Numerical simulation to evaluate guidewire and catheter behavior during catheter introduction

摘要

© 2023 The Japan Society of Mechanical Engineers. This is an open access article under the terms of the Creative Commons Attribution 4.0 International license (https://creativecommons.org/licenses/by/4.0/), All Rights Reserved.A national questionnaire survey on guidewire penetration accidents by the Japanese Society for Neuroendovascular Therapy reported examples of perforation accidents occurring “during catheter introduction” (75.2 of accidents). In this study, we evaluated the behavior of a guidewire and a catheter during catheter introduction by numerical simulations, based on the results of the national survey. Using the contact force between the medical devices and the vessel wall, and the medical device position as criteria, we investigated the mechanism and the risk of penetration by the device tip during device introduction. We also evaluated the effects of the insertion velocity of the guidewire and the catheter. The contact force gradually increased during insertion of the guidewire, and the maximum contact force was observed after the guidewire passed through a bend in the blood vessel. After that, when introducing a catheter along the guidewire at the bend in the blood vessel, the guidewire imparted a greater load on the vessel wall than when the guidewire itself was introduced. This is the same tendency seen in our previous study and the national survey. One reason for the force increase during catheter introduction is a decrease in the contact area, which concentrates the contact force. Another reason for the force increase is that the bending stiffness of the guidewire covered by the catheter is the sum of the stiffnesses of the two devices, which is larger than that of only the guidewire. Different from guidewire introduction, as the insertion velocity of the catheter increased, the maximum contact force decreased under the influence of the bend shape and the contact force distribution. Moreover, the guidewire oscillated considerably when the catheter was introduced, and this oscillation increased as the insertion velocity increased, leading to a risk of mistakenly straying into a perforating branch.