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Dos Santos FJ, Hernandez BA, Santos R, Machado M, Souza M, Capello Sousa EA, Andrade A. Bioabsorbable Polymeric Stent for the Treatment of Coarctation of the Aorta (CoA) in Children: A Methodology to Evaluate the Design and Mechanical Properties of PLA Polymer. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4403. [PMID: 37374585 DOI: 10.3390/ma16124403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/11/2023] [Indexed: 06/29/2023]
Abstract
This study presents a methodology that combines experimental tests and the finite element method, which is able to analyse the influence of the geometry on the mechanical behaviour of stents made of bioabsorbable polymer PLA (PolyLactic Acid) during their expansion in the treatment of coarctation of the aorta (CoA). Tensile tests with standardized specimen samples were conducted to determine the properties of a 3D-printed PLA. A finite element model of a new stent prototype was generated from CAD files. A rigid cylinder simulating the expansion balloon was also created to simulate the stent opening performance. A tensile test with 3D-printed customized stent specimens was performed to validate the FE stent model. Stent performance was evaluated in terms of elastic return, recoil, and stress levels. The 3D-printed PLA presented an elastic modulus of 1.5 GPa and a yield strength of 30.6 MPa, lower than non-3D-printed PLA. It can also be inferred that crimping had little effect on stent circular recoil performance, as the difference between the two scenarios was on average 1.81%. For an expansion of diameters ranging from 12 mm to 15 mm, as the maximum opening diameter increases, the recoil levels decrease, ranging from 10 to 16.75% within the reported range. These results point out the importance of testing the 3D-printed PLA under the conditions of using it to access its material properties; the results also indicate that the crimping process could be disregarded in simulations to obtain fast results with lower computational cost and that new proposed stent geometry made of PLA might be suitable for use in CoA treatments-the approach that has not been applied before. The next steps will be to simulate the opening of an aorta vessel using this geometry.
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Affiliation(s)
- Flávio José Dos Santos
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Bruno Agostinho Hernandez
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Rosana Santos
- Department of Engineering, PUC-Pontifical Catholic University of São Paulo, São Paulo 05014-901, Brazil
| | - Marcel Machado
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Mateus Souza
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Edson A Capello Sousa
- Department of Mechanical Engineering, Centre for Simulation in Bioengineering, Biomechanics and Biomaterials, School of Engineering (CS3B), Campus of Bauru, UNESP-São Paulo State University, São Paulo 17033-360, Brazil
| | - Aron Andrade
- CEAC-Centre for Engineering in Circulatory Assistance, Dante Pazzanese Institute of Cardiology, São Paulo 04012-909, Brazil
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Morgan GJ, Zablah J. A new FDA approved stent for congenital heart disease: First-in-man experiences with G-ARMOR TM. Catheter Cardiovasc Interv 2022; 100:1261-1266. [PMID: 36321626 DOI: 10.1002/ccd.30447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/25/2022] [Accepted: 10/08/2022] [Indexed: 11/07/2022]
Abstract
We present the first clinical experience with a new hybrid cell structure covered stent, designed for congenital heart disease applications. It represents a significant redesign of the Cheatham Platinum (CP) Stent (Numed Inc.), maintaining the traditional benefits of the covered CP whilst significantly decreasing shortening and allowing controlled flaring at the ends through its combination of larger and standard sized cells. We first implanted the stent in 2 patients with superior sinus venosus defects with anomalous drainage of the right upper and middle lobe pulmonary veins. The first was a 40 year male and the second a 36 year old female. The third case was a 60 year old patient with near atresia of the aorta, with pre and poststenotic aortic dilation. The clinical result in all cases was excellent with no obstruction to pulmonary venous return and no visible L-R shunt on the transthoracic echo on 24 h and 2 week follow-up for the patient with sinus venosus defects and uniform complete revascularization of the aorta without any vascular complications in the patient with coarctation. These are the first uses of this stent in human subjects. The design is specifically aimed toward procedures where stent shortening is undesirable. Hence, coarctation of the aorta as well as stent implantation in preparation for percutaneous pulmonary valve placement are obvious use areas, as well as the growing body of evidence supporting percutaneous treatment of sinus venosus defects.
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Affiliation(s)
- Gareth J Morgan
- School of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
| | - Jenny Zablah
- School of Medicine, University of Colorado Anschutz Medical Campus, Denver, Colorado, USA
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Lee SH, Kim SW, Kim JM, Son WC. In vivo evaluation of histopathologic findings of vascular damage after mechanical thrombectomy with the Tromba device in a canine model of cerebral infarction. PLoS One 2022; 17:e0276108. [PMID: 36240152 PMCID: PMC9565453 DOI: 10.1371/journal.pone.0276108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 09/29/2022] [Indexed: 12/03/2022] Open
Abstract
A novel stent retriever device for in vivo mechanical thrombectomy for acute cerebral infarction has been developed. In this study, we compared the thrombus removal capacity, potential complications, and extent of vessel wall damage of this novel device with those of the Solitaire FR device by performing a histopathologic analysis using an autopsied canine model. Through this experimental evaluation, we aimed to assess the safety and efficacy of the newly developed thrombus removal device for cerebral infarction. Blood clots (autologous thrombus) were injected into 12 canines. Mechanical thrombectomy was performed in six canines using the newly developed Tromba thrombectomy device (experimental group) and in the other six canines using the Solitaire FR thrombectomy device (control group). Angiographic and histopathologic evaluations were performed 1 month after the blood vessels underwent mechanical thrombectomy. In the experimental group, the reperfusion patency was classified as "no narrowing" in five cases and "moderate narrowing (25%-50% stenosis)" in one case. In the control group, the reperfusion patency was classified as "no narrowing" in four cases, "moderate narrowing (25%-50% stenosis)" in one case, and "slight narrowing (less than 25% stenosis)" in one case. In the experimental group, intimal proliferation was observed in only two cases, endothelial loss was observed in two cases, and device-induced medial injury was observed in one case. In the control group, intimal proliferation was observed in two cases, endothelial loss was observed in one case, and thrombosis (fibrin/platelet) was observed in one case. The Tromba thrombectomy device showed no significant difference to the conventional Solitaire device in angiographic and histopathologic evaluations after thrombus removal. The stability and efficiency of the newly developed Tromba device are considered to be high and comparable to those of Solitaire.
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Affiliation(s)
- Sang-Hun Lee
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
- * E-mail:
| | - Sang Woo Kim
- Laboratory Animal Center, Osong Medical Innovation Foundation (K-BIO HEALTH), Cheonju, Republic of Korea
| | - Jong Min Kim
- Laboratory Animal Center, Osong Medical Innovation Foundation (K-BIO HEALTH), Cheonju, Republic of Korea
| | - Woo Chan Son
- Department of Pathology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Tang Y, Li M, Wang T, Dong X, Hu W, Sitti M. Wireless Miniature Magnetic Phase-Change Soft Actuators. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2204185. [PMID: 35975467 PMCID: PMC7613683 DOI: 10.1002/adma.202204185] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/09/2022] [Indexed: 05/28/2023]
Abstract
Wireless miniature soft actuators are promising for various potential high-impact applications in medical, robotic grippers, and artificial muscles. However, these miniature soft actuators are currently constrained by a small output force and low work capacity. To address such challenges, a miniature magnetic phase-change soft composite actuator is reported. This soft actuator exhibits an expanding deformation and enables up to a 70 N output force and 175.2 J g-1 work capacity under remote magnetic radio frequency heating, which are 106 -107 times that of traditional magnetic soft actuators. To demonstrate its capabilities, a wireless soft robotic device is first designed that can withstand 0.24 m s-1 fluid flows in an artery phantom. By integrating it with a thermally-responsive shape-memory polymer and bistable metamaterial sleeve, a wireless reversible bistable stent is designed toward future potential angioplasty applications. Moreover, it can additionally locomote inside and jump out of granular media. At last, the phase-change actuator can realize programmable bending deformations when a specifically designed magnetization profile is encoded, enhancing its shape-programming capability. Such a miniature soft actuator provides an approach to enhance the mechanical output and versatility of magnetic soft robots and devices, extending their medical and other potential applications.
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Affiliation(s)
- Yichao Tang
- School of Mechanical Engineering Tongji University Shanghai 201804, China; Physical Intelligence Department Max Planck Institute for Intelligent Systems 70569, Stuttgart, Germany
| | - Mingtong Li
- Physical Intelligence Department Max Planck Institute for Intelligent Systems 70569, Stuttgart, Germany; Institute of Functional Nano & Soft Materials (FUNSOM) Jiangsu Key Laboratory for Carbon-Based Functional Materials & Devices Soochow University Suzhou, Jiangsu 215123, China
| | - Tianlu Wang
- Physical Intelligence Department Max Planck Institute for Intelligent Systems 70569, Stuttgart, Germany; Institute for Biomedical Engineering ETH Zurich Zurich 8092, Switzerland
| | - Xiaoguang Dong
- Physical Intelligence Department Max Planck Institute for Intelligent Systems 70569, Stuttgart, Germany; of Mechanical Engineering Vanderbilt University Nashville, TN 37215, USA; Vanderbilt Institute for Surgery and Engineering Vanderbilt University Nashville, TN 37215, USA
| | - Wenqi Hu
- Physical Intelligence Department Max Planck Institute for Intelligent Systems 70569, Stuttgart, Germany
| | - Metin Sitti
- Physical Intelligence Department Max Planck Institute for Intelligent Systems 70569, Stuttgart, Germany; Institute for Biomedical Engineering ETH Zurich Zurich 8092, Switzerland; School of Medicine and College of Engineering Koç University Istanbul 34450, Turkey
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Mousavi J. S. SM, Faghihi D, Sommer K, Bhurwani MMS, Patel TR, Santo B, Waqas M, Ionita C, Levy EI, Siddiqui AH, Tutino VM. Realistic computer modelling of stent retriever thrombectomy: a hybrid finite-element analysis-smoothed particle hydrodynamics model. J R Soc Interface 2021; 18:20210583. [PMID: 34905967 PMCID: PMC8672072 DOI: 10.1098/rsif.2021.0583] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/22/2021] [Indexed: 01/11/2023] Open
Abstract
Stent retriever thrombectomy is a pre-eminent treatment modality for large vessel ischaemic stroke. Simulation of thrombectomy could help understand stent and clot mechanics in failed cases and provide a digital testbed for the development of new, safer devices. Here, we present a novel, in silico thrombectomy method using a hybrid finite-element analysis (FEA) and smoothed particle hydrodynamics (SPH). Inspired by its biological structure and components, the blood clot was modelled with the hybrid FEA-SPH method. The Solitaire self-expanding stent was parametrically reconstructed from micro-CT imaging and was modelled as three-dimensional finite beam elements. Our simulation encompassed all steps of mechanical thrombectomy, including stent packaging, delivery and self-expansion into the clot, and clot extraction. To test the feasibility of our method, we simulated clot extraction in simple straight vessels. This was compared against in vitro thrombectomies using the same stent, vessel geometry, and clot size and composition. Comparisons with benchtop tests indicated that our model was able to accurately simulate clot deflection and penetration of stent wires into the clot, the relative movement of the clot and stent during extraction, and clot fragmentation/embolus formation. In this study, we demonstrated that coupling FEA and SPH techniques could realistically model stent retriever thrombectomy.
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Affiliation(s)
- S. Mostafa Mousavi J. S.
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14203, USA
| | - Danial Faghihi
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14203, USA
| | - Kelsey Sommer
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14203, USA
| | - Mohammad M. S. Bhurwani
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14203, USA
| | - Tatsat R. Patel
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14203, USA
| | - Briana Santo
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY 14203, USA
| | - Muhammad Waqas
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14203, USA
| | - Ciprian Ionita
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA
- Department of Biomedical Engineering, University at Buffalo, Buffalo, NY 14203, USA
| | - Elad I. Levy
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Adnan H. Siddiqui
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
| | - Vincent M. Tutino
- Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY 14203, USA
- Department of Mechanical and Aerospace Engineering, University at Buffalo, Buffalo, NY 14203, USA
- Department of Neurosurgery, University at Buffalo, Buffalo, NY 14203, USA
- Department of Pathology and Anatomical Sciences, University at Buffalo, Buffalo, NY 14203, USA
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Bhattacharya D, Ali SJV, Cheng LK, Xu W. RoSE: A Robotic Soft Esophagus for Endoprosthetic Stent Testing. Soft Robot 2020; 8:397-415. [PMID: 32758017 DOI: 10.1089/soro.2019.0205] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Soft robotic systems are well suited for developing devices for biomedical applications. A bio-mimicking robotic soft esophagus (RoSE) is developed as an in vitro testing device of endoprosthetic stents for dysphagia management. Endoprosthetic stent placement is an immediate and cost-effective therapy for dysphagia caused by malignant esophageal strictures from esophageal cancer. However, later stage complications, such as stent migration, could weaken the swallow efficacy in the esophagus. The stent radial force (RF) on the esophageal wall is pivotal in avoiding stent migration. Due to limited randomized controlled trials in patients, the stent design and stenting guidelines are still unconstructive. To address the knowledge deficit, we have investigated the capabilities of the RoSE by implanting two stents (stent A and B) of different radial stiffness characteristics, to measure the stent RF and its effect on the stent migration. Also, endoscopic manometry on the RoSE under peristalsis has been performed to study the impact of stenting and stent dysfunctionality on the intrabolus pressure signatures (IBPSs) in the RoSE, and further its effects on the swallowing efficacy. Each implanted stent in the RoSE underwent a set of experiments with various test variables (peristalsis velocity and wavelength, and bolus concentrations). In this study, the conducted tests are representative of the application of RoSE to perform a wide-ranging assessment of the stent behavior. The usability of RoSE has been discussed by comparing the results of stent A and B, for various combinations of the test variables mentioned earlier. The results have demonstrated that the stiffer stent B has a higher RF, whereas stent A maintained its RF at a low profile due to its lesser stiffness. The results have also implicated that a high RF is necessary to minimize the stent migration under prolonged peristaltic contractions in the RoSE. For the manometry experiments, stent A slightly increased the IBPS, but the stiffer stent B significantly decreased the IBPS, especially for the higher concentration boluses. It was found that if a stiffer stent buckles, it can reduce the swallow efficacy and cause recurrent dysphagia. Therefore, RoSE is an innovative soft robotic platform that is capable of testing various endoprosthetic stents, thereby offering a solution to many existing clinical challenges in the area of stent testing.
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Affiliation(s)
- Dipankar Bhattacharya
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand.,Riddet Institute, Palmerston North, New Zealand
| | - Sherine J V Ali
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand.,Riddet Institute, Palmerston North, New Zealand
| | - Leo K Cheng
- Riddet Institute, Palmerston North, New Zealand.,Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand.,Medical Technologies Centre of Research Excellence, Auckland, New Zealand
| | - Weiliang Xu
- Department of Mechanical Engineering, The University of Auckland, Auckland, New Zealand.,Riddet Institute, Palmerston North, New Zealand.,Medical Technologies Centre of Research Excellence, Auckland, New Zealand
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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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Severe, recurrent in-stent carotid restenosis: endovascular approach, risk factors. Results from a prospective academic registry of 2637 consecutive carotid artery stenting procedures (TARGET-CAS). ADVANCES IN INTERVENTIONAL CARDIOLOGY 2019; 15:465-471. [PMID: 31933663 PMCID: PMC6956450 DOI: 10.5114/aic.2019.90221] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/09/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction Optimal management of severe carotid in-stent restenosis remains unknown. Prevalence and risk factors of first and recurrent carotid in-stent restenosis in the multi-stent approach have not been established yet. Aim To evaluate the safety of different methods of endovascular treatment of carotid in-stent restenosis/recurrent restenosis and to establish its rate and risk factors. Material and methods Between January 2001 and June 2016, 2637 neuroprotected carotid artery stenting (CAS) procedures were performed in 2443 patients (men: 67.0%; mean age: 67.9 ±8.8 years, symptomatic: 45.5%). Doppler ultrasound (DUS) evaluation was performed at discharge, after 3-6 months, 12 months, and then annually. Peak systolic velocity of 2-3 and > 3.0 m/s as well as end diastolic velocity of 0.5-0.9 and > 0.9 m/s were DUS criteria for 50-69% and ≥ 70% carotid in-stent restenosis (ISR) respectively. For angiographically confirmed ≥ 70% stenosis balloon re-angioplasty was first line treatment. Results Out of 95 DUS detected > 50% ISR (95/2637; 3.6%), 53 were confirmed in angiography as ≥ 70% (53/2637; 2.0%, one total occlusion). All patients were treated with bare balloon (n = 19), drug-eluting balloon (n = 27) or stent-supported (n = 6) angioplasty. One procedure was complicated with stroke (1.9%). Angiographic diameter stenosis (DS) was reduced from 83 ±8.3% to 13 ±7.6% (p < 0.001). There were 13 cases of ≥ 70% recurrent ISR. Bilateral and high-grade stenosis were independent risk factors of restenosis. Initial Carotid Wallstent implantation was a risk factor of first and recurrent in-stent restenosis. Conclusions Endovascular treatment of carotid in-stent restenosis is safe. Bilateral and high-grade carotid artery stenosis may increase the risk of restenosis. Initial Carotid Wallstent implantation may increase the risk of first and recurrent restenosis.
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Wu MCH, Muchowski HM, Johnson EL, Rajanna MR, Hsu MC. Immersogeometric fluid-structure interaction modeling and simulation of transcatheter aortic valve replacement. COMPUTER METHODS IN APPLIED MECHANICS AND ENGINEERING 2019; 357:112556. [PMID: 32831419 PMCID: PMC7442159 DOI: 10.1016/j.cma.2019.07.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative to surgical treatments of valvular heart disease. TAVR offers many advantages, however, the safe anchoring of the transcatheter heart valve (THV) in the patients anatomy is key to a successful procedure. In this paper, we develop and apply a novel immersogeometric fluid-structure interaction (FSI) framework for the modeling and simulation of the TAVR procedure to study the anchoring ability of the THV. To account for physiological realism, methods are proposed to model and couple the main components of the system, including the arterial wall, blood flow, valve leaflets, skirt, and frame. The THV is first crimped and deployed into an idealized ascending aorta. During the FSI simulation, the radial outward force and friction force between the aortic wall and the THV frame are examined over the entire cardiac cycle. The ratio between these two forces is computed and compared with the experimentally estimated coefficient of friction to study the likelihood of valve migration.
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Affiliation(s)
- Michael C. H. Wu
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
- School of Engineering, Brown University, 184 Hope Street, Providence, Rhode Island 02912, USA
| | - Heather M. Muchowski
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
- Department of Mathematics, Iowa State University, 396 Carver Hall, Ames, Iowa 50011, USA
| | - Emily L. Johnson
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
| | - Manoj R. Rajanna
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
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Praveen Kumar G, Liang Leo H, Cui F. Design and evaluation of the crimping of a hooked self-expandable caval valve stent for the treatment of tricuspid regurgitation. Comput Methods Biomech Biomed Engin 2019; 22:533-546. [PMID: 30773049 DOI: 10.1080/10255842.2019.1569636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
To design a hooked self-expandable caval valve stent and determine the best crimping scenario for its percutaneous implantation in the Superior and Inferior Vena Cava (SVC & IVC) for the treatment of tricuspid regurgitation (TR). A hooked, Nitinol based stent design was modeled using SOLIDWORKS and finite element analysis (FEA) was carried out using ABAQUS. The Nitinol material used in this study was modeled in ABAQUS as superelastic-plastic. Two cases were simulated. In case A, the stent model was crimped to 18 F by compressing the stent main body and then: (i) bending both the proximal and distal hooks; (ii) straightening the proximal hooks and bending the distal hooks. In case B, the stent model was crimped to 18 F by: (i) bending the proximal and distal hooks and then compressing the stent main body; (ii) straightening the proximal hooks and bending the distal hooks and then compressing the stent main body. The maximum strain after crimping was used to evaluate the best crimping scenario. Hook straightening produced strains of 10.7% and 10.96% as opposed to 12.6% and 13.0% produced by hook bending. From comparison of results of both cases simulated, it was found that straightening the hooks gave lower strain and thus was the best crimping procedure. The analysis performed in this paper may help understand the critical issue of crimpability of the new stent design. The best crimping scenario can be found based on finite element modeling and simulation. Identifying the best crimping way will also help the design team to optimize the delivery system that will eventually be used to deploy this caval valve stent.
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Affiliation(s)
| | - Hwa Liang Leo
- b Department of Biomedical Engineering , National University of Singapore , Singapore
| | - Fangsen Cui
- a Institute of High Performance Computing, A*STAR , Singapore
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MEHRABI REZA, PARIZI FATEMEHSALEMIZADEH. INVESTIGATION OF MECHANICAL BEHAVIOR OF NiTi STENT UNDER DIFFERENT LOADINGS. J MECH MED BIOL 2018. [DOI: 10.1142/s021951941850029x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Biocompatible stent implants that have been made of shape memory alloys (SMA) are being used in arteries which are restoring normal blood flow. A high failure rate of stent implants in femoral artery causes the investigation of the mechanical behavior of stent implants, and its design and manufacturing, a necessity study. In this paper, two different stent designs, with different geometries, have been simulated. One is a Diamond-shaped profile stent and the other one is a V-shaped profile stent. These stents have been simulated under different loadings such as tensile and bending loadings that are very similar to the loading environment imposed by the arterial wall and blood flow. Two different temperatures have been selected to investigate superelasticity as well as shape memory effect of NiTi stents. During unloading for the shape memory case, the residual strains are recovered by heating the stents. The verified model based on microplane model is numerically considered for simulation of the stents. Numerical results show that the V-shaped stent design stretches more than the Diamond-shaped stent design under tensile loading. In addition, the V-shaped stent bends more than Diamond-shaped stent under the same bending loading, which shows more flexibility.
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Affiliation(s)
- REZA MEHRABI
- Department of Mechanical Engineering, Vali-e-Asr University of Rafsanjan, Rafsanjan 77139-36417, Iran
- Dynamic and Smart Systems Laboratory, MIME Department, University of Toledo, Toledo, OH 43606, USA
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12
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Zhao F, Xue W, Wang F, Yu C, Xu H, Hao Y, Wang L. A new approach to improve the local compressive properties of PPDO self-expandable stent. J Mech Behav Biomed Mater 2017; 68:318-326. [PMID: 28237687 DOI: 10.1016/j.jmbbm.2017.02.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 02/11/2017] [Accepted: 02/12/2017] [Indexed: 02/07/2023]
Abstract
The radial performance of bioabsorbable polymeric intravascular stents is extremely important in assessing the efficiency of these devices in expanding narrow lumen, reducing stent recoil, and recovering to their original states after suffering from pulsating pressure. However, these stents remain inferior to metallic stents. Several thermal treatment conditions (60°C, 80°C, and 100°C for 1h) were investigated to improve the characteristics of poly(p-dioxanone) (PPDO) self-expandable stents. The local compressive force, stiffness, and viscoelasticity of these stents were also evaluated. Wide-angle X-ray diffraction and different scanning calorimetry measurements were performed to evaluate the recrystalline and thermodynamic changes of molecular chains. The declining conformer entropy of PPDO monofilaments was examined via energy analysis. The untreated stents had compressive modules of 514.80±70.59mN/mm, which was much higher than those of 80°C and 100°C treated stents (332.35±66.08mN/mm and 394.31±64.71mN/mm, respectively). Nevertheless, 100°C annealing stents had less stress relaxation and prior elastic recovery rate of 82.32±3.43mN and 92.55±1.61%, respectively, showing a much better shape stability than untreated stents (139.51±16.67mN and 86.18±3.57%, respectively). These findings present important clinical implications in the stent manufacturing process and warrant further study to develop new bioabsorbable stents with outstanding clinical efficacy.
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Affiliation(s)
- Fan Zhao
- College of Textiles, Donghua University, Shanghai 201620, China; Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Shanghai 201620, China
| | - Wen Xue
- College of Textiles, Donghua University, Shanghai 201620, China; Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Shanghai 201620, China
| | - Fujun Wang
- College of Textiles, Donghua University, Shanghai 201620, China; Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Shanghai 201620, China.
| | - Chenglong Yu
- College of Textiles, Donghua University, Shanghai 201620, China
| | - Haiyan Xu
- College of Textiles, Donghua University, Shanghai 201620, China
| | - Yi Hao
- College of Textiles, Donghua University, Shanghai 201620, China
| | - Lu Wang
- College of Textiles, Donghua University, Shanghai 201620, China; Key Laboratory of Textile Science and Technology of Ministry of Education and College of Textiles, Donghua University, 2999 North Renmin Road, Shanghai 201620, China.
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13
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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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14
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WEI LINGLING, CHEN QIANG, LI ZHIYONG. STUDY ON THE IMPACT OF STRAIGHT STENTS ON ARTERIES WITH DIFFERENT CURVATURES. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500937] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Different stent structures lead to different deformations of blood vessels, such as different cross-sectional shapes, which further influence the blood flow patterns. In this paper, six non-commercial stents with different link structures called I-, C-, S-, U-, N- and W-types were considered. Their influences on arteries with five different curvatures (i.e., 0[Formula: see text], 15[Formula: see text], 30[Formula: see text], 45[Formula: see text] and 60[Formula: see text]) were studied using finite element method. Four indices including the maximum plastic strain of stents, the rate of expansion, the maximum von Mises stress and the ellipticity of arteries, were compared for all cases. The results showed that the S-type or U-type stents, with larger plastic strain and lower von Mises stress on the arteries, provided the optimal outcome. As the link structures became complex, the arterial expansion increased monotonically, while the ellipticity of arteries showed a decreasing tendency in the vessel models. The present study could be useful for the commercial design and clinic selection of a stent with different link structures for different curved arteries.
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Affiliation(s)
- LINGLING WEI
- Biomechanics Laboratory, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, P. R. China
| | - QIANG CHEN
- Biomechanics Laboratory, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, P. R. China
| | - ZHIYONG LI
- Biomechanics Laboratory, School of Biological Science & Medical Engineering, Southeast University, Nanjing 210096, P. R. China
- School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology (QUT), Brisbane, QLD 4001, Australia
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15
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Praveen Kumar G, Jafary-Zadeh M, Cui F. Deployment of a Bulk Metallic Glass-Based Self-Expandable Stent in a Patient-Specific Descending Aorta. ACS Biomater Sci Eng 2016; 2:1951-1958. [DOI: 10.1021/acsbiomaterials.6b00342] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Gideon Praveen Kumar
- Institute
of High Performance Computing, A*STAR, 1 Fusionopolis Way #16-16 Connexis, Singapore 138632
| | - Mehdi Jafary-Zadeh
- Institute
of High Performance Computing, A*STAR, 1 Fusionopolis Way #16-16 Connexis, Singapore 138632
| | - Fangsen Cui
- Institute
of High Performance Computing, A*STAR, 1 Fusionopolis Way #16-16 Connexis, Singapore 138632
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16
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Lee SL, Aguib H, Chapron J, Bahmanyar R, Borghi A, Murphy O, McLeod C, ElGuindy A, Yacoub M. Spatial Orientation and Morphology of the Pulmonary Artery: Relevance to Optimising Design and Positioning of a Continuous Pressure Monitoring Device. J Cardiovasc Transl Res 2016; 9:239-248. [PMID: 27075735 PMCID: PMC4873544 DOI: 10.1007/s12265-016-9690-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 03/29/2016] [Indexed: 11/01/2022]
Abstract
Personalised treatment of heart disease requires an understanding of the patient-specific characteristics, which can vary over time. A newly developed implantable surface acoustic wave pressure sensor, capable of continuous monitoring of the left ventricle filling pressure, is a novel device for personalised management of patients with heart disease. However, a one-size-fits-all approach to device sizing will affect its positioning within the pulmonary artery and its relationship to the interrogating device on the chest wall on a patient-specific level. In this paper, we analyse the spatial orientation and morphology of the pulmonary artery and its main branches in patients who could benefit from the device and normal controls. The results could optimise the design of the sensor, its stent, and importantly its placement, ensuring long-term monitoring in patient groups.
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Affiliation(s)
- Su-Lin Lee
- The Hamlyn Centre, Imperial College London, Room 414A, Bessemer Building, South Kensington Campus, London, SW7 2AZ, UK.
| | - Heba Aguib
- Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | | | - Reza Bahmanyar
- Institute of Biomedical Engineering, Imperial College London, London, UK
| | | | | | - Chris McLeod
- Institute of Biomedical Engineering, Imperial College London, London, UK
| | - Ahmed ElGuindy
- Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt
| | - Magdi Yacoub
- Aswan Heart Centre, Magdi Yacoub Foundation, Aswan, Egypt.,Harefield Heart Science Centre, National Heart & Lung Institute, Imperial College London, London, UK
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17
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The association between periprocedural factors and the late outcome of percutaneous stenting of lower extremity arteries. A retrospective cohort study. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:108-13. [PMID: 26161102 PMCID: PMC4495126 DOI: 10.5114/pwki.2015.52283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction About 20–30% of the population have peripheral artery disease. Many of them require intervention, with a percutaneous procedure currently being the first choice. However, the outcomes of these interventions need regular evaluation due to continuous progress in endovascular techniques and the devices used. Aim The aim of this study was to analyze procedural factors influencing the outcome of endovascular intervention in patients stented for the first time due to lower extremity atherosclerosis. Material and methods The medical documentation of 91 patients with at least 1 year of follow-up after stenting of a lower limb artery was retrospectively evaluated. Uni- and multivariate analyses were performed. Results The mean observation time was 544.4 ±502.9 days. The primary patency of a stent after such a follow-up was 68.1%. Cox proportional hazard analysis revealed that the risk of target lesion revascularization was affected by the following (hazard risk, 95% confidence interval): the number of vascular segments with significant lesions (13.14, 2.28–75.8); critical limb ischemia (5.68, 1.23–26.2); localization of the target lesion in an aorto-iliac in comparison with a femoro-popliteal vascular segment (0.37, 0.14–0.7); aorto-iliac lesion class according to the TASC-II consensus (1.96, 1.1–3.8); and claudication distance (1.02, 1.01–1.03). Conclusions The common primary patency of a stent implanted into either an aorto-iliac or a femoro-popliteal vascular segment was similar to that found in other reports. The main factors affecting the outcome of the endovascular procedures performed were mainly related to atherosclerosis severity, not to the type of technique or device used.
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