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(Circulation Research. 1999;84:378-383.)
© 1999 American Heart Association, Inc.

Original Contribution

Balloon-Artery Interactions During Stent Placement

A Finite Element Analysis Approach to Pressure, Compliance, and Stent Design as Contributors to Vascular Injury

Presented at the 23rd Annual Meeting of the Society for Biomaterials, New Orleans, La, April 30–May 4, 1997, and the 70th Scientific Sessions of the American Heart Association, Orlando, Fla, November 9–12, 1997, and published in abstract form (Circulation. 1997;96[suppl I]:I-402).

Campbell Rogers, David Y. Tseng, James C. Squire, Elazer R. Edelman

From the Cardiac Catheterization Laboratory and Coronary Care Unit, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass, and Harvard-MIT Division of Health Science and Technology, Massachusetts Institute of Technology, Cambridge, Mass.

Correspondence to Campbell Rogers, MD, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. E-mail cdrogers{at}bics.bwh.harvard.edu

Abstract—Endovascular stents expand the arterial lumen more than balloon angioplasty and reduce rates of restenosis after coronary angioplasty in selected patients. Understanding the factors involved in vascular injury imposed during stent deployment may allow optimization of stent design and stent-placement protocols so as to limit vascular injury and perhaps reduce restenosis. Addressing the hypothesis that a previously undescribed mechanism of vascular injury during stent deployment is balloon-artery interaction, we have used finite element analysis to model how balloon-artery contact stress and area depend on stent-strut geometry, balloon compliance, and inflation pressure. We also examined superficial injury during deployment of stents of varied design in vivo and in a phantom model ex vivo to show that balloon-induced damage can be modulated by altering stent design. Our results show that higher inflation pressures, wider stent-strut openings, and more compliant balloon materials cause markedly larger surface-contact areas and contact stresses between stent struts. Appreciating that the contact stress and contact area are functions of placement pressure, stent geometry, and balloon compliance may help direct development of novel stent designs and stent-deployment protocols so as to minimize vascular injury during stenting and perhaps to optimize long-term outcomes.

Key Words: stent • restenosis • vascular injury • balloon • finite element analysis

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