Flow Patterns at Stented Coronary Bifurcations

Katritsis, Demosthenes G.; Theodorakakos, A.; Pantos, Ioannis; Gavaises, Manolis; Karcanias, N.; Efstathopoulos, Efstathios

doi:10.1161/circinterventions.112.968347

Cited by 62 publications

(52 citation statements)

References 36 publications

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“…This indicates that the stent implantation has reduced the wall shear stresses. In a previous study a stented coronary artery was analyzed and the maximum stress observed at the stented region is recorded to be greater than 2.3 Pa [33]. But, the present study exhibited a maximum shear stress of 12 Pa in the bifurcated stented region of femoral artery.…”

Section: Blood Pressure Stagescontrasting

confidence: 62%

See 1 more Smart Citation

Flow Dynamics and Wall Shear Stresses in a Bifurcated Femoral Artery

Gogineni¹,

Ts²

2017

J Biomed Eng Med Devic

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The present paper presents peak wall shear stresses and velocities in a bifurcated femoral artery. This artery is modeled along with blockage downstream of bifurcation, blockage at bifurcation, blockage downstream of stented femoral artery. The femoral artery is subjected to peripheral artery disease. A two-dimensional computational fluid dynamic analysis is conducted in all the models, assuming steady blood flow and seventy percent plaque. However, the blood viscosity and blood pressure vary in the femoral artery models as they are subjected to other medical conditions. Femoral artery bifurcates into profunda femoris and the bifurcation angles are assumed to vary at 30, 45 and 60 degrees. The blocked bifurcated artery is replaced with a wall stent and in many cases, a blockage develops downstream of the bifurcated stented artery as a consequence of stent implantation. The wall shear stresses and velocities results from the bifurcated and blocked femoral arterial models are compared to a normal artery characteristic. Further, a comparative study has been conducted along the blocked bifurcated artery with and without the stent.

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Section: Blood Pressure Stagescontrasting

confidence: 62%

“…Blood is usually a non-Newtonian fluid flowing through the artery. However, blood behaves as Newtonian fluid at high strain rate [28][29][30][31][32][33][34][35][36] and the density of blood is assumed 1050 kg/m 3 . The cell zone inside the artery is selected as blood and a steady state blood flow is assumed in the analysis.…”

Section: Computational Analysismentioning

confidence: 99%

Flow Dynamics and Wall Shear Stresses in a Bifurcated Femoral Artery

Gogineni¹,

Ts²

2017

J Biomed Eng Med Devic

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“…Measurements of bifurcation angle in this study are in line with the average bifurcation angle reported by these studies, with diseased LAD having left coronary angulation of more than 80° (mean angle: 94.3°), while the normal LAD having angulation of less than 80° (mean angle: 76.5°). This strong relationship between the angle of the left coronary artery and the presence of plaques within the left coronary bifurcation could be used as guidance for analysis of potential effects of the hemodynamics on the local characteristics and distribution of plaques [24–29], although further studies are warranted to evaluate the potential value of these findings.…”

Section: Discussionmentioning

confidence: 99%

Coronary CT Angiography in Coronary Artery Disease: Correlation between Virtual Intravascular Endoscopic Appearances and Left Bifurcation Angulation and Coronary Plaques

Sun¹

2013

BioMed Research International

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The aim of this study is to investigate the relationship between intraluminal appearances of coronary plaques and left coronary bifurcation angle and plaque components using coronary CT virtual intravascular endoscopy (VIE). Fifty patients suspected of coronary artery disease undergoing coronary CT angiography were included in the study. The left bifurcation angle in patients with diseased left coronary artery which was measured as 94.3° ± 16.5 is significantly larger than that in patients with normal left coronary artery, which was measured as 76.5° ± 15.9 (P < 0.001). Irregular VIE appearances were found in 10 out of 11 patients with mixed plaques in the left anterior descending (LAD) and left circumflex (LCx), while, in 29 patients with calcified plaques in the LAD and LCx, irregular VIE appearances were only noticed in 5 patients. Using 80° as a cut-off value to determine coronary artery disease, smooth VIE appearances were found in 95% of patients (18/19) with left bifurcation angle of less than 80°, while irregular VIE appearances were observed in nearly 50% of patients (15/31) with left bifurcation angle of more than 80°. This preliminary study shows that VIE appearances of the coronary lumen are directly related to the types of plaques.

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“…5,6,20,24,39,40 Similarly, computational fluid dynamics (CFD) simulations have been widely used to investigate the hemodynamic properties of stented arteries and their implications for neointimal hyperplasia. 3,4,15,18,23,33 However, the only numerical studies conducted on stent mis-sizing were found to be on balloon-expandable stents deployed in straight cylindrical models of healthy 3,18 or calcified coronary arteries. 37 Due to the significant differences in their deployment procedures, the results from these studies could not be adopted for self-expandable Nitinol stents.…”

Section: Introductionmentioning

confidence: 99%

Nitinol Stent Oversizing in Patients Undergoing Popliteal Artery Revascularization: A Finite Element Study

et al. 2015

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Abstract-Nitinol stent oversizing is frequently performed in peripheral arteries to ensure a desirable lumen gain. However, the clinical effect of mis-sizing remains controversial. The goal of this study was to provide a better understanding of the structural and hemodynamic effects of Nitinol stent oversizing. Five patient-specific numerical models of noncalcified popliteal arteries were developed to simulate the deployment of Nitinol stents with oversizing ratios ranging from 1.1 to 1.8. In addition to arterial biomechanics, computational fluid dynamics methods were adopted to simulate the physiological blood flow inside the stented arteries. Results showed that stent oversizing led to a limited increase in the acute lumen gain, albeit at the cost of a significant increase in arterial wall stresses. Furthermore, localized areas affected by low Wall Shear Stress increased with higher oversizing ratios. Stents were also negatively impacted by the procedure as their fatigue safety factors gradually decreased with oversizing. These adverse effects to both the artery walls and stents may create circumstances for restenosis. Although the ideal oversizing ratio is stentspecific, this study showed that Nitinol stent oversizing has a very small impact on the immediate lumen gain, which contradicts the clinical motivations of the procedure.

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Flow Patterns at Stented Coronary Bifurcations

Cited by 62 publications

References 36 publications

Flow Dynamics and Wall Shear Stresses in a Bifurcated Femoral Artery

Flow Dynamics and Wall Shear Stresses in a Bifurcated Femoral Artery

Coronary CT Angiography in Coronary Artery Disease: Correlation between Virtual Intravascular Endoscopic Appearances and Left Bifurcation Angulation and Coronary Plaques

Nitinol Stent Oversizing in Patients Undergoing Popliteal Artery Revascularization: A Finite Element Study

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