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Cassese S, Voll F. Hypoechoic Halos After Femoropopliteal Stenting: Looking Beyond the Borders. JACC Cardiovasc Interv 2023; 16:1665-1667. [PMID: 37438034 DOI: 10.1016/j.jcin.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Salvatore Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.
| | - Felix Voll
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Erkol A, Dalgıç Y, Yıldırım S, Turan B. Incidence and predictors of prolonged hemodynamic depression after carotid artery stenting: Yet another benefit of statins? Clin Neurol Neurosurg 2021; 207:106786. [PMID: 34198224 DOI: 10.1016/j.clineuro.2021.106786] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We aimed to assess the incidence and predictors of prolonged hemodynamic depression (PHD) after carotid artery stenting (CAS). METHODS We retrospectively analyzed data from 216 CAS procedures performed in 207 patients (156 male; median and interquartile range (IQR) of age 68 (62-73) yr) between July 2012 and October 2020. PHD was defined as hypotension (systolic blood pressure ≤ 90 mmHg) and/or bradycardia (heart rate < 60 bpm) lasting >1 h. RESULTS The incidence of PHD was 25.9%. At multivariate analysis, asymptomatic lesions (OR: 2.43, 95% CI (1.16-5.06), p: 0.018), the stenosis proximity (<10 mm) to bifurcation (OR: 2.94, 95% CI (1.34-6.43), p: 0.007) and implantation of a Protege stent (OR: 2.93, 95% CI (1.14-7.53), p: 0.025) were independent risk factors, while statin usage (OR: 0.48, 95% CI (0.24-0.95), p: 0.036) was an independent protective factor for PHD after CAS. CONCLUSIONS Patients with asymptomatic lesions and stenosis close to the bifurcation are more prone to PHD. The type of the stent selected significantly influences the risk of PHD. Further prospective randomized studies are warranted to investigate the possible protective role of statins against PHD after CAS.
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Affiliation(s)
- Ayhan Erkol
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey.
| | - Yalçın Dalgıç
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Serhan Yıldırım
- Department of Neurology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Burak Turan
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
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3
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Scott JCR, Doman DA, Johnston CR. A Parametric Analysis of Endovascular Stent Geometry Manipulation On Radial Force Performance. J Med Device 2020. [DOI: 10.1115/1.4048233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Stents were manufactured to investigate the impact of altering stent design characteristics (leg length, bend angle, bend radius, wire diameter) on radial force generation. Results from this design parameter study showed that leg length, bend angle and wire diameter have a statistically significant impact on radial force generation, while lesser changes in bend radius did not (1.00mm vs. the original 0.794mm [1/32in]). However a larger variation of this parameter (1.588mm [1/16in]) was statistically significant. Results gathered for all parameters were used in the creation of a prototypal software. Using input values of patient specific arterial diameter and compliance, as well as stent design characteristic dimensions, this program has been developed to predict stent radial force at varying levels of expansion.
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Affiliation(s)
- Joel C. R. Scott
- Department of Mechanical Engineering Dalhousie University, Halifax, Nova Scotia, Canada, B3H 4R2
| | - Darrel A. Doman
- Department of Mechanical Engineering Dalhousie University, Halifax, Nova Scotia, Canada, B3H 4R2
| | - Clifton R. Johnston
- Department of Mechanical Engineering Dalhousie University, Halifax, Nova Scotia, Canada, B3H 4R2
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Laasch HU, Milward GD, Edwards DW. ‘Radial force’ of colonic stents: A parameter without consistency, definition or standard. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2020. [DOI: 10.18528/ijgii200005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Hans-Ulrich Laasch
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
- Department of Natural Sciences, University of Chester, Chester, UK
- Minnova Medical Foundation C.I.C., Wilmslow, UK
| | | | - Derek W. Edwards
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
- Department of Natural Sciences, University of Chester, Chester, UK
- Minnova Medical Foundation C.I.C., Wilmslow, UK
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Oshin O, Varcoe R, Wong J, Burrows S, Altaf N, Schlaich M, Weerasooriya R, Gray W, Deloose K, Baumgartner I, Mwipatayi BP. Multivariable Analysis of Patients With Severe Persistent Postprocedural Hypotension After Carotid Artery Stenting. J Endovasc Ther 2019; 26:759-767. [DOI: 10.1177/1526602819869929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To assess the incidence and predictors of severe, persistent postprocedural hypotension (PPH) after carotid artery stenting (CAS). Materials and Methods: A total of 146 patients (mean age 72.8 years; 104 men) who underwent 160 CAS procedures using a standardized protocol at 3 vascular centers were retrospectively analyzed. The primary endpoint was postprocedural hypotension, defined as a reduction in systolic blood pressure (SBP) >40 mm Hg from baseline or an SBP of <90 mm Hg sustained for >1 hour after CAS. Potential prognostic factors for postprocedural hypotension were identified and subjected to logistic regression analyses; outcomes are presented as the odds ratios (ORs) with 95% confidence intervals (CIs). Results: PPH developed in 36 (24.7%) patients after 37 (23.1%) CAS procedures. These patients had significantly longer intensive care unit and hospital stays than those who did not develop hypotension (p<0.001). PPH was associated with severe lesion calcification (OR 6.28, 95% CI 1.81 to 21.98, p=0.004) and contrast volume (OR 1.02, 95% CI 1.01 to 1.02, p<0.001). A 4-fold increase in the risk of PPH (OR 4.22, 95% CI 1.38 to 13.33, p=0.012) was found between the embolic protection device most associated with PPH (Angioguard) and the device least associated with PPH (Emboshield NAV6). A similar trend was also observed for the Precise vs Xact stents (OR 6, 95% CI 2.08 to 17.6, p=0.001). Bootstrapped multivariable modeling identified the Precise stent and contrast volume as significant predictors of persistent postprocedural hypotension. Further investigation of the contrast volume revealed associations with sex, severe calcification, arch type, previous coronary artery bypass surgery, and primary stenting, suggesting that the contrast volume reflects the complexity of the procedure. Conclusion: The complexity of the procedure and type of stent may play a role in the development of postprocedural hypotension after CAS.
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Affiliation(s)
- Olufemi Oshin
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
| | - Ramon Varcoe
- Department of Vascular Surgery, Prince of Wales, Sydney, Australia
| | - Jackie Wong
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
| | - Sally Burrows
- School of Medicine, University of Western Australia, Perth, Australia
| | - Nishath Altaf
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
| | - Markus Schlaich
- School of Medicine, University of Western Australia, Perth, Australia
- Dobney Hypertension Centre, Royal Perth Hospital, Perth, Australia
| | | | - William Gray
- Division of Cardiovascular Disease, Lankenau Heart Institute, Philadelphia, PA, USA
| | - Koen Deloose
- Department of Vascular Surgery, AZ Sint Blasius, Dendermonde, Belgium
| | - Iris Baumgartner
- Department of Angiology, Swiss Cardiovascular Center, Inselspital-Bern University Hospital, Bern, Switzerland
| | - Bibombe P. Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
- School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, University of Western Australia, Perth, Australia
- Department of Vascular Surgery, Joondalup Health Campus, Perth, Australia
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CHIANG CHENGHSIEN, HUNG TINKAN, YEH MINGLONG, CHEN WEILING, KAN CHUNGDANN. FIXATION STUDY OF SINGLE AND DOUBLE STENT GRAFTS FOR ENDOVASCULAR AORTIC REPAIR. J MECH MED BIOL 2018. [DOI: 10.1142/s0219519418500549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Application of double-barreled cannon stent grafts aortic repair (DoBAR) was reported in 2011 for extremely large aortic aneurysms of patients when there was no proper size of grafts for the emergent treatment. Fixation characteristics of the double stent grafts are obtained in a laboratory setting, and are incorporated with those of single Zenith TX2 grafts of sizes from 34 to 42[Formula: see text]mm. Radial stress and shear increase linearly with the oversizing parameter but decrease with increasing stent diameter. The slope of the linear relationship is practically the same for this group of grafts. When the original circular stent grafts of diameter 36 and 38[Formula: see text]mm are deformed to form DoBAR of diameter 44 or 46.4[Formula: see text]mm, the formation could provide higher radial stress and shear to secure fixation for endo-aortic repair. The experimental results of single and DoBAR grafts can be incorporated for clinical application of DoBAR for emergent treatment.
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Affiliation(s)
- CHENG-HSIEN CHIANG
- Department of Biomedical Engineering, National Cheng Kung University, No. 1, Daxue Road, East District, Tainan City 701, Taiwan
| | - TIN-KAN HUNG
- Department of Bioengineering, University of Pittsburgh, 700 O’Hara Street, Pittsburgh, PA 15261, USA
| | - MING-LONG YEH
- Department of Biomedical Engineering, National Cheng Kung University, No. 1, Daxue Road, East District, Tainan City 701, Taiwan
| | - WEI-LING CHEN
- Department of Engineering and Maintenance, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying District, Kaohsiung City 81362, Taiwan
| | - CHUNG-DANN KAN
- Division of Cardiovascular Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138 Sheng-Li Road, Tainan 704, Taiwan
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Self-expanding nitinol stents of high versus low chronic outward force in de novo femoropopliteal occlusive arterial lesions (BIOFLEX-COF trial): study protocol for a randomized controlled trial. Trials 2017; 18:594. [PMID: 29237489 PMCID: PMC5729260 DOI: 10.1186/s13063-017-2338-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 11/20/2017] [Indexed: 11/17/2022] Open
Abstract
Background Self-expanding nitinol stents must be oversized at least by a minimal amount to ensure contact with the vessel wall and prevent migration. Once the stent is deployed it exerts a continuous force upon the vascular wall, termed chronic outward force (COF). Animal studies have found an increased neointimal hyperplasia in stents with high oversizing and thus high COF. Data about correlation between COF and neointimal hyperplasia in humans are currently lacking. The objective of the BIOFLEX-COF trial is to prospectively investigate differences in formation of intimal hyperplasia at 1 and 2 years after implantation of nitinol stents with high versus low COF in de novo femoropopliteal occlusive arterial lesions. Methods The BIOFLEX-COF trial is a prospective, quantitative, randomized study. Eighty subjects with symptomatic peripheral arterial lesions eligible for endovascular stent implantation will be enrolled and randomly assigned to either a high COF group (LifeStent Flexstar, Bard Peripheral Vascular Inc., Tempe, AZ, USA) or low COF group (Pulsar, Biotronik AG, Bülach, Switzerland) using an online randomization program to generate a random 1:1 group allocation (block randomization). After implantation and dilatation, COF at every 2 mm along the stent axis will be calculated from the actual stent diameter versus its nominal diameter. There will be two follow-up evaluations at 12 and 24 months. Primary endpoint is the amount of in-stent neointima at 1 year, assessed by contrast-enhanced CT angiography (CTA). In the control examinations, stent diameter and true lumen diameter will be measured on DICOM images every 2 mm along the stent axis to quantify the relative amount of in-stent restenosis. Secondary objectives are the amount of in-stent neointima at 2 years, device- and procedure-related adverse events and target lesion revascularization (TLR) rate. The scheduled time for recruitment is 2 years. Recruitment is expected to be complete in October 2017. Discussion This trial is the first to prospectively investigate the influence of COF on stent patency. If successful, the results will aid in a more precise selection of stent type and size in a given target vessel. The present study is challenging in that it compares two different self-expanding nitinol stents head-to-head against each other. To optimize the power of this study, traditional binary outcome parameters such as TLR and restenosis at Doppler ultrasound were dropped as primary endpoints. Instead, the amount of neointima inside the stent accessed by CTA was selected as (continuous) outcome parameter. Trial registration ClinicalTrials.gov Identifier: NCT03097679. Date of registration: 14 March 2017 (retrospectively registered). Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2338-0) contains supplementary material, which is available to authorized users.
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8
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Understanding the requirements of self-expandable stents for heart valve replacement: Radial force, hoop force and equilibrium. J Mech Behav Biomed Mater 2017; 68:252-264. [PMID: 28219851 DOI: 10.1016/j.jmbbm.2017.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 02/03/2017] [Accepted: 02/05/2017] [Indexed: 11/22/2022]
Abstract
A proper interpretation of the forces developed during stent crimping and deployment is of paramount importance for a better understanding of the requirements for successful heart valve replacement. The present study combines experimental and computational methods to assess the performance of a nitinol stent for tissue-engineered heart valve implantation. To validate the stent model, the mechanical response to parallel plate compression and radial crimping was evaluated experimentally. Finite element simulations showed good agreement with the experimental findings. The computational models were further used to determine the hoop force on the stent and radial force on a rigid tool during crimping and self-expansion. In addition, stent deployment against ovine and human pulmonary arteries was simulated to determine the hoop force on the stent-artery system and the equilibrium diameter for different degrees of oversizing.
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9
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Løvdal ALV, Calve S, Yang S, Van Alstine W, Binkert CA, Klausen K. Evaluation of a Bioabsorbable Self-Expandable Vein Stent-Base Made of Poly(l-lactide) In Vitro and In Vivo. Cardiovasc Intervent Radiol 2016; 40:112-119. [DOI: 10.1007/s00270-016-1491-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 10/26/2016] [Indexed: 11/30/2022]
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10
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An Experimental Evaluation of Device/Arterial Wall Compliance Mismatch for Four Stent-Graft Devices and a Multi-layer Flow Modulator Device for the Treatment of Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2016; 51:44-55. [DOI: 10.1016/j.ejvs.2015.07.041] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 07/29/2015] [Indexed: 11/19/2022]
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Matsumoto T, Matsubara Y, Aoyagi Y, Matsuda D, Okadome J, Morisaki K, Inoue K, Tanaka S, Ohkusa T, Maehara Y. Radial force measurement of endovascular stents: Influence of stent design and diameter. Vascular 2015; 24:171-6. [DOI: 10.1177/1708538115590040] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and purpose Angioplasty and endovascular stent placement is used in case to rescue the coverage of main branches to supply blood to brain from aortic arch in thoracic endovascular aortic repair. This study assessed mechanical properties, especially differences in radial force, of different endovascular and thoracic stents. Material and methods We analyzed the radial force of three stent models (Epic™, E-Luminexx® and SMART®) stents using radial force-tester method in single or overlapping conditions. We also analyzed radial force in three thoracic stents using Mylar® film testing method: conformable Gore®-TAG®, Relay®, and Valiant® Thoracic Stent Graft. Results Overlapping SMART stents had greater radial force than overlapping Epic or Luminexx stents ( P < 0.01). The radial force of the thoracic stents was greater than that of all three endovascular stents ( P < 0.01). Conclusions Differences in radial force depend on types of stents, site of deployment, and layer characteristics. In clinical settings, an understanding of the mechanical characteristics, including radial force, is important in choosing a stent for each patient.
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Affiliation(s)
- Takuya Matsumoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yutaka Matsubara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yukihiko Aoyagi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Daisuke Matsuda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Jun Okadome
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Morisaki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kentarou Inoue
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinichi Tanaka
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoko Ohkusa
- Kirameki Project Career Support Center, Kyushu University Hospital, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Lucatelli P, Fanelli F, Cirelli C, Sacconi B, Anzidei M, Montisci R, Sanfilippo R, Tamponi E, Catalano C, Saba L. Carotid endarterectomy versus stenting: Does the flow really change? An Echo-Color-Doppler analysis. Int J Cardiovasc Imaging 2015; 31:773-81. [PMID: 25697722 DOI: 10.1007/s10554-015-0623-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 02/16/2015] [Indexed: 11/26/2022]
Abstract
To assess potential hemodynamic differences after carotid endarterectomy (CEA) and carotid artery stenting (CAS) and their eventual impact on clinical management. Between July 2012 and October 2013 two groups of 30 patients each referred for CEA or CAS were prospectively enrolled in two tertiary hospital care centers. Pre-procedural imaging assessment of carotid artery disease was performed with Echo-Color-Doppler (ECD) and computed tomography angiography (CTA). ECD was repeated within 24 h and 1, 6 and 12 months after surgical/endovascular procedures. Peak systolic velocity (PSV) and end diastolic velocity (EDV) were assessed at two standard sites: common carotid artery (CCA) and distal internal carotid artery (ICA). Twenty-four hours ECD findings highly differ between the two populations. CCA PSV in the CEA and CAS groups was respectively 44.88 ± 9.16 and 69.20 ± 20.04 cm/s (p = 0.002); CCA EDV was 16.11 ± 2.29 and 19.13 ± 6.42 cm/s (p = 0.065); ICA PSV was 46.11 ± 7.9 and 94.02 ± 57.7 cm/s (p = 0.0012); ICA EDV was 20.22 ± 4.33 and 30.47 ± 18.33 cm/s (p = 0.025). One month, 6 months and 1 year findings confirmed the different trend in the two cohorts; in particular, at 1 year: CCA PSV was 50.94 ± 12.44 and 60.59 ± 26.84 cm/s (p = 0.181); CCA EDV was 17.11 ± 3.46 and 19 ± 16.35 cm/s (p = 0.634); ICA PSV was 51.66 ± 10.1 and 70.86 ± 20.64 cm/s (p = 0.014); ICA EDV was 25.05 ± 8.65 and 32.66 ± 13 cm/s (p = 0.0609). ECD follow-up of patients undergone CEA or CAS may play a critical role in the clinical management. Strict surveillance of blood flow velocities allows reducing false positive re-stenosis diagnosis and choosing the best anti-aggregation therapies. Within the first month CEA patients benefit from a lower risk condition in comparison with CAS patients, due to a significantly faster PSV drop; moreover, long-term CCA PSV after CEA could be used as a surrogate marker of neointima formation.
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MESH Headings
- Aged
- Angioplasty/adverse effects
- Angioplasty/instrumentation
- Blood Flow Velocity
- Carotid Artery, Common/diagnostic imaging
- Carotid Artery, Common/physiopathology
- Carotid Artery, Common/surgery
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/physiopathology
- Carotid Artery, Internal/surgery
- Carotid Stenosis/diagnostic imaging
- Carotid Stenosis/physiopathology
- Carotid Stenosis/surgery
- Carotid Stenosis/therapy
- Endarterectomy, Carotid/adverse effects
- Female
- Humans
- Italy
- Male
- Middle Aged
- Predictive Value of Tests
- Prospective Studies
- Recurrence
- Regional Blood Flow
- Severity of Illness Index
- Stents
- Tertiary Care Centers
- Time Factors
- Tomography, X-Ray Computed
- Treatment Outcome
- Ultrasonography, Doppler, Color
- Vascular Patency
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy,
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Borghi A, Murphy O, Bahmanyar R, McLeod C. Effect of Stent Radial Force on Stress Pattern After Deployment: A Finite Element Study. JOURNAL OF MATERIALS ENGINEERING AND PERFORMANCE 2014; 23:2599-2605. [PMID: 25089084 PMCID: PMC4102392 DOI: 10.1007/s11665-014-0913-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 02/09/2014] [Indexed: 05/25/2023]
Abstract
The present article presents a method for assessing the radial stiffness of nitinol stents. An idealized stent model was created, and its radial stiffness was calculated by means of finite element modeling. The calculations were validated against experimental measurements. The variation of radial stiffness with geometrical dimensions was calculated, and the effect of increasing radial stiffness on endovascular deployment was analyzed. Peak tensile and compressive stresses as well as stent penetration were calculated in the case of an idealized pulmonary artery model having realistic dimensions as well as stiffness. The results of stress calculations were compared with a second set of simulations, where an idealized behavior of the stent (uniform expansion to a theoretical contact diameter) was modeled. The results show how in reality nitinol stents behave in a non-ideal way, having a non-uniform expansion and exerting non-uniform pressure on the contact areas with the artery. Such non-ideality decreases though with the increase in radial stiffness. The radial force alone may be insufficient in describing the stent-artery interaction, and numerical modeling proves to be necessary for capturing such complexity.
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Affiliation(s)
| | - Olive Murphy
- Institute of Biomedical Engineering, Imperial College London, London, UK
| | - Reza Bahmanyar
- Institute of Biomedical Engineering, Imperial College London, London, UK
| | - Chris McLeod
- Institute of Biomedical Engineering, Imperial College London, London, UK
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McElhinney DB, Marshall AC, Schievano S. Fracture of Cardiovascular Stents in Patients With Congenital Heart Disease. Circ Cardiovasc Interv 2013; 6:575-85. [DOI: 10.1161/circinterventions.113.000148] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Doff B. McElhinney
- From the NYU Langone Medical Center, New York, NY (D.B.M.); Boston Children’s Hospital, Boston, MA (A.C.M.); and UCL Institute of Cardiovascular science & Great Ormond Street Hospital for Children, London, UK (S.S.)
| | - Audrey C. Marshall
- From the NYU Langone Medical Center, New York, NY (D.B.M.); Boston Children’s Hospital, Boston, MA (A.C.M.); and UCL Institute of Cardiovascular science & Great Ormond Street Hospital for Children, London, UK (S.S.)
| | - Silvia Schievano
- From the NYU Langone Medical Center, New York, NY (D.B.M.); Boston Children’s Hospital, Boston, MA (A.C.M.); and UCL Institute of Cardiovascular science & Great Ormond Street Hospital for Children, London, UK (S.S.)
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15
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Walker AM, Johnston CR, Rival DE. The quantification of hemodynamic parameters downstream of a Gianturco Zenith stent wire using newtonian and non-newtonian analog fluids in a pulsatile flow environment. J Biomech Eng 2013; 134:111001. [PMID: 23387783 DOI: 10.1115/1.4007746] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although deployed in the vasculature to expand vessel diameter and improve blood flow, protruding stent struts can create complex flow environments associated with flow separation and oscillating shear gradients. Given the association between magnitude and direction of wall shear stress (WSS) and endothelial phenotype expression, accurate representation of stent-induced flow patterns is critical if we are to predict sites susceptible to intimal hyperplasia. Despite the number of stents approved for clinical use, quantification on the alteration of hemodynamic flow parameters associated with the Gianturco Z-stent is limited in the literature. In using experimental and computational models to quantify strut-induced flow, the majority of past work has assumed blood or representative analogs to behave as Newtonian fluids. However, recent studies have challenged the validity of this assumption. We present here the experimental quantification of flow through a Gianturco Z-stent wire in representative Newtonian and non-Newtonian blood analog environments using particle image velocimetry (PIV). Fluid analogs were circulated through a closed flow loop at physiologically appropriate flow rates whereupon PIV snapshots were acquired downstream of the wire housed in an acrylic tube with a diameter characteristic of the carotid artery. Hemodynamic parameters including WSS, oscillatory shear index (OSI), and Reynolds shear stresses (RSS) were measured. Our findings show that the introduction of the stent wire altered downstream hemodynamic parameters through a reduction in WSS and increases in OSI and RSS from nonstented flow. The Newtonian analog solution of glycerol and water underestimated WSS while increasing the spatial coverage of flow reversal and oscillatory shear compared to a non-Newtonian fluid of glycerol, water, and xanthan gum. Peak RSS were increased with the Newtonian fluid, although peak values were similar upon a doubling of flow rate. The introduction of the stent wire promoted the development of flow patterns that are susceptible to intimal hyperplasia using both Newtonian and non-Newtonian analogs, although the magnitude of sites affected downstream was appreciably related to the rheological behavior of the analog. While the assumption of linear viscous behavior is often appropriate in quantifying flow in the largest arteries of the vasculature, the results presented here suggest this assumption overestimates sites susceptible to hyperplasia and restenosis in flow characterized by low and oscillatory shear.
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Affiliation(s)
- Andrew M Walker
- Department of Mechanical and Manufacturing Engineering, University of Calgary, 2500 University Drive N.W., Calgary, AB T2N 1N4, Canada.
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Scheumann J, Heilmann C, Beyersdorf F, Siepe M, Brenner RM, Böckler D, Griepp RB, Bischoff MS. Early histological changes in the porcine aortic media after thoracic stent-graft implantation. J Endovasc Ther 2012; 19:363-9. [PMID: 22788888 DOI: 10.1583/12-3845r.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To describe the histological findings in the aortic wall 5 days after thoracic endovascular aortic repair (TEVAR) in a porcine model. METHODS Two overlapping stent-grafts were implanted in each of 6 juvenile pigs, covering the entire descending thoracic aorta (DTA). On the 5(th) postoperative day, tissue samples were taken from the DTA in each animal. Medial thickness and medial necrosis were quantified and compared to measurements from the aortas of 6 control animals. RESULTS Significant medial thinning was observed in stent-covered regions in the test animals. At the proximal landing zone, aortic wall thickness changed from 1387±68 to 782±74 µm within the covered aortic segment (p = 0.028); at the distal landing site, the wall thickness was 365±67 µm within the stent and 501±57 µm distally (p = 0.028). In the overlap zone, the aortic wall measured 524±122 vs. 1053±77 µm in native controls (p = 0.004). Aortic thickness proximal to the graft did not differ from the proximal region of native aortas (1468±96 vs. 1513±80 µm, p = 0.423), but the aorta was significantly thinner distal to the stent (707±38 vs. 815±52 µm, p = 0.004). Laminar necrosis constituted 38%±7% of the media in the proximal landing zone, 54%±4% in the overlap zone, and 46%±13% in the distal landing zone. CONCLUSION In this porcine model, significant medial thinning and necrosis of the stented aorta was observed. The findings suggest an early phase of vulnerability of the aortic wall, before scarring and adaptive changes have strengthened the residual aorta.
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Affiliation(s)
- Johannes Scheumann
- Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, NY, USA.
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A literature review of the numerical analysis of abdominal aortic aneurysms treated with endovascular stent grafts. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2012; 2012:820389. [PMID: 22997538 PMCID: PMC3445816 DOI: 10.1155/2012/820389] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 07/16/2012] [Indexed: 11/18/2022]
Abstract
The purpose of this paper is to present the basic principles and relevant advances in the computational modeling of abdominal aortic aneurysms and endovascular aneurysm repair, providing the community with up-to-date state of the art in terms of numerical analysis and biomechanics. Frameworks describing the mechanical behavior of the aortic wall already exist. However, intraluminal thrombus nonhomogeneous structure and porosity still need to be well characterized. Also, although the morphology and mechanical properties of calcifications have been investigated, their effects on wall stresses remain controversial. Computational fluid dynamics usually assumes a rigid artery wall, whereas fluid-structure interaction accounts for artery compliance but is still challenging since arteries and blood have similar densities. We discuss alternatives to fluid-structure interaction based on dynamic medical images that address patient-specific hemodynamics and geometries. We describe initial stresses, elastic boundary conditions, and statistical strength for rupture risk assessment. Special emphasis is accorded to workflow development, from the conversion of medical images into finite element models, to the simulation of catheter-aorta interactions and stent-graft deployment. Our purpose is also to elaborate the key ingredients leading to virtual stenting and endovascular repair planning that could improve the procedure and stent-grafts.
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