Superficial femoral arteries (SFAs) treated with self-expanding stents are widely affected by in-stent restenosis (ISR), especially in case of long lesions and multiple overlapping devices. The altered hemodynamics provoked by the stent is considered as a promoting factor of ISR. In this context, this work aims to analyze the impact of stent design and stent overlapping on patient-specific SFA hemodynamics.

Methods

Through a morphing technique, single or multiple stents were virtually implanted within two patient-specific, post-operative SFA models reconstructed from computed tomography. The stented domains were used to perform computational fluid dynamics simulations, quantifying wall shear stress (WSS) based descriptors including time-averaged WSS (TAWSS), oscillatory shear index (OSI), transverse WSS (transWSS), and WSS ratio (WSS_RATIO). Four stent designs (three laser-cut – EverFlex, Zilver and S.M.A.R.T. – and one prototype braided stent), and three typical clinical scenarios accounting for different order of stent implantation and overlapping length were compared.

Results

The main hemodynamic differences were found between the two types of stent designs (i.e. laser-cut vs. braided stents). The braided stent presented lower median transWSS and higher median WSS_RATIO than the laser-cut stents (p < 0.0001). The laser-cut stents presented comparable WSS-based descriptor values, except for the Zilver, exhibiting a median TAWSS ∼30% higher than the other stents. Stent overlapping provoked an abrupt alteration of the WSS-based descriptors. The overlapping length, rather than the order of stent implantation, highly and negatively impacted the hemodynamics.

Conclusion

The proposed computational workflow compared different SFA stent designs and stent overlapping configurations, highlighting those providing the most favorable hemodynamic conditions.

Highlights

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Virtual stent implantation method based on mesh morphing.

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Hemodynamics simulations of stented, human superficial femoral artery models.

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The local hemodynamics induced by laser-cut vs. braided stents is different.

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In case of multiple stenting, the overlapping length highly impacts the hemodynamics.

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The order of stent implantation has a negligible impact on hemodynamics.

References

[1]

F.G.R. Fowkes, V. Aboyans, F.J.I. Fowkes, M.M. McDermott, U.K.A. Sampson, M.H. Criqui, Peripheral artery disease: epidemiology and global perspectives, Nat. Rev. Cardiol. 14 (2016) 156–170,.

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