Assessment of shape memory alloy stent deployment in a stenosed artery
Tóm tắt
Shape memory alloy (SMA) stents have been used increasingly for the treatment of complex arterial occlusions. There is an immediate need to quantify the mechanical performance of SMA stents to open occluded arteries. The stent crimping and expanding process was assessed through both numerical modeling and in-vitro studies. The implantation of a SMA stent in curved arteries with eccentric stenosis were simulated to evaluate the effect of artery curvature on arterial mechanics. The crimping process stored a considerable amount of strain energy in the stent, which were then released through self-expansion until a balance between the stent and stenosed artery was achieved. The deployed SMA stent exhibited a dog-bone shape, where the longitudinal ends of the stent penetrated into the artery causing arterial stress concentrations. However, the maximum arterial stress was observed at the central portion of artery contacting the thin side of the plaque. Furthermore, stent-induced arterial mechanics were more pronounced in the curved artery than the straight artery. The maximum Von Mises stress in the curved artery with a curvature of 0.05 mm-1 was 37% larger than that found in the straight artery. The percentage of the intimal area at higher stress level (> 0.05 MPa) is 5.51% in the curved artery, compared to 1.76% in the straight artery. This work provided a fundamental understanding of the behavior of SMA stent and its impact on the vascular wall, and illuminated the possibilities for exploiting their potential to alleviate arterial injury.
Tài liệu tham khảo
Bedoya J, Meyer CA, Timmins LH, Moreno MR, Moore JE. Effects of stent design parameters on normal artery wall mechanics. J Biomech Eng. 2006; 128(5):757–765.
Holzapfel GA, Stadler M, Gasser TC. Changes in the mechanical environment of stenotic arteries during interaction with stents: computational assessment of parametric stent designs. J Biomech Eng. 2005; 127(1):166–180.
Lally C, Dolan F, Prendergast PJ. Cardiovascular stent design and vessel stresses: a finite element analysis. J Biomech. 2005; 38(8):1574–1581.
Park WP, Cho SK, Ko JY, Kristensson A, Al-Hassani STS, Kim HS, Lim D. Evaluation of stent performances using FEA considering a realistic balloon expansion. Int J Eng Phys Sci. 2008; 2(2):103–108.
Pericevic I, Lally C, Toner D, Kelly DJ. The influence of plaque composition on underlying arterial wall stress during stent expansion: the case for lesion-specific stents. Med Eng Phys. 2009; 31(4):428–433.
De Beule M, Mortier P, Carlier SG, Verhegghe B, Van Impe R, Verdonck P. Realistic finite element-based stent design: the impact of balloon folding. J Biomech. 2008; 41(2):383–389.
Zahedmanesh H, John Kelly D, Lally C. Simulation of a balloon expandable stent in a realistic coronary artery-determination of the optimum modelling strategy. J Biomech. 2010; 43(11):2126–2132.
Kleinstreuer C, Li Z, Basciano CA, Seelecke S, Farber MA. Computational mechanics of nitinol stent grafts. J Biomech. 2008; 41(11):2370–2378.
Migliavacca F, Petrini L, Massarotti P, Schievano S, Auricchio F, Dubini G. Stainless and shape memory alloy coronary stents: a computational study on the interaction with the vascular wall. Biomech Model Mechanobiol. 2004; 2(4):205–217.
Kim JH, Kang TJ, Yu WR. Simulation of mechanical behavior of temperature-responsive braided stents made of shape memory polyurethanes. J Biomech. 2010; 43(4):632–643.
Conti M, Auricchio F, De Beule M, Verhegghe B. Numerical simulation of Nitinol peripheral stents: from laser-cutting to deployment in a patient specific anatomy. ESOMAT. 2009; doi:10.1051/esomat/200906008.
Rebelo N, Fu R, Lawrenchuk M. Study of a nitinol stent deployed into anatomically accurate artery geometry and subjected to realistic service loading. J Mater Eng Perform. 2009; 18(5–6):655–663.
Wu W, Qi M, Liu XP, Yang DZ, Wang WQ. Delivery and release of nitinol stent in carotid artery and their interactions: a finite element analysis. J Biomech. 2007; 40(13):3034–3040.
Zhao SJ, Gu LX, Hammel JM, Lang HL. Mechanical behavior of porcine pulmonary artery. Proc ASME IMECE 2010. 2010;39012.
Rebelo N, Walker N, Foadian H. Simulation of implantable nitinol stents. Conf Proc Abaqus Users. 2001.
Prosi M, Perktold K, Ding Z, Friedman MH. Influence of curvature dynamics on pulsatile coronary artery flow in a realistic bifurcation model. J Biomech. 2004; 37(11):1767–1775.
Uren NG, Schwarzacher SP, Metz JA, Lee DP, Honda Y, Yeung AC, Fitzgerald PJ, Yock PG. Predictors and outcomes of stent thrombosis. Eur Heart J. 2002; 23(2):124–132.
Cheneau E, Satler LF, Escolar E, Suddath WO, Kent KM, Weissman NJ, Waksman R, Pichard AD. Underexpansion of sirolimus-eluting stents: incidence and relationship to delivery pressure. Catheter Cardio Inte. 2005; 65(2):222–226.
Fujii K, Carlier SG, Mintz GS, Yang YM, Moussa I, Weisz G, Dangas G, Mehran R, Lansky AJ, Kreps EM, Collins M, Stone GW, Moses JW, Leon MB. Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study. J Am Coll Cardiol. 2005; 45(7):995–998.
Kan HC. Investigation of plaque effects on cardiovascular stent system. iCBBE. 2010; doi: 10.1109/ICBBE.2010.5516850.
Cook S, Wenaweser P, Togni M, Billinger M, Morger C, Seiler C, Vogel R, Hess O, Meier B, Windecker S. Incomplete stent apposition and very late stent thrombosis after drug-eluting stent implantation. Circulation. 2007; 115(18):2426–2434.
Pfisterer ME. Late stent thrombosis after drug-eluting stent implantation for acute myocardial infarction: a new red flag is raised. Circulation. 2008; 118(11):1117–1119.
Timmins LH, Meyer CA, Moreno MR, Moore JE. Effects of stent design and atherosclerotic plaque composition on arterial wall biomechanics. J Endovasc Ther. 2008; 15(6):643–654.
Liao R, Green NE, Chen SY, Messenger JC, Hansgen AR, Groves BM, Carroll JD. Three-dimensional analysis of in vivo coronary stent—coronary artery interactions. Int J Carduivasc Imaging. 2004; 20(4):305–313.
Colombo A, Stankovic G, Moses JW. Selection of coronary stents. J Am Coll Cardiol. 2002; 40(6):1021–1033.
Gamero AM, Armentano RL, Levenson J. Arterial wall diameter and viscoelasticity variability. Comput Cardiol. 2002; 29:513–516.
Moore JE, Berry JL. Fluid and solid mechanical implications of vascular stenting. Ann Biomed Eng. 2002; 30(4):498–508.