@article{GeithNothdurfterHeimletal., author = {Geith, Markus A. and Nothdurfter, Laurenz and Heiml, Manuel and Agrafiotis, Emmanouil and Gruber, Markus and Sommer, Gerhard and Schratzenstaller, Thomas and Holzapfel, Gerhard A.}, title = {Quantifying stent-induced damage in coronary arteries by investigating mechanical and structural alterations}, series = {Acta Biomaterialia}, volume = {116}, journal = {Acta Biomaterialia}, number = {October}, publisher = {Elsevier}, doi = {10.1016/j.actbio.2020.08.016}, pages = {285 -- 301}, abstract = {Vascular damage develops with diverging severity during and after percutaneous coronary intervention with stent placement and is the prevailing stimulus for in-stent restenosis. Previous work has failed to link mechanical data obtained in a realistic in vivo or in vitro environment with data collected during imaging processes. We investigated whether specimens of porcine right coronary arteries soften when indented with a stent strut shaped structure, and if the softening results from damage mechanisms inside the fibrillar collagen structure. To simulate the multiaxial loading scenario of a stented coronary artery, we developed the testing device 'LAESIO' that can measure differences in the stress-stretch behavior of the arterial wall before and after the indentation of a strut-like stamp. The testing protocol was optimized according to preliminary experiments, more specifically equilibrium and relaxation tests. After chemical fixation of the specimens and subsequent tissue clearing, we performed three-dimensional surface and second-harmonic generation scans on the deformed specimens. We analyzed and correlated the mechanical response with structural parameters of high-affected tissue located next to the stamp indentation and low-affected tissue beyond the injured area. The results reveal that damage mechanisms, like tissue compression as well as softening, fiber dispersion, and the lesion extent, are direction-dependent, and the severity of them is linked to the strut orientation, indentation pressure, and position. The findings highlight the need for further investigations by applying the proposed methods to human coronary arteries. Additional data and insights might help to incorporate the observed damage mechanisms into material models for finite element analyses to perform more accurate simulations of stent-implantations.}, language = {en} } @article{WiesentSchultheissSchmidetal., author = {Wiesent, Lisa and Schultheiss, Ulrich and Schmid, Christof and Schratzenstaller, Thomas and Nonn, Aida}, title = {Experimentally validated simulation of coronary stents considering different dogboning ratios and asymmetric stent positioning}, series = {PlOS One}, volume = {14}, journal = {PlOS One}, number = {10}, publisher = {PLOS}, doi = {10.1371/journal.pone.0224026}, pages = {1 -- 25}, abstract = {In-stent restenosis remains a major problem of arteriosclerosis treatment by stenting. Expansion-optimized stents could reduce this problem. With numerical simulations, stent designs/ expansion behaviours can be effectively analyzed. For reasons of efficiency, simplified models of balloon-expandable stents are often used, but their accuracy must be challenged due to insufficient experimental validation. In this work, a realistic stent life-cycle simulation has been performed including balloon folding, stent crimping and free expansion of the balloon-stent-system. The successful simulation and validation of two stent designs with homogenous and heterogeneous stent stiffness and an asymmetrically positioned stent on the balloon catheter confirm the universal applicability of the simulation approach. Dogboning ratio, as well as the final dimensions of the folded balloon, the crimped and expanded stent, correspond well to the experimental dimensions with only slight deviations. In contrast to the detailed stent life-cycle simulation, a displacement-controlled simulation can not predict the transient stent expansion, but is suitable to reproduce the final expanded stent shape and the associated stress states. The detailed stent life-cycle simulation is thus essential for stent expansion analysis/optimization, whereas for reasons of computational efficiency, the displacement-controlled approach can be considered in the context of pure stress analysis.}, subject = {Stent}, language = {en} } @article{GeithSwidergalHochholdingeretal., author = {Geith, Markus A. and Swidergal, Krzysztof and Hochholdinger, Bernd and Schratzenstaller, Thomas and Wagner, Marcus and Holzapfel, Gerhard A.}, title = {On the importance of modeling balloon folding, pleating, and stent crimping: An FE study comparing experimental inflation tests}, series = {International Journal for Numerical Methods in Biomedical Engineering}, volume = {35}, journal = {International Journal for Numerical Methods in Biomedical Engineering}, number = {11}, publisher = {Wiley}, doi = {10.1002/cnm.3249}, abstract = {Finite element (FE)-based studies of preoperative processes such as folding,pleating, and stent crimping with a comparison with experimental inflation tests are not yet available. Therefore, a novel workflow is presented in which residual stresses of balloon folding and pleating, as well as stent crimping, and the geometries of all contact partners were ultimately implemented in an FE code to simulate stent expansion by using an implicit solver. The numerical results demonstrate that the incorporation of residual stresses and strains experienced during the production step significantly increased the accuracy of the subsequent simulations, especially of the stent expansion model. During the preoperative processes, stresses inside the membrane and the stent material also reached a rather high level. Hence, there can be no presumption that balloon catheters or stents are undamaged before the actual surgery. The implementation of the realistic geometry, in particular the balloon tapers, and the blades of the process devices improved the simulation of the expansion mech-anisms, such as dogboning, concave bending, or overexpansion of stent cells. This study shows that implicit solvers are able to precisely simulate the mentioned preoperative processes and the stent expansion procedure without a preceding manipulation of the simulation time or physical mass.}, subject = {Stent}, language = {en} } @misc{WiesentHupkeBalketal., author = {Wiesent, Lisa and Hupke, Constantin and Balk, Christian and Schultheiss, Ulrich and Schratzenstaller, Thomas}, title = {Optimization of the cardiovascular stent design towards improved expansion behaviour and radial stiffness properties}, series = {Biomedizinische Technik}, volume = {63}, journal = {Biomedizinische Technik}, number = {s1}, doi = {10.1515/bmt-2018-6031}, abstract = {- Development of a FEA Tool for a realistic stent simulation - investigation on minor modification on the stent design on the expansion behaviour - analysis of three stent designs: classical stent design with pronounced dogbone effect, two modified stent design (non-dogbone-design)}, subject = {Kardiovaskul{\"a}res System}, language = {en} } @inproceedings{GeithSommerSchratzenstalleretal., author = {Geith, Markus A. and Sommer, Gerhard and Schratzenstaller, Thomas and Holzapfel, Gerhard A.}, title = {First Approaches in Quantifying Acute Vascular Damage due to Stenting}, series = {23rd Congress of the European Society of Biomechanics, July 2-5,2017, Seville, Spain}, booktitle = {23rd Congress of the European Society of Biomechanics, July 2-5,2017, Seville, Spain}, subject = {Stent}, language = {en} }