Clark A. Meyer

Stented artery biomechanics and device design optimization.

The deployment of a vascular stent aims to increase lumen diameter for the restoration of blood flow, but the accompanied alterations in the mechanical environment possibly affect the long-term patency of these devices. The primary aim of this investigation was to develop an algorithm to optimize stent design, allowing for consideration of competing solid mechanical concerns (wall stress, lumen gain, and cyclic deflection). Finite element modeling (FEM) was used to estimate artery wall stress and systolic/diastolic geometries, from which single parameter outputs were derived expressing stress, lumen gain, and cyclic artery wall deflection. An optimization scheme was developed using Lagrangian interpolation elements that sought to minimize the sum of these outputs, with weighting coefficients. Varying the weighting coefficients results in stent designs that prioritize one output over another. The accuracy of the algorithm was confirmed by evaluating the resulting outputs of the optimized geometries using FEM. The capacity of the optimization algorithm to identify optimal geometries and their resulting mechanical measures was retained over a wide range of weighting coefficients. The variety of stent designs identified provides general guidelines that have potential clinical use (i.e., lesion-specific stenting).

Effects of stent design and atherosclerotic plaque composition on arterial wall biomechanics.

Purpose: To examine the solid mechanical effects of varying stent design and atherosclerotic plaque stiffness on the biomechanical environment induced in a diseased artery wall model. Methods: Computational modeling techniques were employed to investigate the final radius of the lumen and artery wall stresses after stent implantation. Two stent designs were studied (one stiff and one less stiff). The stenotic artery was modeled as an axisymmetrical diseased vessel with a 20% stenosis by diameter. The material properties of the diseased tissue in the artery models varied. Atherosclerotic plaques half as stiff (0.5×), of equal stiffness (1.0×), or twice as stiff (2.0×) as the artery wall were investigated. Results: Final lumen radius was dependent on stent design, and the stiffer stent deformed the artery to an approximately 10% greater radius than the more compliant design. Alternatively, circumferential stress levels were dependent on both stent design and plaque material properties. Overall, the stiffer stent subjected the artery wall to much higher stress values than the more compliant design, with differences in peak values of 0.50, 0.31, and 0.09 MPa for the 2.0×, 1.0×, and 0.5× stiff plaques, respectively. Conclusion: Evidence suggests that a judicious choice of stent design can minimize stress while maintaining a patent lumen in stenotic arteries. If confronted with a rigid, calcified plaque, stent design is more important, as design differences can impose dramatically different stress fields, while still providing arterial patency. Alternatively, stent design is not as much of an issue when treating a soft, lipid-laden plaque, as stress fields do not vary significantly among stent designs.

Mechanical modeling of stents deployed in tapered arteries.

The biomechanical interaction of stents and the arteries into which they are deployed is a potentially important consideration for long-term success. Adverse arterial reactions to excessive stress and the resulting damage have been linked to the development of restenosis. Complex geometric features often encountered in these procedures can confound treatment. In some cases, it is desirable to deploy a stent across a region in which the diameter decreases significantly over the length of the stent. This study aimed to assess the final arterial diameter and circumferential stress in tapered arteries into which two different stents were deployed (one stiff and one less stiff). The artery wall was assumed to be made of a strain stiffening material subjected to large deformations, with a 10% decrease in diameter over the length of the stent. A commercially available finite element code was employed to solve the contact problem between the two elastic bodies. The stiffer stent dominated over arterial taper, resulting in a nearly constant final diameter along the length of the stent, and very high stresses, particularly at the distal end. The less stiff stent followed more closely the tapered contour of the artery, resulting in lower artery wall stresses. More compliant stents should be considered for tapered artery applications, perhaps even to the exclusion of tapered stents.

Trans-Thrombus Blood Pressure Effects in Abdominal Aortic Aneurysms

How much and how the thrombus supports the wall of an abdominal aortic aneurysm (AAA) is unclear. While some previous studies have indicated that thrombus lacks the mechanical integrity to support much load compared with the aneurysm wall, others have shown that removing thrombus in computational AAA models drastically changes aneurysm wall stress. Histopathological studies have shown that thrombus properties vary through the thickness and it can be porous. The goal of this study is to explore the variations in thrombus properties, including the ability to isolate pressure from the aneurysm wall, incomplete attachment, and their effects on aneurysm wall stress, an important parameter in determining risk for rupture. An analytical model comprised of cylinders and two patient specific models were constructed with pressurization boundary conditions applied at the lumen or the thrombus/aneurysm wall interface (to simulate complete transmission of pressure through porous thrombus). Aneurysm wall stress was also calculated in the absence of thrombus. The potential importance of partial thrombus attachment was also analyzed. Pressurizing at either surface (lumen versus interface) made little difference to mean von Mises aneurysm wall stress values with thrombus completely attached (3.1% analytic, 1.2% patient specific) while thrombus presence reduced mean von Mises stress considerably (79% analytic, 40-46% patient specific) in comparison to models without it. Peak von Mises stresses were similarly influenced with pressurization surface differing slightly (3.1% analytic, 1.4% patient specific) and reductions in stress by thrombus presence (80% analytic, 28-37% patient specific). The case of partial thrombus attachment was investigated using a cylindrical model in which there was no attachment between the thrombus and aneurysm wall in a small area (10 deg). Applying pressure at the lumen resulted in a similar stress field to fully attached thrombus, whereas applying pressure at the interface resulted in a 42% increase in peak aneurysm wall stress. Taken together, these results show that the thrombus can have a wall stress reducing role even if it does not shield the aneurysm wall from direct pressurization--as long as the thrombus is fully attached to the aneurysm wall. Furthermore, the potential for porous thrombus to transmit pressure to the interface can result in a considerable increase in aneurysm wall stress in cases of partial attachment. In the search for models capable of accurately assessing the risk for rupture, the nature of the thrombus and its attachment to the aneurysm wall must be carefully assessed.

Stereoscopically Observed Deformations of a Compliant Abdominal Aortic Aneurysm Model

A new experimental setup has been implemented to precisely measure the deformations of an entire model abdominal aortic aneurysm (AAA). This setup addresses a gap between the computational and experimental models of AAA that have aimed at improving the limited understanding of aneurysm development and rupture. The experimental validation of the deformations from computational approaches has been limited by a lack of consideration of the large and varied deformations that AAAs undergo in response to physiologic flow and pressure. To address the issue of experimentally validating these calculated deformations, a stereoscopic imaging system utilizing two cameras was constructed to measure model aneurysm displacement in response to pressurization. The three model shapes, consisting of a healthy aorta, an AAA with bifurcation, and an AAA without bifurcation, were also evaluated with computational solid mechanical modeling using finite elements to assess the impact of differences between material properties and for comparison against the experimental inflations. The device demonstrated adequate accuracy (surface points were located to within 0.07 mm) for capturing local variation while allowing the full length of the aneurysm sac to be observed at once. The experimental model AAA demonstrated realistic aneurysm behavior by having cyclic strains consistent with reported clinical observations between pressures 80 and 120 mm Hg. These strains are 1-2%, and the local spatial variations in experimental strain were less than predicted by the computational models. The three different models demonstrated that the asymmetric bifurcation creates displacement differences but not cyclic strain differences within the aneurysm sac. The technique and device captured regional variations of strain that are unobservable with diameter measures alone. It also allowed the calculation of local strain and removed rigid body motion effects on the strain calculation. The results of the computations show that an asymmetric aortic bifurcation created displacement differences but not cyclic strain differences within the aneurysm sac.

Differential progressive remodeling of coronary and cerebral arteries and arterioles in an aortic coarctation model of hypertension

Objectives: Effects of hypertension on arteries and arterioles often manifest first as a thickened wall, with associated changes in passive material properties (e.g., stiffness) or function (e.g., cellular phenotype, synthesis and removal rates, and vasomotor responsiveness). Less is known, however, regarding the relative evolution of such changes in vessels from different vascular beds. Methods: We used an aortic coarctation model of hypertension in the mini-pig to elucidate spatiotemporal changes in geometry and wall composition (including layer-specific thicknesses as well as presence of collagen, elastin, smooth muscle, endothelial, macrophage, and hematopoietic cells) in three different arterial beds, specifically aortic, cerebral, and coronary, and vasodilator function in two different arteriolar beds, the cerebral and coronary. Results: Marked geometric and structural changes occurred in the thoracic aorta and left anterior descending coronary artery within 2 weeks of the establishment of hypertension and continued to increase over the 8-week study period. In contrast, no significant changes were observed in the middle cerebral arteries from the same animals. Consistent with these differential findings at the arterial level, we also found a diminished nitric oxide-mediated dilation to adenosine at 8 weeks of hypertension in coronary arterioles, but not cerebral arterioles. Conclusion: These findings, coupled with the observation that temporal changes in wall constituents and the presence of macrophages differed significantly between the thoracic aorta and coronary arteries, confirm a strong differential progressive remodeling within different vascular beds. Taken together, these results suggest a spatiotemporal progression of vascular remodeling, beginning first in large elastic arteries and delayed in distal vessels.

FEM Modeling of Patient-Specific AAA Treated With Endografts

Abdominal aortic aneurysm (AAA) rupture occurs when wall stress exceeds wall strength. Endografts aim to prevent rupture by reducing wall stress. However, after implantation, AAA may shrink, grow, or stabilize in diameter, even in the absence of apparent flow into the sac or pressurization. This may result in graft failure through loss of seal, kinking, or component separation. Insight from models of treated AAA could provide insight into treatment methods/limitations and for device design. The nature of the stress reduction in AAA by endograft treatment was modeled using FEM in two patients followed at three time points each (pre-treatment, early follow-up, and late follow-up) — one with a “stable” aneurysm and one with a “shrinking” aneurysm.Copyright

Stented Artery Biomechanics in the Presence of Stenoses and Tapering

The implantation of a balloon expandable stent induces chronic stent-induced stresses on the artery wall. These highly non-physiologic stresses can provoke inflammation and smooth muscle cell proliferation. Ultimately, this cascade of events leads to restenosis, or the development of a new blockage in the stented artery. Since the initial human implantation of balloon expandable stents, technological advances in stent design, material properties, and deliverability have expanded the application and success rate of the procedure. More recently, anti-restenotic strategies such as drug-eluting stents have aimed to counteract the restenosis process. While clinical trials have demonstrated the success of drug eluting stents in coronary arteries [1], risk of late thrombosis [2] and failure to prevent restenosis in peripheral arteries [3] has limited this technology. A further investigation into the artery wall stresses induced by stent implantation, and the pursuit of strategies to minimize them could reduce the restenosis rates for both bare metal and drug-eluting stents.Copyright