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Schoenborn S, Lorenz T, Kuo K, Fletcher DF, Woodruff MA, Pirola S, Allenby MC. Fluid-structure interactions of peripheral arteries using a coupled in silico and in vitro approach. Comput Biol Med 2023; 165:107474. [PMID: 37703711 DOI: 10.1016/j.compbiomed.2023.107474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 09/15/2023]
Abstract
Vascular compliance is considered both a cause and a consequence of cardiovascular disease and a significant factor in the mid- and long-term patency of vascular grafts. However, the biomechanical effects of localised changes in compliance cannot be satisfactorily studied with the available medical imaging technologies or surgical simulation materials. To address this unmet need, we developed a coupled silico-vitro platform which allows for the validation of numerical fluid-structure interaction results as a numerical model and physical prototype. This numerical one-way and two-way fluid-structure interaction study is based on a three-dimensional computer model of an idealised femoral artery which is validated against patient measurements derived from the literature. The numerical results are then compared with experimental values collected from compliant arterial phantoms via direct pressurisation and ring tensile testing. Phantoms within a compliance range of 1.4-68.0%/100 mmHg were fabricated via additive manufacturing and silicone casting, then mechanically characterised via ring tensile testing and optical analysis under direct pressurisation with moderately statistically significant differences in measured compliance ranging between 10 and 20% for the two methods. One-way fluid-structure interaction coupling underestimated arterial wall compliance by up to 14.7% compared with two-way coupled models. Overall, Solaris™ (Smooth-On) matched the compliance range of the numerical and in vivo patient models most closely out of the tested silicone materials. Our approach is promising for vascular applications where mechanical compliance is especially important, such as the study of diseases which commonly affect arterial wall stiffness, such as atherosclerosis, and the model-based design, surgical training, and optimisation of vascular prostheses.
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Affiliation(s)
- S Schoenborn
- BioMimetic Systems Engineering (BMSE) Lab, School of Chemical Engineering, University of Queensland (UQ), St Lucia, QLD, 4072, Australia; Biofabrication and Tissue Morphology (BTM) Group, Faculty of Engineering, Centre for Biomedical Technologies, Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia
| | - T Lorenz
- Institute of Textile Technology, RWTH Aachen University, 52074, Aachen, Germany
| | - K Kuo
- Institute of Textile Technology, RWTH Aachen University, 52074, Aachen, Germany
| | - D F Fletcher
- School of Chemical and Biomolecular Engineering, University of Sydney, Darlington, NSW, 2006, Australia
| | - M A Woodruff
- Biofabrication and Tissue Morphology (BTM) Group, Faculty of Engineering, Centre for Biomedical Technologies, Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia
| | - S Pirola
- BHF Centre of Research Excellence, Faculty of Medicine, Institute of Clinical Sciences, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom; Department of Biomechanical Engineering, Faculty of Mechanical Engineering (3me), Delft University of Technology (TUD), Delft, the Netherlands
| | - M C Allenby
- BioMimetic Systems Engineering (BMSE) Lab, School of Chemical Engineering, University of Queensland (UQ), St Lucia, QLD, 4072, Australia; Biofabrication and Tissue Morphology (BTM) Group, Faculty of Engineering, Centre for Biomedical Technologies, Queensland University of Technology (QUT), Kelvin Grove, QLD, 4059, Australia.
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Abbasnezhad N, Zirak N, Champmartin S, Shirinbayan M, Bakir F. An Overview of In Vitro Drug Release Methods for Drug-Eluting Stents. Polymers (Basel) 2022; 14:2751. [PMID: 35808798 PMCID: PMC9269075 DOI: 10.3390/polym14132751] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 01/08/2023] Open
Abstract
The drug release profile of drug-eluting stents (DESs) is affected by a number of factors, including the formulation, design, and physicochemical properties of the utilized material. DES has been around for twenty years and despite its widespread clinical use, and efficacy in lowering the rate of target lesion restenosis, it still requires additional development to reduce side effects and provide long-term clinical stability. Unfortunately, for analyzing these implants, there is still no globally accepted in vitro test method. This is owing to the stent's complexity as well as the dynamic arterial compartments of the blood and vascular wall. The former is the source of numerous biological, chemical, and physical mechanisms that are more commonly observed in tissue, lumen, and DES. As a result, universalizing bio-relevant apparatus, suitable for liberation testing of such complex implants is difficult. This article aims to provide a comprehensive review of the methods used for in vitro release testing of DESs. Aspects related to the correlation of the release profiles in the cases of in vitro and in vivo are also addressed.
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Affiliation(s)
- Navideh Abbasnezhad
- Arts et Métiers Institute of Technology, CNAM, LIFSE, HESAM University, F-75013 Paris, France; (N.Z.); (S.C.)
- Arts et Métiers Institute of Technology, CNAM, PIMM, HESAM University, F-75013 Paris, France;
| | - Nader Zirak
- Arts et Métiers Institute of Technology, CNAM, LIFSE, HESAM University, F-75013 Paris, France; (N.Z.); (S.C.)
- Arts et Métiers Institute of Technology, CNAM, PIMM, HESAM University, F-75013 Paris, France;
| | - Stéphane Champmartin
- Arts et Métiers Institute of Technology, CNAM, LIFSE, HESAM University, F-75013 Paris, France; (N.Z.); (S.C.)
| | - Mohammadali Shirinbayan
- Arts et Métiers Institute of Technology, CNAM, PIMM, HESAM University, F-75013 Paris, France;
| | - Farid Bakir
- Arts et Métiers Institute of Technology, CNAM, LIFSE, HESAM University, F-75013 Paris, France; (N.Z.); (S.C.)
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Mennuni MG, Sagazio E, Patti G. In‐Stent Restenosis in the New Generation DES Era. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Pleouras DS, Karanasiou GS, Loukas VS, Semertzioglou A, Moulas AN, Fotiadis DI. Investigation of the drug release time from the biodegrading coating of an everolimus eluting stent. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1698-1701. [PMID: 34891613 DOI: 10.1109/embc46164.2021.9629813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This case-study examines the release time of the everolimus drug from an experimental biodegrading coating of a Rontis corp. drug eluting stent (DES). The controlled drug release is achieved by the degradation of the coating, which consists of a mixture of polylactic co-glycolic acid (PLGA) and everolimus (55:45). In our analysis, we used the outcome of another study, which contains the geometry of an in-silico deployed Rontis corp. stent in a 3D reconstructed coney arterial segment. Using this geometry as input, the everolimus release was simulated using a computational model that includes: i) modeling of the blood flow dynamics, ii) modeling of PLGA degradation, and iii) modeling of the everolimus advection and diffusion towards both the lumen and the arterial wall. The results show the rapid release of everolimus. This is justified due to the high porosity of the coating, which is caused by the initial high concentration of everolimus in the coating.Clinical Relevance - The methodology presented in this work is an additional step towards predicting accurately drug release from DES. Also, the results of our work prove that high drug concentration in the coating causes its rapid release, which could be used as input in the design of new DES.
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Mandal AP, Mandal PK. Specific and nonspecific binding of drug eluted from a half-embedded stent in presence of atherosclerotic plaque. Comput Methods Biomech Biomed Engin 2021; 25:922-935. [PMID: 34615426 DOI: 10.1080/10255842.2021.1986813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
This study is dealt with the two-phase binding (specific and nonspecific) of drug eluted from a half- embedded drug-eluting stent in presence of atherosclerotic plaque. The specific binding due to the interaction of drug molecules with specific receptors and nonspecific binding caused by the trapping of drug in the extra-cellular matrix have been paid due attention. An idealised wall consisting of a plaque and a healthy tissue region has been considered. Moreover, a Dirichlet release condition is imposed on the strut surface. In this investigation, a two-dimensional model governing drug transport and its two-phase binding in cylindrical polar coordinate system has been solved numerically by a finite-difference method. Our simulation predicts that plaque behaves like a physical barrier in two types of the binding process and there is an inverse relationship between bound drug concentration and plaque thickness. Simulations show that a single peak profile of drug is noted when the struts are situated one-strut radius apart and as the inter-strut distance increases, the peak concentration falls and distinct peak profiles over each strut are visualised. The model also reveals that in the region downstream of a strut, the concentration of both bound drug forms in the plaque and healthy regions increases, and eventually, the saturation length of binding sites increases. Predicted results show for smaller Damköhler number, the rapid saturation of binding sites takes place and the stent having thinner strut may perform well in terms of effectiveness as well as efficacy in the stent-based delivery.
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Affiliation(s)
- Akash Pradip Mandal
- Department of Mathematics, Ananda Chandra College, North Bengal University, Jalpaiguri, West Bengal, India
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SARIFUDDIN, ALSEMIRY REIMAD, MANDAL PRASHANTAKUMAR. EFFECTS OF COATING PROPERTIES ON CONTROLLED DELIVERY FROM AN EMBEDDED DRUG-ELUTING STENT: A SIMULATION STUDY. J BIOL SYST 2021. [DOI: 10.1142/s0218339021500145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The present investigation deals with the effects of biodegradable, biodurable and polymer-free coating of a stent on the release mechanism of the drug in a porous medium. The Brinkman equations for the interstitial fluid, the unsteady convection-diffusion-reaction equation for the transport of free drug in the tissue and the unsteady reaction equations for the bound as well as the internalized drug have been considered. In the coating, the transport of drug has been modeled as a diffusion process. Effects of different percentages of the embedment, convection and various coating properties of the stent on the transport of free drug, its retention and the internalization of the bound drug have been studied. Immersed Boundary Method (IBM) in the staggered grid formulation (IBM-MAC) has been used to tackle numerically the system of nonlinear governing equations. Simulated results predict the fastest release of drug from a biodegradable coating, but the averaged concentrations of all drug forms do reach a quasi-steady state in case of a biodurable coating irrespective of the degrees of embedment. Moreover, for all embedment levels of the stent, a biodegradable coating is superior to that of biodurable and polymer-free coating in the presence/absence of convection for larger times, but this superiority is lost for smaller times. Unlike biodurable coating, it is also predicted that the more the embedment level does not necessarily imply the more the effectiveness of delivery for biodegradable and polymer-free coatings of a stent.
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Affiliation(s)
- SARIFUDDIN
- Department of Mathematics, Berhampore College, P.O.-Berhampore, Dist.-Murshidabad, WB 742101, India
| | - REIMA D. ALSEMIRY
- Department of Mathematics, Faculty of Science, Taibah University, P.O. Box 89, Yanbu 41911, Saudi Arabia
- Department of Mathematical Sciences, Universiti Teknologi Malaysia, 81310 UTM Johor Bahru, Johor, Malaysia
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Song J, Kouidri S, Bakir F. Review on the numerical investigations of mass transfer from drug eluting stent. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sarifuddin, Roy S, Mandal PK. Computational model of stent-based delivery from a half-embedded two-layered coating. Comput Methods Biomech Biomed Engin 2020; 23:815-831. [PMID: 32588648 DOI: 10.1080/10255842.2020.1767775] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
An attempt is made in the present investigation to develop a computational model for the purpose of studying the effect of interstitial flow in the porous media on the distribution of drug eluted from a half-embedded drug-eluting stent and its retention in the presence of two-layered coating of the stent. The transport of free drug inside the coatings is considered as an unsteady diffusion process while that in the tissue as an unsteady convection-diffusion-reaction process. The bound drug is governed by an unsteady reaction process only. Immersed boundary method (IBM) in the staggered grid formulation, popularly known as marker and cell (MAC) method, has been leveraged to tackle numerically the governing equations. This model highlights the benefits of consideration of two-layered coating and does predict underlying mechanism for better efficacy by tweaking the kinetics parameters. Comparisons are also made with the results available for stent-based delivery.
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Affiliation(s)
- Sarifuddin
- Department of Mathematics, Berhampore College, Berhampore, West Bengal, India
| | - Somnath Roy
- Department of Mechanical Engineering, Indian Institute of Technology, Kharagpur, West Bengal, India
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Escuer J, Cebollero M, Peña E, McGinty S, Martínez MA. How does stent expansion alter drug transport properties of the arterial wall? J Mech Behav Biomed Mater 2020; 104:103610. [DOI: 10.1016/j.jmbbm.2019.103610] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/23/2019] [Accepted: 12/29/2019] [Indexed: 11/28/2022]
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Flow-Mediated Drug Transport from Drug-Eluting Stents is Negligible: Numerical and In-vitro Investigations. Ann Biomed Eng 2018; 47:878-890. [PMID: 30552528 DOI: 10.1007/s10439-018-02176-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 11/27/2018] [Indexed: 12/21/2022]
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11
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Saha R. A Computational Approach for Stent Elution Rate Determined Specific Drug Binding and Receptor-mediated Effects in Arterial Tissue. JOURNAL OF EXPLORATORY RESEARCH IN PHARMACOLOGY 2018; 3:105-118. [DOI: 10.14218/jerp.2018.00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Vo TTN, Morgan S, McCormick C, McGinty S, McKee S, Meere M. Modelling drug release from polymer-free coronary stents with microporous surfaces. Int J Pharm 2018; 544:392-401. [PMID: 29229513 DOI: 10.1016/j.ijpharm.2017.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 11/30/2017] [Accepted: 12/03/2017] [Indexed: 11/26/2022]
Abstract
Traditional coronary drug-eluting stents (DES) are made from metal and are coated with a permanent polymer film containing an anti-proliferative drug. Subsequent to stent deployment in a diseased coronary artery, the drug releases into the artery wall and helps prevent restenosis by inhibiting the proliferation of smooth muscle cells. Although this technology has proven to be remarkably successful, there are ongoing concerns that the presence of a polymer in the artery can lead to deleterious medical complications, such as late stent thrombosis. Polymer-free DES may help overcome such shortcomings. However, the absence of a rate-controlling polymer layer makes optimisation of the drug release profile a particular challenge. The use of microporous stent surfaces to modulate the drug release rate is an approach that has recently shown particularly promising clinical results. In this study, we develop a mathematical model to describe drug release from such stents. In particular, we develop a mathematical model to describe drug release from microporous surfaces. The model predicts a two-stage release profile, with a relatively rapid initial release of most of the drug, followed by a slower release of the remaining drug. In the model, the slow release phase is accounted for by an adsorption/desorption mechanism close to the stent surface. The theoretical predictions are compared with experimental release data obtained in our laboratory, and good agreement is found. The valuable insights provided by our model will serve as a useful guide for designing the enhanced polymer-free stents of the future.
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Affiliation(s)
- Tuoi T N Vo
- MACSI, Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
| | - Sarah Morgan
- Department of Biomedical Engineering, University of Strathclyde, Glasgow G4 0NW, UK
| | | | - Sean McGinty
- Division of Biomedical Engineering, University of Glasgow, Glasgow G12 8QQ, UK.
| | - Sean McKee
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow G1 1XH, UK
| | - Martin Meere
- Department of Applied Mathematics, NUI Galway, Galway, Ireland
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Saha R, Mandal PK. Modelling Time-dependent Release Kinetics in Stent-based Delivery. JOURNAL OF EXPLORATORY RESEARCH IN PHARMACOLOGY 2018; 3:61-70. [DOI: 10.14218/jerp.2018.00001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Mandal AP, Mandal PK. Distribution and retention of drug through an idealised atherosclerotic plaque eluted from a half-embedded stent. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s40435-017-0372-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Quantifying the influence of oscillatory flow disturbances on blood flow. J Theor Biol 2017; 430:195-206. [DOI: 10.1016/j.jtbi.2017.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 05/29/2017] [Accepted: 07/11/2017] [Indexed: 11/23/2022]
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Stefanini G, Byrne R, Windecker S, Kastrati A. State of the art: coronary artery stents – past, present and future. EUROINTERVENTION 2017; 13:706-716. [DOI: 10.4244/eij-d-17-00557] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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17
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Mandal AP, Mandal PK. Computational Modelling of Three-phase Stent-based Delivery. JOURNAL OF EXPLORATORY RESEARCH IN PHARMACOLOGY 2017; 2:31-40. [DOI: 10.14218/jerp.2017.00001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vijayaratnam PRS, Barber TJ, Reizes JA. The Localized Hemodynamics of Drug-Eluting Stents Are Not Improved by the Presence of Magnetic Struts. J Biomech Eng 2017; 139:2588205. [PMID: 27893059 DOI: 10.1115/1.4035263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Indexed: 11/08/2022]
Abstract
The feasibility of implementing magnetic struts into drug-eluting stents (DESs) to mitigate the adverse hemodynamics which precipitate stent thrombosis is examined. These adverse hemodynamics include platelet-activating high wall shear stresses (WSS) and endothelial dysfunction-inducing low wall shear stresses. By magnetizing the stent struts, two forces are induced on the surrounding blood: (1) magnetization forces which reorient red blood cells to align with the magnetic field and (2) Lorentz forces which oppose the motion of the conducting fluid. The aim of this study was to investigate whether these forces can be used to locally alter blood flow in a manner that alleviates the thrombogenicity of stented vessels. Two-dimensional steady-state computational fluid dynamics (CFD) simulations were used to numerically model blood flow over a single magnetic drug-eluting stent strut with a square cross section. The effects of magnet orientation and magnetic flux density on the hemodynamics of the stented vessel were elucidated in vessels transporting oxygenated and deoxygenated blood. The simulations are compared in terms of the size of separated flow regions. The results indicate that unrealistically strong magnets would be required to achieve even modest hemodynamic improvements and that the magnetic strut concept is ill-suited to mitigate stent thrombosis.
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Affiliation(s)
- P R S Vijayaratnam
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney 2052, Australia e-mail:
| | - T J Barber
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney 2052, Australia e-mail:
| | - J A Reizes
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney 2052, Australia e-mail:
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Mennuni MG, Presbitero P. In-Stent Restenosis in New Generation DES Era. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Marco G. Mennuni
- Department of Cardiology; Humanitas Research Hospital; Rozzano Milan Italy
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Shishido K, Antoniadis AP, Takahashi S, Tsuda M, Mizuno S, Andreou I, Papafaklis MI, Coskun AU, O'Brien C, Feldman CL, Saito S, Edelman ER, Stone PH. Effects of Low Endothelial Shear Stress After Stent Implantation on Subsequent Neointimal Hyperplasia and Clinical Outcomes in Humans. J Am Heart Assoc 2016; 5:JAHA.115.002949. [PMID: 27628570 PMCID: PMC5079004 DOI: 10.1161/jaha.115.002949] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background In‐stent hyperplasia (ISH) may develop in regions of low endothelial shear stress (ESS), but the relationship between the magnitude of low ESS, the extent of ISH, and subsequent clinical events has not been investigated. Methods and Results We assessed the association of poststent ESS with neointimal ISH and clinical outcomes in patients treated with percutaneous coronary interventions (PCI). Three‐dimensional coronary reconstruction was performed in 374 post‐PCI patients at baseline and 6 to 10 months follow‐up as part of the PREDICTION Study. Each vessel was divided into 1.5‐mm‐long segments, and we calculated the local ESS within each stented segment at baseline. At follow‐up, we assessed ISH and the occurrence of a clinically indicated repeat PCI for in‐stent restenosis. In 246 total stents (54 overlapping), 100 (40.7%) were bare‐metal stents (BMS), 104 (42.3%) sirolimus‐eluting stents, and 42 (17.1%) paclitaxel‐eluting stents. In BMS, low ESS post‐PCI at baseline was independently associated with ISH (β=1.47 mm2 per 1‐Pa decrease; 95% CI, 0.38–2.56; P<0.01). ISH was minimal in drug‐eluting stents. During follow‐up, repeat PCI in BMS was performed in 21 stents (8.5%). There was no significant association between post‐PCI ESS and in‐stent restenosis requiring PCI. Conclusions Low ESS after BMS implantation is associated with subsequent ISH. ISH is strongly inhibited by drug‐eluting stents. Post‐PCI ESS is not associated with in‐stent restenosis requiring repeat PCI. ESS is an important determinant of ISH in BMS, but ISH of large magnitude to require PCI for in‐stent restenosis is likely attributed to factors other than ESS within the stent.
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Affiliation(s)
- Koki Shishido
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Antonios P Antoniadis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Saeko Takahashi
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | | | - Shingo Mizuno
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Ioannis Andreou
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Michail I Papafaklis
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ahmet U Coskun
- Mechanical and Industrial Engineering, Northeastern University, Boston, MA
| | - Caroline O'Brien
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Charles L Feldman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kamakura, Japan
| | - Elazer R Edelman
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA
| | - Peter H Stone
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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21
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Stuijfzand WJ, Raijmakers PG, Driessen RS, Lammertsma AA, van Rossum AC, Nap A, Appelman Y, Lemkes JS, van Leeuwen MA, van Royen N, Knaapen P. Evaluation of myocardial blood flow and coronary flow reserve after implantation of a bioresorbable vascular scaffold versus metal drug-eluting stent: an interim one-month analysis of the VANISH trial. EUROINTERVENTION 2016; 12:e584-94. [DOI: 10.4244/eijv12i5a98] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Computational Model of Drug-Coated Balloon Delivery in a Patient-Specific Arterial Vessel with Heterogeneous Tissue Composition. Cardiovasc Eng Technol 2016; 7:406-419. [PMID: 27443840 DOI: 10.1007/s13239-016-0273-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 07/06/2016] [Indexed: 01/23/2023]
Abstract
Balloon angioplasty followed by local delivery of antiproliferative drugs to target tissue is increasingly being considered for the treatment of obstructive arterial disease, and yet there is much to appreciate regarding pharmacokinetics in arteries of non-uniform disease. We developed a computational model capable of simulating drug-coated balloon delivery to arteries of heterogeneous tissue composition comprising healthy tissue, as well as regions of fibrous, fibro-fatty, calcified and necrotic core lesions. Image processing using an unsupervised clustering technique was used to reconstruct an arterial geometry from a single, patient-specific color image obtained from intravascular ultrasound-derived virtual histology. Transport of free drug was modeled using a time-dependent reaction-diffusion model and the bound, immobilized drug using the time-dependent reaction equation. The governing equations representing the transport of free as well as bound drug along with a set of initial settings and boundary conditions were solved numerically using an explicit finite difference scheme that satisfied the Courant-Friedrichs-Lewy stability criterion. Our results support previous findings related to the transport and binding of drug in arteries where tissue retention is strongly dependent on local pharmacologic properties. Additionally, modeling results indicate that non-uniform disease composition leads to heterogeneous arterial drug distribution patterns, although further validation using animal studies is required to fully appreciate pharmacokinetics in disease-laden arteries.
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Drug deposition in coronary arteries with overlapping drug-eluting stents. J Control Release 2016; 238:1-9. [PMID: 27432751 DOI: 10.1016/j.jconrel.2016.07.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 01/20/2023]
Abstract
Drug-eluting stents are accepted as mainstream endovascular therapy, yet concerns for their safety may be under-appreciated. While failure from restenosis has dropped to below 5%, the risk of stent thrombosis and associated mortality remain relatively high. Further optimization of drug release is required to minimize thrombosis risk while maintaining therapeutic dose. The complex three-dimensional geometry of deployed stents together with the combination of diffusive and advective drug transport render an intuitive understanding of the situation exceedingly difficult. In situations such as this, computational modeling has proven essential, helping define the limits of efficacy, determine the mode and mechanism of drug release, and identify alternatives to avoid toxicity. A particularly challenging conformation is encountered in coronary arteries with overlapping stents. To study hemodynamics and drug deposition in such vessels we combined high-resolution, multi-scale ex vivo computed tomography with a flow and mass transfer computational model. This approach ensures high geometric fidelity and precise, simultaneous calculation of blood flow velocity, shear stress and drug distribution. Our calculations show that drug uptake by the arterial tissue is dependent both on the patterns of flow disruption near the wall, as well as on the relative positioning of drug-eluting struts. Overlapping stent struts lead to localized peaks of drug concentration that may increase the risk of thrombosis. Such peaks could be avoided by anisotropic stent structure or asymmetric drug release designed to yield homogeneous drug distribution along the coronary artery and, at the least, suggest that these issues need to remain in the forefront of consideration in clinical practice.
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O’Brien CC, Kolandaivelu K, Brown J, Lopes AC, Kunio M, Kolachalama VB, Edelman ER. Constraining OCT with Knowledge of Device Design Enables High Accuracy Hemodynamic Assessment of Endovascular Implants. PLoS One 2016; 11:e0149178. [PMID: 26906566 PMCID: PMC4764338 DOI: 10.1371/journal.pone.0149178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 12/27/2015] [Indexed: 11/21/2022] Open
Abstract
Background Stacking cross-sectional intravascular images permits three-dimensional rendering of endovascular implants, yet introduces between-frame uncertainties that limit characterization of device placement and the hemodynamic microenvironment. In a porcine coronary stent model, we demonstrate enhanced OCT reconstruction with preservation of between-frame features through fusion with angiography and a priori knowledge of stent design. Methods and Results Strut positions were extracted from sequential OCT frames. Reconstruction with standard interpolation generated discontinuous stent structures. By computationally constraining interpolation to known stent skeletons fitted to 3D ‘clouds’ of OCT-Angio-derived struts, implant anatomy was resolved, accurately rendering features from implant diameter and curvature (n = 1 vessels, r2 = 0.91, 0.90, respectively) to individual strut-wall configurations (average displacement error ~15 μm). This framework facilitated hemodynamic simulation (n = 1 vessel), showing the critical importance of accurate anatomic rendering in characterizing both quantitative and basic qualitative flow patterns. Discontinuities with standard approaches systematically introduced noise and bias, poorly capturing regional flow effects. In contrast, the enhanced method preserved multi-scale (local strut to regional stent) flow interactions, demonstrating the impact of regional contexts in defining the hemodynamic consequence of local deployment errors. Conclusion Fusion of planar angiography and knowledge of device design permits enhanced OCT image analysis of in situ tissue-device interactions. Given emerging interests in simulation-derived hemodynamic assessment as surrogate measures of biological risk, such fused modalities offer a new window into patient-specific implant environments.
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Affiliation(s)
- Caroline C. O’Brien
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- * E-mail:
| | - Kumaran Kolandaivelu
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Jonathan Brown
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Augusto C. Lopes
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Mie Kunio
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - Vijaya B. Kolachalama
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Charles Stark Draper Laboratory, 555 Technology Square, Cambridge, MA, United States of America
| | - Elazer R. Edelman
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
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McKittrick CM, Kennedy S, Oldroyd KG, McGinty S, McCormick C. Modelling the Impact of Atherosclerosis on Drug Release and Distribution from Coronary Stents. Ann Biomed Eng 2016; 44:477-87. [PMID: 26384667 PMCID: PMC4764635 DOI: 10.1007/s10439-015-1456-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 09/09/2015] [Indexed: 11/24/2022]
Abstract
Although drug-eluting stents (DES) are now widely used for the treatment of coronary heart disease, there remains considerable scope for the development of enhanced designs which address some of the limitations of existing devices. The drug release profile is a key element governing the overall performance of DES. The use of in vitro, in vivo, ex vivo, in silico and mathematical models has enhanced understanding of the factors which govern drug uptake and distribution from DES. Such work has identified the physical phenomena determining the transport of drug from the stent and through tissue, and has highlighted the importance of stent coatings and drug physical properties to this process. However, there is limited information regarding the precise role that the atherosclerotic lesion has in determining the uptake and distribution of drug. In this review, we start by discussing the various models that have been used in this research area, highlighting the different types of information they can provide. We then go on to describe more recent methods that incorporate the impact of atherosclerotic lesions.
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Affiliation(s)
- C M McKittrick
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - S Kennedy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - K G Oldroyd
- West of Scotland Region Heart and Lung Centre, Golden Jubilee National Hospital, Dunbartonshire, UK
| | - S McGinty
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - C McCormick
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.
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26
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Mennuni MG, Pagnotta PA, Stefanini GG. Coronary Stents: The Impact of Technological Advances on Clinical Outcomes. Ann Biomed Eng 2015; 44:488-96. [DOI: 10.1007/s10439-015-1399-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 07/17/2015] [Indexed: 12/29/2022]
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Vijayaratnam PRS, O’Brien CC, Reizes JA, Barber TJ, Edelman ER. The Impact of Blood Rheology on Drug Transport in Stented Arteries: Steady Simulations. PLoS One 2015; 10:e0128178. [PMID: 26066041 PMCID: PMC4466567 DOI: 10.1371/journal.pone.0128178] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/24/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND METHODS It is important to ensure that blood flow is modelled accurately in numerical studies of arteries featuring drug-eluting stents due to the significant proportion of drug transport from the stent into the arterial wall which is flow-mediated. Modelling blood is complicated, however, by variations in blood rheological behaviour between individuals, blood's complex near-wall behaviour, and the large number of rheological models which have been proposed. In this study, a series of steady-state computational fluid dynamics analyses were performed in which the traditional Newtonian model was compared against a range of non-Newtonian models. The impact of these rheological models was elucidated through comparisons of haemodynamic flow details and drug transport behaviour at various blood flow rates. RESULTS Recirculation lengths were found to reduce by as much as 24% with the inclusion of a non-Newtonian rheological model. Another model possessing the viscosity and density of blood plasma was also implemented to account for near-wall red blood cell losses and yielded recirculation length increases of up to 59%. However, the deviation from the average drug concentration in the tissue obtained with the Newtonian model was observed to be less than 5% in all cases except one. Despite the small sensitivity to the effects of viscosity variations, the spatial distribution of drug matter in the tissue was found to be significantly affected by rheological model selection. CONCLUSIONS/SIGNIFICANCE These results may be used to guide blood rheological model selection in future numerical studies. The clinical significance of these results is that they convey that the magnitude of drug uptake in stent-based drug delivery is relatively insensitive to individual variations in blood rheology. Furthermore, the finding that flow separation regions formed downstream of the stent struts diminish drug uptake may be of interest to device designers.
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Affiliation(s)
- Pujith R. S. Vijayaratnam
- School of Mechanical and Manufacturing Engineering, the University of New South Wales, Sydney, New South Wales, Australia
| | - Caroline C. O’Brien
- Harvard-MIT Biomedical Engineering Center, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
| | - John A. Reizes
- School of Mechanical and Manufacturing Engineering, the University of New South Wales, Sydney, New South Wales, Australia
| | - Tracie J. Barber
- School of Mechanical and Manufacturing Engineering, the University of New South Wales, Sydney, New South Wales, Australia
| | - Elazer R. Edelman
- Harvard-MIT Biomedical Engineering Center, Massachusetts Institute of Technology, Cambridge, Massachusetts, United States of America
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Hu T, Yang J, Cui K, Rao Q, Yin T, Tan L, Zhang Y, Li Z, Wang G. Controlled Slow-Release Drug-Eluting Stents for the Prevention of Coronary Restenosis: Recent Progress and Future Prospects. ACS APPLIED MATERIALS & INTERFACES 2015; 7:11695-11712. [PMID: 26011753 DOI: 10.1021/acsami.5b01993] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Drug-eluting stents (DES) have become more widely used by cardiologists than bare metal stents (BMS) because of their better ability to control restenosis. However, recognized negative events, particularly including delayed or incomplete endothelialization and late stent thrombosis, have caused concerns over the long-term safety of DES. Although stent-based drug delivery can facilitate a drug's release directly to the restenosis site, a burst of drug release can seriously affect the pharmacological action and is a major factor accounting for adverse effects. Therefore, the drug release rate has become an important criterion in evaluating DES. The factors affecting the drug release rate include the drug carrier, drug, coating methods, drug storage, elution direction, coating thickness, pore size in the coating, release conditions (release medium, pH value, temperature), and hemodynamics after the stent implantation. A better understanding of how these factors influence drug release is particularly important for the reasonable use of efficient control strategies for drug release. This review summarizes the factors influencing the drug release from DES and presents strategies for enhancing the control of the drug's release, including the stent design, the application of absorbable stents, the development of new polymers, and the application of nanocarriers and improvements in the coating technology. Therefore, this paper provides a reference for the preparation of novel controlled slow-release DES.
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Affiliation(s)
- Tingzhang Hu
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Jiali Yang
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Kun Cui
- ‡Center of Cardiology, Chongqing Zhongshan Hospital, Chongqing 400013, China
| | - Qiong Rao
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Tieying Yin
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Lili Tan
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
| | - Yuan Zhang
- ‡Center of Cardiology, Chongqing Zhongshan Hospital, Chongqing 400013, China
| | - Zhenggong Li
- ‡Center of Cardiology, Chongqing Zhongshan Hospital, Chongqing 400013, China
| | - Guixue Wang
- †Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), State and Local Joint Engineering Laboratory for Vascular Implants (Chongqing), Bioengineering College of Chongqing University, Chongqing 400030, China
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Chabi F, Champmartin S, Sarraf C, Noguera R. Critical evaluation of three hemodynamic models for the numerical simulation of intra-stent flows. J Biomech 2015; 48:1769-76. [PMID: 26044195 DOI: 10.1016/j.jbiomech.2015.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 11/16/2022]
Abstract
We evaluate here three hemodynamic models used for the numerical simulation of bare and stented artery flows. We focus on two flow features responsible for intra-stent restenosis: the wall shear stress and the re-circulation lengths around a stent. The studied models are the Poiseuille profile, the simplified pulsatile profile and the complete pulsatile profile based on the analysis of Womersley. The flow rate of blood in a human left coronary artery is considered to compute the velocity profiles. "Ansys Fluent 14.5" is used to solve the Navier-Stokes and continuity equations. As expected our results show that the Poiseuille profile is questionable to simulate the complex flow dynamics involved in intra-stent restenosis. Both pulsatile models give similar results close to the strut but diverge far from it. However, the computational time for the complete pulsatile model is five times that of the simplified pulsatile model. Considering the additional "cost" for the complete model, we recommend using the simplified pulsatile model for future intra-stent flow simulations.
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Affiliation(s)
- Fatiha Chabi
- ENSAM PARIS, 151 bd de l'Hôpital, 75013 Paris, France
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30
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Migliavacca F, Chiastra C, Chatzizisis YS, Dubini G. Virtual bench testing to study coronary bifurcation stenting. EUROINTERVENTION 2015; 11 Suppl V:V31-4. [DOI: 10.4244/eijv11sva7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Kolandaivelu K, O'Brien CC, Shazly T, Edelman ER, Kolachalama VB. Enhancing physiologic simulations using supervised learning on coarse mesh solutions. J R Soc Interface 2015; 12:20141073. [PMID: 25652458 PMCID: PMC4345474 DOI: 10.1098/rsif.2014.1073] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 01/15/2015] [Indexed: 11/29/2022] Open
Abstract
Computational modelling of physical and biochemical processes has emerged as a means of evaluating medical devices, offering new insights that explain current performance, inform future designs and even enable personalized use. Yet resource limitations force one to compromise with reduced order computational models and idealized assumptions that yield either qualitative descriptions or approximate, quantitative solutions to problems of interest. Considering endovascular drug delivery as an exemplary scenario, we used a supervised machine learning framework to process data generated from low fidelity coarse meshes and predict high fidelity solutions on refined mesh configurations. We considered two models simulating drug delivery to the arterial wall: (i) two-dimensional drug-coated balloons and (ii) three-dimensional drug-eluting stents. Simulations were performed on computational mesh configurations of increasing density. Supervised learners based on Gaussian process modelling were constructed from combinations of coarse mesh setting solutions of drug concentrations and nearest neighbourhood distance information as inputs, and higher fidelity mesh solutions as outputs. These learners were then used as computationally inexpensive surrogates to extend predictions using low fidelity information to higher levels of mesh refinement. The cross-validated, supervised learner-based predictions improved fidelity as compared with computational simulations performed at coarse level meshes--a result consistent across all outputs and computational models considered. Supervised learning on coarse mesh solutions can augment traditional physics-based modelling of complex physiologic phenomena. By obtaining efficient solutions at a fraction of the computational cost, this framework has the potential to transform how modelling approaches can be applied in the evaluation of medical technologies and their real-time administration in an increasingly personalized fashion.
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Affiliation(s)
- Kumaran Kolandaivelu
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Caroline C O'Brien
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Tarek Shazly
- College of Engineering and Computing, University of South Carolina, Columbia, SC 29208, USA
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Vijaya B Kolachalama
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA Charles Stark Draper Laboratory, 555 Technology Square, Cambridge, MA 02139, USA
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Effects of endothelium, stent design and deployment on the nitric oxide transport in stented artery: a potential role in stent restenosis and thrombosis. Med Biol Eng Comput 2015; 53:427-39. [DOI: 10.1007/s11517-015-1250-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 02/02/2015] [Indexed: 10/24/2022]
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Serruys PW, Chevalier B, Dudek D, Cequier A, Carrié D, Iniguez A, Dominici M, van der Schaaf RJ, Haude M, Wasungu L, Veldhof S, Peng L, Staehr P, Grundeken MJ, Ishibashi Y, Garcia-Garcia HM, Onuma Y. A bioresorbable everolimus-eluting scaffold versus a metallic everolimus-eluting stent for ischaemic heart disease caused by de-novo native coronary artery lesions (ABSORB II): an interim 1-year analysis of clinical and procedural secondary outcomes from a randomised controlled trial. Lancet 2015; 385:43-54. [PMID: 25230593 DOI: 10.1016/s0140-6736(14)61455-0] [Citation(s) in RCA: 449] [Impact Index Per Article: 49.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite rapid dissemination of an everolimus-eluting bioresorbable scaffold for treatment for coronary artery disease, no data from comparisons with its metallic stent counterpart are available. In a randomised controlled trial we aimed to compare an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent. Here we report secondary clinical and procedural outcomes after 1 year of follow-up. METHODS In a single-blind, multicentre, randomised trial, we enrolled eligible patients aged 18-85 years with evidence of myocardial ischaemia and one or two de-novo native lesions in different epicardial vessels. We randomly assigned patients in a 2:1 ratio to receive treatment with an everolimus-eluting bioresorbable scaffold (Absorb, Abbott Vascular, Santa Clara, CA, USA) or treatment with an everolimus-eluting metallic stent (Xience, Abbott Vascular, Santa Clara, CA, USA). Randomisation was stratified by diabetes status and number of planned target lesions. The co-primary endpoints of this study are vasomotion (change in mean lumen diameter before and after nitrate administration at 3 years) and difference between minimum lumen diameter (after nitrate administration) after the index procedure and at 3 years. Secondary endpoints were procedural performance assessed by quantitative angiography and intravascular ultrasound; composite clinical endpoints based on death, myocardial infarction, and coronary revascularisation; device and procedural success; and angina status assessed by the Seattle Angina Questionnaire and exercise testing at 6 and 12 months. Cumulative angina rate based on adverse event reporting was analysed post hoc. This trial is registered at ClinicalTrials.gov, number NCT01425281. FINDINGS Between Nov 28, 2011, and June 4, 2013, we enrolled 501 patients and randomly assigned them to the bioresorbable scaffold group (335 patients, 364 lesions) or the metallic stent group (166 patients, 182 lesions). Dilatation pressure and balloon diameter at the highest pressure during implantation or postdilatation were higher and larger in the metallic stent group, whereas the acute recoil post implantation was similar (0.19 mm for both, p=0.85). Acute lumen gain was lower for the bioresorbable scaffold by quantitative coronary angiography (1.15 mm vs 1.46 mm, p<0.0001) and quantitative intravascular ultrasound (2.85 mm(2)vs 3.60 mm(2), p<0.0001), resulting in a smaller lumen diameter or area post procedure. At 1 year, however, cumulative rates of first new or worsening angina from adverse event reporting were lower (72 patients [22%] in the bioresorbable scaffold group vs 50 [30%] in the metallic stent group, p=0.04), whereas performance during maximum exercise and angina status by SAQ were similar. The 1-year composite device orientated endpoint was similar between the bioresorbable scaffold and metallic stent groups (16 patients [5%] vs five patients [3%], p=0.35). Three patients in the bioresorbable scaffold group had definite or probable scaffold thromboses (one definite acute, one definite sub-acute, and one probable late), compared with no patients in the metallic stent group. There were 17 (5%) major cardiac adverse events in the bioresorbable scaffold group compared with five (3%) events in the metallic stent group, with the most common adverse events being myocardial infarction (15 cases [4%] vs two cases [1%], respectively) and clinically indicated target-lesion revascularisation (four cases [1%] vs three cases [2%], respectively). INTERPRETATION The everolimus-eluting bioresorbable scaffold showed similar 1-year composite secondary clinical outcomes to the everolimus-eluting metallic stent. FUNDING Abbott Vascular.
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Affiliation(s)
- Patrick W Serruys
- International Centre for Cardiovascular Health, Imperial College, London, UK.
| | | | - Dariusz Dudek
- Jagiellonian University, Department of Cardiology and Cardio Vascular Interventions, University Hospital, Krakow, Poland
| | | | | | | | | | | | - Michael Haude
- Städtisches Kliniken Neuss Lukaskrankenhaus GmbH, Neuss, Germany
| | | | | | - Lei Peng
- Abbott Vascular, Santa Clara, CA, USA
| | | | | | | | | | - Yoshinobu Onuma
- Erasmus MC, Rotterdam, Netherlands; Cardialysis BV, Rotterdam, Netherlands
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