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Alterations of Blood Flow Through Arteries Following Atherectomy and the Impact on Pressure Variation and Velocity

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Abstract

Simulations were made of the pressure and velocity fields throughout an artery before and after removal of plaque using orbital atherectomy plus adjunctive balloon angioplasty or stenting. The calculations were carried out with an unsteady computational fluid dynamic solver that allows the fluid to naturally transition to turbulence. The results of the atherectomy procedure leads to an increased flow through the stenotic zone with a coincident decrease in pressure drop across the stenosis. The measured effect of atherectomy and adjunctive treatment showed decrease the systolic pressure drop by a factor of 2.3. Waveforms obtained from a measurements were input into a numerical simulation of blood flow through geometry obtained from medical imaging. From the numerical simulations, a detailed investigation of the sources of pressure loss was obtained. It is found that the major sources of pressure drop are related to the acceleration of blood through heavily occluded cross sections and the imperfect flow recovery downstream. This finding suggests that targeting only the most occluded parts of a stenosis would benefit the hemodynamics. The calculated change in systolic pressure drop through the lesion was a factor of 2.4, in excellent agreement with the measured improvement. The systolic and cardiac-cycle-average pressure results were compared with measurements made in a multi-patient study treated with orbital atherectomy and adjunctive treatment. The agreements between the measured and calculated systolic pressure drop before and after the treatment were within 3%. This excellent agreement adds further confidence to the results. This research demonstrates the use of orbital atherectomy to facilitate balloon expansion to restore blood flow and how pressure measurements can be utilized to optimize revascularization of occluded peripheral vessels.

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Acknowledgments

The authors gratefully acknowledge the support of Cardiovascular Systems Inc.

Conflict of Interest

The authors declare no conflicts of interest.

Statement of Human Studies

Patient data were collected in accordance with Institutional Review Board approval.

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No animals were used in this study.

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Authors and Affiliations

  1. School of Engineering, University of St. Thomas, 2115 Summit Ave, St. Paul, MN, 55105-1079, USA

    Brian D. Plourde, Lauren J. Vallez, Biyuan Sun, Brittany B. Nelson-Cheeseman & John P. Abraham

  2. Division of Cardiology, New York University, 530 First Ave, New York, NY, 10016, USA

    Cezar S. Staniloae

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  1. Brian D. Plourde
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Correspondence to John P. Abraham.

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Associate Editor Ajit P. Yoganathan oversaw the review of this article.

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Plourde, B.D., Vallez, L.J., Sun, B. et al. Alterations of Blood Flow Through Arteries Following Atherectomy and the Impact on Pressure Variation and Velocity. Cardiovasc Eng Tech 7, 280–289 (2016). https://doi.org/10.1007/s13239-016-0269-7

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