The Quantification of Hemodynamic Parameters Downstream of a Gianturco Zenith Stent Wire Using Newtonian and Non-Newtonian Analog Fluids in a Pulsatile Flow Environment

Abstract

Although deployed in the vasculature to expand vessel diameter and improve blood flow, protruding stent struts can create complex flow environments associated with flow separation and oscillating shear gradients. Given the association between magnitude and direction of wall shear stress (WSS) and endothelial phenotype expression, accurate representation of stent-induced flow patterns is critical if we are to predict sites susceptible to intimal hyperplasia. Despite the number of stents approved for clinical use, quantification on the alteration of hemodynamic flow parameters associated with the Gianturco Z-stent is limited in the literature. In using experimental and computational models to quantify strut-induced flow, the majority of past work has assumed blood or representative analogs to behave as Newtonian fluids. However, recent studies have challenged the validity of this assumption. We present here the experimental quantification of flow through a Gianturco Z-stent wire in representative Newtonian and non-Newtonian blood analog environments using particle image velocimetry (PIV). Fluid analogs were circulated through a closed flow loop at physiologically appropriate flow rates whereupon PIV snapshots were acquired downstream of the wire housed in an acrylic tube with a diameter characteristic of the carotid artery. Hemodynamic parameters including WSS, oscillatory shear index (OSI), and Reynolds shear stresses (RSS) were measured. Our findings show that the introduction of the stent wire altered downstream hemodynamic parameters through a reduction in WSS and increases in OSI and RSS from nonstented flow. The Newtonian analog solution of glycerol and water underestimated WSS while increasing the spatial coverage of flow reversal and oscillatory shear compared to a non-Newtonian fluid of glycerol, water, and xanthan gum. Peak RSS were increased with the Newtonian fluid, although peak values were similar upon a doubling of flow rate. The introduction of the stent wire promoted the development of flow patterns that are susceptible to intimal hyperplasia using both Newtonian and non-Newtonian analogs, although the magnitude of sites affected downstream was appreciably related to the rheological behavior of the analog. While the assumption of linear viscous behavior is often appropriate in quantifying flow in the largest arteries of the vasculature, the results presented here suggest this assumption overestimates sites susceptible to hyperplasia and restenosis in flow characterized by low and oscillatory shear.