Simulation of cardiac motion on non-Newtonian, pulsating flow development in the human left anterior descending coronary artery

Theodorakakos, A.; Gavaises, Manolis; Andriotis, A.; Zifan, Ali; Liatsis, Panos; Pantos, Ioannis; Efstathopoulos, Efstathios; Katritsis, Demosthenes G.

doi:10.1088/0031-9155/53/18/002

Cited by 61 publications

(33 citation statements)

References 39 publications

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“…Coronaries are in fact embedded in the myocardium and the heart beating basically drives not only their fluid dynamics (the flow is diastolic) [56] but also their wall displacements [57]. However, this effect is still on study and debated in literature [20,[22][23][24][25]58,59]. The work of Prosi et al [23] shows the importance to impose physiologically realistic flow in the correct phase relationship with vessel motion when simulating coronary artery hemodynamics.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the results of the study of Pivkin et al [24] indicate that the combined effect of pulsatile inflow and dynamic geometry depends strongly on the phase difference between the flow wave and arterial motion. Neglecting the cardiac motion, it can be accepted as reported by Theodorakakos et al [25]. They investigated the effect of myocardial motion on pulsating blood flow distribution of a stenotic LAD coronary artery focusing their attention on the WSS distribution and flow pattern.…”

Section: Discussionmentioning

confidence: 99%

“…They showed that the flow rate ratio between the side branch and the main branch in the vicinity of the bifurcation is significantly influenced by the combined unsteady phenomena of flow and varying geometry. Finally Theodorakakos et al [25] investigated the effect of the myocardial motion on pulsating blood flow distribution on a stenotic LAD branch coronary artery. They found an important influence of pulsatile flow on the overall coronary fluid dynamics but no significant differences in WSS spatial distribution between stationary and moving coronary artery.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Unsteady blood flow and mass transfer of a human left coronary artery bifurcation: FSI vs. CFD

Malvè

García

Ohayon

et al. 2012

International Communications in Heat and Mass Transfer

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Unsteady blood flow and mass transfer of a human left coronary artery bifurcation: FSI vs. CFD

Malvè

García

Ohayon

et al. 2012

International Communications in Heat and Mass Transfer

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“…However, myocardial motion has only a minor effect on the flow distribution within the coronary tree [54]. It influences the instantaneous WSS field but does not significantly affect the TAWSS field [55].…”

Section: Limitationsmentioning

confidence: 99%

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

Chiastra

Morlacchi

Gallo

et al. 2013

J. R. Soc. Interface.

112

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One of the relevant phenomenon associated with in-stent restenosis in coronary arteries is an altered haemodynamics in the stented region. Computational fluid dynamics (CFD) offers the possibility to investigate the haemodynamics at a level of detail not always accessible within experimental techniques. CFD can quantify and correlate the local haemodynamics structures which might lead to in-stent restenosis. The aim of this work is to study the fluid dynamics of realistic stented coronary artery models which replicate the complete clinical procedure of stent implantation. Two cases of pathologic left anterior descending coronary arteries with their bifurcations are reconstructed from computed tomography angiography and conventional coronary angiography images. Results of wall shear stress and relative residence time show that the wall regions more prone to the risk of restenosis are located next to stent struts, to the bifurcations and to the stent overlapping zone for both investigated cases. Considering a bulk flow analysis, helical flow structures are generated by the curvature of the zone upstream from the stent and by the bifurcation regions. Helical recirculating microstructures are also visible downstream from the stent struts. This study demonstrates the feasibility to virtually investigate the haemodynamics of patient-specific coronary bifurcation geometries.

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“…Although early atherosclerosis is localized at sites of low WSS, such as the outer walls of vessel bifurcations, 32 at advanced to severe atherosclerosis, plaques grow circumferentially from the low WSS region into the high WSS flow divider 33 ; thus, severe ostial stenoses become circumferentially symmetrical. The vessels were considered straight, noncompliant, and stationary, because studies have shown that myocardial motion has only a minor effect on flow distribution within the arterial tree relative to the effect of the blood pressure pulse, 34 and stent implantation causes straightening of the vessel and reduces its regional compliance. 35 In all considered cases, optimal stent deployment and complete apposition of stent struts against the vessel walls were considered, although in real-life inadequate stent deployment is frequent and multiple overlapping stents increase the likelihood of strut malapposition.…”

Section: Study Limitationsmentioning

confidence: 99%

Flow Patterns at Stented Coronary Bifurcations

Katritsis

Theodorakakos

Pantos

et al. 2012

Circ: Cardiovascular Interventions

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Background— The ideal bifurcation stenting technique is not established, and data on the hemodynamic characteristics at stented bifurcations are limited. Methods and Results— We used computational fluid dynamics analysis to assess hemodynamic parameters known affect the risk of restenosis and thrombosis at coronary bifurcations after the use of various single- and double-stenting techniques. We assessed the distributions and surface integrals of the time averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (t r ). Single main branch stenting without side branch balloon angioplasty or stenting provided the most favorable hemodynamic results (integrated values of TAWSS=4.13·10 −4 N, OSI=7.52·10 −6 m 2 , t r =5.57·10 −4 m 2 /Pa) with bifurcational area subjected to OSI values >0.25, >0.35, and >0.45 calculated as 0.36 mm 2 , 0.04 mm 2 , and 0 mm 2 , respectively. Extended bifurcation areas subjected to these OSI values were seen after T-stenting: 0.61 mm 2 , 0.18 mm 2 , and 0.02 mm 2 , respectively. Among the considered double-stenting techniques, crush stenting (integrated values of TAWSS=1.18·10 −4 N, OSI=7.75·10 −6 m 2 , t r =6.16·10 −4 m 2 /Pa) gave the most favorable results compared with T-stenting (TAWSS=0.78·10 −4 N, OSI=10.40·10 −6 m 2 , t r =6.87·10 −4 m 2 /Pa) or the culotte technique (TAWSS=1.30· 10 −4 N, OSI=9.87·10 −6 m 2 , t r =8.78·10 −4 m 2 /Pa). Conclusions— In the studied models of computer simulations, stenting of the main branch with our without balloon angioplasty of the side branch offers hemodynamic advantages over double stenting. When double stenting is considered, the crush technique with the use of a thin-strut stent may result in improved immediate hemodynamics compared with culotte or T-stenting.

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Simulation of cardiac motion on non-Newtonian, pulsating flow development in the human left anterior descending coronary artery

Cited by 61 publications

References 39 publications

Unsteady blood flow and mass transfer of a human left coronary artery bifurcation: FSI vs. CFD

Unsteady blood flow and mass transfer of a human left coronary artery bifurcation: FSI vs. CFD

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

Flow Patterns at Stented Coronary Bifurcations

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