Quantification of Local Hemodynamic Alterations Caused by Virtual Implantation of Three Commercially-Available Stents for the Treatment of Aortic Coarctation
Patients with coarctation of the aorta (CoA) are prone to morbidity including atherosclerotic plaque that has been shown to correlate with altered wall shear stress (WSS) in the descending thoracic aorta (dAo). We created the first patient-specific computational fluid dynamics (CFD) model of a CoA patient treated by Palmaz stenting, and compared resulting WSS distributions to those from virtual implantation of the NumedCP and GenesisXD stents also commonly used for CoA. CFD models were created from magnetic resonance, fluoroscopy and blood pressure (BP) data. Simulations incorporated vessel deformation, downstream vascular resistance and compliance to match measured data and generate blood flow velocity and time-averaged WSS (TAWSS) results. TAWSS was quantified longitudinally and circumferentially in the stented region and dAo. While modest differences were seen in the distal portion of the stented region, marked differences were observed downstream along the posterior dAo and depended on stent type. The GenesisXD model had the least area of TAWSS values exceeding the threshold for platelet aggregation in vitro, followed by the Palmaz and NumedCP stents. Alterations in local blood flow patterns and WSS imparted on the dAo appear to depend on the type of stent implanted for CoA. These findings may aid pediatric interventional cardiologists in choosing the most appropriate stent for each patient, and ultimately reduce long-term morbidity following treatment for CoA by stenting.