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Drug-eluting coronary stents in stenosed arteries: medical investigation and computational modelling

Subject Area Mechanics
Cardiology, Angiology
Term from 2018 to 2024
Project identifier Deutsche Forschungsgemeinschaft (DFG) - Project number 395712048
 
Final Report Year 2023

Final Report Abstract

CARD: The methodology established herein for in vivo OCT analysis shall aid in obtaining patientspecific morphological data regarding the extent of ISR observed after stent implantation, which can then be utilized for setting up patient-specific in silico models and validate the macroscopic ISR outcomes. The Chandler loop model in congruence with the field emission scanning electron microscopy provided insights into the endothelial progenitor cell attachment on DES surfaces as well as the initial endothelial denudation observed after stent implantation. The in-vivo injury score developed herein enables the periprocedural assessment of stent-induced damage and therefore allows for an optimization of the stent implantation process. Refinement of the Sirius red staining procedure, the second harmonic generation imaging technique, the vessel tissue opening angle as well as the O-ring tensile failure experiments performed within the scope of the project shall further enhance the resolution of the modeling of the mechanical response of the arterial wall. CATS: Our research aims to advance the understanding of hemodynamics in stented arteries, by investigating several aspects of the complex interplay between blood flow, stent design, tissue inflammation, and drug release. Specifically, we examined the potential influence of shear-thinning models on blood and the effects of WSS on tissue inflammation and the resulting ISR. We focused on the indentation percentages, which have not been previously explored in the available literature. Our simulations provided physical confirmation of experimental risk factors obtained by CARD. Additionally, we investigated the drug elution process in a quasi-steady formulation, with the modern Xience V stent. To validate our computational models, we used the ring stent test case, which allows us to develop and test a fully coupled FSI setup. To address the challenge of high computational costs, we adopted two MOR techniques, which were applied to the simplified 2D axisymmetric ring stent. IFAM: The computational efficiency of the reduced-integration Q1SP (solid) and Q1STb (solid-beam) formulations in modeling the multi-layered stent constructs was validated. The modeling of the mechanical behavior of the arterial wall was achieved utilizing already established methodologies for modeling composites with transversely isotropic fibres embedded in isotropic ground matrices. Further, the key mediators of ISR were identified through an extensive study of the relevant physiological literature and crucial inputs from the CARD team. The development of the multiphysics modeling framework capturing key biochemical and cellular interactions influencing the complex pathophysiology of ISR has been a significant step towards understanding and optimizing the interventional procedures aimed at resolving coronary artery disease. We have been able to successfully capture the influence of endothelial denudation that modulates platelet aggregation and the subsequent inflammatory response of the vessel wall through the release of mitogens, chemokines, and cytokines from the blood flow. Through the efforts herein, we aim to promote the development of in silico tools for clinicians in cardiology which help them gauge and mitigate the risks associated with interventional procedures patient-specifically.

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