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November 24, 2023MicromachinesOpen Access

Numerical Analysis of Stress Force on Vessel Walls in Atherosclerotic Plaque Removal through Coronary Rotational Atherectomy

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Key result

A 4.5 mm rotational atherectomy burr generates ~4-fold higher vessel wall pressure than smaller burrs.

Figures

Why the study?

It is difficult to analyze the stress force on vessel walls during coronary rotational atherectomy directly using experiments.

Does the burr-to-artery diameter ratio and rotational speed during coronary rotational atherectomy affect vessel wall pressure, shear stress force, and flow field stability in simulated atherosclerotic vessels?

Key Points

To analyze stress forces and hemodynamic alterations exerted on arterial walls during plaque grinding in coronary rotational atherectomy using computational fluid dynamics.
Constructed physical and computational fluid dynamics simulation models representing atherosclerotic plaque removal in arterial vessels.
Evaluated grinding tool diameters of 2.5 mm, 3.5 mm, and 4.5 mm across different vessel diameters and rotational speeds.
Analyzed flow velocity distributions, vortex shedding patterns, vessel wall pressure, and circumferential stress force profiles.
A smaller ratio between the burr and arterial diameter (B/A = 0.5) established a more stable flow field domain.
The 4.5 mm diameter grinding tool generated peak pressure of 92.77 kPa and stress force of 10.36 kPa, compared to a maximum pressure of 23.52 kPa for the 2.5 mm tool.
Maximum flow velocity exceeded 2 m/s near the burr, with the 4.5 mm tool producing approximately double the peak flow rate of the 3.5 mm tool at equivalent rotational speeds.

Structured PICO

Does the burr-to-artery diameter ratio and rotational speed during coronary rotational atherectomy affect vessel wall pressure, shear stress force, and flow field stability in simulated atherosclerotic vessels?

P

Population

Physical and 3D computational fluid dynamics simulation models of 5 mm and 6 mm calcified arterial vessels undergoing rotational atherectomy.

I

Intervention

Coronary rotational atherectomy using rotary grinding tools (burrs) of 2.5 mm, 3.5 mm, and 4.5 mm diameters operating at rotational speeds of 110,000 rpm, 125,000 rpm, 140,000 rpm, 155,000 rpm, and 170,000 rpm.

C

Comparator

Comparison across four groups defined by burr-to-artery diameter ratios (B/A) using 2.5 mm, 3.5 mm, and 4.5 mm burrs inside 5 mm and 6 mm simulated vessels, validated against laser particle image velocimetry (PIV) physical testing.

O

Outcome

Hemodynamic characteristics including flow velocity distribution, vortex formation, simulated vessel wall pressure, and wall shear stress (WSS) forcesurrogate

Main Result

Absolute Event Rate: 92.77% vs 23.52%

Computational fluid dynamics and particle image velocimetry demonstrate that maintaining a lower burr-to-artery ratio (B/A = 0.5) and avoiding oversized burrs (such as 4.5 mm) during rotational atherectomy stabilizes arterial flow and reduces excessive wall pressure and shear stress that could cause vessel rupture.

Limitations

Difficult to measure pressure, stress force, and flow indicators directly in vivo
Deionized water was used as a blood substitute in the physical particle image velocimetry (PIV) experimental platform
Simplified physical and computational model using PVC pipe and idealized ellipsoidal plaque geometry
Direct experimental measurement of stress force on vessel walls is difficult, requiring reliance on numerical simulation
Deionized water was used as a blood substitute in the physical PIV experiment to avoid flocculation of tracer particles
Simplified geometric modeling of the artery and ellipsoidal plaque

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Caution with larger burrs to limit wall stress; leaves open optimal sizing pending human validation.

Abstract

Coronary rotational atherectomy is an effective technique for treating cardiovascular disease by removing calcified tissue using small rotary grinding tools. However, it is difficult to analyze the stress force on vessel walls using experiments directly. Using computational fluid dynamics is a better way to study the stress force characteristics of the burr grinding procedure from a fluid dynamics perspective. For this purpose, physical and simulation models of atherosclerotic plaque removal were constructed in this study. The simulation results show that smaller ratios between the burr and arterial diameter (B/A = 0.5) result in a more stable flow field domain. Additionally, the pressure and stress force generated by the 4.5 mm diameter grinding tool reach 92.77 kPa and 10.36 kPa, surpassing those of the 2.5 mm and 3.5 mm grinding tools. The study has demonstrated the use of computational fluid dynamics to investigate wall shear stress characteristics in medical procedures, providing valuable guidance for optimizing the procedure and minimizing complications.

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Cite This Study

Zhu et al. (2023) studied Calcified atherosclerotic coronary and peripheral artery lesions. Coronary rotational atherectomy (4.5 mm diameter rotary grinding tool / burr) vs. Smaller diameter rotary grinding tools (2.5 mm and 3.5 mm burrs) was evaluated on Maximum vessel wall pressure and stress force. A 4.5 mm rotational atherectomy burr generated 92.77 kPa pressure and 10.36 kPa wall stress force, surpassing 2.5 mm (23.52 kPa) and 3.5 mm tools while B/A of 0.5 improved flow stability.

synapsesocial.com/papers/6a84656d880bd6494af7b517 https://doi.org/10.3390/mi14122148

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