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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



  • 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).


  • 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.


  • 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.


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