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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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. |
doi_str_mv | 10.1016/j.compbiomed.2023.107554 |
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•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.</description><identifier>ISSN: 0010-4825</identifier><identifier>ISSN: 1879-0534</identifier><identifier>EISSN: 1879-0534</identifier><identifier>DOI: 10.1016/j.compbiomed.2023.107554</identifier><identifier>PMID: 37839217</identifier><language>eng</language><publisher>United States: Elsevier Ltd</publisher><subject>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</subject><ispartof>Computers in biology and medicine, 2023-11, Vol.166, p.107554, Article 107554</ispartof><rights>2023</rights><rights>Copyright © 2023. Published by Elsevier Ltd.</rights><rights>Copyright Elsevier Limited Nov 2023</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c402t-7efa62fb464f89308ff18a7ae89b87775243a9190c5b0c4137c01171c09e34983</citedby><cites>FETCH-LOGICAL-c402t-7efa62fb464f89308ff18a7ae89b87775243a9190c5b0c4137c01171c09e34983</cites><orcidid>0000-0003-3644-9400 ; 0000-0001-9275-8887</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2883296885?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,64361,64363,64365,65309,72215</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37839217$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Luan, Jingyang</creatorcontrib><creatorcontrib>Qiao, Yonghui</creatorcontrib><creatorcontrib>Mao, Le</creatorcontrib><creatorcontrib>Fan, Jianren</creatorcontrib><creatorcontrib>Zhu, Ting</creatorcontrib><creatorcontrib>Luo, Kun</creatorcontrib><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</title><title>Computers in biology and medicine</title><addtitle>Comput Biol Med</addtitle><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.</description><subject>Abdomen</subject><subject>Adult</subject><subject>Aged</subject><subject>Aorta</subject><subject>Aorta - diagnostic imaging</subject><subject>Aorta - physiopathology</subject><subject>Aorta - surgery</subject><subject>Aortic dissection</subject><subject>Aortic Dissection - diagnostic imaging</subject><subject>Aortic Dissection - physiopathology</subject><subject>Aortic Dissection - surgery</subject><subject>Aortic morphology</subject><subject>Cardiovascular system</subject><subject>Clinical medicine</subject><subject>Computational fluid dynamics</subject><subject>Computed tomography</subject><subject>Computer applications</subject><subject>Coronary vessels</subject><subject>Dissection</subject><subject>Distal stent graft-induced new entry tear</subject><subject>Enlargement</subject><subject>Female</subject><subject>Fluid dynamics</subject><subject>Geometry</subject><subject>Humans</subject><subject>Hydrodynamics</subject><subject>Implants</subject><subject>Male</subject><subject>Mathematical models</subject><subject>Middle Aged</subject><subject>Models, Cardiovascular</subject><subject>Morphology</subject><subject>Patients</subject><subject>Stents</subject><subject>Stress concentration</subject><subject>Thoracic endovascular aortic repair</subject><subject>Thoracic surgery</subject><subject>Thorax</subject><subject>Tomography, X-Ray Computed</subject><subject>Type B aortic dissection</subject><subject>Veins & 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role of aorta distal to stent in the occurrence of distal stent graft-induced new entry tear: A computational fluid dynamics and morphological study</title><author>Luan, Jingyang ; Qiao, Yonghui ; Mao, Le ; Fan, Jianren ; Zhu, Ting ; Luo, Kun</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c402t-7efa62fb464f89308ff18a7ae89b87775243a9190c5b0c4137c01171c09e34983</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdomen</topic><topic>Adult</topic><topic>Aged</topic><topic>Aorta</topic><topic>Aorta - diagnostic imaging</topic><topic>Aorta - physiopathology</topic><topic>Aorta - surgery</topic><topic>Aortic dissection</topic><topic>Aortic Dissection - diagnostic imaging</topic><topic>Aortic Dissection - physiopathology</topic><topic>Aortic Dissection - surgery</topic><topic>Aortic morphology</topic><topic>Cardiovascular system</topic><topic>Clinical medicine</topic><topic>Computational fluid dynamics</topic><topic>Computed tomography</topic><topic>Computer applications</topic><topic>Coronary vessels</topic><topic>Dissection</topic><topic>Distal stent graft-induced new entry tear</topic><topic>Enlargement</topic><topic>Female</topic><topic>Fluid dynamics</topic><topic>Geometry</topic><topic>Humans</topic><topic>Hydrodynamics</topic><topic>Implants</topic><topic>Male</topic><topic>Mathematical models</topic><topic>Middle Aged</topic><topic>Models, Cardiovascular</topic><topic>Morphology</topic><topic>Patients</topic><topic>Stents</topic><topic>Stress concentration</topic><topic>Thoracic endovascular aortic repair</topic><topic>Thoracic surgery</topic><topic>Thorax</topic><topic>Tomography, X-Ray Computed</topic><topic>Type B aortic dissection</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Luan, Jingyang</creatorcontrib><creatorcontrib>Qiao, Yonghui</creatorcontrib><creatorcontrib>Mao, Le</creatorcontrib><creatorcontrib>Fan, Jianren</creatorcontrib><creatorcontrib>Zhu, Ting</creatorcontrib><creatorcontrib>Luo, Kun</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Computing Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology 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Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Computers in biology and medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Luan, Jingyang</au><au>Qiao, Yonghui</au><au>Mao, Le</au><au>Fan, Jianren</au><au>Zhu, Ting</au><au>Luo, Kun</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Computers in biology and medicine</jtitle><addtitle>Comput Biol Med</addtitle><date>2023-11</date><risdate>2023</risdate><volume>166</volume><spage>107554</spage><pages>107554-</pages><artnum>107554</artnum><issn>0010-4825</issn><issn>1879-0534</issn><eissn>1879-0534</eissn><abstract>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.</abstract><cop>United States</cop><pub>Elsevier Ltd</pub><pmid>37839217</pmid><doi>10.1016/j.compbiomed.2023.107554</doi><orcidid>https://orcid.org/0000-0003-3644-9400</orcidid><orcidid>https://orcid.org/0000-0001-9275-8887</orcidid></addata></record> |
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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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