The role of aorta distal to stent in the occurrence of distal stent graft-induced new entry tear: A computational fluid dynamics and morphological study

Distal stent graft-induced new entry tear (dSINE) is an important complication of thoracic endovascular aortic repair (TEVAR) for the treatment of type B aortic dissection (TBAD). This study aims to explore whether the aorta distal to the stent plays an important role in the occurrence of dSINE. Six...

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Veröffentlicht in:Computers in biology and medicine 2023-11, Vol.166, p.107554, Article 107554
Hauptverfasser: Luan, Jingyang, Qiao, Yonghui, Mao, Le, Fan, Jianren, Zhu, Ting, Luo, Kun
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Qiao, Yonghui
Mao, Le
Fan, Jianren
Zhu, Ting
Luo, Kun
description Distal stent graft-induced new entry tear (dSINE) is an important complication of thoracic endovascular aortic repair (TEVAR) for the treatment of type B aortic dissection (TBAD). This study aims to explore whether the aorta distal to the stent plays an important role in the occurrence of dSINE. Sixty-nine patient-specific geometrical models of twenty-three enrolled patients were reconstructed from preoperative, postoperative, and predSINE computed tomography scans. Computational fluid dynamics (CFD) simulations were performed to calculate the von Mises stress in the CFD group. Meanwhile, morphological measurements were performed in all patients, including measurements of the inverted pyramid index at different follow-up time points and the postoperative true lumen volume change rate. In the CFD study, the time-averaged von Mises stress of the true lumen distal to the stent in dSINE patients was significantly higher than that in the CFD controls (20.42 kPa vs. 15.47 kPa). In the morphological study, a special aortic plane (plane A) with an extremely small area distal to the stent was observed in dSINE patients, which resulted in an inverted pyramid structure in the true lumen distal to the stent. This structure in dSINE patients became increasingly obvious during the follow-up period and finally reached the maximum value before dSINE occurred (mean, 3.91 vs. 1.23). At the same time, enlargement of the true lumen distal to the stent occurs before dSINE, manifesting as a continuous increase in the true lumen volume (mean, 0.70 vs. 013). A new theory of what causes dSINE to occur has been proposed: the inverted pyramid structure of the true lumen distal to the stent caused an increase in the von Mises stress in this region and aortic enlargement, which ultimately led to the occurrence of dSINE. •The interaction between the blood flow, stent-graft, and aortic wall was considered.•Time-averaged von Mises stress of the true lumen distal to the stent was evaluated.•An inverted pyramid structure was observed after thoracic endovascular aortic repair.•A new theory of what causes dSINE to occur has been first proposed.
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subjects Abdomen
Adult
Aged
Aorta
Aorta - diagnostic imaging
Aorta - physiopathology
Aorta - surgery
Aortic dissection
Aortic Dissection - diagnostic imaging
Aortic Dissection - physiopathology
Aortic Dissection - surgery
Aortic morphology
Cardiovascular system
Clinical medicine
Computational fluid dynamics
Computed tomography
Computer applications
Coronary vessels
Dissection
Distal stent graft-induced new entry tear
Enlargement
Female
Fluid dynamics
Geometry
Humans
Hydrodynamics
Implants
Male
Mathematical models
Middle Aged
Models, Cardiovascular
Morphology
Patients
Stents
Stress concentration
Thoracic endovascular aortic repair
Thoracic surgery
Thorax
Tomography, X-Ray Computed
Type B aortic dissection
Veins & arteries
title The role of aorta distal to stent in the occurrence of distal stent graft-induced new entry tear: A computational fluid dynamics and morphological study
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