Stresses in peripheral arteries following stent placement: a finite element analysis

Early, Michael; Lally, Caitríona; Prendergast, Patrick J.; Kelly, Daniel J.

doi:10.1080/10255840802136135

Cited by 62 publications

(69 citation statements)

References 46 publications

(44 reference statements)

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“…These elements were connected to the centre of the stent (ground) on one end and to the stent nodes on the other end. Elements with similar function have previously been used and are outlined in detail in [5]. These connector elements simulate expansion of a stent with a non-compliant angioplasty balloon as they prevent the stent from expanding beyond the balloon diameter yet allow the characteristic dog-boning observed during stent expansion.…”

Section: Boundary Conditionsmentioning

confidence: 99%

Determination of the influence of stent strut thickness using the finite element method: implications for vascular injury and in-stent restenosis

Zahedmanesh

Lally

2009

Med Biol Eng Comput

120

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Many clinical studies, including the ISAR-STEREO trial, have identified stent strut thickness as an independent predictor of in-stent restenosis where thinner struts result in lower restenosis than thicker struts. The aim of this study was to more conclusively identify the mechanical stimulus for in-stent restenosis using results from such clinical trials as the ISAR-STEREO trial. The mechanical environment in arteries stented with thin and thicker strut stents was investigated using numerical modelling techniques. Finite element models of the stents used in the ISAR-STEREO clinical trial were developed and the stents were deployed in idealised stenosed vessel geometries in order to compare the mechanical environment of the vessel for each stent. The stresses induced within the stented vessels by these stents were compared to determine the level of vascular injury caused to the artery by the stents with different strut thickness. The study found that when both stents were expanded to achieve the same initial maximum stent diameter that the thinner strut stent recoiled to a greater extent resulting in lower luminal gain but also lower stresses in the vessel wall, which is hypothesised to be responsible for the lower restenosis outcome. This study supports the hypothesis that arteries develop restenosis in response to injury, where high vessel stresses are a good measure of that injury. This study points to a critical stress level in arteries, above which an aggressive healing response leads to in-stent restenosis in stented vessels. Stents can be designed to reduce stresses in this range in arteries using preclinical tools such as numerical modelling.

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Section: Boundary Conditionsmentioning

confidence: 99%

Determination of the influence of stent strut thickness using the finite element method: implications for vascular injury and in-stent restenosis

Zahedmanesh

Lally

2009

Med Biol Eng Comput

120

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“…In this regard, Finite element (FE) analysis could be used to study the mechanical behaviour of stents and their interaction with the vascular wall during its deployment. Actually, while an extensive application of FE modelling for simulating the treatment of vessel stenoses can be found in the literature (Migliavacca et al 2004;Wu et al 2007;De Beule et al 2008;Gijsen et al 2008;Early et al 2009;Mortier et al 2010), to date the amount of similar studies on cerebral aneurysm treatment has been very limited. In fact, the Finite Element method (FEM) allows very complex models to be developed, including high non-linearity due to material properties (for instance, Holzapfel et al 2005, for the biomechanics of coronary arteries, and Petrini et al 2005, for the material properties of the stent) and kinematics, which facilitate accurate description of the stenting procedure.…”

Section: Introductionmentioning

confidence: 99%

Deployment of self-expandable stents in aneurysmatic cerebral vessels: comparison of different computational approaches for interventional planning

Bernardini

Larrabide

Petrini

et al. 2012

Computer Methods in Biomechanics and Biomedical Engineering

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JOB NUMBER: 527838 JOURNAL: GCMB Q1 Please check the affiliation details 'a and c'. Q2The reference citation 'Appanaboyina et al. (2007)' has been changed to 'Appanaboyina et al. (2008)' as per the reference list. Please check and confirm. Q3We have made a change to this sentence. Please review our edit.Q4 Please confirm our edit of the word 'modulus' to 'ratio' in this sentence. In the last few years, there has been a growing focus on faster computational methods to support clinicians in planning stenting procedures. This study investigates the possibility of introducing computational approximations in modelling stent deployment in aneurysmatic cerebral vessels to achieve simulations compatible with the constraints of real clinical workflows. The release of a self-expandable stent in a simplified aneurysmatic vessel was modelled in four different initial positions. Six progressively simplified modelling approaches (based on Finite Element method and Fast Virtual Stenting -FVS) have been used. Comparing accuracy of the results, the final configuration of the stent is more affected by neglecting mechanical properties of materials (FVS) than by adopting 1D instead of 3D stent models. Nevertheless, the differences showed are acceptable compared to those achieved by considering different stent initial positions. Regarding computational costs, simulations involving 1D stent features are the only ones feasible in clinical context.

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“…Without considering such phenomena it will not be possible to develop models to accurately predict lumen gain during clinical procedures such as angioplasty and stenting (Early and Kelly, 2011;Early and Kelly, 2010;Early et al, 2009;Pericevic et al, 2009). In this study an anisotropic inelastic constitutive model is formulated to describe stress softening and permanent set for arterial tissue.…”

Section: Introductionmentioning

confidence: 99%

An anisotropic inelastic constitutive model to describe stress softening and permanent deformation in arterial tissue

Maher

Creane

Lally

et al. 2012

Journal of the Mechanical Behavior of Biomedical Materials

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This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.A n anisotropic inelastic constitutive model to describe stress softening and permanent deformation in arterial tissue A bstractInelastic phenomena such as softening and unrecoverable inelastic strains induced by loading have been observed experimentally in soft tissues such as arteries. These phenomena need to be accounted for in constitutive models of arterial tissue so that computational models can accurately predict the outcomes of interventional procedures such as balloon angioplasty and stenting that involve non-physiological loading of the tissue. In this study, a novel constitutive model is described that accounts for inelastic effects such as Mullins-type softening and permanent set in a fibre reinforced tissue. The evolution of inelasticity is governed by a set of internal variables. Softening is introduced through a typical continuum damage mechanics approach, while the inelastic residual strains are introduced through an additive split in the stress tensor. Numerical simulations of aorta and carotid arterial tissue subjected to uniaxial testing in the longitudinal, circumferential and axial directions reproduce the anisotropic inelastic behaviour of the tissue. Material parameters derived from best-fits to experimental data are provided to describe these inelastic effects for both aortic and carotid tissue.

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Stresses in peripheral arteries following stent placement: a finite element analysis

Cited by 62 publications

References 46 publications

Determination of the influence of stent strut thickness using the finite element method: implications for vascular injury and in-stent restenosis

Determination of the influence of stent strut thickness using the finite element method: implications for vascular injury and in-stent restenosis

Deployment of self-expandable stents in aneurysmatic cerebral vessels: comparison of different computational approaches for interventional planning

An anisotropic inelastic constitutive model to describe stress softening and permanent deformation in arterial tissue

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