Stent deformation, physical stress, and drug elution obtained with provisional stenting, conventional culotte and Tryton-based culotte to treat bifurcations: a virtual simulation study

Morlacchi, Stefano; Chiastra, Claudio; Cutrì, Elena; Zunino, Paolo; Burzotta, Francesco; Formaggia, Luca; Dubini, Gabriele; Migliavacca, Francesco

doi:10.4244/eijv9i12a242

Cited by 27 publications

(15 citation statements)

References 42 publications

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“…Despite this observation, very few studies have adopted a sequential analysis methodology to assess both the mechanical and hemodynamic impact of stent deployment. 2,11,38,43,58,60,61,70,93 Furthermore, no study has yet employed a sequential analysis methodology to compare and contrast the performance of several different coronary stent designs.…”

Section: Introductionmentioning

confidence: 99%

“…In this study, the mechanical impact of the stent within the artery was neglected and only a single stent design was considered. Finally, in 2014, Morlacchi et al 60 employed a sequential analysis methodology to investigate the mechanical and hemodynamic impact of both a conventional and a bifurcation stent design using different deployment strategies. To the authors' knowledge, this is the first study in which both the mechanical and hemodynamic impact of more than a single coronary stent design have been reported.…”

Section: Introductionmentioning

confidence: 99%

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Sequential Structural and Fluid Dynamics Analysis of Balloon-Expandable Coronary Stents: A Multivariable Statistical Analysis

Martín¹,

Boyle²

2015

Cardiovasc Eng Tech

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Abstract-Several clinical studies have identified a strong correlation between neointimal hyperplasia following coronary stent deployment and both stent-induced arterial injury and altered vessel hemodynamics. As such, the sequential structural and fluid dynamics analysis of balloon-expandable stent deployment should provide a comprehensive indication of stent performance. Despite this observation, very few numerical studies of balloon-expandable coronary stents have considered both the mechanical and hemodynamic impact of stent deployment. Furthermore, in the few studies that have considered both phenomena, only a small number of stents have been considered. In this study, a sequential structural and fluid dynamics analysis methodology was employed to compare both the mechanical and hemodynamic impact of six balloon-expandable coronary stents. To investigate the relationship between stent design and performance, several common stent design properties were then identified and the dependence between these properties and both the mechanical and hemodynamic variables of interest was evaluated using statistical measures of correlation. Following the completion of the numerical analyses, stent strut thickness was identified as the only common design property that demonstrated a strong dependence with either the mean equivalent stress predicted in the artery wall or the mean relative residence time predicted on the luminal surface of the artery. These results corroborate the findings of the large-scale ISAR-STEREO clinical studies and highlight the crucial role of strut thickness in coronary stent design. The sequential structural and fluid dynamics analysis methodology and the multivariable statistical treatment of the results described in this study should prove useful in the design of future balloon-expandable coronary stents.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Sequential Structural and Fluid Dynamics Analysis of Balloon-Expandable Coronary Stents: A Multivariable Statistical Analysis

Martín¹,

Boyle²

2015

Cardiovasc Eng Tech

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“…Interestingly, the patterns of restenosis, defined by diameter stenosis >50 % in QCA, were quite different. The angiography-guided group showed a significantly higher incidence of restenosis in distal MV than the FFR-guided group (1.7 vs. 9.2 %, p=0.01), whereas the FFR-guided group showed significantly higher rates of restenosis in SB (21.2 [51] vs. 11.8 %, p=0.037). Taken together, previous studies suggest that FFR-guided decision-making in provisional strategy significantly lowers the incidence of SB intervention, simplifies the procedure, and reduces restenosis rates in the MV, and similar if not reduced clinical event rates compared with angiography-guided SB intervention.…”

Section: Ffr-guided Versus Angiography-guided Approach To the Jailed mentioning

confidence: 54%

“…3). The use of imaging device also enables the interventionist to confirm optimal re-wiring into MV [51,55]. By contrast, when implanting the crush technique, it is highly recommended to cross the proximal cell to avoid recrossing wire through outside of the crushed SB stent and subsequent malapposition of the strut with SB ostium after balloon dilatation of SB stent [49••, 56, 57].…”

Section: Optimizing 2-stenting Techniquesmentioning

confidence: 99%

Stenting of Coronary Bifurcation Lesions: a Literature and Technical Review

et al. 2015

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Newer generation drug-eluting stents have improved outcomes in various subsets of coronary lesions including bifurcation lesions. This article reviews the current literature on various issues in bifurcation percutaneous coronary intervention (PCI). Generally, the provisional approach of placing one stent in the main vessel is the preferred first-line treatment for most bifurcation lesions. However, some lesions require 2-stenting. It is unknown whether 2nd-generation DES have improved outcomes with 2-stenting. The use of fractional flow reserve (FFR) for the assessment of functional significance of the jailed side branch can help avoid unnecessary stenting in complex lesions. Skilled techniques in every step of the 2-stenting process and meticulous use of imaging techniques including IVUS or OCT are warranted to obtain optimal angiographic and clinical results. Dedicated bifurcation stents are feasible treatment options and may change future concepts in bifurcation PCI, although larger trials with control groups are required in order to widely apply these techniques into daily routine practice.

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“…Compounding this is the inherent geometric disparity between the Y-shape of the bifurcation and the cylindrical tube of an expanded stent. 6 This can delay healing, with reduced intima formation over these sites, which may explain the higher incidence of procedural myocardial infarction (MI), stent thrombosis and restenosis that has been observed with such techniques. 7 The carina itself is subject to high shear stress and flow, and hence often free from significant atheroma.…”

mentioning

confidence: 99%

AXXESS– Stent: Delivery Indications and Outcomes

Rawlins

Din

Talwar

2015

Interventional Cardiology Review

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A bifurcation lesion within the coronary arterial circulation is defined as a stenosis occurring at, or adjacent to, a significant division of a major epicardial coronary artery.1 Bifurcation lesions account for 1-20 % of all percutaneous coronary interventions (PCIs), and treatment remain technically challenging despite advances in PCI techniques and thirdgeneration drug-eluting stent (DES) technology. In general, outcomes are less favourable, with an increase in the rates of major adverse cardiac events (MACE), target lesion revascularisation (TLR) and target vessel revascularisation. 2,3 Recommendations from the European Bifurcation Club (EBC) 1 derived from a systematic evaluation of over 10 years of data comparing a provisional single stent (main vessel [MV] only) with a planned two stent (MV plus side branch [SB]) conclude that a provisional singlestent approach should be the technique of choice for the treatment of the majority of bifurcation lesions. If SB coverage is then required, either a T or T and protrude (TAP) technique can be adopted to secure Thrombolysis in Myocardial Infarction flow.1 Favourable results with this technique, however, is dependent on successful SB rewiring, which may be technically challenging, particularly when SB vessels contain significant ostial disease. Difficulties may also be encountered when treating disease in the distal MV once the SB has been treated with TAP configuration and especially with a long neocarina protruding into the MV.Despite their overall recommendations, the EBC concede that there will always remain a role for an upfront two-stent strategy covering both MV and SB. 1 There are a number of two-stent strategies available, as outlined in the comprehensive review by Louvard et al. 4 None of these have demonstrated any benefit over provisional MV stenting in the randomised trials, with the exception of the double kiss (DK) crush technique.5 Despite this, MV and SB two-stent techniques continue to be performed by PCI operators largely because the SB disease is considered to be causative of ischaemia or the SB would be significantly compromised by an MV-only stent strategy and needs to be protected first with a stent.To be certain of ostial coverage, all two-stent bifurcation techniques (crush/TAP/culotte etc) result in neocarina formation, with multiple metallic stent layers overlapping. Compounding this is the inherent geometric disparity between the Y-shape of the bifurcation and the cylindrical tube of an expanded stent. 6 This can delay healing, with reduced intima formation over these sites, which may explain the higher incidence of procedural myocardial infarction (MI), stent thrombosis and restenosis that has been observed with such techniques. 7 The carina itself is subject to high shear stress and flow, and hence often free from significant atheroma. Systematic histopathological analysis has confirmed this, questioning the benefit of covering this area with metal ( Figure 1). 8 An interventional technique that avoids creation of a neocarina, leaving ...

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Stent deformation, physical stress, and drug elution obtained with provisional stenting, conventional culotte and Tryton-based culotte to treat bifurcations: a virtual simulation study

Cited by 27 publications

References 42 publications

Sequential Structural and Fluid Dynamics Analysis of Balloon-Expandable Coronary Stents: A Multivariable Statistical Analysis

Sequential Structural and Fluid Dynamics Analysis of Balloon-Expandable Coronary Stents: A Multivariable Statistical Analysis

Stenting of Coronary Bifurcation Lesions: a Literature and Technical Review

AXXESS– Stent: Delivery Indications and Outcomes

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