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Load-sharing characteristics of stenting and post-dilation in heavily calcified coronary artery
Pengfei Dong1, Jose Colmenarez1, Juhwan Lee2
1Department of Biomedical Engineering and Science, Florida Institute of Technology, Melbourne, FL, 32901, USA.
Insights
Stenting in calcified arteries shows a dog bone shape, requiring higher pressure for effective expansion. Increased inflation pressure improves stent expansion and lumen diameter, supporting high-pressure balloon use.
Area of Science:
- Biomedical Engineering
- Cardiovascular Research
- Medical Device Design
Background:
- Coronary artery calcification poses challenges for stent deployment and efficacy.
- Understanding stent-device-artery interactions is crucial for optimizing treatment outcomes.
Purpose of the Study:
- To quantify stenting in non-calcified and calcified arteries regarding pressure-diameter relationships and load transfer.
- To characterize post-dilation efficacy in terms of load sharing and tissue mechanics.
- To investigate the impact of inflation pressure on stent expansion and calcified tissue mechanics.
Main Methods:
- Quantitative analysis of stenting in simulated non-calcified and heavily calcified coronary arteries.
- Measurement of diameter-pressure relationships and load transfer during stenting.
- Characterization of load sharing and tissue mechanics post-dilation.
Main Results:
- Stent expansion was cylindrical in non-calcified lesions and dog-boned in heavily calcified lesions.
- Significantly higher pressure load was transferred to heavily calcified lesions (19 N, 12%) compared to non-calcified ones (1.4 N, 0.8%).
- Increasing inflation pressure (10 to 20 atm) effectively improved minimal lumen diameter, stress, and strain energy in calcified lesions, indicating potential for calcification fracture.
Conclusions:
- Increasing inflation pressure is effective for improving stent expansion, especially when a dog-bone shape is observed.
- High-pressure balloons are supported for post-dilation in calcified lesions, considering potential risks.
- Findings inform stent design and material selection to enhance expansion in calcified regions and reduce arterial stress.
Abstract:
In this work, stenting in non-calcified and heavily calcified coronary arteries was quantified in terms of diameter-pressure relationships and load transfer from the balloon to the artery. The efficacy of post-dilation in non-calcified and heavily calcified coronary arteries was also characterized in terms of load sharing and the changes in tissue mechanics. Our results have shown that stent expansion exhibits a cylindrical shape in non-calcified lesions, while it exhibits a dog bone shape in heavily calcified lesions. Load-sharing analysis has shown that only a small portion of the pressure load (1.4 N, 0.8% of total pressure load) was transferred to the non-calcified lesion, while a large amount of the pressure load (19 N, 12%) was transferred to the heavily calcified lesion. In addition, the increasing inflation pressure (from 10 to 20 atm) can effectively increase the minimal lumen diameter (from 1.48 to 2.82 mm) of the heavily calcified lesion, the stress (from 1.5 to 8.4 MPa) and the strain energy in the calcification (1.77 mJ to 26.5 mJ), which are associated with the potential of calcification fracture. Results indicated that increasing inflation pressure can be an effective way to improve the stent expansion if a dog bone shape of the stenting profile is observed. Considering the risk of a balloon burst, our results support the design and application of the high-pressure balloon for post-dilation. This work also sheds some light on the stent design and choice of stent materials for improving the stent expansion at the dog bone region and mitigating stresses on arterial tissues.
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