Impact of plaque type and side branch geometry on side branch compromise after provisional stent implantation: a simulation study

Iannaccone, Francesco; Chiastra, Claudio; Καρανάσος, Αντώνιος; Migliavacca, Francesco; Gijsen, Frank; Segers, Patrick; Mortier, Peter; Verhegghe, Benedict; Dubini, Gabriele; Beule, Matthieu De; Regar, Evelyn; Wentzel, Jolanda J.

doi:10.4244/eij-d-16-00498

Cited by 18 publications

(13 citation statements)

References 38 publications

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“…The vast majority of FE studies modeling the artery consider it as hyperelastic. Some papers modeled it as an isotropic hyperelastic material using either the Neo‐Hookean, 47 the Ogden, 30 or the Mooney‐Rivlin 18 models. Others considered incorporating anisotropy 48 to the non‐linear hyperelastic material, mainly using Holzapfel‐Gasser‐Ogden (H‐G‐O) model with dispersed families of collagen fibers 49 .…”

Section: Methodsmentioning

confidence: 99%

Influence of balloon design, plaque material composition, and balloon sizing on acute post angioplasty outcomes: An implicit finite element analysis

Helou

Bel-Brunon

Dupont

et al. 2021

Numer Methods Biomed Eng

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In this work we propose a generic modeling approach for simulating percutaneous transluminal angioplasty (PTA) endovascular treatment, and evaluating the influence of balloon design, plaque composition, and balloon sizing on acute post‐procedural outcomes right after PTA, without stent implantation. Clinically‐used PTA balloons were classified into two categories according to their compliance characteristics, and were modeled correspondingly. Self‐defined elastoplastic constitutive laws were implemented within the plaque and artery models, after calibration based on experimental and clinical data. Finite element method (FEM) implicit solver was used to simulate balloon inflation and deflation. Besides balloon profile at max inflation, results are mainly assessed in terms of the elastic recoil ratio (ERR) and lumen gain ratio (LGR) obtained immediately after PTA. No variations in ERR nor LGR values were detected when the balloon design changed, despite the differences observed in their profile at max inflation. Moreover, LGR and ERR inversely varied with the augmentation of calcification level within the plaque (−11% vs. +4% respectively, from fully lipidic to fully calcified plaque). Furthermore, results showed a direct correlation between balloon sizing and LGR and ERR, with noticeably higher rates of change for LGR (+18% and +2% for LGR and ERR respectively for a calcified plaque and a balloon pressure increasing from 10 to 14 atm). However a larger LGR comes with a higher risk of arterial rupture. This proposed methodology opens the way for evaluation of angioplasty balloon selections towards clinical procedure optimization.

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Section: Methodsmentioning

confidence: 99%

Influence of balloon design, plaque material composition, and balloon sizing on acute post angioplasty outcomes: An implicit finite element analysis

Helou

Bel-Brunon

Dupont

et al. 2021

Numer Methods Biomed Eng

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“…The stents were first crimped from their nominal states using surface elements driven by radial displacement. Then, the crimped stents and balloons were positioned and bent along the artery centerline 16 .…”

Section: Methodsmentioning

confidence: 99%

Patient-specific computational simulation of coronary artery bifurcation stenting

Zhao

Samant

et al. 2021

Sci Rep

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Patient-specific and lesion-specific computational simulation of bifurcation stenting is an attractive approach to achieve individualized pre-procedural planning that could improve outcomes. The objectives of this work were to describe and validate a novel platform for fully computational patient-specific coronary bifurcation stenting. Our computational stent simulation platform was trained using n = 4 patient-specific bench bifurcation models (n = 17 simulations), and n = 5 clinical bifurcation cases (training group, n = 23 simulations). The platform was blindly tested in n = 5 clinical bifurcation cases (testing group, n = 29 simulations). A variety of stent platforms and stent techniques with 1- or 2-stents was used. Post-stenting imaging with micro-computed tomography (μCT) for bench group and optical coherence tomography (OCT) for clinical groups were used as reference for the training and testing of computational coronary bifurcation stenting. There was a very high agreement for mean lumen diameter (MLD) between stent simulations and post-stenting μCT in bench cases yielding an overall bias of 0.03 (− 0.28 to 0.34) mm. Similarly, there was a high agreement for MLD between stent simulation and OCT in clinical training group [bias 0.08 (− 0.24 to 0.41) mm], and clinical testing group [bias 0.08 (− 0.29 to 0.46) mm]. Quantitatively and qualitatively stent size and shape in computational stenting was in high agreement with clinical cases, yielding an overall bias of < 0.15 mm. Patient-specific computational stenting of coronary bifurcations is a feasible and accurate approach. Future clinical studies are warranted to investigate the ability of computational stenting simulations to guide decision-making in the cardiac catheterization laboratory and improve clinical outcomes.

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“…We replicated the SKS procedure ‘virtually’ by performing a finite element analysis of stent implantation, as previously done to investigate other coronary bifurcation stenting techniques . Two Resolute Integrity™ stents (Medtronic, USA) were deployed in SKS pattern in an idealized geometry comprising a 60° bifurcation measuring 4.0 mm at the LMS, 3.0 mm at the LAD and 2.5 mm at the Cx, a configuration obeying Finet's law (Figure ).…”

Section: Methodsmentioning

confidence: 99%

Simultaneous kissing stents to treat unprotected left main stem coronary artery bifurcation disease; stent expansion, vessel injury, hemodynamics, tissue healing, restenosis, and repeat revascularization

Morris

Iqbal

Chiastra

et al. 2018

Cathet Cardio Intervent

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ObjectivesTo perform detailed analysis of stent expansion, vessel wall stress, hemodynamics, re‐endothelialization, restenosis, and repeat PCI in the simultaneous kissing stents (SKS) technique of bifurcation left main stem (LMS) stenting.BackgroundThe SKS technique is useful to treat patients with true bifurcation disease of the LMS but remains controversial.Methods and ResultsComputational structural analysis of SKS expansion demonstrated undistorted and evenly expanded stents. Computational fluid dynamics modelling revealed largely undisturbed blood flow. 239 PCI procedures were performed on 217 patients with unprotected bifurcation LMS disease with SKS using DES (2004‐2017). We electively studied 13 stable patients from baseline to 10 years post‐SKS with repeat angiography and optical coherence tomography, and demonstrated tissue coverage of the stent struts at the carina, with no evidence of lacunae behind the stents. We studied all patients with symptomatic recurrence. Target lesion revascularization rate was 3.2% at 1 year and 4.6% at 2 years. Of all 20 patients with restenosis, the site was the LMS‐Cx stent in 7, the LMS‐LAD stent in 2 and both in 11. Two‐year recurrence rate was 7/32 (5.3%) for first, and 4/108 (3.7%) for second generation DES. Treatment with repeat kissing techniques was undertaken in 19/20, with sustained clinical results with re‐SKS.ConclusionThe SKS technique for treating unprotected LMS bifurcation disease does not distort the stents, is associated with favorable hemodynamics, tissue coverage of the exposed struts, and a low restenosis rate when performed with contemporary stents. Re‐PCI with repeat SKS appears feasible, safe, and durable.

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Impact of plaque type and side branch geometry on side branch compromise after provisional stent implantation: a simulation study

Cited by 18 publications

References 38 publications

Influence of balloon design, plaque material composition, and balloon sizing on acute post angioplasty outcomes: An implicit finite element analysis

Influence of balloon design, plaque material composition, and balloon sizing on acute post angioplasty outcomes: An implicit finite element analysis

Patient-specific computational simulation of coronary artery bifurcation stenting

Simultaneous kissing stents to treat unprotected left main stem coronary artery bifurcation disease; stent expansion, vessel injury, hemodynamics, tissue healing, restenosis, and repeat revascularization

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