Shijia Zhao

The Relation Between the Arterial Stress and Restenosis Rate After Coronary Stenting

Two commercially available stents (the Palmaz-Schatz (PS) and S670 stents) with reported high and low restenosis rates, respectively, have been investigated in this paper. Finite element models simulating the stent, plaque, and artery interactions in 3 mm stenosed right coronary arteries were developed. These models were used to determine the stress field in artery walls after stent implantation. The material properties of porcine arteries were measured and implemented in the numerical models. The stress concentration induced in the artery by the PS stent was found to be more than double that of the S670 stent. It demonstrated a good correlation with the reported restenosis rate. The effects of stent structures, compliance mismatch, plaque geometry, and level of stenosis were studied. Results suggested that stent designs and tissue properties cause alterations in vascular anatomy that adversely affect arterial stress distributions within the wall, which impact vessel responses such as restenosis. Appropriate modeling of stent, plaque, and artery interactions provided insights for evaluating alterations to the arterial mechanical environment, as well as biomechanical factors leading to restenosis.

The Impact of Wire Stent Fabrication Technique on the Performance of Stent Placement

Braided wire stents demonstrate distinct characteristics compared to welded ones. In this study, both braided and welded wire stents with the same nominal dimensions were crimped inside a sheath and then deployed into a stenosed artery using finite element analysis. The braided wire stent was generated by overlapping wires to form crisscross shape. A welded wire stent was created by welding the intersection points of wires to avoid sliding between wires. The effect of fabrication technique on mechanical behavior of Nitinol wire stents was evaluated. The results showed that relative sliding between wires reduced the deformation of the braided stent, which led to less radial strength than the welded one; therefore, the deployed braided stent was more conformed to the anatomic shape of the lesion and much less efficient for restoring the patency of the stenotic artery. Post balloon-dilation was commonly used to improve its performance in terms of lumen gain and deployed shape of the stent. On the contrary, the welded wire stent exhibited a high capacity for pushing the occlusion outward. It reached an approximately uniform shape after deployment. The welded joints caused larger deformation and high strain on the stent struts, which indicate a potential earlier failure for the welded stent. In addition, higher contact pressure at the stent-lesion interface and higher arterial stresses were observed in the artery supported by the welded stent. The peak stress concentration may increase the occurrence of neointimal hyperplasia.

Finite Element Analysis of the Implantation of a Self-Expanding Stent: Impact of Lesion Calcification

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Performance of Self-Expanding Nitinol Stent in a Curved Artery: Impact of Stent Length and Deployment Orientation

The primary aim of this work was to investigate the performance of self-expanding Nitinol stents in a curved artery through finite element analysis. The interaction between a PROTÉGÉ™ GPS™ self-expanding Nitinol stent and a stenosed artery, as well as a sheath, was characterized in terms of acute lumen gain, stent underexpansion, incomplete stent apposition, and tissue prolapse. The clinical implications of these parameters were discussed. The impact of stent deployment orientation and the stent length on the arterial wall stress distribution were evaluated. It was found that the maximum principal stress increased by 17.46%, when the deployment orientation of stent was varied at a 5 deg angle. A longer stent led to an increased contact pressure between stent and underlying tissue, which might alleviate the stent migration. However, it also caused a severe hinge effect and arterial stress concentration correspondingly, which might aggravate neointimal hyperplasia. The fundamental understanding of the behavior of a self-expanding stent and its clinical implications will facilitate a better device design.

Implementation and Validation of Aortic Remodeling in Hypertensive Rats

A computational framework was implemented and validated to better understand the hypertensive artery remodeling in both geometric dimensions and material properties. Integrating the stress-modulated remodeling equations into commercial finite element codes allows a better control and visualization of local mechanical parameters. Both arterial thickening and stiffening effects were captured and visualized. An adaptive material remodeling strategy combined with the element birth and death techniques for the geometrical growth were implemented. The numerically predicted remodeling results in terms of the wall thickness, inner diameter, and the ratio of elastin to collagen content of the artery were compared with and fine-tuned by the experimental data from a documented rat model. The influence of time constant on the material remodeling was also evaluated and discussed. In addition, the geometrical growth and material remodeling were isolated to better understand the contributions of each element to the arterial remodeling and their coupling effect. Finally, this framework was applied to an image-based 3D artery generated from computer tomography to demonstrate its heterogeneous remodeling process. Results suggested that hypertension induced arterial remodeling are quite heterogeneous due to both nonlinear geometry and material adaptation process. The developed computational model provided more insights into the evolutions of morphology and material of the artery, which could complement the discrete experimental data for improving the clinical management of hypertension. The proposed framework could also be extended to study other types of stress-driven tissue remodeling including in-stent restenosis and grafting.

ARTERIAL WALL MECHANICS AND CLINICAL IMPLICATIONS AFTER CORONARY STENTING: COMPARISONS OF THREE STENT DESIGNS

The goal of this work is to quantitatively assess the relationship between the reported restenosis rates and stent induced arterial stress or strain parameters through finite element method. The impact of three stent designs (Palmaz–Schatz stent, Express stent, and Multilink Vision stent) on the arterial stress distributions were characterized. The influences of initial stent deployment location, stent-tissue friction, and plaque properties on the arterial stresses were also investigated. Higher arterial stresses were observed at the proximal end of the plaque. The Multilink–Vision stent induced lesser stress concentrations due to the high stiffness of the Cobalt Chromium material and thinner strut thickness. The stentinduced arterial stress concentrations were positively correlated with the reported in-stent restenosis rates, with a correlation coefficient of 0.992. Stent deployment initiated at the center of the lumen led to less arterial stress variation, while deployment closer to the thinner edge of the plaque causes higher arterial stresses. The friction between the stent and tissue was found to contribute to larger stress alternations for the plaque only. Increased plaque stiffness resulted in a reduced arterial stress concentration and clinical restenosis rate. Results presented herein suggested that arterial stresses serve as a comprehensive index factor to predict the occurrence of in-stent restenosis, which will facilitate the new stent design and surgical planning.

On the Importance of Modeling Stent Procedure for Predicting Arterial Mechanics

The stent-artery interactions have been increasingly studied using the finite element method for better understanding of the biomechanical environment changes on the artery and its implications. However, the deployment of balloon-expandable stents was generally simplified without considering the balloon-stent interactions, the initial crimping process of the stent, its overexpansion routinely used in the clinical practice, or its recoil process. In this work, the stenting procedure was mimicked by incorporating all the above-mentioned simplifications. The impact of various simplifications on the stent-induced arterial stresses was systematically investigated. The plastic strain history of stent and its resulted geometrical variations, as well as arterial mechanics were quantified and compared. Results showed the model without considering the stent crimping process underestimating the minimum stent diameter by 17.2%, and overestimating the maximum radial recoil by 144%. It was also suggested that overexpansion resulted in a larger stent diameter, but a greater radial recoil ratio and larger intimal area with high stress were also obtained along with the increase in degree of overexpansion.

Mechanical Behavior of Porcine Pulmonary Artery

Proper characterization of the material properties of pulmonary arterial tissue is needed for many medical applications. The objective of this study was to investigate the stress-strain relationship and characterize the nonlinear elastic behavior of porcine pulmonary arteries; thus, uniaxial tension tests and cyclic loading-unloading tests were conducted on healthy porcine pulmonary arterial tissue. In these experiments, pulmonary arteries from different piglets and a commercial pulmonary valved conduit, called “Contegra 200”, were subjected to uniaxial tension. Results demonstrated a higher stiffness along the circumferential direction than the axial direction. The “Contegra 200” was much suffer than real pulmonary arterial tissue along the axial direction and had a similar stiffness to natural tissue along the circumferential direction within physiological stretch ranges, which is less than 40% strain. Elastic hysteresis was observed from cyclic loading-unloading tests, which indicates that more energy was required during the loading than the unloading. A nonlinear hyperelastic model based on second order polynomial constitutive equation was derived from average values of the test data along both axial and circumferential directions. The material model could be used in numerical analysis of pulmonary arterial response and facilitate the design of intravascular devices.Copyright

Experimental investigation of the stent-artery interaction

Abstract It is well acknowledged that stent implantation causes abnormal stretch and strains on the arterial wall, which contribute to the formation and progression of restenosis. However, the experimental characterization of the strain field on the stented vessel is scant. In this work, the balloon-expandable stent implantation inside an artery analogue was captured through two high-speed CCD cameras. The surface strain maps on the stented tube were quantified with a 3-D digital image correlation technique. The strain history at one specific reference point illustrated three stenting phases, including balloon inflation, pressurization and deflation. The surface strain distributions along one axial path were obtained at various time points to demonstrate the stent–vessel interactions. The radial wall thickness reduction history was used to evaluate the pressure–diameter relationship for the balloon. Results indicated that the expansion process of the balloon was significantly altered by the external loadings from both the stent and artery analogue. In addition, the repeatability of the stenting experiments was demonstrated through two tests with a change of 5% in the stent-induced maximum first principal strain. Moreover, a computational model of the stenting procedure was developed to recapture the stenting experiments. Comparison between experiments and simulation showed a difference of 7.17% in the first principal strain averaged over the high strain area. This indicated the validation of the computational framework, which can be used to investigate the strain or stress field throughout the computational domain, a feature that is not affected by experimental techniques.

Elasticity of Differentiated and Undifferentiated Human Neuroblastoma Cells Characterized by Atomic Force Microscopy

Human neuroblastoma (SH-SY5Y) cells, with its ability to differentiate into neurons, have been widely used as the in vitro cell culture model for neuroscience research, especially in studying the pathogenesis of Parkinsons disease (PD) and developing therapeutic strategies. Cellular elasticity could potentially serve as a biomarker to quantitatively distinguish undifferentiated and differentiated SH-SY5Y cells. The goal of this work is to characterize the retinoic acid (RA) induced alternations of elastic properties of SH-SY5Y cells using atomic force microscopy (AFM). The elasticity was measured at multiple points of a single cell. Results have shown that the differentiation of SH-SY5Y cell led to a larger elastic modulus, which is three times more than that of undifferentiated cells. A higher indentation rate applied during AFM measurements led to a larger elastic modulus of the cell. This work provides new insights into the differentiation process identified by the elasticity marker, which could be extended to investigate the function, health and ageing of cells.