Skip to main content
Springer Nature Link
Log in

The consequences of the mechanical environment of peripheral arteries for nitinol stenting

  • Original Article
  • Published:
Medical & Biological Engineering & Computing Aims and scope Submit manuscript

Abstract

The use of stents in peripheral arteries has not been as successful as in coronary arteries, with high rates of restenosis and stent fracture common. Normal joint flexion induces a range of forces on the arteries, which has an unknown effect on the outcomes of stenting. The objective of this study is to determine how physiological levels of vessel bending and compression following stent implantation will influence the magnitude of stent stresses and hence the risks of fatigue fracture. A further objective is to compare how this mechanical environment will influence arterial stresses following implantation of either stainless steel or nitinol stents. To this end, models of both nitinol and stainless steel stents deployed in peripheral arteries were created, with appropriate loading conditions applied. At high levels of bending and compression, the strain amplitude threshold value for fatigue failure is exceeded for nitinol stents. Bending was predicted to induce high stresses in the artery following stenting, with higher arterial stresses predicted following implantation of a stainless steel stent compared to a nitinol stent. Both bending and compression may contribute to stent fracture by increasing the strain amplitude within the stent, with the dominant factor dependant on location within the arterial tree. For the specific stent types investigated in this study, the model predictions suggest that compression is the dominant mechanical factor in terms of stent fatigue in the femoral arteries, whereas bending is the most significant factor in the popliteal artery. To increase fatigue life and reduce arterial injury, location specific stent designs are required for peripheral arteries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Auricchio F, Petrini L (2002) Improvements and algorithmical considerations on a recent three-dimensional model describing stress-induced solid phase transformations. Int J Numer Methods Eng 55(11):1255–1284

    Article  Google Scholar 

  2. Ballyk PD (2006) Intramural stress increases exponentially with stent diameter: a stress threshold for neointimal hyperplasia. J Vasc Interv Radiol 17(7):1139–1145

    Article  PubMed  Google Scholar 

  3. Bedoya J, Meyer CA, Timmins LH et al (2006) Effects of stent design parameters on normal artery wall mechanics. J Biomech Eng 128(5):757–765

    Article  PubMed  Google Scholar 

  4. Boyle CJ, Lennon AB, Early M et al (2010) Computational simulation methodologies for mechanobiological modelling: a cell-centred approach to neointima development in stents. Philos Trans R Soc A 368(1921):2919–2935

    CAS  Google Scholar 

  5. Capelli C, Gervaso F, Petrini L et al (2009) Assessment of tissue prolapse after balloon-expandable stenting: influence of stent cell geometry. Med Eng Phys 31(4):441–447

    Article  PubMed  Google Scholar 

  6. Cejna M, Thurnher S, Illiasch H et al (2001) PTA versus Palmaz stent placement in femoropopliteal artery obstructions: a multicenter prospective randomized study. J Vasc Interv Radiol 12(1):23–31

    Article  PubMed  CAS  Google Scholar 

  7. Cheng CP, Wilson NM, Hallett RL et al (2006) 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(6):979–987

    Article  PubMed  Google Scholar 

  8. Duda SH, Bosiers M, Lammer J et al (2005) Sirolimus-eluting versus bare nitinol stent for obstructive superficial femoral artery disease: the SIROCCO II trial. J Vasc Interv Radiol 16(3):331–338

    PubMed  Google Scholar 

  9. Duda SH, Bosiers M, Lammer J et al (2006) Drug-eluting and bare nitinol stents for the treatment of atherosclerotic lesions in the superficial femoral artery: long-term results from the SIROCCO trial. J Endovasc Ther 13(6):701–710

    Article  PubMed  Google Scholar 

  10. Early M, Kelly DJ (2010) The role of vessel geometry and material properties on the mechanics of stenting in the coronary and peripheral arteries. Proc Inst Mech Eng H 224(3):465–476

    Article  PubMed  CAS  Google Scholar 

  11. Early M, Lally C, Prendergast PJ et al (2009) Stresses in peripheral arteries following stent placement: a finite element analysis. Comput Methods Biomech Biomed Eng 12(1):25–33

    Article  Google Scholar 

  12. Favier D, Liu Y, Orgeas L et al (2006) Influence of thermomechanical processing on the superelastic properties of a Ni-rich nitinol shape memory alloy. Mater Sci Eng A 429(1–2):130–136

    Google Scholar 

  13. Gervaso F, Capelli C, Petrini L et al (2008) On the effects of different strategies in modelling balloon-expandable stenting by means of finite element method. J Biomech 41(6):1206–1212

    Article  PubMed  Google Scholar 

  14. Holzapfel GA, Stadler M, Gasser TC (2005) Changes in the mechanical environment of stenotic arteries during interaction with stents: computational assessment of parametric stent designs. J Biomech Eng 127(1):166–180

    Article  PubMed  Google Scholar 

  15. Hozapfel GA, Schulze-Bauer CAJ, Stadler M (2000) Mechanics of angioplasty: wall, balloon and stent. In: Casey J, Bao G (eds) Mechanics in Biology ASME, New York

  16. Hsiao HM, Nikanorov A, Prabhu S et al (2007) Simulation of renal stent in respiration. In: Proceedings of the frontiers in biomedical devices conference, Irvine

  17. Jaff M (2004) The nature of SFA disease. Endovasc Today 4:13–15

    Google Scholar 

  18. Lally C, Dolan F, Prendergast PJ (2005) Cardiovascular stent design and vessel stresses: a finite element analysis. J Biomech 38(8):1574–1581

    Article  PubMed  CAS  Google Scholar 

  19. Menichelli M, Parma A, Pucci E et al (2007) Randomized trial of sirolimus-eluting stent versus bare-metal stent in acute myocardial infarction (SESAMI). J Am Coll Cardiol 49(19):1924–1930

    Article  PubMed  CAS  Google Scholar 

  20. Migliavacca F, Petrini L, Massarotti P et al (2004) Stainless and shape memory alloy coronary stents: a computational study on the interaction with the vascular wall. Biomech Model Mechanobiol 2(4):205–217

    Article  PubMed  Google Scholar 

  21. Mortier P, De Beule M, Van Loo D et al (2009) Finite element analysis of side branch access during bifurcation stenting. Med Eng Phys 31(4):434–440

    Article  PubMed  Google Scholar 

  22. Mortier P, Holzapfel GA, De Beule M et al (2010) A novel simulation strategy for stent insertion and deployment in curved coronary bifurcations: comparison of three drug-eluting stents. Ann Biomed Eng 38(1):88–99

    Article  PubMed  Google Scholar 

  23. Nikanorov A, Smouse HB, Osman K et al (2008) Fracture of self-expanding nitinol stents stressed in vitro under simulated intravascular conditions. J Vasc Surg 48(2):435–440

    Article  PubMed  Google Scholar 

  24. Pelton AR, Schroeder V, Mitchell MR et al (2008) Fatigue and durability of nitinol stents. J Mech Behav Biomed Mater 1(2):153–164

    Article  PubMed  CAS  Google Scholar 

  25. Pericevic I, Lally C, Toner D et al (2009) The influence of plaque composition on underlying arterial wall stress during stent expansion: the case for lesion-specific stents. Med Eng Phys 31(4):428–433

    Article  PubMed  Google Scholar 

  26. Prendergast PJ, Lally C, Daly S et al (2003) Analysis of prolapse in cardiovascular stents: a constitutive equation for vascular tissue and finite-element modelling. J Biomech Eng 125(5):692–699

    Article  PubMed  CAS  Google Scholar 

  27. Scheinert D, Scheinert S, Sax J et al (2005) Prevalence and clinical impact of stent fractures after femoropopliteal stenting. J Am Coll Cardiol 45(2):312–315

    Article  PubMed  Google Scholar 

  28. Schievano S, Taylor AM, Capelli C et al (2010) Patient specific finite element analysis results in more accurate prediction of stent fractures: application to percutaneous pulmonary valve implantation. J Biomech 43(4):687–693

    Article  PubMed  Google Scholar 

  29. Schillinger M, Sabeti S, Loewe C et al (2006) Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. N Engl J Med 354(18):1879–1888

    Article  PubMed  CAS  Google Scholar 

  30. Schulze-Bauer CA, Morth C, Holzapfel GA (2003) Passive biaxial mechanical response of aged human iliac arteries. J Biomech Eng 125(3):395–406

    Article  PubMed  Google Scholar 

  31. Smouse HB, Nikanorov A, LaFlash D (2005) Biomechanical forces in the femoropopliteal arterial segment. Endovasc Today 4:60–66

    Google Scholar 

  32. Timmins LH, Meyer CA, Moreno MR et al (2008) Effects of stent design and atherosclerotic plaque composition on arterial wall biomechanics. J Endovasc Ther 15(6):643–654

    Article  PubMed  Google Scholar 

  33. Wiersma S, Dolan F, Taylor D (2006) Fatigue and fracture in materials used for micro-scale biomedical components. Biomed Mater Eng 16(2):137–146

    PubMed  CAS  Google Scholar 

  34. Wu W, Wang WQ, Yang DZ et al (2007) Stent expansion in curved vessel and their interactions: a finite element analysis. J Biomech 40(11):2580–2585

    Article  PubMed  Google Scholar 

  35. Wu W, Qi M, Liu XP et al (2007) Delivery and release of nitinol stent in carotid artery and their interactions: a finite element analysis. J Biomech 40(13):3034–3040

    Article  PubMed  Google Scholar 

  36. Zahedmanesh H, John Kelly D, Lally C (2010) Simulation of a balloon expandable stent in a realistic coronary artery—determination of the optimum modelling strategy. J Biomech 43(11):2126–2132

    Article  PubMed  Google Scholar 

  37. Zhao HQ, Nikanorov A, Virmani R et al (2009) Late stent expansion and neointimal proliferation of oversized Nitinol stents in peripheral arteries. Cardiovasc Intervent Radiol 32(4):720–726

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This project was funded in part by a grant from Enterprise Ireland (CFTD/07/129).

Author information

Authors and Affiliations

  1. Trinity Centre for Bioengineering, School of Engineering, Trinity College, Dublin, Ireland

    Michael Early & Daniel J. Kelly

Authors
  1. Michael Early
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Daniel J. Kelly
    View author publications

    You can also search for this author inPubMed Google Scholar

Corresponding author

Correspondence to Daniel J. Kelly.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Early, M., Kelly, D.J. The consequences of the mechanical environment of peripheral arteries for nitinol stenting. Med Biol Eng Comput 49, 1279–1288 (2011). https://doi.org/10.1007/s11517-011-0815-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11517-011-0815-2

Keywords