Key result
Provisional stenting simulations reveal ~2-fold higher biomechanical stress in the side branch versus main branch.
Why the study?
In-stent restenosis and stent thrombosis remain significant issues in vascular bifurcations, and the combined role of wall shear stress and circumferential wall stresses during bifurcation stenting is unclear.
Does provisional stenting of a diseased coronary artery bifurcation alter local biomechanical stresses?
Does provisional stenting of a diseased coronary artery bifurcation alter local biomechanical stresses?
Computational simulations demonstrate that provisional stenting of a diseased bifurcation increases the biomechanical stress ratio in the side branch, which may explain the higher clinical rates of restenosis and thrombosis in this region.
May explain side branch restenosis risk after provisional stenting; leaves open clinical validation in human bifurcations.
Although stenting of non-branched arterial segments has acceptable clinical outcomes, in-stent restenosis (ISR) and stent thrombosis remain clinically significant issues for vascular bifurcations (15–28% restenosis). Local fluid and solid stresses appear to play an important role in restenosis and thrombosis. The combined role of wall shear stress (WSS) and circumferential wall stresses (CWS) is unclear in the case of stenting at vascular bifurcations. Using numerical simulations, we computed the fluid shear, solid stresses and the stress ratio at the the bifurcation region. Stenting of main vessel increased the maximum CWS in the the side branch (SB), resulting in a nearly two-fold increase of stress ratio in the SB compared to the MB (5.1 × 10 5 vs. 9.2 × 10 5 ). The existence of plaque decreased WSS and increased CWS near the carina, increasing the stress ratio at the SB. The changes of stress ratio were highly consistent with clinical data on bifurcation stenting. Fluid dynamics and solids mechanics should be considered in planning of stenting for a specific bifurcation, as their combined biomechanical effect may play an important role in stent restenosis and thrombosis.
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Chen et al. (2020) studied Coronary artery bifurcation disease. Provisional stenting vs. Main branch or without plaque was evaluated on Biomechanical stress ratio (Solid CWS/Fluid WSS). Computational simulations of provisional stenting in a coronary bifurcation model demonstrated that the side branch experiences a nearly two-fold larger biomechanical stress ratio than the main branch.
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