Key result
Simulated stent malapposition does not worsen hemodynamic metrics linked to stent thrombosis.
Why the study?
Stent malapposition could reduce stent tissue coverage and increase late stent thrombosis risk, but its impact on intracoronary flow dynamics required investigation.
Does stent malapposition negatively impact intracoronary flow dynamics compared to fully-apposed stents in a patient-specific computational model?
Does stent malapposition negatively impact intracoronary flow dynamics compared to fully-apposed stents in a patient-specific computational model?
Computational fluid dynamics modeling suggests that stent malapposition may not significantly worsen negative hemodynamic metrics associated with stent thrombosis compared to fully-apposed stents in this specific model.
Stent malapposition may not drive adverse thrombosis hemodynamics in this model; challenges consensus yet leaves open clinical relevance.
Percutaneous coronary intervention with stent implantation has emerged as a popular approach to treat coronary artery stenosis. Stent malapposition (SM), also referred as incomplete stent apposition, could reduce stent tissue coverage and hence increase the risk of late stent thrombosis. The objective of this study was to investigate the impact of SM on intracoronary flow dynamics by combining optical coherence tomography (OCT) image-based model reconstruction and computational analysis. Firstly, a stenosed coronary artery model was reconstructed from OCT and angiography imaging data of a patient. Two structural analyses were carried out to simulate two types of coronary artery stent implantations: a fully-apposed (FA) case and a SM case. Then, based on the two deformed coronary geometries, two computational fluid dynamics (CFD) analyses were performed to evaluate the differences of hemodynamic metrics between the FA and the SM cases, including wall shear stress (WSS), time-averaged WSS (TWSS), oscillatory shear index (OSI), WSS gradient (WSSG), time-averaged WSSG (TWSSG), and relative residence time (RRT). The results indicated that maximum flow velocity was higher in the SM case than that of the FA case, due to the incomplete expansion of the stent and artery. Moreover, the SM case had a lower percentage of areas of adverse WSS (< 0.5 Pa) and RRT (> 10/Pa) but a higher percentage of areas of adverse OSI (> 0.1) and WSSG (> 5000 Pa/m). Specifically, the differences of OSI, WSSG, and RRT between the two cases were relatively small. It was suggested that SM might not be responsible for negative hemodynamic metrics which would further result in stent thrombosis on the basis of the present specific model.
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Wei et al. (2021) studied this question. Stent malapposition resulted in higher maximum flow velocity but not adverse changes in hemodynamic metrics associated with stent thrombosis, suggesting SM may not be a primary risk factor.
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