Document Detail


Impact of main branch stenting on endothelial shear stress: role of side branch diameter, angle and lesion.
MedLine Citation:
PMID:  22112654     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In-stent restenosis and stent thrombosis remain clinically significant problems for bifurcation lesions. The objective of this study is to determine the haemodynamic effect of the side branch (SB) on main branch (MB) stenting. We hypothesize that the presence of a SB has a negative effect on MB wall shear stress (WSS), wall shear stress gradient (WSSG) and oscillatory shear index (OSI); and that the bifurcation diameter ratio (SB diameter/MB diameter) and angle are important contributors. We further hypothesized that stent undersizing exaggerates the negative effects on WSS, WSSG and OSI. To test these hypotheses, we developed computational models of stents and non-Newtonian blood. The models were then interfaced, meshed and solved in a validated finite-element package. Stents at bifurcation models were created with 30° and 70° bifurcation angles and bifurcations with diameter ratios of SB/MB = 1/2 and 3/4. It was found that stents placed in the MB at a bifurcation lowered WSS dramatically, while elevating WSSG and OSI. Undersizing the stent exaggerated the decrease in WSS, increase in WSSG and OSI, and disturbed the flow between the struts and the vessel wall. Stenting the MB at bifurcations with larger SB/MB ratios or smaller SB angles (30°) resulted in lower WSS, higher WSSG and OSI. Stenosis at the SB lowered WSS and elevated WSSG and OSI. These findings highlight the effects of major biomechanical factors in MB stenting on endothelial WSS, WSSG, OSI and suggests potential mechanisms for the potentially higher adverse clinical events associated with bifurcation stenting.
Authors:
Henry Y Chen; Issam D Moussa; Charles Davidson; Ghassan S Kassab
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2011-11-23
Journal Detail:
Title:  Journal of the Royal Society, Interface / the Royal Society     Volume:  9     ISSN:  1742-5662     ISO Abbreviation:  J R Soc Interface     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-04-24     Completed Date:  2012-08-15     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  101217269     Medline TA:  J R Soc Interface     Country:  England    
Other Details:
Languages:  eng     Pagination:  1187-93     Citation Subset:  IM    
Affiliation:
Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
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MeSH Terms
Descriptor/Qualifier:
Animals
Arteries / pathology,  physiopathology*,  surgery*
Blood Flow Velocity
Blood Pressure
Blood Vessel Prosthesis / adverse effects
Computer Simulation
Endothelium, Vascular / physiopathology*
Graft Occlusion, Vascular / etiology*,  physiopathology*
Humans
Models, Anatomic
Models, Cardiovascular*
Shear Strength
Stents / adverse effects*
Grant Support
ID/Acronym/Agency:
HL084529/HL/NHLBI NIH HHS; HL087235/HL/NHLBI NIH HHS
Comments/Corrections

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