Biomechanical Response of Stented Carotid Arteries to Swallowing and Neck Motion

Purpose: To examine the effects of swallowing and side-to-side head turning on stents in the internal carotid artery. Methods: Seven patients (4 men; mean age 76.9 years) who underwent carotid artery stenting for the treatment of atherosclerotic cervical carotid artery disease were examined with cine fluoroscopy. Geometric processing techniques were used to quantify carotid stent deformations due to head turning and swallowing forces. The variables measured included radial, axial, and crush deformations, as well as radii of stent curvatures during tested maneuvers. Results: Radial deformations of the stented vessels were significantly less than axial and crush deformations, ranging from −10.2% to 15.5%. Axial deformations in response to both swallowing and head turning were positive (average 4.5%, range −14.5% to 14.1%), indicating a general lengthening of the stented vessel due to biomechanical motions. Crush strains exhibited the largest range of all of the deformation modes during both swallowing and head turning. Strain values ranged from −18.7% to 25.9% in the anteroposterior direction and from −25.6% to 21.9% in the lateral direction. Head turning produced fairly symmetrical crushing of the stent. Conversely, swallowing resulted in a preferential medial crush of the stented artery due to contraction of the pharyngeal constrictor muscles. Curvature measurements revealed a tightest radius of curvature of ∼1.5 cm during ipsilateral head turning, with average values during both swallowing and head turning of ∼10 cm. Conclusion: In general, head turning toward the stented artery produced greater deformation in the vessels than swallowing. Since patients are expected to undergo far more swallowing cycles than head turns, however, the accumulated deformations from swallowing may be more significant and should be considered in the design of fatigue resistant stents for carotid arteries.