In-Stent Restenosis Progression in Human Superficial Femoral Arteries: Dynamics of Lumen Remodeling and Impact of Local Hemodynamics

Monika Colombo, Yong He, Anna Corti, Diego Gallo, Federica Ninno, Stefano Casarin, Jared M. Rozowsky, Francesco Migliavacca, Scott Berceli, Claudio Chiastra

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

In-stent restenosis (ISR) represents a major drawback of stented superficial femoral arteries (SFAs). Motivated by the high incidence and limited knowledge of ISR onset and development in human SFAs, this study aims to (i) analyze the lumen remodeling trajectory over 1-year follow-up period in human stented SFAs and (ii) investigate the impact of altered hemodynamics on ISR initiation and progression. Ten SFA lesions were reconstructed at four follow-ups from computed tomography to quantify the lumen area change occurring within 1-year post-intervention. Patient-specific computational fluid dynamics simulations were performed at each follow-up to relate wall shear stress (WSS) based descriptors with lumen remodeling. The largest lumen remodeling was found in the first post-operative month, with slight regional-specific differences (larger inward remodeling in the fringe segments, p < 0.05). Focal re-narrowing frequently occurred after 6 months. Slight differences in the lumen area change emerged between long and short stents, and between segments upstream and downstream from stent overlapping portions, at specific time intervals. Abnormal patterns of multidirectional WSS were associated with lumen remodeling within 1-year post-intervention. This longitudinal study gave important insights into the dynamics of ISR and the impact of hemodynamics on ISR progression in human SFAs.

Original languageEnglish (US)
Pages (from-to)2349-2364
Number of pages16
JournalAnnals of Biomedical Engineering
Volume49
Issue number9
DOIs
StatePublished - Sep 2021

Keywords

  • Computational fluid dynamics
  • In-stent restenosis
  • Longitudinal study
  • Patient-specific computer modeling
  • Peripheral artery disease
  • Stent overlapping
  • Vascular remodeling
  • Wall shear stress

ASJC Scopus subject areas

  • Biomedical Engineering

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