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Optimization Study of the Hemodynamics of Saline Flushing in Endoscopic Imaging of Chronic Total Occlusions (CTOs)

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Abstract

Purpose

In this study, in vitro experiments and computational fluid dynamic (CFD) simulations are used to expand the understand of the physics of saline flushing of a blocked artery to enable optical imaging. This process involves saline injection, mixing with blood, and advection of the mixture away from the region of interest to provide a clear optical path for imaging.

Methods

CFD simulations are used as a rapid turn-around tool for the evolutionary design process of an endovascular catheter that combines imaging forward-viewing element with saline flushing lumens.

Results

A novel design and control technique is developed that provides the method to regulate the pressure in a blocked artery during saline flushing, so only small deviations from physiological pressure values are exerted on the damaged artery wall at any time, minimizing risk of rupture. In vitro experiments demonstrate the optical clearing process in phantoms simulating chronic total occlusions (CTOs) in coronary arteries with an opaque blood surrogate being removed by saline flushing. With the CFD compared by the experiments, parametric analyses of artery diameter and curvature, and flushing lumen diameter size were conducted to understand their impact on flushing times and pressures. Different plaque morphologies were studied to explore the feasibility of saline flushing in different CTO conditions.

Conclusions

A new catheter design is demonstrated to safely and effectively produce saline flushing, leading to a clear optical imaging field, and an improved technique is outlined that overcomes some practical challenges and limitations commonly encountered in angioscopy.

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Acknowledgments

Funding was provided by the University of Washington CoMotion Innovation Fund (PI Aliseda) and Phase 1 SBIR 1R43HL139323-01 (PI McMorrow, subcontract to Seibel). We acknowledge Dr. John Petersen II for providing clinical advice to the team. We also acknowledge Erik Hagstrom for industrial advice, and Matt Carson and Cathy Olivo for assistance with the design and setup of the in vitro experiment.

Funding

Funding was provided by the University of Washington CoMotion Innovation Fund (PI Aliseda) and Phase 1 SBIR 1R43HL139323-01 (PI McMorrow, subcontract to Seibel).

Data Availability

All data was generated by the study or used via reference from previously published literature.

Code Availability

Software used: MATLAB (Mathworks Inc., Natick, MA) StarCCM++ (CD-Adapco/Siemens, Melville, NY).

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Authors and Affiliations

  1. Mechanical Engineering Department, University of Washington, Seattle, USA

    Syed Faisal, Eric J. Seibel & Alberto Aliseda

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  1. Syed Faisal
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  2. Eric J. Seibel
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  3. Alberto Aliseda
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Correspondence to Alberto Aliseda.

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Conflict of interest

The authors are co-inventors of a patent (Application Number is 17/311,308) owned by the University of Washington and participate in a royalty sharing program at the University of Washington.

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Associate Editor Ajit P. Yoganathan oversaw the review of this article.

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Faisal, S., Seibel, E.J. & Aliseda, A. Optimization Study of the Hemodynamics of Saline Flushing in Endoscopic Imaging of Chronic Total Occlusions (CTOs). Cardiovasc Eng Tech 12, 541–555 (2021). https://doi.org/10.1007/s13239-021-00550-x

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  • DOI: https://doi.org/10.1007/s13239-021-00550-x

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