Association of stent‐induced changes in coronary geometry with late stent failure: Insights from three‐dimensional quantitative coronary angiographic analysis

Zhang, Bu-Chun; Tu, Shengxian; Καρανάσος, Αντώνιος; Geuns, Robert‐Jan van; Jaegere, Peter de; Zijlstra, Felix; Regar, Evelyn

doi:10.1002/ccd.27520

Cited by 6 publications

(3 citation statements)

References 41 publications

(50 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Помимо моментального влияния стента, большой интерес представляют отложенные гемодинамические изменения. Так, в работе [22] авторы исследовали влияние угла изгиба при поражениях коронарных артерий на проходимость стента в отдаленном периоде. Анализ показал, что изменение естественного извилистого хода коронарных сосудов при имплантации стента с уменьшением угла изгиба коронарных артерий является потенциально основным фактором, способствующим несостоятельности стентированного сегмента.…”

Section: Discussionunclassified

Towards effects from stent implantation into coronary bifurcation stenosis: experiment and simulation

Gaifutdinov,

Kuyanova,

Khelimsky

et al. 2024

Sibirskij nauchnyj medicinskij zhurnal

View full text Add to dashboard Cite

Coronary artery disease is a widespread cause of death and disability in the population. Angioplasty of the coronary arteries is one of the most common methods of eliminating the cause of ischemia – stenosis of the coronary arteries. As a result of stent installation, a change in the angle of vascular bifurcation occurs usually, as well as a redistribution of volumetric blood flow in the coronary artery system. Considering the high variability of the branching angioarchitecture of these arteries, as well as the structure of their environment, the problem of predicting the specific redistribution of blood flow in these arteries remains unsolved; the main ways of its implementation are computational and experimental hemodynamics. Material and methods. This paper uses an experimental approach to explore the effect of stent placement in a model of coronary artery stenosis, and also provides an analysis of the current level of awareness of the scientific community on this issue. Results and discussion. The experiment showed that the throughput of the model increases by 14 % compared to the model with stenosis, and the redistribution of flows in the model depends not on diameters but on the anatomy of a particular vascular network. The data of the performed mathematical modeling are generally consistent with the results of the experiment before stent installation, when the coronary tree consists of several load-bearing branches, but have quantitative differences for the distal branches of the coronary artery model in the presence of an installed stent. Conclusions. The results of the work can be used to accumulate an experimental data array on the restructuring of blood flow during angioplasty, and can also be used to verify the numerical hemodynamics of the coronary arteries during the virtual installation of a stent in them to resolve stenosis.

show abstract

Section: Discussionunclassified

Towards effects from stent implantation into coronary bifurcation stenosis: experiment and simulation

Gaifutdinov,

Kuyanova,

Khelimsky

et al. 2024

Sibirskij nauchnyj medicinskij zhurnal

View full text Add to dashboard Cite

show abstract

“…The authors described coronary curvatures by measuring the maximum and mean bending angles at different time points. They showed that the mean systolic post-stent bending angle and the change in the mean systolic bending angle after stenting may be predictors of restenosis [17]. In that study the maximum and mean bending angles were chosen to describe the target segment’s bending angles.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional evaluation of the spatial morphology of stented coronary artery segments in relation to restenosis

Üveges

Jenei

Kiss³

et al. 2019

Int J Cardiovasc Imaging

View full text Add to dashboard Cite

To investigate the correlations between the three-dimensional (3D) parameters of target coronary artery segments and restenosis after stent implantation. Sixty-four patients after single, cobalt chromium platform stent (27 BM stents and 37 DES) implantation were investigated retrospectively 12 ± 6 months after the index procedure. 3D coronary artery reconstruction was performed before and after the stent implantation using appropriate projections by a dedicated reconstruction software. The curve of the target segment was characterized by the ratio of the vessel length measured at midline (arc: A) and the distance between the edge points of the stent (chord: C): A/C ratio (ACr). Age, diabetes and hyperlipidaemia were taken into account for the statistical evaluation. 22 patients were diagnosed with ISR, while 42 patients without any restenosis served as controls. The two groups did not differ regarding major cardiovascular risk factors, proportion of the treated vessels or the type of stents. Higher initial ACr values were associated with greater straightening of the vessel curvature in all groups (p < 0.001). Significant negative correlations were found in cases of proximal or distal edge bending angles (p < 0.001). Pre-stent edge bending angles < 7° often showed an increase after the stent implantation, while in case of higher initial values, the bending angles generally decreased. Using multivariate logistic regression modelling we found that the pre-stent ACr was an independent predictor of in-stent restenosis (odds ratio for 1% increase of the ACr: 1.08; p = 0.012). Changes of angles at the stent edges following stent implantation correlate with the initial local bending angles. The ACr predispose to chronic shear stress in the vessel wall, which may contribute to the pathological intimal proliferation.

show abstract

“…Once implanted, coronary stents will be exposed to cyclic deformation at least 86,400 times per day. Therefore, the indices of dynamic arterial morphology may be useful to estimate stent failure risk (35)(36)(37). For example, Girasis et al (36,37) analyzed the dynamic changes in 3D bifurcation angle (BA) of the left main coronary artery.…”

Section: Assessment Of the Mechanical Failure Risk Of Coronary Stentsmentioning

confidence: 99%

Angiography-Based 4-Dimensional Superficial Wall Strain and Stress: A New Diagnostic Tool in the Catheterization Laboratory

Ono

Kawashima

et al. 2021

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

A novel method for four-dimensional superficial wall strain and stress (4D-SWS) is derived from the arterial motion as pictured by invasive coronary angiography. Compared with the conventional finite element analysis of cardiovascular biomechanics using the estimated pulsatile pressure, the 4D-SWS approach can calculate the dynamic mechanical state of the superficial wall in vivo, which could be directly linked with plaque rupture or stent fracture. The validation of this approach using in silico models showed that the distribution and maximum values of superficial wall stress were similar to those calculated by conventional finite element analysis. The in vivo deformation was validated on 16 coronary arteries, from the comparison of centerlines predicted by the 4D-SWS approach against the actual centerlines reconstructed from angiograms at a randomly selected time-point, which demonstrated a good agreement of the centerline morphology between both approaches (scaling: 0.995 ± 0.018 and dissimilarity: 0.007 ± 0.014). The in silico vessel models with softer plaque and larger plaque burden presented more variation in mean lumen diameter and resulted in higher superficial wall stress. In more than half of the patients (n = 16), the maximum superficial wall stress was found at the proximal lesion shoulder. Additionally, in three patients who later suffered from acute coronary syndrome, the culprit plaque rupture sites co-localized with the site of highest superficial wall stress on their baseline angiography. These representative cases suggest that angiography-based superficial wall dynamics have the potential to identify coronary segments at high-risk of plaque rupture and fracture sites of implanted stents. Ongoing studies are focusing on identifying weak spots in coronary bypass grafts, and on exploring the biomechanical mechanisms of coronary arterial remodeling and aneurysm formation. Future developments involve integration of fast computational techniques to allow online availability of superficial wall strain and stress in the catheterization laboratory.

show abstract

Association of stent‐induced changes in coronary geometry with late stent failure: Insights from three‐dimensional quantitative coronary angiographic analysis

Abstract: Our study suggests that a change in the natural tortuous course of the coronaries by stent implantation with the decrease in coronary bending angle is a potentially major contributor in stent failure.

Cited by 6 publications

References 41 publications

Towards effects from stent implantation into coronary bifurcation stenosis: experiment and simulation

Towards effects from stent implantation into coronary bifurcation stenosis: experiment and simulation

Three-dimensional evaluation of the spatial morphology of stented coronary artery segments in relation to restenosis

Angiography-Based 4-Dimensional Superficial Wall Strain and Stress: A New Diagnostic Tool in the Catheterization Laboratory

Contact Info

Product

Resources

About