期刊
JOURNAL OF BIOMECHANICS
卷 63, 期 -, 页码 164-173出版社
ELSEVIER SCI LTD
DOI: 10.1016/j.jbiomech.2017.09.016
关键词
Computational fluid dynamics; Malapposition; Curved arteries; Haemodynamics; Coronary stent
资金
- Australian Research Council through ARC [LP150100233]
- Australian Government
- Melbourne Bioinformatics at the University of Melbourne [VR0210]
- Australian Research Council [LP150100233] Funding Source: Australian Research Council
Incomplete stent apposition (ISA, also known as malapposition) is a complication that affects day-to-day coronary stenting procedures. ISA is more prominent in complex arterial geometries, such as curvature, as a result of the limited conformability of coronary stents. These malapposed struts disturb the otherwise near-wall laminar blood flow and form a micro-recirculation environment. The micro-recirculation environment is often associated with low wall shear stress (WSS) and upsets the delicate balance of vascular biology, providing possible nidus for thrombosis and restenosis. In this study, a three-dimensional (3D) stent model was virtually deployed into an idealised curved coronary artery. Computational fluid dynamics (CFD) simulations were carried out to systematically analyse the haemodynamic effects of increasing maximum ISA distances, ranging from 180 (moderate), 400 (intermediate) to 910 mu m (severe) in an artery with decreasing radius of curvature (ROC). Micro-recirculations around both proximal and distal malapposed struts become more pronounced as compared to fully-apposed struts. The accompanying areas of low temporally-averaged WSS (AL-TAWSS) can increase twofold compared to the fully-apposed condition. Furthermore, substantial regions (similar to 5.2% and 9.0%) of AL-TAWSS are detached from the distal end of the malapposed struts in both moderate and intermediate cases respectively. Malapposed stents also induce more variation of TAWSS at the inner bend of the artery. At the stent surface, maximum WSS increases threefold from the fully-apposed case to intermediate ISA. High WSS on the strut surface is known to activate platelets which when exposed to the micro-recirculation environment may lead to their deposition and thrombosis. (C) 2017 Elsevier Ltd. All rights reserved.
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