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Stents: Biomechanics, Biomaterials, and Insights from Computational Modeling

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Abstract

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.

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Acknowledgments

This work was funded in part by grants R01 GM49039 (ERE) from the National Institutes of Health and appointment to the Research Participation Program at FDA administered by Oak Ridge Institute for Science and Education (CC) and internal CBSET funds (ART).

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Authors and Affiliations

  1. Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science, University of Ioannina, University Campus of Ioannina, Ioannina, 45100, Greece

    Georgia S. Karanasiou & Dimitrios I. Fotiadis

  2. Foundation for Research and Technology-Hellas (FORTH), Ioannina, Greece

    Georgia S. Karanasiou & Dimitrios I. Fotiadis

  3. Second Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece

    Michail I. Papafaklis & Lampros K. Michalis

  4. Michailideion Cardiac Center, University of Ioannina, Ioannina, Greece

    Michail I. Papafaklis & Lampros K. Michalis

  5. Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA

    Michail I. Papafaklis, Claire Conway, Rami Tzafriri & Elazer R. Edelman

  6. CBSET, Lexington, MA, USA

    Rami Tzafriri

  7. Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Elazer R. Edelman

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  1. Georgia S. Karanasiou
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Correspondence to Dimitrios I. Fotiadis.

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Associate Editor Peter E. McHugh oversaw the review of this article.

Elazer R. Edelman and Dimitrios I. Fotiadis share equally as senior authors.

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Karanasiou, G.S., Papafaklis, M.I., Conway, C. et al. Stents: Biomechanics, Biomaterials, and Insights from Computational Modeling. Ann Biomed Eng 45, 853–872 (2017). https://doi.org/10.1007/s10439-017-1806-8

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