Stents: Biomechanics, Biomaterials, and Insights from Computational Modeling.
Coronary stents have revolutionized the treatment of coronary artery disease. Improvement in clinical outcomes requires detailed evaluation of the performance of stent biomechanics and the effectiveness as well as safety of biomaterials aiming at optimization of endovascular devices. Stents need to harmonize the hemodynamic environment and promote beneficial vessel healing processes with decreased thrombogenicity. Stent design variables and expansion properties are critical for vessel scaffolding. Drug-elution from stents, can help inhibit in-stent restenosis, but adds further complexity as drug release kinetics and coating formulations can dominate tissue responses. Biodegradable and bioabsorbable stents go one step further providing complete absorption over time governed by corrosion and erosion mechanisms. The advances in computing power and computational methods have enabled the application of numerical simulations and the in silico evaluation of the performance of stent devices made up of complex alloys and bioerodible materials in a range of dimensions and designs and with the capacity to retain and elute bioactive agents. This review presents the current knowledge on stent biomechanics, stent fatigue as well as drug release and mechanisms governing biodegradability focusing on the insights from computational modeling approaches.
Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, University Campus of Ioannina, Ioannina, 45100, Greece.|Foundation for Research and Technology-Hellas (FORTH), Ioannina, Greece.
Georgia S
GS
Karanasiou
Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.|Michailideion Cardiac Center, University of Ioannina, Ioannina, Greece.|Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
Michail I
0000-0002-5646-0378
MI
Papafaklis
Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
Claire
C
Conway
Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece.|Michailideion Cardiac Center, University of Ioannina, Ioannina, Greece.
Lampros K
LK
Michalis
Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.|CBSET, Lexington, MA, USA.
Rami
R
Tzafriri
Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.|Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Elazer R
ER
Edelman
Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, University Campus of Ioannina, Ioannina, 45100, Greece. fotiadis@cc.uoi.gr.|Foundation for Research and Technology-Hellas (FORTH), Ioannina, Greece. fotiadis@cc.uoi.gr.
Dimitrios I
DI
Fotiadis
D000818:Animals; D001672:Biocompatible Materials; D003198:Computer Simulation; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008955:Models, Cardiovascular; D015607:Stents
D001672:Biocompatible Materials
Biomaterials; Biomechanics; Computational modeling; Corrosion; Degradation; Drug-elution; Hemodynamic environment; Stent