Integrating Hemodynamics into Predictive Modeling of In-Stent Restenosis: A Computational Study

The influence of hemodynamics has often been underestimated in mathematical models that replicate the restenosis process in stented arteries. This oversight has limited our understanding of the complex interactions between blood flow and arterial wall responses. This work aims to fill this gap by introducing a simplified model of tissue growth influenced by the distribution of mean shear stress on the vessel wall. Through an iterative series of three-dimensional Computational Fluid Dynamics simulations applied to idealized coronary and femoral arteries, along with a semi-empirical parametrization of endothelium growth, we demonstrated that the progression of restenosis can be accurately modeled and distinguished based on the intensity of time-varying flow velocities.

Our findings revealed that restenosis progresses more rapidly in the femoral artery (approximately 15 days) compared to the coronary artery (approximately 30 days). This disparity, resulting from different hemodynamic conditions, underscores the significant impact of local flow dynamics and highlights the importance of accurately modeling both the anatomical structure and corresponding hemodynamics of arteries when predicting in-stent restenosis. Understanding these dynamics is essential for developing more effective stent designs and therapeutic strategies.