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research-article

Elevated blood viscosity and micro-recirculation linked to coronary stent malapposition

[+] Author and Article Information
Eric Poon

Department of Mechanical Engineering, The University of Melbourne, Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
epoon@unimelb.edu.au

Vikas Thondapu

Department of Mechanical Engineering, The University of Melbourne, Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
vthondapu@student.unimelb.edu

Umair Hayat

Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Victoria 3010, Australia
umair_hayat@hotmail.com

Peter Barlis

Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Department of Medicine, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Victoria 3010, Australia
pbarlis@unimelb.edu.au

Chooi Yap

Department of Mechanical Engineering, The University of Melbourne, Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
c.yap3@student.unimelb.edu.au

Po Kuo

Department of Mechanical Engineering, The University of Melbourne, Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
phkuo@student.unimelb.edu.au

Qisen Wang

Department of Mechanical Engineering, The University of Melbourne, Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
qisenw@student.unimelb.edu.au

Jiawei Ma

Department of Mechanical Engineering, The University of Melbourne, Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
jiaweim@student.unimelb.edu.au

Shuang Zhu

Department of Mechanical Engineering, The University of Melbourne, Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
sjzhu@unimelb.edu.au

Stephen Moore

IBM Research Australia, IBM Research Australia, Carlton, Victoria 3053, Australia
stevemoore@au1.ibm.com

Andrew Ooi

Department of Mechanical Engineering, The University of Melbourne, Department of Mechanical Engineering, Melbourne School of Engineering, The University of Melbourne, Victoria 3010, Australia
a.ooi@unimelb.edu.au

1Corresponding author.

ASME doi:10.1115/1.4039306 History: Received June 27, 2017; Revised January 28, 2018

Abstract

One particular complexity of coronary artery is the natural tapering of the vessel with proximal segments having larger caliber and distal tapering as the vessel get smaller. The natural tapering of a coronary artery often leads to proximal incomplete stent apposition (ISA). ISA alters coronary hemodynamics and creates pathological path to develop complications such as in-stent restenosis, and more worryingly, stent thrombosis. By employing state-of-the-art computer-aided design software, generic stent hoops were virtually deployed in an idealized tapered coronary artery with decreasing malapposition distance. Pulsatile blood flow simulations were carried out using computational fluid dynamics (CFD) on these computer-aided design models. CFD results reveal unprecedented details in both spatial and temporal development of micro-recirculation environments throughout the cardiac cycle. Arterial tapering also introduces secondary micro-recirculation. These primary and secondary micro-recirculations provoke significant fluctuations in arterial wall shear stress (WSS). There has been a direct correlation with changes in WSS and the development of atherosclerosis. Further, the presence of these micro-recirculations influence strongly on the local levels of blood viscosity in the vicinity of the malapposed stent struts. The observation of secondary micro-recirculations and changes in blood rheology is believed to complement the wall (-based) shear stress, perhaps providing additional physical explanations for tissue accumulation near ISA detected from high resolution optical coherence tomography. This work may aid in helping to optimize future stent properties and designs that will translate to innovations that directly impact clinical outcomes.

Copyright (c) 2018 by ASME
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