Computational modeling of low-density lipoprotein accumulation at the carotid artery bifurcation after stenting
Author(s)
Johari, Nasrul H
Menichini, Claudia
Hamady, Mohamad
Xu, Xiao Y
Type
Journal Article
Abstract
Restenosis typically occurs in regions of low and oscillating wall shear stress, which also favor the accumulation of atherogenic macromolecules such as low-density lipoprotein (LDL). This study aims to evaluate LDL transport and accumulation at the carotid artery bifurcation following carotid artery stenting (CAS) by means of computational simulation. The computational model consists of coupled blood flow and LDL transport, with the latter being modeled as a dilute substance dissolved in the blood and transported by the flow through a convection-diffusion transport equation. The endothelial layer was assumed to be permeable to LDL, and the hydraulic conductivity of LDL was shear-dependent. Anatomically realistic geometric models of the carotid bifurcation were built based on pre- and post-stent computed tomography (CT) scans. The influence of stent design was investigated by virtually deploying two different types of stents (open- and closed-cell stents) into the same carotid bifurcation model. Predicted LDL concentrations were compared between the post-stent carotid models and the relatively normal contralateral model reconstructed from patient-specific CT images. Our results show elevated LDL concentration in the distal section of the stent in all post-stent models, where LDL concentration is 20 times higher than that in the contralateral carotid. Compared with the open-cell stents, the closed-cell stents have larger areas exposed to high LDL concentration, suggesting an increased risk of stent restenosis. This computational approach is readily applicable to multiple patient studies and, once fully validated against follow-up data, it can help elucidate the role of stent strut design in the development of in-stent restenosis after CAS.
Date Issued
2023-12
Date Acceptance
2023-09-04
Citation
International Journal for Numerical Methods in Biomedical Engineering, 2023, 39 (12)
ISSN
1069-8299
Publisher
Wiley
Journal / Book Title
International Journal for Numerical Methods in Biomedical Engineering
Volume
39
Issue
12
Copyright Statement
© 2023 The Authors. International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd. This is an open access article under the terms of theCreative Commons AttributionLicense, which permits use, distribution and reproduction in any medium, providedthe original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/37730441
Subjects
carotid artery stenting
low-density lipoprotein
stent design
Publication Status
Published
Coverage Spatial
England
Article Number
e3772
Date Publish Online
2023-09-20