Numerical Modeling of Nitinol Stent Oversizing in Arteries with Clinically Relevant Levels of Peripheral Arterial Disease: The Influence of Plaque Type on the Outcomes of Endovascular Therapy

Gökgöl, Can; Diehm, Nicolas Alexander; Büchler, Philippe (2017). Numerical Modeling of Nitinol Stent Oversizing in Arteries with Clinically Relevant Levels of Peripheral Arterial Disease: The Influence of Plaque Type on the Outcomes of Endovascular Therapy. Annals of biomedical engineering, 45(6), pp. 1420-1433. Springer 10.1007/s10439-017-1803-y

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Oversizing of the Nitinol stents in the femoro-popliteal arterial tract is commonly performed
by clinicians and further encouraged by stent manufacturers. However, in spite of the
procedure’s supposed benefits of strong wall apposition and increased luminal gain, its
effects on the mechanical behavior of arteries with Peripheral Arterial Disease are not fully
clear. In this study, finite element analyses of endovascular revascularization of an idealized
artery with 70% stenosis and three different plaque types have been performed to examine
the influence of Nitinol stent oversizing on the arterial stresses and acute lumen gain. The
analyses included the simulation of balloon angioplasty to model plaque failure, followed by
stent implantation, in which four different oversizing ratios were investigated. Results
showed that balloon angioplasty was crucial in determining the stress levels of the artery
prior to stent implantation and heavily affected the outcome of endovascular therapy. For all
plaque types, Nitinol stent oversizing was found to produce a marginal lumen gain in
contrast to a significant increase in arterial stresses. For the lightly and moderately calcified
arteries, oversizing was found to be non-critical; whereas for the heavily calcified arteries,
the procedure should be avoided due to a risk of tissue failure.

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