Impact of different stenting techniques on the blood flow within the peripheral artery bifurcation

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Embargoed until 2020-09-01
Copyright: Lotfi, Azadeh
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Abstract
Despite the prevalent use of stents in restoring the blood flow within atherosclerotic peripheral arteries, failures due to the occurrence of in-stent restenosis associated with haemodynamic alterations from vascular stenting has yet to be overcome. This, appears to be more technically challenging in peripheral bifurcations. Computational fluid dynamics model have been utilised to examine different hemodynamic scenarios caused by the most common stenting techniques i.e. “Provisional side branch (PSB), Culotte (CUL), Crush (CRU) and Standard T techniques under pulsatile flow condition. This has been investigated considering the effect of meshing, oversize ratio and the main branch stent of appropriate size. The results obtained from the validity of a variety of wall shear stress-based haemodynamic indices in exploring the likely location and severity of ISR was were applied to explain the correlation. Based on these studies, the oversize ratio of 10%, main branch stenting with reference to the distal smaller diameter and proximal optimisation technique were considered to virtually generate the double-stenting techniques. The hybrid adaptive tetrahedral-prismatic mesh, which was shown to be associated with less error band and accurate solution, were utilised for discretising the complex geometries of stented cases where creating the hexahedral grids appeared unfeasible. Detrimental stent interactions at the proximal MB resulted in the highest risk of ISR in CUL, followed by CRU. However, both CUL and CRU revealed the most favourable results in preserving the bifurcation ostium patency as the least adverse events and ultimately ISR was obtained for this area, most notably due to the better SB ostial coverage provided by multiple layers of struts. PSB is shown to be superior to double-stent techniques only when the side branch (SB) is not severely diseased. Among double-stent models, T showed to provide a balanced haemodynamic environment that maintained the flow condition most closely resembling that of the PSB model in the MB while offering good enough scaffolding for cases with SB lesions. In terms of severity in double stent models, CUL showed the highest chance of developing severe ISR, followed by CRU and T.
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Author(s)
Lotfi, Azadeh
Supervisor(s)
Barber, Tracie
Simmons, Anne
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Publication Year
2019
Resource Type
Thesis
Degree Type
PhD Doctorate
UNSW Faculty
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