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Haemodynamics and Flow Modification Stents for Peripheral Arterial Disease: A Review.

Kokkalis E, Aristokleous N, Houston JG - Ann Biomed Eng (2015)

Bottom Line: This secondary flow motion is lost in atheromatous disease and its re-introduction after endovascular treatment of PAD has been suggested as a method to induce stabilised and coherent haemodynamics.Stent designs able to generate spiral flow may support endothelial function and therefore increase patency rates.This review is focused on secondary flow phenomena in arteries and the development of flow modification stent technologies for the treatment of PAD.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Mail Box 1, Dundee, DD1 9SY, United Kingdom.

ABSTRACT
Endovascular stents are widely used for the treatment of peripheral arterial disease (PAD). However, the development of in-stent restenosis and downstream PAD progression remain a challenge. Stent revascularisation of PAD causes arterial trauma and introduces abnormal haemodynamics, which initiate complicated biological processes detrimental to the arterial wall. The interaction between stent struts and arterial cells in contact, and the blood flow field created in a stented region, are highly affected by stent design. Spiral flow is known as a normal physiologic characteristic of arterial circulation and is believed to prevent the development of flow disturbances. This secondary flow motion is lost in atheromatous disease and its re-introduction after endovascular treatment of PAD has been suggested as a method to induce stabilised and coherent haemodynamics. Stent designs able to generate spiral flow may support endothelial function and therefore increase patency rates. This review is focused on secondary flow phenomena in arteries and the development of flow modification stent technologies for the treatment of PAD.

No MeSH data available.


Related in: MedlinePlus

Single spiral flow detected with colour Doppler ultrasound; (a) femoral artery; (b) internal and external carotid arteries.
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Fig1: Single spiral flow detected with colour Doppler ultrasound; (a) femoral artery; (b) internal and external carotid arteries.

Mentions: Ku and Giddens,47 and Karino et al.41 showed the development of secondary flow motions in realistic peripheral arterial models as a result of bifurcations and branching. Complicated vortical structures were associated with flow separation and stagnation. In 1991, Stonebridge and Brophy68 detected spiral flow in peripheral arteries of the lower extremities and were the first to conclude that flow in arteries may be spiral in nature. Since that, the presence of spiral flow in right and left iliac and femoral arteries of healthy volunteers has been confirmed by several researchers using colour Doppler and vector Doppler imaging.31,63,70 Spiral flow can be detected using colour Doppler ultrasound with the transducer perpendicular to the vessel and appears as a red–blue split (Fig. 1).31 Caro et al.7 used phase contrast MRI to present rotating asymmetric axial velocity profiles in iliac and carotid arteries. In addition, the existence of rotational patterns distal from the carotid bifurcation have been confirmed with both MRI and ultrasound imaging techniques.29,74Figure 1


Haemodynamics and Flow Modification Stents for Peripheral Arterial Disease: A Review.

Kokkalis E, Aristokleous N, Houston JG - Ann Biomed Eng (2015)

Single spiral flow detected with colour Doppler ultrasound; (a) femoral artery; (b) internal and external carotid arteries.
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4764640&req=5

Fig1: Single spiral flow detected with colour Doppler ultrasound; (a) femoral artery; (b) internal and external carotid arteries.
Mentions: Ku and Giddens,47 and Karino et al.41 showed the development of secondary flow motions in realistic peripheral arterial models as a result of bifurcations and branching. Complicated vortical structures were associated with flow separation and stagnation. In 1991, Stonebridge and Brophy68 detected spiral flow in peripheral arteries of the lower extremities and were the first to conclude that flow in arteries may be spiral in nature. Since that, the presence of spiral flow in right and left iliac and femoral arteries of healthy volunteers has been confirmed by several researchers using colour Doppler and vector Doppler imaging.31,63,70 Spiral flow can be detected using colour Doppler ultrasound with the transducer perpendicular to the vessel and appears as a red–blue split (Fig. 1).31 Caro et al.7 used phase contrast MRI to present rotating asymmetric axial velocity profiles in iliac and carotid arteries. In addition, the existence of rotational patterns distal from the carotid bifurcation have been confirmed with both MRI and ultrasound imaging techniques.29,74Figure 1

Bottom Line: This secondary flow motion is lost in atheromatous disease and its re-introduction after endovascular treatment of PAD has been suggested as a method to induce stabilised and coherent haemodynamics.Stent designs able to generate spiral flow may support endothelial function and therefore increase patency rates.This review is focused on secondary flow phenomena in arteries and the development of flow modification stent technologies for the treatment of PAD.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Mail Box 1, Dundee, DD1 9SY, United Kingdom.

ABSTRACT
Endovascular stents are widely used for the treatment of peripheral arterial disease (PAD). However, the development of in-stent restenosis and downstream PAD progression remain a challenge. Stent revascularisation of PAD causes arterial trauma and introduces abnormal haemodynamics, which initiate complicated biological processes detrimental to the arterial wall. The interaction between stent struts and arterial cells in contact, and the blood flow field created in a stented region, are highly affected by stent design. Spiral flow is known as a normal physiologic characteristic of arterial circulation and is believed to prevent the development of flow disturbances. This secondary flow motion is lost in atheromatous disease and its re-introduction after endovascular treatment of PAD has been suggested as a method to induce stabilised and coherent haemodynamics. Stent designs able to generate spiral flow may support endothelial function and therefore increase patency rates. This review is focused on secondary flow phenomena in arteries and the development of flow modification stent technologies for the treatment of PAD.

No MeSH data available.


Related in: MedlinePlus