TY - JOUR
T1 - In-Stent Restenosis Progression in Human Superficial Femoral Arteries
T2 - Dynamics of Lumen Remodeling and Impact of Local Hemodynamics
AU - Colombo, Monika
AU - He, Yong
AU - Corti, Anna
AU - Gallo, Diego
AU - Ninno, Federica
AU - Casarin, Stefano
AU - Rozowsky, Jared M.
AU - Migliavacca, Francesco
AU - Berceli, Scott
AU - Chiastra, Claudio
N1 - Funding Information:
This work has been supported by Fondazione Cariplo, Italy (Grant Number 2017-0792, TIME). Open access funding has been provided by Politecnico di Torino within the CRUI-CARE Agreement.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/9
Y1 - 2021/9
N2 - 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.
AB - 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.
KW - Computational fluid dynamics
KW - In-stent restenosis
KW - Longitudinal study
KW - Patient-specific computer modeling
KW - Peripheral artery disease
KW - Stent overlapping
KW - Vascular remodeling
KW - Wall shear stress
KW - Humans
KW - Middle Aged
KW - Hydrodynamics
KW - Male
KW - Patient-Specific Modeling
KW - Constriction, Pathologic/physiopathology
KW - Femoral Artery/pathology
KW - Stents/adverse effects
KW - Aged
KW - Hemodynamics
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U2 - 10.1007/s10439-021-02776-1
DO - 10.1007/s10439-021-02776-1
M3 - Article
C2 - 33928465
AN - SCOPUS:85105449476
SN - 0090-6964
VL - 49
SP - 2349
EP - 2364
JO - Annals of Biomedical Engineering
JF - Annals of Biomedical Engineering
IS - 9
ER -