Drug deposition in coronary arteries with overlapping drug-eluting stents
Name
nihms805243.pdf
Size
2.61 MB
Format
Adobe PDF
Checksum (MD5)
ac835cc5e462a46e7eff13a0718aed4e
Author(s)
Olgac, Ufuk
Poulikakos, Dimos
Kurtcuoglu, Vartan
Rikhtegar Nezami, Farhad
Edelman, Elazer R
Date Issued
July 2016
Journal
Journal of Controlled Release
Publisher
Elsevier
Citation
Rikhtegar, Farhad et al. “Drug Deposition in Coronary Arteries with Overlapping Drug-Eluting Stents.” Journal of Controlled Release 238 (September 2016): 1–9 © 2016 Elsevier B.V.
Version
Final published version
Abstract
Drug-eluting stents are accepted as mainstream endovascular therapy, yet concerns for their safety may be under-appreciated. While failure from restenosis has dropped to below 5%, the risk of stent thrombosis and associated mortality remain relatively high. Further optimization of drug release is required to minimize thrombosis risk while maintaining therapeutic dose. The complex three-dimensional geometry of deployed stents together with the combination of diffusive and advective drug transport render an intuitive understanding of the situation exceedingly difficult. In situations such as this, computational modeling has proven essential, helping define the limits of efficacy, determine the mode and mechanism of drug release, and identify alternatives to avoid toxicity. A particularly challenging conformation is encountered in coronary arteries with overlapping stents. To study hemodynamics and drug deposition in such vessels we combined high-resolution, multi-scale ex vivo computed tomography with a flow and mass transfer computational model. This approach ensures high geometric fidelity and precise, simultaneous calculation of blood flow velocity, shear stress and drug distribution. Our calculations show that drug uptake by the arterial tissue is dependent both on the patterns of flow disruption near the wall, as well as on the relative positioning of drug-eluting struts. Overlapping stent struts lead to localized peaks of drug concentration that may increase the risk of thrombosis. Such peaks could be avoided by anisotropic stent structure or asymmetric drug release designed to yield homogeneous drug distribution along the coronary artery and, at the least, suggest that these issues need to remain in the forefront of consideration in clinical practice.
MIT Department
Massachusetts Institute of Technology. Institute for Medical Engineering & Science
Terms of Use
Creative Commons Attribution-NonCommercial-NoDerivs License
Persistent DSpace Link
DOI of Published Version
https://doi.org/10.1016/J.JCONREL.2016.07.023
