Investigation of the Effects of Pulsatile Blood Flow on Arterial Drug Uptake for Drug-eluting Coronary Stents

Authors

1 Mechanical Engineering Department, Arak University, Arak, Iran

2 Arak University

10.22044/jsfm.2024.14409.3852

Abstract

Blood flow characteristics have a considerable impact on drug uptake from drug-eluting stents. For this reason, in this study, the effect of pulsatile blood flow induced by heartbeats on hemodynamics and drug transfer from drug-eluting stents has been investigated using computational fluid dynamics. Previous studies have investigated the effect of this feature on renal vessels; However, this issue has not been investigated in the case of coronary arteries. For this purpose, the blood flow and drug transport in the lumen and tissue of a stented right coronary artery have been simulated in an unsteady and non-Newtonian manner. To analyze the impact of pulsatile flow waveform, three different pulsatile flows including a physiological waveform in the human right coronary artery, a general physiological waveform in the arteries of the human body, and a simple sinusoidal waveform were imposed. Furthermore, the results were compared for three Womersley numbers and two Reynolds numbers. The results indicate that the blood flow waveforms and their frequency (Womersley number) have a negligible effect on hemodynamics and drug transfer parameters. However, the impact of Reynolds number is significant. The results also show that the impact of Newtonian or non-Newtonian blood viscosity on hemodynamics and drug transfer is negligible. Therefore, assuming blood as a Newtonian fluid in these simulations could be accurate.

Keywords

Main Subjects

References

[1] Zeng Y, Xu J, Deng Y, Li X, Chen W, Tang Y. (2024) Drug-eluting stents for coronary artery disease in the perspective of bibliometric analysis. Front Cardiovasc Med;11:1288659.
[2] Morlacchi S, Migliavacca F. (2013) Modeling stented coronary arteries: where we are, where to go. Ann Biomed Eng.
[3] Janicki C, Hwang CW, Edelman ER. (2003) Dose model for stent-based delivery of a radioactive compound for the treatment of restenosis in coronary arteries. Med Phys.
]4[   بهین فر پ, نورانی ا. (2023) حل تحلیلی و عددی استنت‌ آگزتیک با هندسه‌ی Re-entrant و بهینه‌سازی چند‌هدفه‌ی آن. مکانیک سازه‌ها و شاره‌ها;12:125–37.
]5[   ایمانی م, معظمی گودرزی ع, مهدی نژاد ج. (2014) بررسی تأثیر هندسه و جنس استنت بر نتایج حاصل از استنت گذاری با استفاده از روش اجزای محدود. مهندسی مکانیک مدرس;14:45–53.
]6[ نعمت زاده ف، فراهانی م. (2021) ارزیابی محاسباتی تأثیر پارامترهای هندسی بر عملکرد مکانیکی استنت های از جنس آلیاژهای حافظه دار برای کاربرد در سیستم‌های تنفسی. مهندسی ساخت و تولید ایران;9:52–65.
]7[ صادق آبادی ا، صدرنژاد خ، حسن زاده نعمتی ن، آصف نژاد آ، قاسمی م. (2021) سیر تکاملی و آینده استنت های کرونری زیست جذب پذیر 2021;29:1–15.
[8]   Pleva L, Kukla P, Hlinomaz O. (2018) Treatment of coronary in-stent restenosis: A systematic review. J. of Geriatric Cardiology;15:173–84.
[9]   Clinical experience with drug-eluting stents - PubMed n.d. https://pubmed.ncbi.nlm.nih.gov/12478233/ (accessed December 4, 2022).
[10] Hofma SH, van Beusekom HMM, Serruys PW, van Der Giessen WJ. (2001) Recent Developments in Coated Stents. Curr Interv Cardiol Rep;3:28–36.
[11] Liistro F, Stankovic G, Di Mario C, Takagi T, Chieffo A, Moshiri S, et al. (2002) First Clinical Experience With a Paclitaxel Derivate–Eluting Polymer Stent System Implantation for In-Stent Restenosis. Circulation;105:1883–6.
[12] McCormick C. (2017) Overview of cardiovascular stent designs. Functionalised Cardiovascular Stents:3–26.
[13] Mukheja Y, Sarkar A, Arora R, Pal K, Ahuja A, Vashishth A, et al. (2024) Unravelling the progress and potential of drug-eluting stents and drug-coated balloons in cardiological insurgencies. Life Sci;352:122908.
[14] Smith EJ, Rothman MT. (2003) Antiproliferative coatings for the treatment of coronary heart disease:. what are the targets and which are the tools? J Interv Cardiol;16:475–83.
[15] Head DE, Sebranek JJ, Zahed C, Coursin DB, Prielipp RC. (2007) A tale of two stents: perioperative management of patients with drug-eluting coronary stents. J Clin Anesth;19:386–96
[16] Weiler JM, Sparrow EM, Ramazani R. (2012) Mass transfer by advection and diffusion from a drug-eluting stent. Int J Heat Mass Transf;55:1–7.
[17] Hsiao HM, Chiu YH, Wu TY, Shen JK, Lee TY. (2013) Effects of through-hole drug reservoirs on key clinical attributes for drug-eluting depot stent. Med Eng Phys;35:884–97.
[18] Sun A, Wang Z, Fan Z, Tian X, Zhan F, Deng X, et al. (2015) Influence of proximal drug eluting stent (DES) on distal bare metal stent (BMS) in multi-stent implantation strategies in coronary arteries. Med Eng Phys;37:840–4.
[19] Gagliardi M. (2020) Numerical analysis of paclitaxel-eluting coronary stents: Mechanics and drug release properties. Med Eng Phys;82:78–85.
[20] Brust M, Schaefer C, Doerr R, Pan L, Garcia M, Arratia PE, et al. (2013) Rheology of human blood plasma: Viscoelastic versus Newtonian behavior. Phys Rev Lett;110.
[21] Karimi S, Dabagh M, Vasava P, Dadvar M, Dabir B, Jalali P. (2014) Effect of rheological models on the hemodynamics within human aorta: CFD study on CT image-based geometry. J Nonnewton Fluid Mech;207:42–52.
[22] Michael Clarion, Michael Deegan, Tyler Helton, Jesse Hudgins, Nick Monteferrante, Evan Ousley, et al. (2018) Contemporary modeling and analysis of steady state and transient human blood rheology. Rheol Acta.
[23] Wang XQ. (2003) The application of Reynolds number in biology. J. Qinghai Univ.:67–9.
[24] Qu SB. (1994) Transcranial doppler ultrasound instrument detection of carotid artery blood flow velocity normal reference range. J. Harbin Med. Univ.:211–3.
[25] Du W. (1996) The effects of exercise on human artery blood flow velocity. J. Beijing Sport Univ.
[26] Seo T, Schachter LG, Barakat AI. (2005) Computational study of fluid mechanical disturbance induced by endovascular stents. Ann Biomed Eng;33:444–56.
[27] Sukavaneshvar S, Rosa GM, Solen KA. (2000) Enhancement of Stent-Induced Thromboembolism by Residual Stenoses: Contribution of Hemodynamics.
[28] Johnston BM, Johnston PR, Corney S, Kilpatrick D. (2004) Non-Newtonian blood flow in human right coronary arteries: Steady state simulations. J Biomech;37:709–20.
[29] Johnston BM, Johnston PR, Corney S, Kilpatrick D. (2006) Non-Newtonian blood flow in human right coronary arteries: Transient simulations. J Biomech;39:1116–28.
[30] O’Brien CC, Kolachalama VB, Barber TJ, Simmons A, Edelman ER. (2013) Impact of flow pulsatility on arterial drug distribution in stent-based therapy. J. Controlled Release;168:115–24.
[31] Vijayaratnam PRS, Reizes JA, Barber TJ. (2019) Flow-Mediated Drug Transport from Drug-Eluting Stents is Negligible: Numerical and In-vitro Investigations. Ann Biomed Eng;47:878–90.
[32]   Dodge JT, Brown BG, Bolson EL, Dodge HT. (1992) Lumen diameter of normal human coronary arteries. Influence of age, sex, anatomic variation, and left ventricular hypertrophy or dilation. Circulation;86:232–46.
[33]   Deen WM (1998) (William M. Analysis of transport phenomena:597.
[34]     Kolachalama VB, Tzafriri AR, Arifin DY, Edelman ER. (2009) Luminal flow patterns dictate arterial drug deposition in stent-based delivery. J. Controlled Release;133:24–30.
[35] Vijayaratnam PRS, O’Brien CC, Reizes JA, Barber TJ, Edelman ER. (2015) The impact of blood rheology on drug transport in stented arteries: Steady simulations. PLoS One;10.
[36]   Tada S, Tarbell JM. (2002) Flow through internal elastic lamina affects shear stress on smooth muscle cells (3D simulations). Am J Physiol Heart Circ Physiol;282.
[37]   The CFL Condition and How to Choose Your Timestep Size | SimScale n.d. https://www.simscale.com/blog/cfl-condition/ (accessed May 3, 2023).
[38]   Balakrishnan B, Tzafriri AR, Seifert P, Groothuis A, Rogers C, Edelman BR. (2005) Strut position, blood flow, and drug deposition: implications for single and overlapping drug-eluting stents. Circulation;111:2958–65.
[39]   Matsuo S, Tsuruta M, Hayano M, Imamura Y, Eguchi Y, Tokushima T, et al. (1988) Phasic coronary artery flow velocity determined by Doppler flowmeter catheter in aortic stenosis and aortic regurgitation. Am J Cardiol;62:917–22.
[40]   Bukač M, Čanić S, Tambača J, Wang Y. (2019) Fluid–structure interaction between pulsatile blood flow and a curved stented coronary artery on a beating heart: A four stent computational study. Comput Methods Appl Mech Eng;350:679–700.
[41]   Sherwin SJ, Blackburn HM. (2005) Three-dimensional instabilities and transition of steady and pulsatile axisymmetric stenotic flows. J Fluid Mech;533:297–327.
[42]   Banerjee MK, Ganguly R, Datta A. (2012) Effect of Pulsatile Flow Waveform and Womersley Number on the Flow in Stenosed Arterial Geometry. ISRN Biomath;2012:1–17.
[43]   Australia H. Bradycardia – symptoms, causes and when to see your doctor 2023.
[44]   Heart Rate - Physiopedia n.d. https://www.physio-pedia.com/Heart_Rate (accessed July 15, 2023).
[45]   Kolachalama VB, Levine EG, Edelman ER. (2009) Luminal Flow Amplifies Stent-Based Drug Deposition in Arterial Bifurcations. PLoS One;4:e8105.
 
Journal of Solid and Fluid Mechanics
Volume 14, Issue 4
September and October 2024
Pages 15-30

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