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The unexplained success of stentplasty vasospasm treatment: Insights using Mechanistic Mathematical Modeling

Bhogal, P and Pederzani, G and Grytsan, A and Loh, Y and Brouwer, P A and Andersson, T and Gundiah, Namrata and Robertson, Anne M and Watton, Paul N and Soderman, Michael (2019) The unexplained success of stentplasty vasospasm treatment: Insights using Mechanistic Mathematical Modeling. In: CLINICAL NEURORADIOLOGY, 29 (4). pp. 763-774.

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Official URL: https://dx.doi.org/10.1007/s00062-019-00776-2

Abstract

BackgroundCerebral vasospasm (CVS) following subarachnoid hemorrhage occurs in up to 70% of patients. Recently, stents have been used to successfully treat CVS. This implies that the force required to expand spastic vessels and resolve vasospasm is lower than previously thought.ObjectiveWe develop a mechanistic model of the spastic arterial wall to provide insight into CVS and predict the forces required to treat it.Material and MethodsThe arterial wall is modelled as a cylindrical membrane using a constrained mixture theory that accounts for the mechanical roles of elastin, collagen and vascular smooth muscle cells (VSMC). We model the pressure diameter curve prior to CVS and predict how it changes following CVS. We propose a stretch-based damage criterion for VSMC and evaluate if several commercially available stents are able to resolve vasospasm.ResultsThe model predicts that dilatation of VSMCs beyond a threshold of mechanical failure is sufficient to resolve CVS without damage to the underlying extracellular matrix. Consistent with recent clinical observations, our model predicts that existing stents have the potential to provide sufficient outward force to successfully treat CVS and that success will be dependent on an appropriate match between stent and vessel.ConclusionMathematical models of CVS can provide insights into biological mechanisms and explore treatment approaches. Improved understanding of the underlying mechanistic processes governing CVS and its mechanical treatment may assist in the development of dedicated stents.

Item Type: Journal Article
Additional Information: Copyright of this article belongs to SPRINGER HEIDELBERG
Keywords: Vasospasm; Stent; Stentplasty; Mathematical modeling; Vascular smooth muscle cells
Department/Centre: Division of Mechanical Sciences > Mechanical Engineering
Depositing User: Id for Latest eprints
Date Deposited: 13 Jan 2020 11:50
Last Modified: 13 Jan 2020 11:50
URI: http://eprints.iisc.ac.in/id/eprint/64341

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