title: Haemodynamics and Flow Modification Stents for Peripheral Arterial Disease: A Review.
abstract: Endovascular stents are widely used for the treatment of peripheral arterial disease (PAD). However, the development of in-stent restenosis and downstream PAD progression remain a challenge. Stent revascularisation of PAD causes arterial trauma and introduces abnormal haemodynamics, which initiate complicated biological processes detrimental to the arterial wall. The interaction between stent struts and arterial cells in contact, and the blood flow field created in a stented region, are highly affected by stent design. Spiral flow is known as a normal physiologic characteristic of arterial circulation and is believed to prevent the development of flow disturbances. This secondary flow motion is lost in atheromatous disease and its re-introduction after endovascular treatment of PAD has been suggested as a method to induce stabilised and coherent haemodynamics. Stent designs able to generate spiral flow may support endothelial function and therefore increase patency rates. This review is focused on secondary flow phenomena in arteries and the development of flow modification stent technologies for the treatment of PAD.
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Mail Box 1, Dundee, DD1 9SY, United Kingdom.
authors.forename: Efstratios
authors.initials: E
authors.lastname: Kokkalis
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Mail Box 1, Dundee, DD1 9SY, United Kingdom. n.aristokleous@dundee.ac.uk.
authors.forename: Nicolas
authors.identifier: http://orcid.org/0000-0002-0206-7773
authors.initials: N
authors.lastname: Aristokleous
authors.affiliation: Division of Cardiovascular and Diabetes Medicine, Ninewells Hospital and Medical School, University of Dundee, Mail Box 1, Dundee, DD1 9SY, United Kingdom.
authors.forename: J Graeme
authors.initials: JG
authors.lastname: Houston
mesh_terms: D000818:Animals; D001783:Blood Flow Velocity; D057510:Endovascular Procedures; D006801:Humans; D008955:Models, Cardiovascular; D058729:Peripheral Arterial Disease / Q000503:physiopathology / Q000601:surgery; D058226:Plaque, Atherosclerotic / Q000503:physiopathology / Q000601:surgery; D015607:Stents
keywords: Endovascular; Flow modification; Flow optimisation; Helical flow; Helical stent; Peripheral arterial disease; Restenosis; Spiral flow; Spiral flow stent; Stent design; Wall shear stress