Numerical Investigation of an Idealized Overlapping Coronary …
257
reattach to the wall, and in the distal part of the second strut, the pressure constantly
continues to decrease. The highest values and the most significant variations are
associated with the diastolic peak (T 2 ).
5 Conclusions
Stent overlap leads to important modifications of the hemodynamic parameters and
significantly alters the flow in the vicinity of the wall, resulting in extended regions
with low WSS, large recirculation regions and high pressure variation. This type
of hemodynamic alterations may account for increased risk of stent thrombosis, as
previously described in various studies.
This paper has obvious limitations due to the idealized 2D features that do not
account for all anatomical and physiological characteristics of a real stented coronary
segment, requiring more complex patient-specific 3D model for validation and further
analyses. However, these findings enhance the knowledge regarding the impact of
overlapping stents on the near-wall hemodynamics and provide useful information
that could potentially help improve future stent deployment techniques and stent
designs.
References
1. L. Räber, P. Jüni, L. Löffel, S. Wandel, S. Cook, P. Wenaweser, M. Togni, R. Vogel, C. Seiler,
F. Eberli, Th. Lüscher, B. Meier, S. Windecke, Impact of stent overlap on angiographic and
long-term clinical outcome in patients undergoing drug-eluting stent implantation. J. Am. Coll.
Cardiol. 55(12), 1178–1188 (2010)
2. C.J. O’Sullivan, G.G. Stefanini, L. Räber, D. Heg, M. Taniwaki, B. Kalesan, T. Pilgrim, T.
Zanchin, A. Moschovitis, L. Büllesfeld, A.A. Khattab, B. Meier, P. Wenaweser, P. Jüni, S.
Windecker, Impact of stent overlap on long-term clinical outcomes in patients treated with
newer-generation drug-eluting stents. EuroIntervention 9(9), 1076–1084 (2014)
3. N. DePaola, M.A. Gimbrone Jr, P.F. Davies, P.F. Dewey Jr, Vascular endothelium responds to
fluid shear stress gradients. Arterioscler. Thromb. 12(11), 1254–7 (1992)
4. J. Ng, Chr. Bourantas, R. Torii, et al., Local hemodynamic forces after stenting implications
on restenosis and thrombosis. Arterioscler. Thromb. Vasc. Biol. 37, 2231–2242 (2017)
5. K. Kolandaivelu, R. Swaminathan, W.J. Gibson, V.B. Kolachalama, K.L. Nguyen-Ehrenreich,
V.L. Giddings, L. Coleman, G.K. Wong, E.R. Edelman, Stent thrombogenicity early in high-risk
interventional settings is driven by stent design and deployment and protected by polymer-drug
coatings. Circulation 123, 1400–1409 (2011)
6. F. Rikhtegar, C. Wyss, K.S. Stok, D. Poulikakos, R. Müller, V. Kurtcuoglu, Hemodynamics in
coronary arteries with overlapping stents. J. Biomech. 47, 505–511 (2014)
7. F. Rikhtegar, E.R. Edelmana, U. Olgac, D. Poulikakosd, V. Kurtcuogluc, Drug deposition in
coronary arteries with overlapping drug-eluting stents. J Control Release 28(238), 1–9 (2016)
257
reattach to the wall, and in the distal part of the second strut, the pressure constantly
continues to decrease. The highest values and the most significant variations are
associated with the diastolic peak (T 2 ).
5 Conclusions
Stent overlap leads to important modifications of the hemodynamic parameters and
significantly alters the flow in the vicinity of the wall, resulting in extended regions
with low WSS, large recirculation regions and high pressure variation. This type
of hemodynamic alterations may account for increased risk of stent thrombosis, as
previously described in various studies.
This paper has obvious limitations due to the idealized 2D features that do not
account for all anatomical and physiological characteristics of a real stented coronary
segment, requiring more complex patient-specific 3D model for validation and further
analyses. However, these findings enhance the knowledge regarding the impact of
overlapping stents on the near-wall hemodynamics and provide useful information
that could potentially help improve future stent deployment techniques and stent
designs.
References
1. L. Räber, P. Jüni, L. Löffel, S. Wandel, S. Cook, P. Wenaweser, M. Togni, R. Vogel, C. Seiler,
F. Eberli, Th. Lüscher, B. Meier, S. Windecke, Impact of stent overlap on angiographic and
long-term clinical outcome in patients undergoing drug-eluting stent implantation. J. Am. Coll.
Cardiol. 55(12), 1178–1188 (2010)
2. C.J. O’Sullivan, G.G. Stefanini, L. Räber, D. Heg, M. Taniwaki, B. Kalesan, T. Pilgrim, T.
Zanchin, A. Moschovitis, L. Büllesfeld, A.A. Khattab, B. Meier, P. Wenaweser, P. Jüni, S.
Windecker, Impact of stent overlap on long-term clinical outcomes in patients treated with
newer-generation drug-eluting stents. EuroIntervention 9(9), 1076–1084 (2014)
3. N. DePaola, M.A. Gimbrone Jr, P.F. Davies, P.F. Dewey Jr, Vascular endothelium responds to
fluid shear stress gradients. Arterioscler. Thromb. 12(11), 1254–7 (1992)
4. J. Ng, Chr. Bourantas, R. Torii, et al., Local hemodynamic forces after stenting implications
on restenosis and thrombosis. Arterioscler. Thromb. Vasc. Biol. 37, 2231–2242 (2017)
5. K. Kolandaivelu, R. Swaminathan, W.J. Gibson, V.B. Kolachalama, K.L. Nguyen-Ehrenreich,
V.L. Giddings, L. Coleman, G.K. Wong, E.R. Edelman, Stent thrombogenicity early in high-risk
interventional settings is driven by stent design and deployment and protected by polymer-drug
coatings. Circulation 123, 1400–1409 (2011)
6. F. Rikhtegar, C. Wyss, K.S. Stok, D. Poulikakos, R. Müller, V. Kurtcuoglu, Hemodynamics in
coronary arteries with overlapping stents. J. Biomech. 47, 505–511 (2014)
7. F. Rikhtegar, E.R. Edelmana, U. Olgac, D. Poulikakosd, V. Kurtcuogluc, Drug deposition in
coronary arteries with overlapping drug-eluting stents. J Control Release 28(238), 1–9 (2016)