Suggestion of potential stent design parameters to reduce restenosis risk driven by foreshortening or dogboning due to non-uniform balloon-stent expansion.

The foreshortening or dogboning of a stent that occurs due to transient non-uniform balloon-stent expansion can induce a vascular injury, resulting in restenosis of the coronary artery. However, previous studies rarely considered the effects of transient non-uniform balloon expansion on analysis of the mechanical properties and behaviors of stents during stent deployment, nor did they determine design parameters to minimize the restenosis risk driven by foreshortening or dogboning. The aim of the current study was, therefore, to suggest potential design parameters capable of reducing the possibility of restenosis risk driven by foreshortening or dogboning through a comparative study of seven commercial stents using finite element (FE) analyses of a realistic transient non-uniform balloon-stent expansion process. The results indicate that using stents composed of opened unit cells connected by bend-shaped link structures, in particular the MAC Plus stent, and controlling the geometrical and morphological features of the unit cell strut or the link structure at the distal ends of stent may prevent restenosis risk caused by foreshortening or dogboning. This study provides a first look at the realistic transient non-uniform balloon-stent expansion by investigating the mechanical properties, behaviors, and design parameters capable of reducing the possibility of restenosis risk induced by the foreshortening or the dogboning.

A morphological model of vertebral trabecular bone.

In their micro-structures, typical natural cellular materials such as vertebral trabecular bone have a network of doubly tapered struts, thickening near the strut joints. However, past analytical models for vertebral trabecular bone do not take account of the effect of strut taper on the mechanical properties. This paper presents an analytical cell model comprised of doubly tapered struts to predict the global mechanical properties of vertebral trabecular bone. The predicted results for male, female, and both sexes fit the experimental data well. By considering several strut taper geometries, it is shown that the horizontal Young's modulus and the horizontal uniaxial collapse stress are, in some cases, approximately 1.8- and 2.2-fold higher, respectively, than those of the uniform strut model. This finding illustrates the importance of increased trabecular thickening near the strut joints (i) for improving the accuracy of calculating the mechanical properties and (ii) for the effective treatment of aged bone using drug therapy. It also highlights the need to combine trabecular architecture measurements with information about the morphology near the strut joints.

A method for investigating the mechanical properties of intracoronary stents using finite element numerical simulation.

The proliferation of stent designs poses difficult problems to clinicians, who have to learn the relative merits of all stents to ensure optimal selection for each lesion, and also to regulatory authorities who have the dilemma of preventing the inappropriate marketing of substandard stents while not denying patients the benefits of advanced technology. Of the major factors influencing long-term results, those of patency and restenosis are being actively studied whereas the mechanical characteristics of devices influencing the technical results of stenting remain under-investigated. Each different stent design has its own particular features. A robust method for the independent objective comparison of the mechanical performance of each design is required. To do this by experimental measurement alone may be prohibitively expensive. A less costly option is to combine computer analysis, employing the standard numerical technique of the finite element method (FEM), with targeted experimental measurements of the specific mechanical behaviour of stents. In this paper the FEM technique is used to investigate the structural behaviour of two different stent geometries: Freedom stent geometry and Palmaz-Schatz (P-S) stent geometry. The effects of altering the stent geometry, the stent wire diameter and contact with (and material properties of) a hard eccentric intravascular lesion (simulating a calcified plaque) on stent mechanical performance were investigated. Increasing the wire diameter and the arterial elastic modulus by 150% results in the need to increase the balloon pressure to expand the stent by 10-fold. Increasing the number of circumferential convolutions increases the pressure required to initiate radial expansion of mounted stents. An incompressible plaque impinging on the mid portion of a stent causes a gross distortion of the Freedom stent and an hour-glass deformity in the P-S stent. These findings are of relevance for future comparative studies of the mechanical performance of stents, in designing newer stents and also in clinical practice.