Three-dimensional numerical simulations of physiological flows in a stented coronary bifurcation
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Published on: January 15, 2022
V Deplano1, C Bertolotti, P Barragan
1Equipe de Biomécanique Cardiovasculaire, IRPHE UMR no. 6594, Technopôle de Chateau Gombert, Marseille, France 2CHP Beauregard, Marseille, France. deplano.valerie@esm2.imt-mrs.fr
Insights
Double stenting in coronary bifurcations can cause blood flow issues. Numerical models show stent strut placement affects flow, potentially leading to clots and suggesting specialized bifurcated stents may be better.
Area of Science:
- Cardiovascular research
- Biomedical engineering
- Fluid dynamics
Background:
- Coronary bifurcation lesions often require double stent implantation.
- The positioning of multiple stents can alter local hemodynamics.
Purpose of the Study:
- To numerically model blood flow in stented coronary bifurcations.
- To investigate the impact of stent strut geometry on flow patterns and shear stress.
Main Methods:
- Finite volumes method used for numerical modeling.
- Simulated double stent implantation in a 90-degree coronary bifurcation model.
- Compared various stent cell configurations to assess strut protrusion effects.
Main Results:
- Stent strut placement significantly altered bifurcation flow dynamics.
- Observed flow stasis and recirculation areas downstream of struts.
- High shear stress zones (up to 20 N m⁻²) near struts could activate platelets.
- Low shear stress zones (around 0.5 N m⁻²) were associated with high shear areas, promoting platelet adhesion and thromboembolism.
Conclusions:
- Stent strut protrusion into collateral branches impacts hemodynamics.
- Current double stenting techniques may increase thromboembolic risk.
- Dedicated bifurcated stents are recommended for treating coronary bifurcation lesions.
Abstract:
When atherosclerotic lesions are found within a coronary bifurcation, a double stent implantation is sometimes required to treat the disease of each branch. The clinical procedure can result in the positioning of several stents in the bifurcation. In the study, physiological flows in typical configurations of such stented coronary bifurcations were numerically modelled using the finite volumes method. Two deployed Palmaz stents were inserted in a 90 degrees coronary bifurcation, simulating a double stent implantation. As the geometric position of the metallic stent cells can vary, several models of broken cells were proposed and compared to characterise the influence of the stent struts protruding into the collateral branch. Flow features in the bifurcation surroundings changed from one model to another. These changes could lead to the occurrence of flow stasis and also of recirculation areas downstream from the struts, depending on the way the strut was opened. The stent struts protruding into the lumen of the collateral branch induced high values of shear stress at the stent wall of about 20 N m(-2), which could stimulate platelet activation. In addition, these areas of high shear stress values were concomitant with areas of low shear stress values of about 0.5 Nm(-2). These regions could be prone to platelet adhesion and so to thrombo-embolic complications. The analysis of the flow field indicated that it would be judicious to use dedicated bifurcated stents to treat bifurcation lesions.
