Research Papers

Computational Modeling and Comparative Tissue Damage Analysis of Angioplasty and Orbital Atherectomy Interventional Procedures

[+] Author and Article Information
Rohit R. Deokar

Department of Mechanical Engineering,
University of Minnesota—Twin Cities,
111 Church Street SE,
Minneapolis, MN 55455
e-mail: deoka002@umn.edu

Barney E. Klamecki

Department of Mechanical Engineering,
University of Minnesota—Twin Cities,
111 Church Street SE,
Minneapolis, MN 55455
e-mail: klamecki@umn.edu

Manuscript received June 30, 2016; final manuscript received March 14, 2017; published online May 3, 2017. Assoc. Editor: Marc Horner.

J. Med. Devices 11(2), 021006 (May 03, 2017) (15 pages) Paper No: MED-16-1256; doi: 10.1115/1.4036299 History: Received June 30, 2016; Revised March 14, 2017

This research was directed toward quantitatively characterizing the effects of arterial mechanical treatment procedures on the stress and strain energy states of the artery wall. Finite element simulations of percutaneous transluminal angioplasty (PTA) and orbital atherectomy (OA) were performed on arterial lesion models with various extents and types of plaque. Stress fields in the artery were calculated and strain energy density was used as an explicit description of potential damage to the artery. The research also included numerical simulations of changes in arterial compliance due to orbital atherectomy. The angioplasty simulations show that the damage energy fields in the media and adventitia are predominant in regions of the lesion that are not protected by a layer of calcification. In addition, it was observed that softening the plaque components leads to a lower peak stress and therefore lesser damage energy in the media and adventitia under the action of a semicompliant balloon. Orbital atherectomy simulations revealed that the major portion of strain energy dissipated is concentrated in the plaque components in contact with the spinning tool. The damage and peak stress fields in the media and adventitia components of the vessel were significantly less. This observation suggests less mechanically induced trauma during a localized procedure like orbital atherectomy. Artery compliance was calculated pre- and post-treatment and an increase was observed after the orbital atherectomy procedure. The localized plaque disruption produced in atherectomy suggests that the undesirable stress states in angioplasty can be mitigated by a combination of procedures such as atherectomy followed by angioplasty.

Copyright © 2017 by ASME
Your Session has timed out. Please sign back in to continue.


Go, A. S. , and Mozaffarian, D. , 2014, “ Heart Disease and Stroke Statistics—2014 Update,” Circulation, 129(3), e28–e292.
Martin, D. , and Boyle, F. , 2013, “ Finite Element Analysis of Balloon-Expandable Coronary Stent Deployment: Influence of Angioplasty Balloon Configuration,” Int. J. Numer. Methods Biomed. Eng., 29(11), pp. 1161–1175. [CrossRef]
Walker, L. N. , Ramsay, M. M. , and Bowyer, D. E. , 1983, “ Endothelial Healing Following Defined Injury to Rabbit Aorta: Depth of Injury and Mode of Repair,” Arteriosclerosis, 47(2), pp. 123–130. [CrossRef]
Wessely, R. , 2010, “ New Drug-Eluting Stent Concepts,” Nat. Rev. Cardiol., 7(4), pp. 194–203. [CrossRef] [PubMed]
Akkus, N. I. , Abdulbaki, A. , Jimenez, E. , and Tandon, N. , 2015, “ Atherectomy Devices: Technology Update,” Med. Devices: Evidence Res., 8, pp. 1–10.
Nguyen, T. , Deokar, R. , Kohler, R. , and Nikanorov, A. , 2016, “ In Vitro Assessment of Arterial Compliance of Calcified Regions After Orbital Atherectomy Using Optical Coherence Tomography,” ASME J. Med. Devices, 10(2), p. 020942. [CrossRef]
Zheng, Y. , Belmont, B. , and Shih, A. J. , 2015, “ Experimental Investigation of the Grinding Wheel Dynamics in Atherectomy,” Proc. Manu., 1, pp. 879–891.
Heuser, R. R. , Safian, R. , Bosiers, M. , and Turco, M. A. , 2006, “ Orbital Atherectomy: Initial Experiences With a New System for the Percutaneous Treatment of Peripheral Vascular Stenosis,” Endovascular Today, 9, pp. 20–26.
Holzapfel, G. A. , Sommer, G. , Gasser, C. T. , and Regitnig, P. , 2005, “ Determination of Layer-Specific Mechanical Properties of Human Coronary Arteries With Nonatherosclerotic Intimal Thickening and Related Constitutive Modeling,” Am. J. Physiol. Heart Circ. Physiol., 289(5), pp. H2048–H2058. [CrossRef] [PubMed]
Lally, C. , Dally, S. , Ried, A. J. , Lee, T. C. , Quinn, D. , and Dolan, F. , 2003, “ Analysis of Prolapse in Cardiovascular Stents: A Constitutive Equation for Vascular Tissue and Finite-Element Modelling,” ASME. J Biomech. Eng., 125(5), pp. 692–699. [CrossRef]
Gultova, E. , Horny, L. , Chlup, H. , and Zitny, R. , 2011,, “ An Anisotropic Pseudo-Elastic Model For The Mullins Effect In Arterial Tissue,” XI International Conference on Computational Plasticity. Fundamentals and Applications (COMPLAS XI), Barcelona, Spain, Sept. 7–9, pp. 713–719.
Horny, L. , Gultova, E. , Chlup, H. , Sedlacek, R. , Kronek, J. , Vesely, J. , and Zitny, R. , 2010, “ Mullins Effect in Human Aorta Described With Limiting Extensibility Evolution,” MEDICON 2010, IFMBE Proceedings, Vol. 29, Springer, Berlin, pp. 768–771.
Weisbecker, H. , Pierce, D. M. , Regitnig, P. , and Holzapfel, G. A. , 2012, “ Layer-Specific Damage Experiments and Modeling of Human Thoracic and Abdominal Aortas With Non-Atherosclerotic Intimal Thickening,” J. Mech. Behav. Biomed. Mater., 12, pp. 93–106. [CrossRef] [PubMed]
Balzani, D. , Schroder, J. , and Gross, D. , 2004, “ A Simple Model for Anisotropic Damage With Applications to Soft Tissues,” Proc. Appl. Math. Mech., 4(1), pp. 236–237. [CrossRef]
Balzani, D. , Schröder, J. , and Gross, D. , 2006, “ Simulation of Discontinuous Damage Incorporating Residual Stresses in Circumferentially Overstretched Atherosclerotic Arteries,” Acta Biomater., 2(6), pp. 609–618. [CrossRef] [PubMed]
Maher, E. , Creane, A. , Sultan, S. , Hynes, N. , Lally, C. , and Daniel, K. , 2011, “ Inelasticity of Human Carotid Atherosclerotic Plaque,” Ann. Biomed. Eng., 39(9), pp. 2445–2455. [CrossRef] [PubMed]
Calvo, B. , Pena, E. , Martinez, M. A. , and Doblare, M. , 2007, “ An Uncoupled Directional Damage Model for Fibred Biological Soft Tissues. Formulation and Computational Aspects,” Int. J. Numer. Methods Eng., 69(10), pp. 2036–2057. [CrossRef]
Loree, H. M. , Kamm, R. D. , Stringfellow, R. G. , and Lee, R. T. , 1992, “ Effects of Fibrous Cap Thickness on Peak Circumferential Stress in Model Atherosclerotic Vessels,” J. Am. Heart Assoc., 71(4), pp. 850–858.
Pericevic, I. , Lally, C. , Toner, D. , and Kelly, D. J. , 2009, “ The Influence of Plaque Composition on Underlying Arterial Wall Stress During Stent Expansion: The Case for Lesion-Specific Stents,” Med. Eng. Phys., 31(4), pp. 428–433. [CrossRef] [PubMed]
Maher, E. , Creane, A. , Sultan, S. , Hynes, N. , Lally, C. , and Kelly, D. J. , 2009, “ Tensile and Compressive Properties of Fresh Human Carotid Atherosclerotic Plaques,” J. Biomech., 42(16), pp. 2760–2767. [CrossRef] [PubMed]
Lawlor, G. M. , O'Donnell, M. R. , O'Connell, B. M. , and Walsh, M. T. , 2011, “ Experimental Determination of Circumferential Properties of Fresh Carotid Plaques,” J. Biomech., 44(9), pp. 1709–1715. [CrossRef] [PubMed]
The, S. H. K. , Gussenhoven, E. J. , Zhong, Y. , Li, W. , van Egmond, F. , Pieterman, H. , van Urk, H. , Gerritsen, P. G. , Borst, C. , Wislon, R. A. , and Bom, N. , 1992, “ Effect of Balloon Angioplasty on Femoral Artery Evaluated With Intravascular Ultrasound Imaging,” Circulation, 86(2), pp. 483–493. [CrossRef] [PubMed]
Virmani, R. , Farb, A. , and Burke, A. P. , 1994, “ Coronary Angioplasty From the Perspective of Atherosclerotic Plaque: Morphologic Predictors of Immediate Success and Restenosis,” Am. Heart J., 127(1), pp. 163–179. [CrossRef] [PubMed]
Baptista, J. , di Mario, C. , Ozaki, Y. , Escaned, J. , Gil, R. , de Feyter, P. , Roelandt, J. R. , and Serruys, P. W. , 1996, “ Impact of Plaque Morphology and Composition on the Mechanism of Lumen Enlargement Using Intracoronary Ultrasound and Quantitative Angiography After Balloon Angioplasty,” Am. J. Cardiol., 77(2), pp. 115–121. [CrossRef] [PubMed]
Castaneda-Zuniga, W. , 1985, “ Pathophysiology of Transluminal Angioplasty,” Improvement of Myocardial Perfusion, J. Meyer , R. Erberl , H. J. Rupprecht , eds., Martinus Nijhoff Publisher, Boston, MA, pp. 138–141.
Schulze-Bauer, C. A. J. , Regitnig, P. , and Holzapfel, G. A. , 2002, “ Mechanics of the Human Femoral Adventitia Including High-Pressure Response,” Am. J. Physiol. Heart Circ., 282(6), pp. H2427–H2440. [CrossRef]
Zollikofer, C. L. , Salomonowitz, E. , Sibley, R. , Chain, J. , Bruehlmann, W. F. , Castaneda-Zuniga, W. R. , and Amplatz, K. , 1994, “ Transluminal Angioplasty Evaluated by Electron Microscopy,” Radiology, 153(2), pp. 369–374. [CrossRef]
Thury, A. , van Langenhove, G. , Carlier, S. G. , Albertal, M. , Kozuma, K. , Regar, E. , Sianos, G. , Wentzel, J. J. , Krams, R. , Slager, C. J. , Piek, J. J. , Serruys, P. W. , and DEBATE Investigators, 2002, “ High Shear Stress After Successful Balloon Angioplasty is Associated With Restenosis and Target Lesion Revascularization,” Am. Heart J., 144(1), pp. 136–143.
Laroche, D. , Delorme, S. , Anderson, T. , and DiRaddo, R. , 2006, “ Computer Prediction of Friction in Balloon Angioplasty and Stent Implantation,” Biomedical Simulation (Lecture Notes in Computer Science), Vol. 4072, M. Harders and G. Székely , eds., Springer, Berlin, pp. 1–8.
Conway, C. , Sharif, F. , McGarry, J. P. , and McHugh, P. E. , 2012, “ A Computational Test-Bed to Assess Coronary Stent Implantation Mechanics Using a Population-Specific Approach,” Cardiovasc. Eng. Technol., 3(4), pp. 374–387. [CrossRef]
Lovik, R. D. , Abraham, J. P. , and Sparrow, E. M. , 2008, “ Assessment of Possible Thermal Damage of Tissue Due to Atherectomy by Means of a Mechanical Debulking Device,” ASME Paper No. SBC2008-191982.
Safian, R. D. , Niazi, K. , Runyon, J. P. , Dulas, D. , Weinstock, B. , Ramaiah, V. , and Heuser, R. , 2009, “ Orbital Atherectomy for Infrapopliteal Disease: Device Concept and Outcome Data for the Oasis Trial,” Catheterization Cardiovasc. Interventions, 73(3), pp. 406–412.
Shammas, N. W. , Lam, R. , Mustapha, J. , Ellichman, J. , Aggarwala, G. , Rivera, E. , Niazi, K. , and Balar, N. , 2012, “ Comparison of Orbital Atherectomy Plus Balloon Angioplasty vs. Balloon Angioplasty Alone in Patients With Critical Limb Ischemia,” J. Endovasc. Ther., 19(4), pp. 480–488. [CrossRef] [PubMed]
Holzapfel, G. A. , Stadler, M. , and Schulze-Bauer, C. A. J. , 2002, “ A Layer-Specific 3D Model for the Simulation of Balloon Angioplasty Using Magnetic Resonance Imaging and Mechanical Testing,” Annals Biomed. Eng., 30(6), pp. 753–767.
Gasser, T. C. , and Holzapfel, G. A. , 2007, “ Finite Element Modeling of Balloon Angioplasty by Considering Overstretch of Remnant Non-Diseased Tissues in Lesions,” Comput. Mech., 40(1), pp. 47–60.
Conway, C. , McGarry, J. P. , and McHugh, P. E. , 2014, “ Modelling of Atherosclerotic Plaque for Use in a Computational Test-Bed for Stent Angioplasty,” Ann. Biomed. Eng., 42(12), pp. 2425–2439. [CrossRef] [PubMed]
Dattilo, R. , Himmelstein, S. I. , and Cuff, R. F. , 2014, “ The COMPLIANCE 360 deg Trial: A Randomized, Prospective, Multicenter, Pilot Study Comparing Acute and Long-Term Results of Orbital Atherectomy to Balloon Angioplasty for Calcified Femoropopliteal Disease,” J. Invasive Cardiol., 26(8), pp. 355–360. [PubMed]
Ogden, R. W. , and Roxburgh, D. G. , 1998, “ A Pseudo-Elastic Model for the Mullins Effect in Filled Rubber,” Proc. R. Soc. London, Ser. A, 455(1988), pp. 2861–2877. [CrossRef]
Romanov, K. I. , 2001, “ The Drucker Stability of a Material,” J. Appl. Math. Mech., 65(1), pp. 155–162. [CrossRef]
Casserly, I. P. , 2009, “ The Role of Atherectomy in the Femoropopliteal Artery,” Endovascular Today, 9(Suppl.), pp. 3–7.
Deokar, R. , 2015, “ Computational Modelling and Comparative Damage Analysis of Angioplasty and Orbital Atherectomy Interventional Procedures,” M.S. dissertation, University of Minnesota, Minneapolis, MN.


Grahic Jump Location
Fig. 1

Mullin's effect in a material under uniaxial loading and unloading

Grahic Jump Location
Fig. 2

Experimental primary hyperelastic response of calcified, echolucent, and mixed plaque types reported by Maher et al. [16]

Grahic Jump Location
Fig. 3

Plaque stress–strain models developed from experimental results of Maher et al. [16] fit to a third order Ogden function with Mullins effect

Grahic Jump Location
Fig. 4

Material data reported by Lawlor et al. [21] for average representative hard, mixed, and soft plaques

Grahic Jump Location
Fig. 5

(a) Combined compressive and tensile material data for echolucent plaque and (b) for calcified plaque

Grahic Jump Location
Fig. 6

Final material model of calcified plaque for (a) angioplasty and (b) orbital atherectomy simulations

Grahic Jump Location
Fig. 7

Final material model of echolucent/soft plaque for (a) angioplasty and (b) orbital atherectomy simulations

Grahic Jump Location
Fig. 8

Comparison of cyclic loading response of the experimental [13] and FEA results for human thoracic aorta tissue

Grahic Jump Location
Fig. 9

Histology image of superficial femoral artery used to model the 3D vessel. (Image provided by Cardiovascular Systems Inc., St Paul, MN)

Grahic Jump Location
Fig. 10

Cross-sectional and axial section views of (a) and (b) SFA model and (c) and (d) idealized SFA model with 90 deg calcification

Grahic Jump Location
Fig. 11

Tri-folded balloon configuration used in angioplasty simulations (a)–(c), cross-sectional view of three stages of balloon deployment (not to scale) (d) and (e) balloon in initial and deployed states

Grahic Jump Location
Fig. 12

(a) von Mises stress (kPa) and (b) damage energy density (J/m3), in artery–plaque structure for plaque extending over 90 deg of internal artery surface

Grahic Jump Location
Fig. 13

Axial section views of von Mises stress (MPa) in (a) media, (b) calcification, (c) adventitia, and (d) soft plaque

Grahic Jump Location
Fig. 14

Von Mises stress (kPa) in lesion for calcification extending over (a) 180 deg and (b) 270 deg of internal artery surface

Grahic Jump Location
Fig. 15

Axial section views of von Mises stress (MPa) in the media for calcification over (a) 90 deg, (c) 180 deg, and (e) 270 deg and in the adventitia with (b) 90 deg, (d) 180 deg, and (f) 270 deg calcification

Grahic Jump Location
Fig. 16

Medial stress for 180 deg plaque with (a) plaque of initial stiffness, (b) plaque component with 50% of original stiffness, and (c) plaque component with 20% of original stiffness

Grahic Jump Location
Fig. 17

Overview of orbital atherectomy simulations with (a) the crown in (b) a longitudinal section of an artery with (c) calcification extending over varying portions of artery cross sections

Grahic Jump Location
Fig. 18

von Mises stress (MPa) in calcified plaque region of artery in (a) longitudinal section and (b) cross section of artery with plaque extending over 90 deg of artery

Grahic Jump Location
Fig. 19

von Mises stress (MPa) in calcified plaque region of artery in (a) longitudinal section and (b) cross section of artery calculated in simulation including permanent set

Grahic Jump Location
Fig. 20

Lumen area-applied pressure simulation results used to calculate compliance of untreated and OA treated arteries



Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging and repositioning the boxes below.

Related Journal Articles
Related eBook Content
Topic Collections

Sorry! You do not have access to this content. For assistance or to subscribe, please contact us:

  • TELEPHONE: 1-800-843-2763 (Toll-free in the USA)
  • EMAIL: asmedigitalcollection@asme.org
Sign In