Predicting neointimal hyperplasia in stented arteries using time-dependant computational fluid dynamics: A review

Abstract

a b s t r a c tThis paper reviews the recent literature regarding the time-dependant computational fluid dynamics (CFD) analyses of blood flow through implanted coronary stents. The in vivo processes which result in arterial restenosis are identified. The definition and range of the computationally predicted variables which are believed to stimulate the restenosis processes are evaluated. The reviewed literature is subdivided into effect-based in which the effects of altering the flow model are investigated and designbased in which different geometric stent configurations are compared. Finally, conclusions are made regarding the body of work reviewed and recommendations are provided for future work in this field.

Patient-Specific, Multi-Scale Modeling of Neointimal Hyperplasia in Vein Grafts

“…Further analysis could be done by considering other shear stress indices, as some of these have been shown to give better predictions in models of other vascular diseases such as atherosclerosis (Alimohammadi et al, 2016), which is also a disease affected by mechanical forces similarly to NIH, although through different cell species and processes. More flow characteristics could be included to describe recirculation and separation zones, all of which have been shown to affect the development of NIH (Murphy and Boyle, 2010). Finally, future work should investigate the use of fluid structure interaction in order to capture the movement of the arterial wall when subject to hemodynamic forces, which might have an influence in the results.…”

“…NIH is, in simple terms, the re-narrowing of a blood vessel after a stenting or vein grafting surgical procedure, due to tissue growing at the site of injury (Murphy and Boyle, 2010). Upon the start of the formation of NIH, smooth muscle cells change their phenotype from contractile to synthetic, making them more proliferative and resulting in thickening of the arterial tissue.…”

Computational fluid dynamic simulations of image-based stented coronary bifurcation models

“…This process, known as neointimal hyperplasia, is triggered by chemical signals from sources that include endothelial cell damage and dysfunction, platelet adhesion, white blood cell infiltration and smooth muscle cell signalling [13]. Abnormal haemodynamics is a stimulus to neointimal hyperplasia through the production of abnormal stresses on the endothelial cells and also through the increased advection of platelets and white blood cells to the arterial wall [13]. Therefore, different haemodynamic quantities were investigated in this study.…”

“…Specific ranges of the wall shear stresses (WSS) and the other near-wall quantities such as the oscillatory shear index (OSI) or the relative residence time (RRT) have shown to be stimuli for the processes which can cause restenosis [13]. As for the impact that the stenting procedure has on bulk flow, here we focus on the analysis of helical flow, which is a peculiar feature of the natural blood flow present in arteries [14,15], and which has been recently found to be instrumental in suppressing flow disturbances, both in healthy vessels [16] and in stented arteries and bypass grafts [2,[17][18][19].…”

Design Optimisation of Coronary Artery Stent Systems

“…18 The review of computational structural modelling of coronary stent deployment by Martin and Boyle provided a detailed consideration of this history and there was a review of computational fluid dynamics (CFD) prediction of neo-intimal hyperplasia (or restenosis) in stented arteries by Murphy and Boyle. 37 Subsequently, Morlacchi and Migliavacca 34 reviewed numerical modelling of stented coronary arteries more generally, including FEA, CFD and drug elution.…”