Identification of Hemodynamically Optimal Coronary Stent Designs Based on Vessel Caliber

Coronary stent design influences local patterns of wall shear stress (WSS) that are associated with neointimal growth, restenosis, and the endothelialization of stent struts. The number of circumferentially repeating crowns N_C for a given stent de- sign is often modified depending on the target vessel caliber, but the hemodynamic implications of altering N_C have not previously been studied. In this investigation, we analyzed the relationship between vessel diameter and the hemodynamically optimal N_C using a derivative-free optimization algorithm coupled with computational fluid dynamics. The algorithm computed the optimal vessel diameter, defined as minimizing the area of stent-induced low WSS, for various configurations (i.e., N_C) of a generic slotted-tube design and designs that resemble commercially available stents. Stents were modeled in idealized coronary arteries with a vessel diameter that was allowed to vary between 2 and 5 mm. The results indicate that the optimal vessel diameter increases for stent configurations with greater N_C, and the designs of current commercial stents incorporate a greater N_C than hemodynamically optimal stent designs. This finding suggests that reducing the N_C of current stents may improve the hemodynamic environment within stented arteries and reduce the likelihood of excessive neointimal growth and thrombus formation.