Reducing In-Stent Restenosis Through Novel Stent Flow Field Augmentation

Murphy, Eóin; Boyle, Fergal J.

doi:10.1007/s13239-012-0109-3

Cited by 24 publications

(16 citation statements)

References 143 publications

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“…Disturbed flow includes flow recirculation and separation, complex flow patterns, non-uniform WSS distribution containing regions of low and high mean WSS, long particle residence times and stagnation. 13 , 59 Flow stagnation drastically reduces the arterial WSS and leads the endothelium to down-regulate the release of anti-thrombotic agents and up-regulate the expression of pro-coagulant agents. In general, disturbed flow may cause platelet activation and therefore increase platelet adhesion which is involved in development of NIH and thrombosis.…”

Section: Arterial Haemodynamicsmentioning

confidence: 99%

“…In order to prove the exact correlation between spiral flow and atheromatous plagues, there is still a need for long-term randomised clinical data where the relationship between flow patterns and development of arterial disease will be characterised. 59 , 67 …”

Section: Secondary Flow Motions In Arteriesmentioning

confidence: 99%

“…These responses can cause re-narrowing of the stented region, which is known as in-stent restenosis, or activate the development of PAD downstream from the treated region. 59 Furthermore in relation to local haemodynamics, stents in infrainguinal arteries do not support the re-introduction and propagation of the physiologic rotational secondary flow motions which may affect their long term clinical results.…”

Section: Introductionmentioning

confidence: 99%

“…The presence of a stent in infrainguinal arteries induces stagnation, recirculation zones, areas of low, high or oscillatory WSS and prolonged particle residence time, creating an unstable environment and disturbing the physiologic spiral flow. 11 , 39 , 59 , 77 Wentzel et al . 78 applied CFD in stented coronary arteries and showed an inverse relationship between in-stent neointimal thickness formation and WSS magnitude.…”

Section: Introducting Flow Optimisation To Stent Designmentioning

confidence: 99%

“…On the other side stent undersizing may leave tiny gaps between the struts and the arterial wall, which introduces flow resistance and increases WSS gradient and OSI in comparison to correct-sized cases. 11 , 59 The patency of a stent is also dependent on the pre-operative arterial geometry. For example, stent revascularisation of a curvy artery may cause arterial straightening.…”

Section: Introducting Flow Optimisation To Stent Designmentioning

confidence: 99%

See 4 more Smart Citations

Haemodynamics and Flow Modification Stents for Peripheral Arterial Disease: A Review

2015

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Endovascular stents are widely used for the treatment of peripheral arterial disease (PAD). However, the development of in-stent restenosis and downstream PAD progression remain a challenge. Stent revascularisation of PAD causes arterial trauma and introduces abnormal haemodynamics, which initiate complicated biological processes detrimental to the arterial wall. The interaction between stent struts and arterial cells in contact, and the blood flow field created in a stented region, are highly affected by stent design. Spiral flow is known as a normal physiologic characteristic of arterial circulation and is believed to prevent the development of flow disturbances. This secondary flow motion is lost in atheromatous disease and its re-introduction after endovascular treatment of PAD has been suggested as a method to induce stabilised and coherent haemodynamics. Stent designs able to generate spiral flow may support endothelial function and therefore increase patency rates. This review is focused on secondary flow phenomena in arteries and the development of flow modification stent technologies for the treatment of PAD.

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Section: Arterial Haemodynamicsmentioning

confidence: 99%

Section: Secondary Flow Motions In Arteriesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introducting Flow Optimisation To Stent Designmentioning

confidence: 99%

Section: Introducting Flow Optimisation To Stent Designmentioning

confidence: 99%

See 3 more Smart Citations

Haemodynamics and Flow Modification Stents for Peripheral Arterial Disease: A Review

2015

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Exploitation of Mechanobiology for Cardiovascular Therapy

2016

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Oxygen Mass Transport in Stented Coronary Arteries

Murphy¹,

Dunne²,

Martín³

et al. 2015

Ann Biomed Eng

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Oxygen deficiency, known as hypoxia, in arterial walls has been linked to increased intimal hyperplasia, which is the main adverse biological process causing in-stent restenosis. Stent implantation has significant effects on the oxygen transport into the arterial wall. Elucidating these effects is critical to optimizing future stent designs. In this study the most advanced oxygen transport model developed to date was assessed in two test cases and used to compare three coronary stent designs. Additionally, the predicted results from four simplified blood oxygen transport models are compared in the two test cases. The advanced model showed good agreement with experimental measurements within the mass-transfer boundary layer and at the luminal surface; however, more work is needed in predicting the oxygen transport within the arterial wall. Simplifying the oxygen transport model within the blood flow produces significant errors in predicting the oxygen transport in arteries. This study can be used as a guide for all future numerical studies in this area and the advanced model could provide a powerful tool in aiding design of stents and other cardiovascular devices.

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Reducing In-Stent Restenosis Through Novel Stent Flow Field Augmentation

Cited by 24 publications

References 143 publications

Haemodynamics and Flow Modification Stents for Peripheral Arterial Disease: A Review

Haemodynamics and Flow Modification Stents for Peripheral Arterial Disease: A Review

Exploitation of Mechanobiology for Cardiovascular Therapy

Oxygen Mass Transport in Stented Coronary Arteries

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