INVESTIGATION INFLUENCE OF RAPID PACING ON THE ROTATION OF FENESTRATED STENTGRAFT IN DEPLOYMENT PROCESS USING A PULSATILE CIRCULATORY SIMULATOR
Hiroki Ito1, Tomoya Fujii1, Miyuki Uematsu2, Takashi Azuma3, Yoshihiko Yokoi3, Azuma Takahashi1, Mitsuo Umezu1, Kiyotaka Iwasaki1
1Center for Advanced Biomedical Sciences, TWIns, Waseda University, Japan;
2National Institute of Health Sciences, Japan;
3Tokyo Women’s Medical University, Japan
Fenestrated stent-graft is an endovascular device for thoracic aortic aneurysm. Fenestrations in the stentgraft has a roll to preserve blood supply via the arch vessels. However, stent-graft received hydrodynamic load under its deployment, which makes the treatment complicated. We hypothesized that decreasing blood flow and pressure by rapid pacing may reduce the hydrodynamic load applied to the stent-grafts, which may induce the rotation of stent-graft.
The aim of this study is to investigate the influence of the rapid pacing of left ventricle model on the amount of the rotation of stent-grafts using the pulsatile circulatory system.
Using CT data of a patient before treatment with a fenestrated stent-graft, the patient specific threedimensional artery model was reconstructed. Then, the patient specific thoracic artery and a iliac artery model was duplicated using silicone. Stent-graft was deployed in the pulsatile circulatory simulator using a catheter inserted from iliac artery model. Using CT images after stent-graft deployment, the rotation angles was calculated. The stent-graft was deployed in the control condition (Mean flow 5.0 L/min, Pressure 120/80 mmHg, Heart rate 70bpm) and in rapid pacing condition (Mean flow 4.2 L/min, Pressure 100/60 mmHg and Heart rate 180 bpm).
RESULT & DISCUSSION
The stent-graft rotation was80.0±12.0° at the control condition and rapid and 64.9±2.6° at the rapid pacing condition, and was significantly decreased using the rapid pacing condition(p=0.02, n=6). Aortic forward flow and flow energy at the rapid pacing condition decreased by 68% and 42% in comparison with those at the control condition.
We found that the rapid pacing is elective to reduce the rotation of the stent-graft during its deployme