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Haemodynamic impact of stent–vessel (mal)apposition following carotid artery stenting: mind the gaps!

Gianluca De Santis UGent, Michele Conti UGent, Bram Trachet UGent, Thomas De Schryver UGent, Matthieu De Beule UGent, Joris Degroote UGent, Jan Vierendeels UGent, Ferdinando Auricchio, Patrick Segers UGent and Pascal Verdonck UGent, et al. (2013) COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING. 16(6). p.648-659
abstract
Carotid artery stenting (CAS) has emerged as a minimally invasive alternative to endarterectomy but its use in clinical treatment is limited due to the post-stenting complications. Haemodynamic actors, related to blood flow in the stented vessel, have been suggested to play a role in the endothelium response to stenting, including adverse reactions such as in-stent restenosis and late thrombosis. Accessing the flow-related shear forces acting on the endothelium in vivo requires space and time resolutions which are currently not achievable with non-invasive clinical imaging techniques but can be obtained from image-based computational analysis. In this study, we present a framework for accurate determination of the wall shear stress (WSS) in a mildly stenosed carotid artery after the implantation of a stent, resembling the commercially available Acculink (Abbott Laboratories, Abbott Park, Illinois, USA). Starting from angiographic CT images of the vessel lumen and a micro-CT scan of the stent, a finite element analysis is carried out in order to deploy the stent in the vessel, reproducing CAS in silico. Then, based on the post-stenting anatomy, the vessel is perfused using a set of boundary conditions: total pressure is applied at the inlet, and impedances that are assumed to be insensitive to the presence of the stent are imposed at the outlets. Evaluation of the CAS outcome from a geometrical and haemodynamic perspective shows the presence of atheroprone regions (low time-average WSS, high relative residence time) colocalised with stent malapposition and stent strut interconnections. Stent struts remain unapposed in the ostium of the external carotid artery disturbing the flow and generating abnormal shear forces, which could trigger thromboembolic events.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
BULK FLOW, SHEAR-STRESS, NUMERICAL SIMULATIONS, COMPUTATIONAL FLUID-DYNAMICS, BLOOD-FLOW, ANEURYSM MODEL, image-based analysis, IMPLANTATION, carotid artery stenting, BIFURCATION, STENOSIS, computational fluid dynamics, pyFormex, ENDARTERECTOMY, finite element analysis, impedance model
journal title
COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING
Comput. Methods Biomech. Biomed. Eng.
volume
16
issue
6
pages
648 - 659
Web of Science type
Article
Web of Science id
000320089000007
JCR category
COMPUTER SCIENCE, INTERDISCIPLINARY APPLICATIONS
JCR impact factor
1.793 (2013)
JCR rank
31/102 (2013)
JCR quartile
2 (2013)
ISSN
1025-5842
DOI
10.1080/10255842.2011.629997
language
English
UGent publication?
yes
classification
A1
copyright statement
I have transferred the copyright for this publication to the publisher
id
2064407
handle
http://hdl.handle.net/1854/LU-2064407
date created
2012-03-12 12:30:26
date last changed
2014-02-17 13:21:38
@article{2064407,
  abstract     = {Carotid artery stenting (CAS) has emerged as a minimally invasive alternative to endarterectomy but its use in clinical treatment is limited due to the post-stenting complications. Haemodynamic actors, related to blood flow in the stented vessel, have been suggested to play a role in the endothelium response to stenting, including adverse reactions such as in-stent restenosis and late thrombosis. Accessing the flow-related shear forces acting on the endothelium in vivo requires space and time resolutions which are currently not achievable with non-invasive clinical imaging techniques but can be obtained from image-based computational analysis. In this study, we present a framework for accurate determination of the wall shear stress (WSS) in a mildly stenosed carotid artery after the implantation of a stent, resembling the commercially available Acculink (Abbott Laboratories, Abbott Park, Illinois, USA). Starting from angiographic CT images of the vessel lumen and a micro-CT scan of the stent, a finite element analysis is carried out in order to deploy the stent in the vessel, reproducing CAS in silico. Then, based on the post-stenting anatomy, the vessel is perfused using a set of boundary conditions: total pressure is applied at the inlet, and impedances that are assumed to be insensitive to the presence of the stent are imposed at the outlets. Evaluation of the CAS outcome from a geometrical and haemodynamic perspective shows the presence of atheroprone regions (low time-average WSS, high relative residence time) colocalised with stent malapposition and stent strut interconnections. Stent struts remain unapposed in the ostium of the external carotid artery disturbing the flow and generating abnormal shear forces, which could trigger thromboembolic events.},
  author       = {De Santis, Gianluca and Conti, Michele and Trachet, Bram and De Schryver, Thomas and De Beule, Matthieu and Degroote, Joris and Vierendeels, Jan and Auricchio, Ferdinando and Segers, Patrick and Verdonck, Pascal and Verhegghe, Benedict},
  issn         = {1025-5842},
  journal      = {COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING},
  keyword      = {BULK FLOW,SHEAR-STRESS,NUMERICAL SIMULATIONS,COMPUTATIONAL FLUID-DYNAMICS,BLOOD-FLOW,ANEURYSM MODEL,image-based analysis,IMPLANTATION,carotid artery stenting,BIFURCATION,STENOSIS,computational fluid dynamics,pyFormex,ENDARTERECTOMY,finite element analysis,impedance model},
  language     = {eng},
  number       = {6},
  pages        = {648--659},
  title        = {Haemodynamic impact of stent--vessel (mal)apposition following carotid artery stenting: mind the gaps!},
  url          = {http://dx.doi.org/10.1080/10255842.2011.629997},
  volume       = {16},
  year         = {2013},
}

Chicago
De Santis, Gianluca, Michele Conti, Bram Trachet, Thomas De Schryver, Matthieu De Beule, Joris Degroote, Jan Vierendeels, et al. 2013. “Haemodynamic Impact of Stent–vessel (mal)apposition Following Carotid Artery Stenting: Mind the Gaps!” Computer Methods in Biomechanics and Biomedical Engineering 16 (6): 648–659.
APA
De Santis, G., Conti, M., Trachet, B., De Schryver, T., De Beule, M., Degroote, J., Vierendeels, J., et al. (2013). Haemodynamic impact of stent–vessel (mal)apposition following carotid artery stenting: mind the gaps! COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING, 16(6), 648–659.
Vancouver
1.
De Santis G, Conti M, Trachet B, De Schryver T, De Beule M, Degroote J, et al. Haemodynamic impact of stent–vessel (mal)apposition following carotid artery stenting: mind the gaps! COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING. 2013;16(6):648–59.
MLA
De Santis, Gianluca, Michele Conti, Bram Trachet, et al. “Haemodynamic Impact of Stent–vessel (mal)apposition Following Carotid Artery Stenting: Mind the Gaps!” COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING 16.6 (2013): 648–659. Print.