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Qin L, Gu X, Wang K, Jia Z, Xue T, Li S, Wang K. Characteristics of Option and Denali Inferior Vena Cava Filters. Ann Vasc Surg 2024; 99:349-355. [PMID: 37852367 DOI: 10.1016/j.avsg.2023.08.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/13/2023] [Accepted: 08/27/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND To assess the characteristics of Option and Denali filters and to identify associations between these characteristics in each filter type. METHODS Consecutive patients who underwent Option or Denali filter placement between August 2019 and August 2022 were included in this retrospective study. RESULTS A total of 119 patients (Option, n = 60; Denali, n = 59) were included. The retrieval rates were 45.0% for Option filters and 40.7% for Denali filters. The incidence of tilt at placement was higher for Option filters (76.7%) than for Denali filters (11.9%; P < 0.001). The tilt angle of Option filters at placement was correlated with the common iliac vein-inferior vena cava (CIV-IVC) angle. The incidence of tilt angle change after placement was higher for Option filters (74.1%) than for Denali filters (8.3%; P = 0.001). The IVC contraction rate after retrieval of Option is less than Denali (22.2% vs. 87.5%, P < 0.001). The median fluoroscopy time during Option filter retrieval was longer than during Denali filter retrieval. The fluoroscopic time was related to tilt angle during retrieval of Option filters. CONCLUSIONS Option filters are more likely than Denali filters to tilt at placement, and the tilt angle of Option filters is more prone to change after placement. The tilt angle at placement in Option filters is related to the CIV-IVC angle. Option filters require a longer fluoroscopic time during retrieval than Denali filters, and this increased fluoroscopic time is related to the tilt angle. Denali is more likely to cause IVC constriction after placement.
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Affiliation(s)
- Lihao Qin
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
| | - Xiaocheng Gu
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
| | - Kai Wang
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
| | - Zhongzhi Jia
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
| | - Tongqing Xue
- Department of Interventional Radiology, Huaian Hospital of Huaian City (Huaian Cancer Hospital), Huaian, China.
| | - Shaoqin Li
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China.
| | - Ke Wang
- Department of Interventional and Vascular Surgery, The Affiliated Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China.
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McQueen A, Escuer J, Schmidt AF, Aggarwal A, Kennedy S, McCormick C, Oldroyd K, McGinty S. An intricate interplay between stent drug dose and release rate dictates arterial restenosis. J Control Release 2022; 349:992-1008. [PMID: 35921913 DOI: 10.1016/j.jconrel.2022.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/14/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
Since the introduction of percutaneous coronary intervention (PCI) for the treatment of obstructive coronary artery disease (CAD), patient outcomes have progressively improved. Drug eluting stents (DES) that employ anti-proliferative drugs to limit excess tissue growth following stent deployment have proved revolutionary. However, restenosis and a need for repeat revascularisation still occurs after DES use. Over the last few years, computational models have emerged that detail restenosis following the deployment of a bare metal stent (BMS), focusing primarily on contributions from mechanics and fluid dynamics. However, none of the existing models adequately account for spatiotemporal delivery of drug and the influence of this on the cellular processes that drive restenosis. In an attempt to fill this void, a novel continuum restenosis model coupled with spatiotemporal drug delivery is presented. Our results indicate that the severity and time-course of restenosis is critically dependent on the drug delivery strategy. Specifically, we uncover an intricate interplay between initial drug loading, drug release rate and restenosis, indicating that it is not sufficient to simply ramp-up the drug dose or prolong the time course of drug release to improve stent efficacy. Our model also shows that the level of stent over-expansion and stent design features, such as inter-strut spacing and strut thickness, influence restenosis development, in agreement with trends observed in experimental and clinical studies. Moreover, other critical aspects of the model which dictate restenosis, including the drug binding site density are investigated, where comparisons are made between approaches which assume this to be either constant or proportional to the number of smooth muscle cells (SMCs). Taken together, our results highlight the necessity of incorporating these aspects of drug delivery in the pursuit of optimal DES design.
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Affiliation(s)
- Alistair McQueen
- Division of Biomedical Engineering, University of Glasgow, Glasgow, UK
| | - Javier Escuer
- Aragón Institute for Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | | | - Ankush Aggarwal
- Glasgow Computational Engineering Centre, Division of Infrastructure and Environment, University of Glasgow, Glasgow, UK
| | - Simon Kennedy
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Keith Oldroyd
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Sean McGinty
- Division of Biomedical Engineering, University of Glasgow, Glasgow, UK; Glasgow Computational Engineering Centre, Division of Infrastructure and Environment, University of Glasgow, Glasgow, UK.
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Rajan A, S Makary M, D Martyn T, D Dowell J. Computational evaluation of inferior vena cava filters through computational fluid dynamics methods. ACTA ACUST UNITED AC 2021; 27:116-121. [PMID: 33252333 DOI: 10.5152/dir.2020.19435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Numerical simulation is growing in its importance toward the design, testing and evaluation of medical devices. Computational fluid dynamics and finite element analysis allow improved calculation of stress, heat transfer, and flow to better understand the medical device environment. Current research focuses not only on improving medical devices, but also on improving the computational tools themselves. As methods and computer technology allow for faster simulation times, iterations and trials can be performed faster to collect more data. Given the adverse events associated with long-term inferior vena cava (IVC) filter placement, IVC filter design and device evaluation are of paramount importance. This work reviews computational methods used to develop, test, and improve IVC filters to ultimately serve the needs of the patient.
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Affiliation(s)
- Anand Rajan
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Mina S Makary
- Division of Vascular and Interventional Radiology, Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | | | - Joshua D Dowell
- Northwest Radiology and St. Vincent Health, Indianapolis, Indiana, USA
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Watson MG, Byrne HM, Macaskill C, Myerscough MR. A multiphase model of growth factor-regulated atherosclerotic cap formation. J Math Biol 2020; 81:725-767. [PMID: 32728827 DOI: 10.1007/s00285-020-01526-6] [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] [Received: 08/15/2019] [Revised: 05/13/2020] [Indexed: 12/17/2022]
Abstract
Atherosclerosis is characterised by the growth of fatty plaques in the inner artery wall. In mature plaques, vascular smooth muscle cells (SMCs) are recruited from adjacent tissue to deposit a collagenous cap over the fatty plaque core. This cap isolates the thrombogenic plaque content from the bloodstream and prevents the clotting cascade that leads to myocardial infarction or stroke. Despite the protective role of the cap, the mechanisms that regulate cap formation and maintenance are not well understood. It remains unclear why some caps become stable, while others become vulnerable to rupture. We develop a multiphase PDE model with non-standard boundary conditions to investigate collagen cap formation by SMCs in response to diffusible growth factor signals from the endothelium. Platelet-derived growth factor stimulates SMC migration, proliferation and collagen degradation, while transforming growth factor (TGF)-[Formula: see text] stimulates SMC collagen synthesis and inhibits collagen degradation. The model SMCs respond haptotactically to gradients in the collagen phase and have reduced rates of migration and proliferation in dense collagenous tissue. The model, which is parameterised using in vivo and in vitro experimental data, reproduces several observations from plaque growth in mice. Numerical and analytical results demonstrate that a stable cap can be formed by a relatively small SMC population and emphasise the critical role of TGF-[Formula: see text] in effective cap formation. These findings provide unique insight into the mechanisms that may lead to plaque destabilisation and rupture. This work represents an important step towards the development of a comprehensive in silico plaque model.
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Affiliation(s)
- Michael G Watson
- School of Mathematics and Statistics, University of Sydney, Sydney, Australia.
| | - Helen M Byrne
- Wolfson Centre for Mathematical Biology, Mathematical Institute, University of Oxford, Oxford, UK
| | - Charlie Macaskill
- School of Mathematics and Statistics, University of Sydney, Sydney, Australia
| | - Mary R Myerscough
- School of Mathematics and Statistics, University of Sydney, Sydney, Australia
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Escuer J, Martínez MA, McGinty S, Peña E. Mathematical modelling of the restenosis process after stent implantation. J R Soc Interface 2019; 16:20190313. [PMID: 31409233 DOI: 10.1098/rsif.2019.0313] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The stenting procedure has evolved to become a highly successful technique for the clinical treatment of advanced atherosclerotic lesions in arteries. However, the development of in-stent restenosis remains a key problem. In this work, a novel two-dimensional continuum mathematical model is proposed to describe the complex restenosis process following the insertion of a stent into a coronary artery. The biological species considered to play a key role in restenosis development are growth factors, matrix metalloproteinases, extracellular matrix, smooth muscle cells and endothelial cells. Diffusion-reaction equations are used for modelling the mass balance between species in the arterial wall. Experimental data from the literature have been used in order to estimate model parameters. Moreover, a sensitivity analysis has been performed to study the impact of varying the parameters of the model on the evolution of the biological species. The results demonstrate that this computational model qualitatively captures the key characteristics of the lesion growth and the healing process within an artery subjected to non-physiological mechanical forces. Our results suggest that the arterial wall response is driven by the damage area, smooth muscle cell proliferation and the collagen turnover among other factors.
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Affiliation(s)
- Javier Escuer
- Applied Mechanics and Bioengineering Group (AMB), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - Miguel A Martínez
- Applied Mechanics and Bioengineering Group (AMB), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
| | - Sean McGinty
- Division of Biomedical Engineering, University of Glasgow, Glasgow, UK
| | - Estefanía Peña
- Applied Mechanics and Bioengineering Group (AMB), Aragón Institute of Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain.,Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Spain
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Watson MG, Byrne HM, Macaskill C, Myerscough MR. A two-phase model of early fibrous cap formation in atherosclerosis. J Theor Biol 2018; 456:123-136. [PMID: 30098319 DOI: 10.1016/j.jtbi.2018.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/01/2018] [Accepted: 08/06/2018] [Indexed: 12/25/2022]
Abstract
Atherosclerotic plaque growth is characterised by chronic, non-resolving inflammation that promotes the accumulation of cellular debris and extracellular fat in the inner artery wall. This material is highly thrombogenic, and plaque rupture can lead to the formation of blood clots that occlude major arteries and cause myocardial infarction or stroke. In advanced plaques, vascular smooth muscle cells (SMCs) are recruited from deeper in the artery wall to synthesise a cap of fibrous tissue that stabilises the plaque and sequesters the thrombogenic plaque content from the bloodstream. The fibrous cap provides crucial protection against the clinical consequences of atherosclerosis, but the mechanisms of cap formation are poorly understood. In particular, it is unclear why certain plaques become stable and robust while others become fragile and dangerously vulnerable to rupture. We develop a multiphase model with non-standard boundary conditions to investigate early fibrous cap formation in the atherosclerotic plaque. The model is parameterised using data from a range of in vitro and in vivo studies, and includes highly nonlinear mechanisms of SMC proliferation and migration in response to an endothelium-derived chemical signal. We demonstrate that the model SMC population naturally evolves towards a steady-state, and predict a rate of cap formation and a final plaque SMC content consistent with experimental observations in mice. Parameter sensitivity simulations show that SMC proliferation makes a limited contribution to cap formation, and demonstrate that stable cap formation relies primarily on a critical balance between the rates of SMC recruitment to the plaque, chemotactic SMC migration within the plaque and SMC loss by apoptosis or phenotype change. This model represents the first detailed in silico study of fibrous cap formation in atherosclerosis, and establishes a multiphase modelling framework that can be readily extended to investigate many other aspects of plaque development.
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Affiliation(s)
- Michael G Watson
- School of Mathematics and Statistics, University of Sydney, Australia.
| | - Helen M Byrne
- Wolfson Centre for Mathematical Biology, Mathematical Institute, University of Oxford, United Kingdom
| | - Charlie Macaskill
- School of Mathematics and Statistics, University of Sydney, Australia
| | - Mary R Myerscough
- School of Mathematics and Statistics, University of Sydney, Australia
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McGarrity S, Halldórsson H, Palsson S, Johansson PI, Rolfsson Ó. Understanding the Causes and Implications of Endothelial Metabolic Variation in Cardiovascular Disease through Genome-Scale Metabolic Modeling. Front Cardiovasc Med 2016; 3:10. [PMID: 27148541 PMCID: PMC4834436 DOI: 10.3389/fcvm.2016.00010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/03/2016] [Indexed: 01/04/2023] Open
Abstract
High-throughput biochemical profiling has led to a requirement for advanced data interpretation techniques capable of integrating the analysis of gene, protein, and metabolic profiles to shed light on genotype-phenotype relationships. Herein, we consider the current state of knowledge of endothelial cell (EC) metabolism and its connections to cardiovascular disease (CVD) and explore the use of genome-scale metabolic models (GEMs) for integrating metabolic and genomic data. GEMs combine gene expression and metabolic data acting as frameworks for their analysis and, ultimately, afford mechanistic understanding of how genetic variation impacts metabolism. We demonstrate how GEMs can be used to investigate CVD-related genetic variation, drug resistance mechanisms, and novel metabolic pathways in ECs. The application of GEMs in personalized medicine is also highlighted. Particularly, we focus on the potential of GEMs to identify metabolic biomarkers of endothelial dysfunction and to discover methods of stratifying treatments for CVDs based on individual genetic markers. Recent advances in systems biology methodology, and how these methodologies can be applied to understand EC metabolism in both health and disease, are thus highlighted.
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Affiliation(s)
- Sarah McGarrity
- Center for Systems Biology, University of Iceland , Reykjavik , Iceland
| | - Haraldur Halldórsson
- Department of Pharmacology and Toxicology, School of Health Sciences, University of Iceland , Reykjavik , Iceland
| | - Sirus Palsson
- Center for Systems Biology, University of Iceland, Reykjavik, Iceland; Sinopia Biosciences Inc., San Diego, CA, USA
| | - Pär I Johansson
- Section for Transfusion Medicine, Capital Region Blood Bank, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
| | - Óttar Rolfsson
- Center for Systems Biology, University of Iceland, Reykjavik, Iceland; Department of Biochemistry and Molecular Biology, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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