Impact of bifurcation stenting on Endothelial Shear Stress
European Bifurcation Club 2014 – EBC 2014 – Bordeaux, France
Bifurcation stenting: learning from bench and simulation
Impact of bifurcation stenting on Endothelial Shear Stress
Author: Ghassan Kassab, MD, California Medical Innovations Ins1tute, San Diego, CA, USA
INTRODUCTION
- Despite advances in percutaneus coronary interventions and the introduction of drug eluding stents (DES), in-stent restenosis and stent thrombosis remain a clinically significant problem for bifurcations.
- The purpose of this study is to determine the effect of dual bifurcation stenting on hemodynamic parameters known to influence restenosis and thrombosis.
- We hypothesized that double sten<ng, especially with a longer (e.g., 30% longer than lesion) SB stent has a negative effect on wall shear stress (WSS), wall shear stress gradient (WSSG), and oscillatory shear index (OSI).
METHODS
- To test this hypothesis, we developed computational models of dual stents at bifurcations and non- Newtonian blood simulations.
- The models were then interfaced, meshed and solved in a validated finite element package.
- The blood was modeled with flow waveform based on human leT coronary artery pulsatile velocity measurements applied at the inlet of vessel.
CONCLUSION
- Stenting of SB can produce comparable endothelialmhemodynamic parameters as provisional stenting for the shorter SB stent.
- A longer SB stent induces worst endothelial hemodynamic parameters than a shorter stent.
- Undersized stents exaggerate the negative endothelial hemodynamic effects of SB stenting.