Personalized 3D printed coronary models in coronary stenting

Abstract

Background: 3D printing has shown great promise in cardiovascular disease, with reports mainly focusing on pre-surgical planning and medical education. Research on utilization of 3D printed models in simulating coronary stenting has not been reported. In this study, we presented our experience of placing coronary stents into personalized 3D printed coronary models with the aim of determining stent lumen visibility with images reconstructed with different postprocessing views and algorithms.Methods: A total of six coronary stents with diameter ranging from 2.5 to 4.0 mm were placed into 3 patient-specific 3D printed coronary models for simulation of coronary stenting. The 3D printed models were placed in a plastic container and scanned on a 192-slice third generation dual-source CT scanner with images reconstructed with soft (Bv36) and sharp (Bv59) kernel algorithms. Thick and thin slab maximumintensity projection (MIP) images were also generated from the original CT data for comparison of stent lumen visibility. Stent lumen diameter was measured on 2D axial and MIP images, while stent diameter was measured on 3D volume rendering images. 3D virtual intravascular endoscopy (VIE) images were generated to provide intraluminal views of the coronary wall and stent appearances.Results: All of these stents were successfully placed into the right and left coronary arteries but 2 of them did not obtain wall apposition along the complete length. The stent lumen visibility ranged from 54 to 97%, depending on the stent location in the coronary arteries. The mean stent lumen diameters measured on 2D axial, thin and thick slab MIP images were found to be significantly smaller than the actual size (P<0.01). Thick slab MIP images resulted in measured stent lumen diameters smaller than those from thin slab MIP images, with significant differences noticed in most of the measurements (4 out of 6 stents) (P<0.05), and no significant differences in the remaining 2 stents (P=0.19-0.38). In contrast, 3D volume rendering images allowed for more accurate measurements with measured stent diameters close to the actual dimensions in most of these coronary stents, except for the stent placed at the right coronary artery in one of the models due to insufficient expansion of the stent. Images reconstructed with sharp kernel Bv59 significantly improved stent lumen visibility when compared to the smooth Bv36 kernel (P=0.01). 3D VIE was successfully generated in all of the datasets with clear visualization of intraluminal views of the stents in relation to the coronary wall.Conclusions: This preliminary report shows the feasibility of using 3D printed coronary artery models in coronary stenting for investigation of optimal coronary CT angiography protocols. Future studies should focus on placement of more stents with a range of stent diameters in the quest to reduce the need for invasive angiography for surveillance.

Clinical Applications of Patient-Specific 3D Printed Models in Cardiovascular Disease: Current Status and Future Directions

“…3D volume rendering images provide clear views of the stent location in relation to the coronary anatomy as shown in Figure 9. These preliminary reports along with others suggest the potential value of using 3D printed coronary or cardiac models for studying the optimal CT protocols, although further research is needed to validate these findings [59,62,63]. Further to the above-mentioned applications, 3D printed coronary artery models can also be used to simulate blood flow to the coronary arteries with regard to the hemodynamic changes associated with the development of atherosclerosis.…”

“…An emerging research area of using 3D printed coronary models is to investigate optimal coronary CT scanning protocols for visualization of calcified plaques and coronary lumen in coronary stenting. Some recent studies by Sun and colleagues reported their experience with promising results achieved through use of personalized coronary models [ 59 , 60 , 61 , 62 , 63 ]. High-resolution CT imaging allows for better visualization and assessment of coronary lumen stenosis caused by calcified plaques, thus further validating previous findings about the effect of spatial resolution on diagnostic assessment of calcified coronary plaques [ 60 ].…”

“…Arrows refer to the stent wires. Reprinted with permission under open access from Sun and Jansen[63].] Comparison of thick slab with thin slab maximum-intensity projection (MIP) images for visualization of stents and stented lumen in 3D printed models of right coronary stents.…”

Study of mechanical behavior of additive manufacturing bioresorbable polymeric stents models

“…4, n. 1, p. 38-51 ISSN 2595-1521MARCH 2020 adriana.delmonaco@usp.br will be carried out in the future, such as resistance to fatigue and compression. Biomodels obtained by additive manufacturing, 3D printing, have been shown to be efficient and important in stent implant testing and training (Sun et al, 2019).…”

3D printed coronary models offer new opportunities for developing optimal coronary CT angiography protocols in imaging coronary stents

“…In that special issue, a number of publications (original studies, technical notes and review articles) were contributed by researchers from different countries with expertise in different fields highlighting the importance of 3D printing in medical applications (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). In addition to these applications, a recent paper in this issue of QIMS presents another new research direction of using personalized 3D printed coronary artery models for simulation of coronary stenting procedure (14).…”