No abstract

Nitinol stents are nowadays widely used for the treatment of occlusions in peripheral arteries. However, the expansion of this indication has also highlighted some complications. In particular, the patient daily activities expose the peripheral arteries to large and cyclic deformations which may cause long-term failure of the device and consequently re-occlusion of the artery. Accordingly, the assessment of the stent fatigue rupture is of primary importance to assure the effectiveness of stenting procedure. However the fatigue behavior characterization of Nitinol for peripheral stent is a quite difficult problem because of the complexity of the in vivo solicitations the stent is subjected to and the strong nonlinearity in the material response. In this paper we approached the problem in two steps: (i) in the first step the study of the stent solicitations under realistic (physiological) conditions was performed through the use of numerical simulations which allowed sophisticated patient-specific models of the stenting procedure; (ii) in the second step, the previous results were used for the design of an experimental campaign and the following execution of the tests for the material mechanical characterization and fatigue life study. The tests were performed on Nitinol specimens derived from the same tubes used for producing a commercial peripheral stent and created following the same procedure employed for the device. As a consequence of the small dimension of the specimens, a preliminary design of the experimental test set-up was also required. The obtained results allowed a sufficiently accurate characterization of the stent material fatigue behavior in the range of interest

No abstract

One contribution of 11 to a theme issue 'Multiscale modelling in biomechanics: theoretical, computational and translational challenges'. Complex congenital heart disease characterized by the underdevelopment of one ventricular chamber (single ventricle (SV) circulation) is normally treated with a three-stage surgical repair. This study aims at developing a multiscale computational framework able to couple a patient-specific three-dimensional finite-element model of the SV to a patient-specific lumped parameter (LP) model of the whole circulation, in a closed-loop fashion. A sequential approach was carried out: (i) cardiocirculatory parameters were estimated by using a fully LP model; (ii) ventricular material parameters and unloaded geometry were identified by means of the stand-alone, three-dimensional model of the SV; and (iii) the three-dimensional model of SV was coupled to the LP model of the circulation, thus closing the loop and creating a multiscale model. Once the patient-specific multiscale model was set using pre-operative clinical data, the virtual surgery was performed, and the post-operative conditions were simulated. This approach allows the analysis of local information on ventricular function as well as global parameters of the cardiovascular system. This methodology is generally applicable to patients suffering from SV disease for surgical planning at different stages of treatment. As an example, a clinical case from stage 1 to stage 2 is considered here.

Despite their success as primary treatment for vascular diseases, Nitinol peripheral stents are still affected by complications related to fatigue failure. Hip and knee movements during daily activities produce large and cyclic deformations of the superficial femoral artery, that concomitant to the effects of pulsatile blood pressure, may cause fatigue failure in the stent. Fatigue failure typically occurs in cases of very extended lesions, which often require the use of two or more overlapping stents. In this study, finite element models were used to study the fatigue behavior of Nitinol stents when subjected to cyclic axial compression in different conditions. A specific commercial Nitinol stent was chosen for the analysis and subjected to cyclic axial compression typical of the femoral vascular region. Three different configurations were investigated: stent alone, stent deployed in a tube, and two overlapping stents deployed in a tube. Results confirm that stent oversizing has an influence in determining both the mean and amplitude strains induced in the stent and plays an important role in determining the fatigue response of Nitinol stents. In case of overlapping stents, numerical results suggest higher amplitude strains concentrate in the region close to the overlapping portion where the abrupt change in stiffness causes higher cyclic compression. These findings help to explain the high incidence of stent fractures observed in various clinical trials located close to the overlapping portion