The effect of plaque eccentricity on blood hemodynamics and drug release in a stented artery. (October 2018)

• Record Type: Journal Article
• Authors: Ferreira, José A.; Gonçalves, Lino; Naghipoor, Jahed; de Oliveira, Paula; Rabczuk, Timon
• Is Part Of: Medical engineering & physics. Volume 60(2018)
• Page Start: 47
• Page End: 60
• Publication Date: 2018-10
• Subjects: Wall shear stress -- Eccentricity -- Drug distribution -- In-stent restenosis -- Numerical simulation; Biomedical engineering -- Periodicals; Biomedical Engineering -- Periodicals; Physics -- Periodicals; Génie biomédical -- Périodiques; Biomedical engineering; Electronic journals; Periodicals; 610.28
• DOI: 10.1016/j.medengphy.2018.07.014
• Languages: English
• ISSNs: 1350-4533

Abstract

Highlights: The effect of stenosis eccentricity on drug distribution and wall shear stress is studied. Plaque rupture and thrombosis occur essentially in the proximal zone of the deployment area where the wall shear stress is higher. Higher wall shear stress is observed in the vessel with eccentric poststenting geometry. There is no meaningful difference between in-stent restenosis in vessels with concentric or eccentric post-stenting geometries. Abstract: Atherosclerosis in the coronary arteries is one of the leading causes of death in the world. Percutaneous coronary interventions (PCI) associated with the implantation of drug eluting stents (DES) is one of the most common forms of revascularization in patients with atherosclerotic coronary artery disease. The use of DES is considered as an effective tool to reduce restenosis after PCI. However despite all the progress made in DES procedures, the rate of restenosis remains relatively high. Mathematical modeling and numerical simulation are believed to play an essential role in identifying zones with a higher risk of in-stent restenosis. In this work the local delivery of a therapeutic agent, from a stent implanted in a coronary artery, is mathematically modeled and numerically simulated. The mathematical model includes the diffusion of the dissolved drug in the biodegradable polymeric coating of the stent, the diffusion and convection of the drug with reversible binding in the viscoelastic arterial wall with plaques of different morphology and the local hemodynamics. The study is an attempt to detect zones with a higher risk of in-stent restenosis and their relation to plaque eccentricity. The location of zones with highest risk of thrombosis and plaque rupture is also addressed. The results are in agreement with claims presented in clinical papers.