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Nitinol Stent Oversizing in Patients Undergoing Popliteal Artery Revascularization: A Finite Element Study

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Abstract

Nitinol stent oversizing is frequently performed in peripheral arteries to ensure a desirable lumen gain. However, the clinical effect of mis-sizing remains controversial. The goal of this study was to provide a better understanding of the structural and hemodynamic effects of Nitinol stent oversizing. Five patient-specific numerical models of non-calcified popliteal arteries were developed to simulate the deployment of Nitinol stents with oversizing ratios ranging from 1.1 to 1.8. In addition to arterial biomechanics, computational fluid dynamics methods were adopted to simulate the physiological blood flow inside the stented arteries. Results showed that stent oversizing led to a limited increase in the acute lumen gain, albeit at the cost of a significant increase in arterial wall stresses. Furthermore, localized areas affected by low Wall Shear Stress increased with higher oversizing ratios. Stents were also negatively impacted by the procedure as their fatigue safety factors gradually decreased with oversizing. These adverse effects to both the artery walls and stents may create circumstances for restenosis. Although the ideal oversizing ratio is stent-specific, this study showed that Nitinol stent oversizing has a very small impact on the immediate lumen gain, which contradicts the clinical motivations of the procedure.

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Acknowledgments

This investigation was supported by the Research Council of the Kantonsspital Aarau, the Swiss Heart Foundation, the Gotthard Schettler Foundation and the Swiss National Science Foundation. The authors have no commercial, proprietary, or financial interest in any products or companies described in this article.

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Authors and Affiliations

  1. Institute for Surgical Technology & Biomechanics, University of Bern, Bern, Switzerland

    Can Gökgöl, Farhad Rikhtegar Nezami & Philippe Büchler

  2. Clinical and Interventional Angiology, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland

    Nicolas Diehm

  3. University of Applied Sciences Furtwangen, Villingen-Schwenningen, Germany

    Nicolas Diehm

  4. Harvard-MIT Biomedical Engineering Center, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA

    Farhad Rikhtegar Nezami

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  1. Can Gökgöl
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Correspondence to Nicolas Diehm.

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Associate Editor Estefanía Peña oversaw the review of this article.

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Gökgöl, C., Diehm, N., Nezami, F.R. et al. Nitinol Stent Oversizing in Patients Undergoing Popliteal Artery Revascularization: A Finite Element Study. Ann Biomed Eng 43, 2868–2880 (2015). https://doi.org/10.1007/s10439-015-1358-8

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