Faculty Collaboration Database

Quantification of local hemodynamic alterations caused by virtual implantation of three commercially available stents for the treatment of aortic coarctation. Pediatr Cardiol 2014 Apr;35(4):732-40

Date

11/22/2013

Pubmed ID

24259013

Pubmed Central ID

PMC3959287

DOI

10.1007/s00246-013-0845-7

Scopus ID

2-s2.0-84897065187 (requires institutional sign-in at Scopus site)   25 Citations

Abstract

Patients with coarctation of the aorta (CoA) are prone to morbidity including atherosclerotic plaque that has been shown to correlate with altered wall shear stress (WSS) in the descending thoracic aorta (dAo). We created the first patient-specific computational fluid dynamics (CFD) model of a CoA patient treated by Palmaz stenting to date, and compared resulting WSS distributions to those from virtual implantation of Genesis XD and modified NuMED CP stents, also commonly used for CoA. CFD models were created from magnetic resonance imaging, fluoroscopy and blood pressure data. Simulations incorporated vessel deformation, downstream vascular resistance and compliance to match measured data and generate blood flow velocity and time-averaged WSS (TAWSS) results. TAWSS was quantified longitudinally and circumferentially in the stented region and dAo. While modest differences were seen in the distal portion of the stented region, marked differences were observed downstream along the posterior dAo and depended on stent type. The Genesis XD model had the least area of TAWSS values exceeding the threshold for platelet aggregation in vitro, followed by the Palmaz and NuMED CP stents. Alterations in local blood flow patterns and WSS imparted on the dAo appear to depend on the type of stent implanted for CoA. Following confirmation in larger studies, these findings may aid pediatric interventional cardiologists in selecting the most appropriate stent for each patient, and ultimately reduce long-term morbidity following treatment for CoA by stenting.

Author List

Kwon S, Feinstein JA, Dholakia RJ, Ladisa JF Jr

Author

John F. LaDisa PhD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Angiography
Aorta, Thoracic
Aortic Coarctation
Blood Vessel Prosthesis
Computer Simulation
Elasticity
Hemodynamics
Humans
Magnetic Resonance Imaging, Cine
Models, Cardiovascular
Prosthesis Design
Stents
Vascular Resistance