Evaluation of local flow conditions in jailed side branch lesions using computational fluid dynamics

Benchmark for Numerical Models of Stented Coronary Bifurcation Flow

In-stent restenosis ails many patients who have undergone stenting. When the stented artery is a bifurcation, the intervention is particularly critical because of the complex stent geometry involved in these structures. Computational fluid dynamics (CFD) has been shown to be an effective approach when modeling blood flow behavior and understanding the mechanisms that underlie in-stent restenosis. However, these CFD models require validation through experimental data in order to be reliable. It is with this purpose in mind that we performed particle image velocimetry (PIV) measurements of velocity fields within flows through a simplified coronary bifurcation. Although the flow in this simplified bifurcation differs from the actual blood flow, it emulates the main fluid dynamic mechanisms found in hemodynamic flow. Experimental measurements were performed for several stenting techniques in both steady and unsteady flow conditions. The test conditions were strictly controlled, and uncertainty was accurately predicted. The results obtained in this research represent readily accessible, easy to emulate, detailed velocity fields and geometry, and they have been successfully used to validate our numerical model. These data can be used as a benchmark for further development of numerical CFD modeling in terms of comparison of the main flow pattern characteristics.

Extracorporeal shock wave stimulates expression of the angiogenic genes via mechanosensory complex in endothelial cells: mimetic effect of fluid shear stress in endothelial cells

BACKGROUND

Extracorporeal shock wave has been used in the noninvasive treatment of various diseases including musculoskeletal disorders. In particular, shock wave with low energy level showed anti-inflammatory effect and increased angiogenesis in ischemic tissues. However, the detailed cellular pathway in endothelial signaling is not fully understood. We investigate the role of shock wave with low energy level in angiogenic gene expression and underlying molecular mechanism by comparing the laminar and oscillatory fluid shear stresses in endothelial cells.

METHODS AND RESULTS

We show that shock wave with low energy level (0.012-0.045 mJ/mm(2)) stimulated phosphorylation of Akt, eNOS and Erk 1/2 in a time-dependent manner which is similar to the effect of laminar fluid shear stress. The transfection of endothelial cells with siRNA encoding VEGFR2, VE-cadherin and PECAM-1 inhibited shock wave-induced phosphorylation of Akt, eNOS and Erk 1/2 and angiogenic gene expressions, including Akt, eNOS, KLF2/4, and Nur77. Moreover, mechanical stimulation through extracorporeal shock wave induced endothelial cell migration and tube formation.

CONCLUSIONS

Our results demonstrate that shock wave-induced Akt/eNOS phosphorylation and angiogenic gene expression were mediated through the mechanosensory complex formation involving VEGFR-2, VE-cadherin and PECAM-1 which was similar to the effect of laminar shear stress.