and is more conducive for endothelialization.
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Citations
Effects of Disturbed Flow on Vascular Endothelium: Pathophysiological Basis and Clinical Perspectives
Jeng Jiann Chiu,Shu Chien +1 more
TL;DR: Current knowledge on the role of disturbed flow in EC physiology and pathophysiology, as well as its clinical implications are summarized to contribute to the understanding of the etiology of lesion development in vascular niches with disturbed flow and help to generate new approaches for therapeutic interventions.
Neoatherosclerosis: overview of histopathologic findings and implications for intravascular imaging assessment
Fumiyuki Otsuka,Robert A. Byrne,Kazuyuki Yahagi,Hiroyoshi Mori,Elena Ladich,David R. Fowler,Robert Kutys,Erion Xhepa,Adnan Kastrati,Renu Virmani,Michael Joner +10 more
TL;DR: Despite the reduction in late thrombotic events with newer-generation drug-eluting stents (DES), late stent failure remains a concern following stent placement and the impact of iterations in stent technology and risk factor modification on disease progression should be assessed.
441
Role of hemodynamic shear stress in cardiovascular disease
Emanuele Cecchi,Cristina Giglioli,Serafina Valente,Chiara Lazzeri,Gian Franco Gensini,Rosanna Abbate,Lucia Mannini +6 more
TL;DR: The evaluation of shear stress may be useful for predicting the risk of developing restenosis after coronary and peripheral angioplasty and for devising a coronary stent with a strut design less thrombogenic and more conducive to endothelization.
390
The importance of the endothelium in atherothrombosis and coronary stenting
Fumiyuki Otsuka,Aloke V. Finn,Saami K. Yazdani,Masataka Nakano,Frank D. Kolodgie,Renu Virmani +5 more
TL;DR: Impairment of vasorelaxation in nonstented proximal and distal segments of stented coronary arteries is more severe with drug-eluting stents than bare-metal stents, and stent-induced flow disturbances resulting in complex spatiotemporal shear stress can also contribute to increased thrombogenicity and inflammation.
359
Computational fluid dynamics modelling in cardiovascular medicine
Paul Morris,Andrew J. Narracott,Hendrik von Tengg-Kobligk,Daniel Alejandro Silva Soto,Sarah Hsiao,Angela Lungu,Paul C. Evans,Neil W. Bressloff,Patricia V. Lawford,D. Rodney Hose,Julian Gunn +10 more
TL;DR: The adoption of CFD modelling signals a new era in cardiovascular medicine and a number of academic and commercial groups are addressing the associated methodological, regulatory, education- and service-related challenges.
353
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