HEMODYNAMIC ANALYSIS OF STENT EXPANSION RATIO FOR VERTEBRAL ARTERY OSTIAL STENOSIS INTERVENTION

Stents have been used successfully for treating stenosis in the vertebral artery ostium. The size of stent is found to be an important link in stent design, implantation strategy, and clinical outcome. However, there is no direct evidence of a relationship between stent expansion ratio and the stented artery. This study investigated the influence of stent expansion ratio on local hemodynamics (such as pressure distribution and pressure gradient) of vertebral artery ostial stenosis to determine a possible biomechanical mechanism. Computer-aided design of models with stents with different expansion ratios (i.e., 1.00, 1.125, and 1.25) and internal flow fields were created. All the models were meshed and simulated using computational fluid dynamics (CFD) tools. The comparisons of pressure distribution and pressure gradient are specifically presented. The results showed that the pressures increase and the pressure gradient decreases after stent implantation. The mean pressure at the stented region rises significantly with the increase of stent oversize. The heterogeneity of the pressure gradient was reduced at the stented region in the case with the expansion ratio of 1.125, whereas this effect was not obvious in other expansion ratio cases. Additionally, the combination of higher pressure and a lower pressure gradient in the case with the expansion ratio of 1.125 was significantly observed. This study demonstrated that the proper size of stent, especially with regards to the expansion ratio, is an important factor influencing the treatment of vertebral artery ostial stenosis. It is the recognition of the necessity to consider the relationship between expansion ratio and stenosis in vertebral artery ostium. These findings could help to address the optimization of hemodynamic performance for stent implantation.