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Impact of strut dimensions and vessel caliber on thrombosis risk of bioresorbable scaffolds using hemodynamic metrics

Michael Stiehm1, Carolin Wüstenhagen1, Stefan Siewert1

  • 1Institute for ImplantatTechnology and Biomaterials e.V., Friedrich-Barnewitz-Str. 4, 18119 Rostock-Warnemünde, Germany.

Biomedizinische Technik. Biomedical Engineering
|June 23, 2018
PubMed

Insights

Bioresorbable scaffolds (BRS) may increase thrombosis risk in small coronary vessels. Thicker struts and smaller vessel sizes elevate platelet activation, transport, and aggregation, suggesting bulky stents in narrow arteries pose higher risks.

Area of Science:

  • Cardiovascular Engineering
  • Biomedical Engineering
  • Computational Fluid Dynamics

Background:

  • Bioresorbable scaffolds (BRS) are promising for treating stenosed coronary vessels.
  • Current clinical data indicate a higher-than-expected thrombosis risk associated with BRS.
  • Understanding the hemodynamic factors influencing thrombosis is crucial for BRS development.

Purpose of the Study:

  • To evaluate the thrombosis risk of coronary stents/scaffolds using computational fluid dynamics (CFD).
  • To introduce and utilize three hemodynamic metrics: platelet shear number (PSN), platelet convection number (PCN), and platelet aggregation number (PAN).
  • To compare the thrombosis risk between thick-strut and thin-strut BRS designs in small and medium coronary vessels.

Main Methods:

  • Transient computational fluid dynamics (CFD) simulations were employed.
  • Analysis focused on platelet activation and diffusion (PSN), convective transport (PCN), and aggregation (PAN).
  • Two stent designs (thick-strut vs. thin-strut) were simulated in two vessel sizes (RVD 2.25 mm vs. 2.70 mm).

Main Results:

  • Thick-strut designs exhibited higher PSN, PCN, and PAN compared to thin-strut designs in both vessel sizes.
  • Smaller vessel size (RVD 2.25 mm) significantly increased PSN and PCN for both stent designs.
  • Sensitivity analysis indicated PSN is primarily influenced by vessel size, while PCN and PAN are sensitive to strut thickness.

Conclusions:

  • Bulky stents implanted in small-caliber coronary arteries may substantially increase thrombosis risk.
  • Strut thickness is a critical device-related factor influencing platelet transport and aggregation.
  • Vessel size is a key lesion-related factor affecting platelet activation and diffusion.

Keywords:
CFDbioresorbable scaffoldnon-Newtoniannumerical simulationthrombosistransient

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