Luminal flow amplifies stent-based drug deposition in arterial bifurcations.
Luminal flow amplifies stent-based drug deposition in arterial bifurcations.
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DOI：
10.1371/journal.pone.0008105
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发表时间：
2009-12-02
期刊：
影响因子：
3.7
通讯作者：
Edelman ER
中科院分区：
文献类型：
--
作者：
Kolachalama VB;Levine EG;Edelman ER
使用药物洗脱支架（DES）治疗动脉分叉病变现在是常见的临床实践，但这些复杂形态中的药物分布机制尚未完全了解。如何有效地确定局部药物递送的功效并量化作为血管毒性和血栓形成预兆的过量药物区域以及与组织过度生长和管腔再狭窄相关的耗尽区域仍然不明显。我们构建了模拟血流和药物转运的支架展开动脉分叉的两相计算模型，以研究使用DES治疗主分支（MB）时调节药物分布的因素。模拟预测了在分叉血管床中广泛的流动介导的药物递送，其中药物分布模式是异质的并且对相对支架位置和管腔流动敏感。MB中的单个DES加上侧支（SB）侧壁上的大逆行管腔血流可在SB管腔-壁界面上提供药物沉积，除非MB支架位于SB分流器的下游。SB的存在以一种甚至更戏剧性的方式影响药物在支架MB中的分布。这里，流体力学效应比SB中发挥更大的作用，特别是当DES穿过分流器并位于分流器下游时，并且以取决于雷诺数的方式。在分叉病变中，血流对药物沉积和随后从血管内DES摄取的影响被放大。当仅一个分支植入支架时，发生复杂的相互作用-植入支架的MB中的药物沉积被SB施加的分流器改变，而SB中的药物沉积被MB中DES的存在改变。在动脉分叉中使用DES需要复杂的演算来平衡血管和支架几何形状以及管腔流量。
Treatment of arterial bifurcation lesions using drug-eluting stents (DES) is now common clinical practice and yet the mechanisms governing drug distribution in these complex morphologies are incompletely understood. It is still not evident how to efficiently determine the efficacy of local drug delivery and quantify zones of excessive drug that are harbingers of vascular toxicity and thrombosis, and areas of depletion that are associated with tissue overgrowth and luminal re-narrowing. We constructed two-phase computational models of stent-deployed arterial bifurcations simulating blood flow and drug transport to investigate the factors modulating drug distribution when the main-branch (MB) was treated using a DES. Simulations predicted extensive flow-mediated drug delivery in bifurcated vascular beds where the drug distribution patterns are heterogeneous and sensitive to relative stent position and luminal flow. A single DES in the MB coupled with large retrograde luminal flow on the lateral wall of the side-branch (SB) can provide drug deposition on the SB lumen-wall interface, except when the MB stent is downstream of the SB flow divider. In an even more dramatic fashion, the presence of the SB affects drug distribution in the stented MB. Here fluid mechanic effects play an even greater role than in the SB especially when the DES is across and downstream to the flow divider and in a manner dependent upon the Reynolds number. The flow effects on drug deposition and subsequent uptake from endovascular DES are amplified in bifurcation lesions. When only one branch is stented, a complex interplay occurs – drug deposition in the stented MB is altered by the flow divider imposed by the SB and in the SB by the presence of a DES in the MB. The use of DES in arterial bifurcations requires a complex calculus that balances vascular and stent geometry as well as luminal flow.
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影响因子：
10.8
作者：
Balakrishnan, Brinda;Dooley, John;Kopia, Gregory;Edelman, Elazer R.
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Edelman, Elazer R.
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