Key result
Single- and dual-layer carotid stents reduce in vitro thrombus formation ~50% by altering near-wall flow.
Why the study?
Dual-layer carotid stents show promise in reducing plaque prolapse and post-procedural embolism, but early signs suggest they may be more thrombogenic than single-layer stents.
Do single- and dual-layer carotid stents influence thrombus formation and platelet adhesion in vitro?
Do single- and dual-layer carotid stents influence thrombus formation and platelet adhesion in vitro?
In vitro and simulation data suggest that both single- and dual-layer carotid stents reduce thrombus formation by altering near-wall flow conditions and reducing platelet adhesion.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for carotid stent design; does not support clinical adoption without in vivo validation.
An ongoing thrombosis on a ruptured atherosclerotic plaque in the carotid may cause stroke. The primary treatment for patients with tandem lesion is stenting. Dual-layer stents have been introduced as an alternative to single-layer stents for elective and emergent carotid artery stenting. While the dual-layer structure shows promise in reducing plaque prolapse through the stent struts and with it the occurrence of post-procedural embolism, there are early signs that this newer generation of stents is more thrombogenic. We investigate a single- and a dual-layer stent design to assess their influence on a set of thrombosis-related flow factors in a novel setup of combined experiments and simulations. The in vitro results reveal that both stents reduce thrombus formation by approximately 50% when human anticoagulated whole blood was perfused through macrofluidic flow chambers coated with either collagen or human atherosclerotic plaque homogenates. Simulations predict that the primary cause is reduced platelet presence in the vicinity of the wall, due to the influence of stents on flow and cellular transport. Both stents significantly alter the near-wall flow conditions, modifying shear rate, shear gradient, cell-free zones, and platelet availability. Additionally, the dual-layer stent has further increased local shear rates on the inner struts. It also displays increased stagnation zones and reduced recirculation between the outer-layer struts. Finally, the dual-layer stent shows further reduced adhesion over an atherosclerotic plaque coating. The novel approach presented here can be used to improve the design optimization process of cardiovascular stents in the future by allowing an in-depth study of the emerging flow characteristics and agonist transport.
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Spieker et al. (2024) studied Carotid artery thrombosis. Single- and dual-layer carotid stents was evaluated on Thrombus formation. Both single- and dual-layer carotid stents reduced in vitro thrombus formation by approximately 50% by altering near-wall flow conditions and reducing platelet presence.
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