Effects of stent shape on focal hemodynamics in intracranial atherosclerotic stenosis: A simulation study with computational fluid dynamics modeling

Abstract

Background and aims: The shape of a stent could influence focal hemodynamics and subsequently plaque growth or in-stent restenosis in intracranial atherosclerotic stenosis (ICAS). In this preliminary study, we aim to investigate the associations between stent shapes and focal hemodynamics in ICAS, using computational fluid dynamics (CFD) simulations with manually manipulated stents of different shapes.

Methods: We built an idealized artery model, and reconstructed four patient-specific models of ICAS. In each model, three variations of stent geometry (i.e., enlarged, inner-narrowed, and outer-narrowed) were developed. We performed static CFD simulation on the idealized model and three patient-specific models, and transient CFD simulation of three cardiac cycles on one patient-specific model. Pressure, wall shear stress (WSS), and low-density lipoprotein (LDL) filtration rate were quantified in the CFD models, and compared between models with an inner- or outer-narrowed stent vs. an enlarged stent. The absolute difference in each hemodynamic parameter was obtained by subtracting values from two models; a normalized difference (ND) was calculated as the ratio of the absolute difference and the value in the enlarged stent model, both area-averaged throughout the arterial wall.

Results: The differences in focal pressure in models with different stent geometry were negligible (ND<1% for all cases). However, there were significant differences in the WSS and LDL filtration rate with different stent geometry, with ND >20% in a static model. Observable differences in WSS and LDL filtration rate mainly appeared in area adjacent to and immediately distal to the stent. In the transient simulation, the LDL filtration rate had milder temporal fluctuations than WSS.

Conclusions: The stent geometry might influence the focal WSS and LDL filtration rate in ICAS, with negligible effect on pressure. Future studies are warranted to verify the relevance of the changes in these hemodynamic parameters in governing plaque growth and possibly in-stent restenosis in ICAS.

Keywords: computational fluid dynamics (CFD); hemodynamics; in-stent restenosis (ISR); intracranial atherosclerotic stenosis (ICAS); low-density lipoprotein (LDL); stent geometry; wall shear stress (WSS).