Finite element simulation of stent implantation and its applications in the interventional planning for hemorrhagic cardio-cerebrovascular diseases_Journal of Biomedical Engineering

Authors：

 WANG Shengzhang ^1,2 , CAI Yunhan ¹ , MENG Zhuangyuan ¹ , ZHANG Xiaolong ³ , YANG Xinjian ⁴ , DONG Zhihui ⁵

1. Institute of Biomechanics, Department of Aeronautics and Astronautics, Fudan University, Shanghai 200433, P.R.China;
2. Institute of Biomedical Engineering Technology, Academy of Engineering and Technology, Fudan University, Shanghai 200433, P.R.China;
3. Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200040, P.R.China;
4. Department of Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, P.R.China;
5. Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R.China;

Corresponding author：

WANG Shengzhang, Email: szwang@fudan.edu.cn

Keywords：

cerebral aneurysm; aortic dissection; braided stent; stent graft; finite element simulation

DOI：

10.7507/1001-5515.202008063

Video：

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Numerical simulation of stent deployment is very important to the surgical planning and risk assess of the interventional treatment for the cardio-cerebrovascular diseases. Our group developed a framework to deploy the braided stent and the stent graft virtually by finite element simulation. By using the framework, the whole process of the deployment of the flow diverter to treat a cerebral aneurysm was simulated, and the deformation of the parent artery and the distributions of the stress in the parent artery wall were investigated. The results provided some information to improve the intervention of cerebral aneurysm and optimize the design of the flow diverter. Furthermore, the whole process of the deployment of the stent graft to treat an aortic dissection was simulated, and the distributions of the stress in the aortic wall were investigated when the different oversize ratio of the stent graft was selected. The simulation results proved that the maximum stress located at the position where the bare metal ring touched the artery wall. The results also can be applied to improve the intervention of the aortic dissection and the design of the stent graft.

Citation： WANG Shengzhang, CAI Yunhan, MENG Zhuangyuan, ZHANG Xiaolong, YANG Xinjian, DONG Zhihui. Finite element simulation of stent implantation and its applications in the interventional planning for hemorrhagic cardio-cerebrovascular diseases. Journal of Biomedical Engineering, 2020, 37(6): 974-982. doi: 10.7507/1001-5515.202008063 Copy

1.	Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
2.	Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China. Circulation, 2017, 135(8): 759-771.
3.	Henkes H, Weber W. The past, present and future of endovascular aneurysm treatment. Clin Neuroradiol, 2015, 25(S2): 317-324.
4.	Hasan D M, Nadareyshvili A I, Hoppe A L, et al. Cerebral aneurysm sac growth as the etiology of recurrence after successful coil embolization. Stroke, 2012, 43(3): 866-868.
5.	Campi A, Ramzi N, Molyneux A J, et al. Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke, 2007, 38(5): 1538-1544.
6.	Bhogal P, Ganslandt O, Bazner H, et al. The fate of side branches covered by flow diverters–results from 140 patients. World Neurosurg, 2017, 103: 789-798.
7.	Bavaria J E, Appoo J J, Makaroun M S, et al. Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: A multicenter comparative trial. J Thorac Cardiovasc Surg, 2007, 133(2): 369-377.
8.	Nienaber C A, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. New Engl J Med, 1999, 340(20): 1539-1545.
9.	Gleason T. Endoleaks after endovascular aortic stent-grafting: Impact, diagnosis, and management. Semin Thorac Cardiovasc Surg, 2009, 21(4): 363-372.
10.	Fanelli F, Cannavale A, O’Sullivan G J, et al. Endovascular repair of acute and chronic aortic type B dissections: Main factors affecting aortic remodeling and clinical outcome. JACC Cardiovasc Interv, 2016, 9(2): 183-191.
11.	Lasheras J C. The biomechanics of arterial aneurysms. Ann Rev Fluid Mech, 2007, 39: 293-319.
12.	Paliwal N, Yu H, Xu J, et al. Virtual stenting workflow with vessel-specific initialization and adaptive expansion for neurovascular stents and flow diverters. Comput Methods Biomech Biomed Engin, 2016, 19(13): 1423-1431.
13.	Peach T W, Ngoepe M, Spranger K, et al. Personalizing flow-diverter intervention for cerebral aneurysms: from computational hemodynamics to biochemical modeling. Int J Numer Method Biomed Eng, 2014, 30(11): 1387-1407.
14.	Zhang Y, Huang Q, Fang Y, et al. A novel flow diverter (Tubridge) for the treatment of recurrent aneurysms: A single-center experience. Korean J Radiol, 2017, 18(5): 852.
15.	Lubicz B, Collignon L, Raphaeli G, et al. Pipeline flow-diverter stent for endovascular treatment of intracranial aneurysms: Preliminary experience in 20 patients with 27 aneurysms. World Neurosurg, 2011, 76(1-2): 114-119.
16.	Leonardi M, Cirillo L, Toni F, et al. Treatment of intracranial aneurysms using flow-diverting silk stents (BALT): A single centre experience. Interv Neuroradiol, 2011, 17(3): 306-315.
17.	郑清丽. 颅内动脉瘤编织支架力学行为有限元分析. 太原: 太原理工大学, 2015.
18.	Kim J H, Kang T J, Yu W. Mechanical modeling of self-expandable stent fabricated using braiding technology. J Biomech, 2008, 41(15): 3202-3212.
19.	Conti M. Finite element analysis of self-expanding braided wire stents. Ghent: Ghent University, 2010.
20.	Fu W, Xia Q. Interaction between flow diverter and parent artery of intracranial aneurysm: A computational study. Appl Bionics Biomech, 2017, 2017: 1-9.
21.	Damiano R J, Ma D, Xiang J, et al. Finite element modeling of endovascular coiling and flow diversion enables hemodynamic prediction of complex treatment strategies for intracranial aneurysm. J Biomech, 2015, 48(12): 3332-3340.
22.	Ma D, Dargush G F, Natarajan S K, et al. Computer modeling of deployment and mechanical expansion of neurovascular flow diverter in patient-specific intracranial aneurysms. J Biomech, 2012, 45(13): 2256-2263.
23.	MA D, Dumount T M, Kosukegawa H, et al. High Fidelity Virtual Stenting (HiFiVS) for intracranial aneurysm flow diversion: In vitro and in silico. Ann Biomed Eng, 2013, 41(10): 2143-2156.
24.	Cai Y, Meng Z, Jiang Y, et al. Finite element modeling and simulation of the implantation of braided stent to treat cerebral aneurysm. Medicine in Novel Technology and Devices, 2020, 5: 100031.
25.	孟庄源, 马韬, 王盛章, 等. 覆膜支架治疗主动脉夹层的有限元分析. 医用生物力学, 2018, 33(3): 31-35.
26.	Ma T, Dong Z H, Wang S, et al. Computational investigation of interaction between stent graft and aorta in retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2018, 68(6S): 14S-21S.
27.	阚晓昕, 白一帆, 马韬, 等. 基于 CT 影像重建的主动脉夹层的流固耦合模拟. 水动力学研究与进展, 2015, 30(6): 701-706.
28.	Carroccio A, Faries P, Morrissey N, et al. Predicting iliac limb occlusions after bifurcated aortic stent grafting: Anatomic and device related causes. J Vasc Surg, 2002, 36(4): 679-684.
29.	Zarins C K, Arko F R, Crabtree T, et al. Explant analysis of AneuRx stent grafts: Relationship between structural findings and clinical outcome. J Vasc Surg, 2004, 40(1): 1-11.
30.	谷雪莲, 胡方遒, 于凯, 等. 两种覆膜支架的生物力学对比分析. 医用生物力学, 2015, 30(5): 410-415.
31.	Meng Z, Ma T, Cai Y, et al. Numerical modeling and simulations of type B aortic dissection treated by stent-grafts with different oversizing ratios. Artif Organs, 2020. Doi: 10.1111/aor.13750.

1. Zhou M, Wang H, Zeng X, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 2019, 394(10204): 1145-1158.
2. Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China. Circulation, 2017, 135(8): 759-771.
3. Henkes H, Weber W. The past, present and future of endovascular aneurysm treatment. Clin Neuroradiol, 2015, 25(S2): 317-324.
4. Hasan D M, Nadareyshvili A I, Hoppe A L, et al. Cerebral aneurysm sac growth as the etiology of recurrence after successful coil embolization. Stroke, 2012, 43(3): 866-868.
5. Campi A, Ramzi N, Molyneux A J, et al. Retreatment of ruptured cerebral aneurysms in patients randomized by coiling or clipping in the International Subarachnoid Aneurysm Trial (ISAT). Stroke, 2007, 38(5): 1538-1544.
6. Bhogal P, Ganslandt O, Bazner H, et al. The fate of side branches covered by flow diverters–results from 140 patients. World Neurosurg, 2017, 103: 789-798.
7. Bavaria J E, Appoo J J, Makaroun M S, et al. Endovascular stent grafting versus open surgical repair of descending thoracic aortic aneurysms in low-risk patients: A multicenter comparative trial. J Thorac Cardiovasc Surg, 2007, 133(2): 369-377.
8. Nienaber C A, Fattori R, Lund G, et al. Nonsurgical reconstruction of thoracic aortic dissection by stent-graft placement. New Engl J Med, 1999, 340(20): 1539-1545.
9. Gleason T. Endoleaks after endovascular aortic stent-grafting: Impact, diagnosis, and management. Semin Thorac Cardiovasc Surg, 2009, 21(4): 363-372.
10. Fanelli F, Cannavale A, O’Sullivan G J, et al. Endovascular repair of acute and chronic aortic type B dissections: Main factors affecting aortic remodeling and clinical outcome. JACC Cardiovasc Interv, 2016, 9(2): 183-191.
11. Lasheras J C. The biomechanics of arterial aneurysms. Ann Rev Fluid Mech, 2007, 39: 293-319.
12. Paliwal N, Yu H, Xu J, et al. Virtual stenting workflow with vessel-specific initialization and adaptive expansion for neurovascular stents and flow diverters. Comput Methods Biomech Biomed Engin, 2016, 19(13): 1423-1431.
13. Peach T W, Ngoepe M, Spranger K, et al. Personalizing flow-diverter intervention for cerebral aneurysms: from computational hemodynamics to biochemical modeling. Int J Numer Method Biomed Eng, 2014, 30(11): 1387-1407.
14. Zhang Y, Huang Q, Fang Y, et al. A novel flow diverter (Tubridge) for the treatment of recurrent aneurysms: A single-center experience. Korean J Radiol, 2017, 18(5): 852.
15. Lubicz B, Collignon L, Raphaeli G, et al. Pipeline flow-diverter stent for endovascular treatment of intracranial aneurysms: Preliminary experience in 20 patients with 27 aneurysms. World Neurosurg, 2011, 76(1-2): 114-119.
16. Leonardi M, Cirillo L, Toni F, et al. Treatment of intracranial aneurysms using flow-diverting silk stents (BALT): A single centre experience. Interv Neuroradiol, 2011, 17(3): 306-315.
17. 郑清丽. 颅内动脉瘤编织支架力学行为有限元分析. 太原: 太原理工大学, 2015.
18. Kim J H, Kang T J, Yu W. Mechanical modeling of self-expandable stent fabricated using braiding technology. J Biomech, 2008, 41(15): 3202-3212.
19. Conti M. Finite element analysis of self-expanding braided wire stents. Ghent: Ghent University, 2010.
20. Fu W, Xia Q. Interaction between flow diverter and parent artery of intracranial aneurysm: A computational study. Appl Bionics Biomech, 2017, 2017: 1-9.
21. Damiano R J, Ma D, Xiang J, et al. Finite element modeling of endovascular coiling and flow diversion enables hemodynamic prediction of complex treatment strategies for intracranial aneurysm. J Biomech, 2015, 48(12): 3332-3340.
22. Ma D, Dargush G F, Natarajan S K, et al. Computer modeling of deployment and mechanical expansion of neurovascular flow diverter in patient-specific intracranial aneurysms. J Biomech, 2012, 45(13): 2256-2263.
23. MA D, Dumount T M, Kosukegawa H, et al. High Fidelity Virtual Stenting (HiFiVS) for intracranial aneurysm flow diversion: In vitro and in silico. Ann Biomed Eng, 2013, 41(10): 2143-2156.
24. Cai Y, Meng Z, Jiang Y, et al. Finite element modeling and simulation of the implantation of braided stent to treat cerebral aneurysm. Medicine in Novel Technology and Devices, 2020, 5: 100031.
25. 孟庄源, 马韬, 王盛章, 等. 覆膜支架治疗主动脉夹层的有限元分析. 医用生物力学, 2018, 33(3): 31-35.
26. Ma T, Dong Z H, Wang S, et al. Computational investigation of interaction between stent graft and aorta in retrograde type A dissection after thoracic endovascular aortic repair for type B aortic dissection. J Vasc Surg, 2018, 68(6S): 14S-21S.
27. 阚晓昕, 白一帆, 马韬, 等. 基于 CT 影像重建的主动脉夹层的流固耦合模拟. 水动力学研究与进展, 2015, 30(6): 701-706.
28. Carroccio A, Faries P, Morrissey N, et al. Predicting iliac limb occlusions after bifurcated aortic stent grafting: Anatomic and device related causes. J Vasc Surg, 2002, 36(4): 679-684.
29. Zarins C K, Arko F R, Crabtree T, et al. Explant analysis of AneuRx stent grafts: Relationship between structural findings and clinical outcome. J Vasc Surg, 2004, 40(1): 1-11.
30. 谷雪莲, 胡方遒, 于凯, 等. 两种覆膜支架的生物力学对比分析. 医用生物力学, 2015, 30(5): 410-415.
31. Meng Z, Ma T, Cai Y, et al. Numerical modeling and simulations of type B aortic dissection treated by stent-grafts with different oversizing ratios. Artif Organs, 2020. Doi: 10.1111/aor.13750.

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Finite element simulation of stent implantation and its applications in the interventional planning for hemorrhagic cardio-cerebrovascular diseases

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