Influence of catheter insertion on the hemodynamic environment in coronary arteries
Introduction
Intravascular stents are small tube-like structures expanded into stenotic arteries to restore blood flow perfusion for the downstream tissues that have become clogged by the build-up over time of fat, cholesterol or others substances [1]. After the first percutaneous coronary intervention (PCI) was performed, more than 1.8 million patients received one or more intracoronary stents annually [2]. The deployment of an intravascular stent has become a widely used and minimally invasive treatment for coronary heart disease [3].
With the widespread use of intravascular stents, perioperative complications have emerged, such as vessel spasm, thrombosis and restenosis [2], [4], [5], [6], [7]. Although rare, these complications are life-threatening complications during and shortly after PCI [8]. Sinha et al. reported that the repeated use of IVUS prior to PCI would result in cardiac arrhythmias and vessel spasm [9]. The antithrombotic and anticoagulant regimens, such as bivalirudin, heparin, glycoprotein IIb/IIIa inhibitors and so on, are essential to avoid thrombogenesis during PCI [10], [11], [12], especially for patients with acute coronary syndromes [13]. Even so, Buller et al. observed that unexplained cases of thrombosis primarily that involved PCI equipment despite administration of acetylsalicylic acid, clopidogrel, subcutaneous enoxaparin and abciximab [14]. On the other hand, De Feyter et al. have also reported that acute coronary artery occlusion during surgery often occasionally happened, and its frequency was higher in patients with unstable angina, multi-vessel disease, and complex lesions [15]. Regar et al. reported that restenosis was related to procedure-specific factor, which was affected by implantation technique [16].
The causes for these perioperative complications remain unknown, and some literatures reported the intraoperative factors such as the degree of damaged endothelial cells and depth of the injury, the plaque composition and shape, the type of intravascular stent expansion and local fluid dynamics [17], [18], [19], [20], [21]. As an essential and intricate part of intervention operation, the catheter insertion process was hardly considered as another potential factor for perioperative complications.
The catheter insertion process was destined to induce interference or hemodynamics change during surgery. Some published studies reported that the catheter or guidewire in coronary artery could exert obstruction effect on measuring pressure drops for the diagnosis of moderate stenosis, and resulting additional “artifactual” stenosis on the blood flow during operation [22], [23], [24], [25], [26]. However, these studies were just conducted with simple 2-D models or 3-D ideal models. The aforesaid interference or hemodynamics change could inevitably appear in realistic coronary arteries with irregular curvature and angulation, and might induce more complicated and serious effects [27]. These effects could directly act on hemodynamic factors such as WSS [28], which has been proved to induce morphological and functional changes in the endothelium and was critically important in regulating the atheroprotective and vessel wall dysfunction [29], [30], [31]. In addition, the previous paper reported the shear-induced platelet activation potency and the potential risk of catheter thrombose during clinical performance of these catheters [32]. Therefore, we hypothesized that the insertion process of catheter could disturb the hemodynamic environment in realistic coronary arteries and then cause susceptible factors, which might negatively make coronary arteries more vulnerable to those perioperative complications.
To test this hypothesis, a realistic coronary artery model was reconstructed based on CT scan images. Seven successive stages in the catheter insertion process were defined and the hemodynamic environment at these stages was numerically simulated. The main objective of the present study was to investigate the influence of catheter insertion process on hemodynamic environment in coronary arteries.
Section snippets
Artery model
The realistic left coronary arterial model was reconstructed based on the computed tomography (CT) scan images with Mimics software (v9.0, Materialise, Ann Arbor, MI, USA). The CT-relevant parameters were described below: 0.9 mm slice thickness, 0.45 mm slice increment, 0.324 mm pixel size, a 512×512 image resolution and total 293 slices. Subsequently simple smoothing and surfacing processes were applied to the model with Geomagic Studio 2012(3D Systems, Morrisville, NC, USA). The left coronary
Flow pattern
The velocity streamlines at four typical stages (Stage Origin and Stage 3, 5, 7) were showed in Fig. 2, which indicated no obvious disturbance of flow pattern in LCA in the catheter insertion process. However, compared with Stage Origin, this insertion process noticeably increased the flow velocity magnitude in LAD after catheter inserted into LAD (Stage 5). The flow velocity in LCxA and LIA was not observably altered.
Wall shear stress (WSS) distribution
The WSS contours in Fig. 3 depicted that the WSS on the wall of LAD increased
Discussion
Although intravascular stenting can reduce the postoperative morbidity and mortality, perioperative complications are still nagging for patients over time [4], [5], [6]. The causes remain unknown, and numerous studies have been conducted to investigate the potential influences of many postoperative and intraoperative factors [3], [4], [17], [21], [39], [40], [41], [42], [43], [44]. Only a few studies had reported that the catheter or guide-wire in coronary artery could exert obstruction effect
Conclusion
This study investigated the influences of the catheter insertion on hemodynamic environment in LCA during surgery. The results revealed that the insertion process could expose the endothelial cells of LAD to high-WSS condition, and the inserted catheter could increase the risk of platelet aggregation in blood flow. We concluded that these influences could make coronary arteries more vulnerable to perioperative complications. The present study concentrates on the rare but life-threatening
Conflicts of interest
There is no conflict of interest involved in the manuscript.
Funding
This work was supported by the National Natural Science Foundation of China (grant no.: 61190123, 11332003, 11472031, 31200703, 11421202), the 111 Project (B13003) and National Key Technology R&D Program of the Ministry of Science and Technology of China (2012BAI14B04).
Ethical approval
Not required.
References (54)
- et al.
A predictive study of the mechanical behaviour of coronary stents by computer modelling
Med Eng Phys
(2005) - et al.
Realistic finite element-based stent design: the impact of balloon folding
J Biomech
(2008) - et al.
Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study
Lancet
(2007) - et al.
Non-cardiac surgery after coronary stenting: early surgery and interruption of antiplatelet therapy are associated with an increase in major adverse cardiac events
J Am Coll Cardiol
(2007) - et al.
Functional and anatomical diagnosis of coronary artery stenoses
J Surg Res
(2008) - et al.
Bivalirudin in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a subgroup analysis from the Acute Catheterization and Urgent Intervention Triage strategy (ACUITY) trial
Lancet
(2007) - et al.
Catheter thrombosis during primary percutaneous coronary intervention for acute ST elevation myocardial infarction despite subcutaneous low-molecular-weight heparin, acetylsalicylic acid, clopidogrel and abciximab pretreatment
Can J Cardiol
(2006) - et al.
On the effects of different strategies in modelling balloon-expandable stenting by means of finite element method
J Biomech
(2008) - et al.
Restenosis and the proportional neo intimal response to coronary artery injury: results in a porcine model
J Am Coll Cardiol
(1992) - et al.
Simulation of a balloon expandable stent in a realistic coronary artery-Determination of the optimum modelling strategy
J Biomech
(2010)
Guidewire flow obstruction effect on pressure drop-flow relationship in moderate coronary artery stenosis
J Biomech
Blood flow and macromolecular transport in complex blood vessels
Clin Biomech (Bristol, Avon)
Hemodynamic characterization of transient blood flow in right coronary arteries with varying curvature and side-branch bifurcation angles
Comput Biol Med
The role of shear stress in the pathogenesis of atherosclerosis
Lab Invest
Finite element modeling of a progressively expanding shape memory stent
J Biomech
The influence of boundary conditions on wall shear stress distribution in patients specific coronary trees
J Biomech
Influence of curvature dynamics on pulsatile coronary artery flow in a realistic bifurcation model
J Biomech
Computation of hemodynamics in the left coronary artery with variable angulations
J Biomech
Coronary stents and perioperative anti-platelet regimen: dilemma of bleeding and stent thrombosis
Br J Anaesth
Perioperative management of patients with coronary stents
J Am Coll Cardiol
Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy
Lancet
Stent expansion in curved vessel and their interactions: a finite element analysis
J Biomech
Numerical simulation of drug eluting coronary stents: mechanics, fluid dynamics and drug release
Comput Methods Appl Mech Eng
Mechanical behaviour modelling of balloon-expandable stents
J Biomech
Analytic solutions of Newtonian and non-Newtonian pipe flows subject to a general time-dependent pressure gradient
J Non-Newtonian Fluid Mech
Vascular dysfunction of brachial artery after transradial access for coronary catheterization: impact of smoking and catheter changes
JACC Cardiovasc Interv
Activation-independent platelet adhesion and aggregation under elevated shear stress
Blood
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