Nickel-Titanium (NiTi) peripheral stents are commonly used for the treatment of diseased femoropopliteal arteries (FPA). However, cyclic deformations of the vessel, induced by limb movements affect device performance and fatigue failure may occur. Stent strut fracture has been described in the literature, and is implicated as a potential causative factor in vessel re-occlusion. In this paper, a numerical approach is proposed to predict the fatigue behaviour of peripheral NiTi stents within patient-specific arterial geometries, as additional information to aid clinician intervention planning. The procedure needs some patient-specific vessel features derived from routine clinical images but, when this information is not available, reference data from the literature may be used, obviously increasing the uncertainties of the results. In addition, specific stent material data are required and can be obtained from experimental tests. Several 3D finite element models resembling stented vessel segments are built and used for fatigue analyses. For each model, axial cyclic boundary conditions are obtained from a patient-specific lumped parameter model representing the entire artery as a series of suitable springs. This allows the simplification of stiffness changes along the vessel due to plaque and stent that affect local axial deformations. Imposed local cyclic bending values depend on the stent location along the FPA. The procedure is exemplified by its application to an actual clinical case that showed two strut fractures at 18 months follow-up. Interestingly, despite the lack of some of patient-specific information and the use of data from the literature to inform the model, the numerical approach was able to interpret the in vivo fractures.
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Similar content being viewed by others Explore related subjectsDiscover the latest articles and news from researchers in related subjects, suggested using machine learning. ReferencesAdlakha, S., M. Sheikh, J. Wu, M. V. Burket, U. Pandya, W. Colyer, M. D. Eltahawy, and C. J. Cooper. Stent fracture in the coronary and peripheral arteries. J. Interv. Cardiol. 23:411–419, 2010.
Ansari, F., L. Pack, S. Brooks, and T. Morrison. Design considerations for studies of the biomechanical environment of the femoropopliteal arteries. J. Vasc. Surg. 58:804–813, 2013.
Azaouzi, M., N. Lebaal, A. Makradi, and S. Belouettar. Optimization based simulation of self-expanding nitinol stent. Mater. Design. 50:917–928, 2013.
Celi, S., and S. Berti. In-vivo segmentation and quantification of coronary lesions by optical coherence tomography images for a lesion type definition and stenosis grading. Med Image Anal. 18(7):1157–1168, 2014.
Centre, National Clinical Guideline. Lower limb peripheral arterial disease. Diagnosis and Management. London: National Clinical Guideline Centre, 2012.
Cheng, C. P., N. M. Wilson, R. L. Hallett, R. J. Herfkens, and C. A. Taylor. In vivo MR angiographic quantification of axial and twisting deformations of the superficial femoral artery resulting from maximum hip and knee flexion. J. Vasc. Interv. Radiol. 17:979–987, 2006.
Dick, P., H. Wallner, S. Sabeti, C. Loewe, W. Mlekusch, J. Lammer, R. Koppensteiner, E. Minar, and M. Schillinger. Balloon angioplasty versus stenting with nitinol stents in intermediate length superficial femoral artery lesions. Catheter. Cardiovasc. Interv. 74:1090–1095, 2009.
Dordoni, E., A. Meoli, W. Wu, G. Dubini, F. Migliavacca, G. Pennati, and L. Petrini. Fatigue behaviour of Nitinol peripheral stents: the role of plaque shape studied with computational structural analyses. Med. Eng. Phys. 36:842–849, 2014.
Early, M., and D. J. Kelly. The consequences of the mechanical environment of peripheral arteries for Nitinol stenting. Med Biol. Eng. Comput. 49:1279–1288, 2011.
Ganguly, A., J. Simons, A. Schneider, B. Keck, N. Bennett, R. Herfkens, S. Coogan, and R. Fahrig. In-vivo imaging of femoral artery nitinol stents for deformation analysis. J. Vasc. Interv. Radiol. 22:244–249, 2011.
Ghriallais, R., and M. Bruzzi. A computational analysis of the deformation of the femoropopliteal artery with stenting. J. Biomech. Eng. 35:1620–1628, 2014.
Gibbs, J. M., C. S. Peña, and J. F. Benenati. Treating the diseased superficial femoral artery. Tech. Vasc. Interv. Radiol. 13:37–42, 2010.
Harvey, S. M. Nitinol stent fatigue in peripheral artery subjected to pulsatile and articulation loading. J. Mater. Eng. Perform. 20:697–705, 2011.
Hsiao, H. M., and M. T. Yin. An intriguing design concept to enhance the pulsatile fatigue life of self-expanding stents. Biomed Microdevices. 16:133–141, 2014.
Jonker, F. S., F. Moll, and B. Muhs. Dynamic forces in the SFA and popliteal artery during knee flexion. Endovasc. Today 5:53–58, 2008.
Joseph, J., E. A. Thomas, M. Sivaprakasam, and S. Suresh. ARTSENS—an image-free system for noninvasive evaluation of arterial compliance. Conf. Proc. IEEE Eng. Med. Biol. Soc. 2013:4054–4057, 2013.
Kamenskiy, A. V., I. I. Pipinos, Y. A. Dzenis, C. S. Lomneth, S. A. Jaffar Kazmi, N. Y. Phillips, and J. N. MacTaggart. Passive biaxial mechanical properties and in vivo axial pre-stretch of the diseased human femoropopliteal and tibial arteries. Acta Biomater. 10:1301–1313, 2014.
Klein, A., S. Chen, J. Messenger, A. Hansgen, M. Plomondon, J. Carroll, and I. Casserly. Quantitative assessment of the conformational change in the femoropopliteal artery with leg movement. Catheter. Cardiovasc. Interv. 74:787–798, 2009.
Learoyd, B., and M. Taylor. Alterations with age in the viscoelastic properties of human arterial walls. Circulation Research. 18:278–292, 1966.
Muller-Hulsbeck, S., P. J. Schãfer, N. Charalambous, H. Yagi, M. Heller, and T. Jahnke. Comparison of second-generation stents for application in the superficial femoral artery: an in vitro evaluation focusing on stent design. J. Endovasc. Ther. 17:767–776, 2010.
Negi, S. I., and O. Rosales. The role of intravascular optical coherence tomography in peripheral percutaneous interventions. J Invasive Cardiol. 25(3):E51–E53, 2013.
Neil, N. Stent fracture in the superficial femoral and proximal popliteal arteries: literature summary and economic impacts. Perspect. Vasc. Surg. Endovasc. Ther. 25:20–27, 2013.
Nikanorov, A., H. Smouse, K. Osman, M. Bialas, S. Shrivastava, and L. Schwartz. Fracture of self-expanding nitinol stents stressed in vitro under simulated intravascular conditions. J. Vasc. Surg. 48:435–440, 2008.
Petrini, L., W. Wu, E. Dordoni, A. Meoli, F. Migliavacca, and G. Pennati. Fatigue behavior characterization of nitinol for peripheral stents. Funct. Mater. Lett. 5(1):216–223, 2012.
Scott, R., A. R. Pelton, and R. O. Ritchie. Mechanical fatigue and fracture of Nitinol. Inter. Mater. Rev. 57(1):1–37, 2011.
Testi, D., N. J. B. McFarlane, H. Wei, Y. Zhao, G. J. Clapworthy, D. M. Ryan, P. V. Lawford. AimaSimul: a software tool to plan stent positioning in peripheral arteries and evaluate the associated fatigue fracture risk. In: 13th IEEE International Conference on BioInformatics and BioEngineering. 10.1109/BIBE.2013.6701648.
Vappou, J., J. Luo, and E. E. Konofagou. Pulse wave imaging for noninvasive and quantitative measurement of arterial stiffness in vivo. Am. J. Hypertens. 23(4):393–398, 2010.
Zeller, T. Current state of endovascular treatment of femoro-popliteal artery disease. Vasc. Med. 12:223–234, 2007.
This work is within the project “RT3S—Real Time Simulation for Safe vascular Stenting” partially funded by the European Commission under the 7th Framework Programme, GA FP7-2009-ICT-4-248801.
Conflict of interestThere is no conflict of interest.
Author information Authors and AffiliationsDepartment of Civil and Environmental Engineering, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milan, Italy
Lorenza Petrini
Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering ‘Giulio Natta’, Politecnico di Milano, Milan, Italy
Antonia Trotta, Elena Dordoni, Francesco Migliavacca, Gabriele Dubini & Giancarlo Pennati
Medical Physics Group, Department of Cardiovascular Science and the Insigneo Institute for in Silico Medicine, University of Sheffield, Sheffield, UK
Patricia V. Lawford, Jivendra N. Gosai & Desmond M. Ryan
CINECA SuperComputing Centre, Casalecchio di Reno, Italy
Debora Testi
Correspondence to Lorenza Petrini.
Additional informationAssociate Editor Abdul I. Barakat oversaw the review of this article.
Electronic supplementary materialBelow is the link to the electronic supplementary material.
About this article Cite this articlePetrini, L., Trotta, A., Dordoni, E. et al. A Computational Approach for the Prediction of Fatigue Behaviour in Peripheral Stents: Application to a Clinical Case. Ann Biomed Eng 44, 536–547 (2016). https://doi.org/10.1007/s10439-015-1472-7
Received: 03 May 2015
Accepted: 24 September 2015
Published: 03 October 2015
Issue Date: February 2016
DOI: https://doi.org/10.1007/s10439-015-1472-7
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