Comput. Biol. Med. - Simulation of the microscopic process during initiation of stent thrombosis.


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JECTIVE: Coronary stenting is one of the most commonly used approaches to open coronary arteries blocked due to atherosclerosis. However, stent struts can induce stent thrombosis due to altered hemodynamics and endothelial dysfunction, and the microscopic process is poorly understood. The objective of this study was to determine the microscale processes during the initiation of stent thrombosis.METHODS: We utilized a discrete element computational model to simulate the transport, collision, adhesion, and activation of thousands of individual platelets and red blood cells in thrombus formation around struts and dysfunctional endothelium.RESULTS: As strut height increased, the area of endothelium activated by low shear stress increased, which increased the number of platelets in mural thrombi. These thrombi were generally outside regions of recirculation for shorter struts. For the tallest strut, wall shear stress was sufficiently low to activate the entire endothelium. With the entire endothelium activated by injury or denudation, the number of platelets in mural thrombi was largest for the shortest strut. The type of platelet activation (by high shear stress or contact with activated endothelium) did not greatly affect results.CONCLUSIONS: During the initiation of stent thrombosis, platelets do not necessarily enter recirculation regions or deposit on endothelium near struts, as suggested by previous computational fluid dynamics simulations. Rather, platelets are more likely to deposit on activated endothelium outside recirculation regions and deposit directly on struts. Our study elucidated the effects of different mechanical factors on the roles of platelets and endothelium in stent thrombosis.

Resumo Limpo

jectiv coronari stent one common use approach open coronari arteri block due atherosclerosi howev stent strut can induc stent thrombosi due alter hemodynam endotheli dysfunct microscop process poor understood object studi determin microscal process initi stent thrombosismethod util discret element comput model simul transport collis adhes activ thousand individu platelet red blood cell thrombus format around strut dysfunct endotheliumresult strut height increas area endothelium activ low shear stress increas increas number platelet mural thrombi thrombi general outsid region recircul shorter strut tallest strut wall shear stress suffici low activ entir endothelium entir endothelium activ injuri denud number platelet mural thrombi largest shortest strut type platelet activ high shear stress contact activ endothelium great affect resultsconclus initi stent thrombosi platelet necessarili enter recircul region deposit endothelium near strut suggest previous comput fluid dynam simul rather platelet like deposit activ endothelium outsid recircul region deposit direct strut studi elucid effect differ mechan factor role platelet endothelium stent thrombosi

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