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Hemodynamics of Stent Implantation Procedures in Coronary Bifurcations: An In Vitro Study
Melissa C Brindise1, Claudio Chiastra2,3, Francesco Burzotta4
1School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN, 47907, USA.
Insights
Different coronary stent implantation methods significantly alter blood flow dynamics in bifurcations. The study found that while crush stenting had drawbacks, provisional side branch and culotte methods maintained normal flow but increased risks associated with blood flow patterns.
Area of Science:
- Cardiovascular research
- Biomedical engineering
- Hemodynamics
Background:
- Coronary artery bifurcation stenting lacks a definitive optimal technique.
- Understanding the hemodynamic impact of different stenting methods is crucial but not well-established.
Purpose of the Study:
- To experimentally investigate and compare the hemodynamic effects of three coronary bifurcation stenting techniques: provisional side branch (PSB), culotte (CUL), and crush (CRU).
- To quantify changes in hemodynamic parameters and pressure dynamics post-stenting.
Main Methods:
- Utilized time-resolved particle image velocimetry (PIV) to measure velocity fields in stented coronary bifurcations under pulsatile flow.
- Calculated hemodynamic parameters: wall shear stress, oscillatory shear index (OSI), and relative residence time (RRT).
- Quantified pressure fields and computed pressure wave speeds, comparing stented cases to an un-stented control.
Main Results:
- Crush (CRU) stenting showed the lowest compliance mismatch but had detrimental interactions.
- Provisional side branch (PSB) and culotte (CUL) stenting maintained more normal flow conditions compared to CRU.
- PSB significantly increased OSI and RRT (approx. 300%), while CUL increased OSI (10%) and RRT (85%).
Conclusions:
- All tested bifurcation stenting techniques alter coronary artery hemodynamics compared to the un-stented state.
- The degree of hemodynamic deviation varies significantly among PSB, CUL, and CRU methods.
- These findings highlight the importance of considering hemodynamic consequences when selecting stenting strategies for coronary bifurcations.
Abstract:
Stent implantation in coronary bifurcations presents unique challenges and currently there is no universally accepted stent deployment approach. Despite clinical and computational studies, the effect of each stent implantation method on the coronary artery hemodynamics is not well understood. In this study the hemodynamics of stented coronary bifurcations under pulsatile flow conditions were investigated experimentally. Three implantation methods, provisional side branch (PSB), culotte (CUL), and crush (CRU), were investigated using time-resolved particle image velocimetry to measure the velocity fields. Subsequently, hemodynamic parameters including wall shear stress, oscillatory shear index (OSI), and relative residence time (RRT) were calculated. The pressure field through the vessel was non-invasively quantified and pressure wave speeds were computed. The effects of each stented case were evaluated and compared against an un-stented case. CRU provided the lowest compliance mismatch, but demonstrated detrimental stent interactions. PSB, the clinically preferred method, and CUL maintained many normal flow conditions. However, PSB provided about a 300% increase in both OSI and RRT. CUL yielded a 10 and 85% increase in OSI and RRT, respectively. The results of this study support the concept that different bifurcation stenting techniques result in hemodynamic environments that deviate from that of un-stented bifurcations, to varying degrees.
