Studying the non-uniform expansion of a stent influenced by the balloon

Finite Element Analysis of the Implantation Process of Overlapping Stents

Overlapping stents are widely used in vascular stent surgeries. However, the rate of stent fractures (SF) and in-stent restenosis (ISR) after using overlapping stents is higher than that of single stent implantations. Published studies investigating the nature of overlapping stents rely primarily on medical images, which can only reveal the effect of the surgery without providing insights into how stent overlap influences the implantation process. In this paper, a finite element analysis of the overlapping stent implantation process was performed to study the interaction between overlapping stents. Four different cases, based on three typical stent overlap modes and two classical balloons, were investigated. The results showed that overlapping contact patterns among struts were edge-to-edge, edge-to-surface, and noncontact. These were mainly induced by the nonuniform deformation of the stent in the radial direction and stent tubular structures. Meanwhile, the results also revealed that the contact pressure was concentrated in the edge of overlapping struts. During the stent overlap process, the contact pattern was primarily edge-to-edge contact at the beginning and edge-to-surface contact as the contact pressure increased. The interactions between overlapping stents suggest that the failure of overlapping stents frequently occurs along stent edges, which agrees with the previous experimental research regarding the safety of overlapping stents. This paper also provides a fundamental understanding of the mechanical properties of overlapping stents.

The need for stent-lesion matching to optimize outcomes of intracoronary stent implantation

Intracoronary stents have markedly improved the outcomes of catheter-based coronary interventions. Intracoronary stent implantation rates of over 90% during coronary angioplasty are common. Stent implantations are associated with a small but statistically significant number of adverse outcomes including restenosis, thrombosis, strut malapposition, incomplete strut endothelialization, and various types of stenting failure. Better matching of biomechanical properties of stents and lesions could further improve the clinical outcome of intracoronary stenting. Thus, in this article, we assess the need for advanced intracoronary stent-lesion matching. We reviewed the data on biomechanics of coronary stents and lesions to develop knowledge-based rationale for optimum intracoronary stent selection. The available technical information on marketed intracoronary stents and the current understanding of the biomechanical properties of coronary lesions at rest and under stress are limited, preventing the development of knowledge-based rationale for optimum intracoronary stent selection at present. Development of knowledge-based selection of intracoronary stents requires standardization of mechanical stent testing, communication of the nonproprietary technical data on stents by the industry and dedicated research into procedural stent-lesion interactions.

Uniform Expansion of a Polymeric Helical Stent

Helical coil polymeric stents provide an alternative method of stenting compared to traditional metallic stents, but require additional investigation to understand deployment, expansion, and fixation. A bilayer helical coil stent consisting of PLLA and PLGA was investigated using the finite element model to evaluate performance by uniform expansion and subsequent recoiling. In vitro material characterization studies showed that a preinsertion water-soaking step to mimic body implantation conditions provided the required ductility level expansion. In this case, the mechanical contribution of the outer PLGA layer was negligible since it softened significantly under environmental conditions. The viscoelastic response was not considered in this study since the strain rate during expansion was relatively slow and the material response was primarily plastic. The numerical model was validated with available experimental expansion and recoiling data. A parametric study was then undertaken to investigate the effect of stent geometry and coefficient of friction at the stent-cylinder interface on the expansion and recoiling characteristics. The model showed that helical stents exhibit a uniform stress distribution after expansion, which is important for controlled degradation when using biodegradable materials. The results indicated that increasing stent width, pitch value, and coil thickness resulted in a larger diameter after recoiling, which would improve fixation in the artery. It was also noted that a helical stent should have more than five coils to be stable after recoiling. This work is part of a larger research study focused on the performance of a balloon-inflated polymeric helical stent for artery applications.