27,569 research outputs found

    Microfocal X-Ray Computed Tomography Post-Processing Operations for Optimizing Reconstruction Volumes of Stented Arteries During 3D Computational Fluid Dynamics Modeling

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    Restenosis caused by neointimal hyperplasia (NH) remains an important clinical problem after stent implantation. Restenosis varies with stent geometry, and idealized computational fluid dynamics (CFD) models have indicated that geometric properties of the implanted stent may differentially influence NH. However, 3D studies capturing the in vivo flow domain within stented vessels have not been conducted at a resolution sufficient to detect subtle alterations in vascular geometry caused by the stent and the subsequent temporal development of NH. We present the details and limitations of a series of post-processing operations used in conjunction with microfocal X-ray CT imaging and reconstruction to generate geometrically accurate flow domains within the localized region of a stent several weeks after implantation. Microfocal X-ray CT reconstruction volumes were subjected to an automated program to perform arterial thresholding, spatial orientation, and surface smoothing of stented and unstented rabbit iliac arteries several weeks after antegrade implantation. A transfer function was obtained for the current post-processing methodology containing reconstructed 16 mm stents implanted into rabbit iliac arteries for up to 21 days after implantation and resolved at circumferential and axial resolutions of 32 and 50 μm, respectively. The results indicate that the techniques presented are sufficient to resolve distributions of WSS with 80% accuracy in segments containing 16 surface perturbations over a 16 mm stented region. These methods will be used to test the hypothesis that reductions in normalized wall shear stress (WSS) and increases in the spatial disparity of WSS immediately after stent implantation may spatially correlate with the temporal development of NH within the stented region

    Aortic stenting in the growing sheep causes aortic endothelial dysfunction but not hypertension: Clinical implications for coarctation repair

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    Stent implantation is the treatment of choice for adolescents and adults with aortic coarctation (CoAo). Despite excellent short-term results, 20%-40% of the patients develop arterial hypertension later in life, which was attributed to inappropriate response of the aortic baroreceptors to increased stiffness of the ascending aorta (ASAO), either congenital or induced by CoAo repair. In particular, it has been hypothesized that stent itself may cause or sustain hypertension. Therefore, we aimed to study the hemodynamic and structural impact following stent implantation in the normal aorta of a growing animal

    Pharmacokinetic analysis after implantation of everolimus-eluting self-expanding stents in the peripheral vasculature

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    Background: A novel self-expanding drug-eluting stent was designed to release everolimus 225 mu g/cm(2) to prevent restenosis following peripheral arterial intervention. The purpose of this study was to measure the pharmacokinetic profile of everolimus following stent implantation. Methods: One hundred four patients with symptomatic peripheral arterial disease underwent implantation of everolimus-eluting stents in the femoropopliteal arteries. In a prespecified subset of 26 patients, blood samples for assay of everolimus content were collected prior to stent implantation, at 1, 4, and 8 hours postprocedure, prior to discharge, and at 1 month postproccdure. Results: A total of 39 stents, ranging from 28 mm to 100 mm in length, were implanted in 26 patients, resulting in a total delivered everolimus dose range of 3.0 to 7.6 mg. Following the procedure, the maximum observed everolimus blood concentrations (C-max) varied from 1.83 +/- 0.05 ng/mL after implantation of a single 80-mm stent to 4.66 +/- 1.78 ng/mL after implantation of two 100-mm stents. The mean time to peak concentration (T-max) varied from 6.8 hours to 35 hours. The pharmacokinetics of everolimus were dose-proportional in that dose-normalized C-max and area under the curve values were constant over the studied dose range. Conclusions: After implantation of everolimus-eluting self-expanding stents in the femoropopliteal arteries, systemic blood concentrations of everolimus are predictable and considerably lower than blood concentrations observed following safe oral administration of everolimus

    Positive geometric vascular remodeling is seen after catheter-based radiation followed by conventional stent implantation but not after radioactive stent implantation

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    BACKGROUND: Recent reports demonstrate that intracoronary radiation affects not only neointimal formation but also vascular remodeling. Radioactive stents and catheter-based techniques deliver radiation in different ways, suggesting that different patterns of remodeling after each technique may be expected. METHODS AND RESULTS: We analyzed remodeling in 18 patients after conventional stent implantation, 16 patients after low-activity radioactive stent implantation, 16 patients after higher activity radioactive stent implantation, and, finally, 17 patients who underwent catheter-based radiation followed by conventional stent implantation. Intravascular ultrasound with 3D reconstruction was used after stent implantation and at the 6-month follow-up to assess remodeling within the stent margins and at its edges. Preprocedural characteristics were similar between groups. In-stent neointimal hyperplasia (NIH) was inhibited by high-activity radioactive stent implantation (NIH 9.0 mm(3)) and by catheter-based radiation followed by conventional stent implantation (NIH 6.9 mm(3)) compared with low-activity radioactive stent implantation (NIH 21.2 mm(3)) and conventional stent implantation (NIH 20.8 mm(3)) (P:=0.008). No difference in plaque or total vessel volume was seen behind the stent in the conventional, low-activity, or high-activity stent implantation groups. However, significant increases in plaque behind the stent (15%) and in total vessel volume (8%) were seen in the group that underwent catheter-based radiation followed by conventional stent implantation. All 4 groups demonstrated significant late lumen loss at the stent edges; however, edge restenosis was seen only in the group subjected to high-activity stent implantation and appeared to be due to an increase in plaque and, to a lesser degree, to negative remodeling. CONCLUSIONS: Distinct differences in the patterns of remodeling exist between conventional, radioactive, and catheter-based radiotherapy with stenting

    Antegrade Iliac Artery Stent Implantation for the Temporal and Spatial Examination of Stent-Induced Neointimal Hyperplasia and Alterations in Regional Fluid Dynamics

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    Neointimal hyperplasia remains an important problem after stent implantation. Previous investigations examining vascular responses to stent implantation and effects of drugs have used a retrograde deployment approach that may inadvertently alter the local fluid dynamics surrounding the stent. We present a model of antegrade iliac artery stent implantation that facilitates the analysis of stent-induced alterations in neointimal hyperplasia and wall shear stress in vivo.Methods: Stent delivery catheters were inserted through the left carotid artery in anesthetized rabbits (n=37). Catheters were advanced under fluoroscopic guidance to the distal iliac arteries, where the stent was deployed. Hemotoxylin and eosin (H&E) staining of unstented and stented vascular sections was performed 21 days after implantation. Results: Selective unilateral stent implantation was successful in 32 of 37 rabbits. No histological abnormalities were observed in the aorta, contralateral unstented iliac, or distal femoral arteries. Neointimal hyperplasia was localized to the stented region.Discussion: The model of stent implantation was relatively easy to perform and produced selective neointimal hyperplasia within the stented region without evidence of damage, cellular proliferation, or flow disruption in the surrounding normal arterial vessels. The model will allow detailed examination of the influence of stent implantation on indices of wall shear stress, neointimal hyperplasia, the mechanisms of cellular proliferation in vivo, and their modification by drugs

    Hemodynamics of Stent Implantation Procedures in Coronary Bifurcations: an in vitro study

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    Stent implantation in coronary bifurcations presents unique challenges and currently there is no universally accepted stent deployment approach. Despite clinical and computational studies, to date, the effect of each stent implantation method on the coronary artery hemodynamics is not well understood. In this study the hemodynamics of stented coronary bifurcations under pulsatile flow conditions were investigated experimentally. Three implantation methods, provisional side branch (PSB), culotte (CUL), and crush (CRU), were investigated using time-resolved particle image velocimetry (PIV) to measure the velocity fields. Subsequently, hemodynamic parameters including wall shear stress (WSS), oscillatory shear index (OSI), and relative residence time (RRT) were calculated and the pressure field through the vessel was non-invasively quantified. The effects of each stented case were evaluated and compared against an un-stented case. CRU provided the lowest compliance mismatch, but demonstrated detrimental stent interactions. PSB, the clinically preferred method, and CUL maintained many normal flow conditions. However, PSB provided about a 300% increase in both OSI and RRT. CUL yielded a 10% and 85% increase in OSI and RRT, respectively. The results of this study support the concept that different bifurcation stenting techniques result in hemodynamic environments that deviate from that of un-stented bifurcations, to varying degrees.Comment: 33 pages, 8 figures, 3 table

    Risk Factors and Outcome of Pulmonary Artery Stenting After Bidirectional Cavopulmonary Connection (BDCPC) in Single Ventricle Circulation

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    After bidirectional cavopulmonary connection (BDCPC) central pulmonary arteries (PAs) of single ventricle (SV) patients can be affected by stenosis or even closure. Aim of this study is to compare SV patients with and without PA-stent implantation post-BDCPC regarding risk factors for stent implantation and outcome. Single center, retrospective (2006-2021) study of 136 SV consecutive patients with and without PA-stent implantation post-BDCPC. Patient characteristics, risk factors for PA-stent implantation and PA growth were assessed comparing angiographic data pre-BDCPC and pre-TCPC. A total of 40/136 (29%) patients underwent PA-stent implantation at median (IQR) 14 (1.1-39.0) days post-BDCPC. 37/40 (92.5%) underwent LPA-stenting. Multiple regression analysis showed single LV patients to receive less likely PA-stents than single RV patients (OR 0.41; p = 0.05). Reduced LPA/BSA (mm/m2) and larger diameter of neo-ascending aorta pre-BDCPC were associated with an increased likelihood of PA-stent implantation post-BDCPC (OR 0.89, p = 0.03; OR 1.05, p = 0.001). Stent re-dilatation was performed in 36/40 (89%) after 1 (0.8-1.5) year. Pulmonary artery diameters pre-BDCPC were lower in the PA-stent group: McGoon (p < 0.001), Nakata (p < 0.001). Indexed pulmonary artery diameters increased equally in both groups but remained lower pre-TCPC in the PA-stent group: McGoon (p < 0.001), Nakata (p = 0.009), and Lower Lobe Index (p = 0.003). LPA and RPA grew symmetrically in both groups. Single RV, larger neo-ascending aorta, and small LPA pre- BDCPC are independent risk factors for PA-stent implantation post-BDCPC. Pulmonary artery diameters after PA-stent implantation and stent re-dilatation showed significant growth together with the contralateral side, but the PA-system remained symmetrically smaller in the stent group

    A Rapid and Computationally Inexpensive Method to Virtually Implant Current and Next-Generation Stents into Subject-Specific Computational Fluid Dynamics Models

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    Computational modeling is often used to quantify hemodynamic alterations induced by stenting, but frequently uses simplified device or vascular representations. Based on a series of Boolean operations, we developed an efficient and robust method for assessing the influence of current and next-generation stents on local hemodynamics and vascular biomechanics quantified by computational fluid dynamics. Stent designs were parameterized to allow easy control over design features including the number, width and circumferential or longitudinal spacing of struts, as well as the implantation diameter and overall length. The approach allowed stents to be automatically regenerated for rapid analysis of the contribution of design features to resulting hemodynamic alterations. The applicability of the method was demonstrated with patient-specific models of a stented coronary artery bifurcation and basilar trunk aneurysm constructed from medical imaging data. In the coronary bifurcation, we analyzed the hemodynamic difference between closed-cell and open-cell stent geometries. We investigated the impact of decreased strut size in stents with a constant porosity for increasing flow stasis within the stented basilar aneurysm model. These examples demonstrate the current method can be used to investigate differences in stent performance in complex vascular beds for a variety of stenting procedures and clinical scenarios

    Comportamiento mecánico ante la sobrexpansión de stents de cromo-cobalto comparados con stents de acero inoxidable, implantados en la aorta abdominal de conejos hipercolesterolémicos

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    Introducción: La fisiopatología de la disfunción diastólica del ventrículo izquierdo incluye alteraciones de la relajación ventricular, rigidez elástica pasiva o una combinación de ambos mecanismos. Mediante el eco-Doppler es posible evaluar parámetros relacionados con la relajación ventricular, pero no de la rigidez elástica pasiva. El estrés parietal diastólico evalúa la rigidez elástica pasiva a través de la disminución de la compresión del miocardio al final de la diástole. Objetivo: Evaluar la rigidez elástica pasiva mediante el estrés parietal diastólico en pacientes con estenosis aórtica grave con fracción de eyección preservada y su relación con la presencia de insuficiencia cardíaca grado III-IV. Material y métodos: Se estudiaron 76 pacientes (edad promedio 67 ± 11 años) portadores de estenosis aórtica grave (índice de área valvular aórtica <0,6 cm2/m2) y fracción de eyección mayor o igual al 50%. El estrés parietal diastólico fue calculado como: (espesor sistólico de pared posterior – espesor diastólico) / espesor sistólico en modo M. Se calculó por métodos no invasivos la relación E/e´, presión de fin de diástole y presión de fin de diástole / volumen de fin de diástole. Los pacientes fueron ordenados en 2 grupos: Grupo 1: insuficiencia cardíaca grado III - IV (n = 5 pacientes) y Grupo 2: sin insuficiencia cardíaca (n = 71 pacientes). Resultados: Los pacientes del grupo 1 presentaron mayor alteración de la rigidez elástica pasiva evidenciada por disminución del estrés parietal diastólico (0,23 ± 0,05 vs. 0,30 ± 0,06 p < 0,01), mayor incremento de E/e´ (20 ± 7 vs. 14 ± 8 p < 0,05), presión de fin de diástole y presión de fin de diástole / volumen de fin de diástole. Conclusión: El estrés parietal diastólico permitiría objetivar alteraciones de la rigidez elástica pasiva en pacientes con estenosis aórtica grave, fracción de eyección preservada e insuficiencia cardíaca que no pueden ser evaluadas mediante los parámetros de función diastólica habituales.Objectives: The aim of this study was to analyze the behavior to overexpansion of cobalt chromium stents compared with stainlesssteel stents.Methods: Twenty New Zealand rabbits were used, fed with a diet supplemented with 1% cholesterol. Animals were divided into twogroups. Group 1 (n=10) received 3.0 mm cobalt chromium stents overexpanded at 20 atmospheres and group 2 (n=10) 3.5 mm stentsdeployed at 10 atmospheres. These stents were compared with a previous series of 20 animals with stainless steel stents, dividedinto the same two groups. A third group with conventional diet was used as control. Intravascular ultrasound (IVUS) was performedto assess the degree of elastic recoil and also the degree of symmetry using ?intertrust angles?.Results: In group 1 of cobalt chromium stents, mean elastic recoil was 0.11±0.13 mm, (3.21% recoil) and in group 2 this was0.3±0.12 mm, (8.26% recoil) (p=0.002). In group 1 of stainless steel stents mean elastic recoil was 0.28±0.18 mm (8.21% recoil) andin group 2 this was 0.10±0.11 mm (2.79% recoil) (p <0.001).Conclusions: In cobalt chromium stents, elastic recoil was lower in overexpanded stents, whereas in stainless steel stents, elasticrecoil was higher in overexpanded stents. No differences in symmetry were observed between the different groups.Fil: Fernandez, Alejandro. Hospital Italiano; ArgentinaFil: Mele, Esteban. Hospital Italiano; ArgentinaFil: Renou, Sandra Judith. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Anatomía Patológica; ArgentinaFil: Olmedo, Daniel Gustavo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Anatomía Patológica; ArgentinaFil: Berrocal, Daniel. Hospital Italiano; ArgentinaFil: Gelpi, Ricardo Jorge. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad de Buenos Aires. Facultad de Odontología. Cátedra de Anatomía Patológica; Argentin

    Implantation of paclitaxel-eluting stents in saphenous vein grafts: clinical and angiographic follow-up results from a multicentre study.

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    Objective: To define the clinical and angiographic follow-up results after implantation of paclitaxel-eluting stents (PESs) in stenotic saphenous vein grafts (SVGs). Design: Prospective multicentre study. Comparison with a control group. Methods: 60 consecutive patients with 65 lesions located in 65 SVGs (mean (SD) age of vein grafts 11.3 (5.7) years) treated with PES (V-Flex Plus, 2.7 mg/mm2 paclitaxel, Cook) and 60 patients with 60 SVG lesions treated with bare metal stent (BMS) were included. Lesions had to be ,20 mm in length and in grafts of 2.75–3.5 mm diameter. The 6 month angiographic follow-up was obtained on 51 lesions (79%) of the PES group and on 51 lesions (85%) of the BMS group. Results: Baseline clinical and angiographic characteristics were comparable between both groups. At angiographic follow-up, three vein grafts in the PES group and five vein grafts in the BMS group were occluded. In-stent late lumen loss was lower in PES than in BMS (0.61 (0.81) vs 1.06 (0.72) mm, respectively; p = 0.021). In-stent binary restenosis rates were 12% vs 33%, respectively, (p = 0.012). Linear regression analysis showed BMS to be the only factor with an effect on late lumen loss (p = 0.011). Target-vessel failure rates were 18% in the PES group and 41% in the BMS group (p = 0.019), whereas major adverse cardiac event (MACE) rates at 180 days were 15% and 37%, respectively (p = 0.014). Conclusions: Implantation of non-polymer-based PES in SVG lesions is associated with a lower late lumen loss and restenosis rate than those of BMS. There remains a substantial target-vessel failure rate and MACE rate even at 6 months owing to graft occlusion or new lesions in the graft
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