Influence of Stent Flexibility on Artery Wall Stress and Wall Shear Stress in Bifurcation Lesions

Noboru Saito, Yuhei Mori, Tomoya Komatsu Terumo Shonan Center, Kanagawa 259-0151, JapanCorrespondence: Noboru SaitoTerumo Shonan Center, 1500 Inokuchi, Nakai-Machi, Ashigarakami-Gun, Kanagawa 259-0151, JapanTel +81-465-81-4251Fax +81-465-81-4217Email noboru_saitou@terumo.co.jpPurpose: Stent flexibil...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Saito N, Mori Y, Komatsu T
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	bifurcation stent flexibility wall shear stress neointimal hyperplasia Medical technology R855-855.5
Acceso en línea:	https://doaj.org/article/e510b1d0f32f4d8e869867cc2e07fbd7
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:e510b1d0f32f4d8e869867cc2e07fbd7
record_format	dspace
spelling	oai:doaj.org-article:e510b1d0f32f4d8e869867cc2e07fbd72021-12-02T13:37:45ZInfluence of Stent Flexibility on Artery Wall Stress and Wall Shear Stress in Bifurcation Lesions1179-1470https://doaj.org/article/e510b1d0f32f4d8e869867cc2e07fbd72020-11-01T00:00:00Zhttps://www.dovepress.com/influence-of-stent-flexibility-on-artery-wall-stress-and-wall-shear-st-peer-reviewed-article-MDERhttps://doaj.org/toc/1179-1470Noboru Saito, Yuhei Mori, Tomoya Komatsu Terumo Shonan Center, Kanagawa 259-0151, JapanCorrespondence: Noboru SaitoTerumo Shonan Center, 1500 Inokuchi, Nakai-Machi, Ashigarakami-Gun, Kanagawa 259-0151, JapanTel +81-465-81-4251Fax +81-465-81-4217Email noboru_saitou@terumo.co.jpPurpose: Stent flexibility can influence clinical outcome, especially in bifurcation lesions. For instance, an overly rigid stent can impose mechanical stress on the artery at the stent edges and alter both arterial geometry and blood flow dynamics in bifurcations. This study investigated the influence of stent flexibility on vessel geometry, histology, wall stress, and blood flow dynamics in arterial bifurcations.Materials and Methods: We compared arterial angulation, stenosis, histopathology, simulated wall shear stress (WSS), and simulated blood flow velocity distribution in swine coronary artery bifurcations following placement of the less flexible Multi-link 8 or more flexible Kaname stent (4.1 ± 0.5 vs 1.5 ± 0.1 mN, p < 0.05, t-test). Stents were implanted into six coronary artery bifurcations each using the single-stent crossover technique without side branch strut dilatation. Outcomes were examined after 28 days.Results: Implantation of both stents significantly increased site angulation (Multi-link 8: 148° ± 8° to 172° ± 2°, p < 0.05, paired t-test; Kaname: 152° ± 5° to 164° ± 4°, p < 0.05, paired t-test), but the change tended to be greater after Multi-link 8 stent implantation (24° ± 15° vs 11° ± 7°, p = 0.1, t-test), suggesting greater straightening of the bifurcation. The Multi-link 8 stent induced greater neointimal thickness than the Kaname stent (0.53 ± 0.3 mm vs 0.26 ± 0.1 mm, p < 0.05, t-test). The distribution of neointimal hyperplasia following stent implantation as revealed by longitudinal histopathology matched the distribution of WSS simulated using computational fluid dynamics (CFD). The endothelium at low WSS areas exhibited aberrant cell morphology and leukocyte adhesion. A CFD model of a curved bifurcation suggested that the region of low WSS is expanded by artery straightening.Conclusion: In bifurcated lesions, stent flexibility influences not only mechanical stress on the artery but also WSS, which may induce local neointimal hyperplasia.Keywords: bifurcation, stent flexibility, wall shear stress, neointimal hyperplasiaSaito NMori YKomatsu TDove Medical Pressarticlebifurcationstent flexibilitywall shear stressneointimal hyperplasiaMedical technologyR855-855.5ENMedical Devices: Evidence and Research, Vol Volume 13, Pp 365-375 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	bifurcation stent flexibility wall shear stress neointimal hyperplasia Medical technology R855-855.5
spellingShingle	bifurcation stent flexibility wall shear stress neointimal hyperplasia Medical technology R855-855.5 Saito N Mori Y Komatsu T Influence of Stent Flexibility on Artery Wall Stress and Wall Shear Stress in Bifurcation Lesions
description	Noboru Saito, Yuhei Mori, Tomoya Komatsu Terumo Shonan Center, Kanagawa 259-0151, JapanCorrespondence: Noboru SaitoTerumo Shonan Center, 1500 Inokuchi, Nakai-Machi, Ashigarakami-Gun, Kanagawa 259-0151, JapanTel +81-465-81-4251Fax +81-465-81-4217Email noboru_saitou@terumo.co.jpPurpose: Stent flexibility can influence clinical outcome, especially in bifurcation lesions. For instance, an overly rigid stent can impose mechanical stress on the artery at the stent edges and alter both arterial geometry and blood flow dynamics in bifurcations. This study investigated the influence of stent flexibility on vessel geometry, histology, wall stress, and blood flow dynamics in arterial bifurcations.Materials and Methods: We compared arterial angulation, stenosis, histopathology, simulated wall shear stress (WSS), and simulated blood flow velocity distribution in swine coronary artery bifurcations following placement of the less flexible Multi-link 8 or more flexible Kaname stent (4.1 ± 0.5 vs 1.5 ± 0.1 mN, p < 0.05, t-test). Stents were implanted into six coronary artery bifurcations each using the single-stent crossover technique without side branch strut dilatation. Outcomes were examined after 28 days.Results: Implantation of both stents significantly increased site angulation (Multi-link 8: 148° ± 8° to 172° ± 2°, p < 0.05, paired t-test; Kaname: 152° ± 5° to 164° ± 4°, p < 0.05, paired t-test), but the change tended to be greater after Multi-link 8 stent implantation (24° ± 15° vs 11° ± 7°, p = 0.1, t-test), suggesting greater straightening of the bifurcation. The Multi-link 8 stent induced greater neointimal thickness than the Kaname stent (0.53 ± 0.3 mm vs 0.26 ± 0.1 mm, p < 0.05, t-test). The distribution of neointimal hyperplasia following stent implantation as revealed by longitudinal histopathology matched the distribution of WSS simulated using computational fluid dynamics (CFD). The endothelium at low WSS areas exhibited aberrant cell morphology and leukocyte adhesion. A CFD model of a curved bifurcation suggested that the region of low WSS is expanded by artery straightening.Conclusion: In bifurcated lesions, stent flexibility influences not only mechanical stress on the artery but also WSS, which may induce local neointimal hyperplasia.Keywords: bifurcation, stent flexibility, wall shear stress, neointimal hyperplasia
format	article
author	Saito N Mori Y Komatsu T
author_facet	Saito N Mori Y Komatsu T
author_sort	Saito N
title	Influence of Stent Flexibility on Artery Wall Stress and Wall Shear Stress in Bifurcation Lesions
title_short	Influence of Stent Flexibility on Artery Wall Stress and Wall Shear Stress in Bifurcation Lesions
title_full	Influence of Stent Flexibility on Artery Wall Stress and Wall Shear Stress in Bifurcation Lesions
title_fullStr	Influence of Stent Flexibility on Artery Wall Stress and Wall Shear Stress in Bifurcation Lesions
title_full_unstemmed	Influence of Stent Flexibility on Artery Wall Stress and Wall Shear Stress in Bifurcation Lesions
title_sort	influence of stent flexibility on artery wall stress and wall shear stress in bifurcation lesions
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/e510b1d0f32f4d8e869867cc2e07fbd7
work_keys_str_mv	AT saiton influenceofstentflexibilityonarterywallstressandwallshearstressinbifurcationlesions AT moriy influenceofstentflexibilityonarterywallstressandwallshearstressinbifurcationlesions AT komatsut influenceofstentflexibilityonarterywallstressandwallshearstressinbifurcationlesions
_version_	1718392707376742400

Influence of Stent Flexibility on Artery Wall Stress and Wall Shear Stress in Bifurcation Lesions

Ejemplares similares