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Forkmann C, Pritsch M, Baumann-Zumstein P, Lootz D, Joner M. In vivo chronic scaffolding force of a resorbable magnesium scaffold. J Biomech 2024; 164:111988. [PMID: 38364489 DOI: 10.1016/j.jbiomech.2024.111988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
The aim of this study is to qualitatively characterize the in vivo chronic scaffolding force of the Magmaris® Resorbable Magnesium Scaffold (RMS). This important parameter of scaffolds must be balanced between sufficient radial support during the healing period of the vessel and avoidance of long-term vessel caging. A finite element model was established using preclinical animal data and used to predict the device diameter and scaffolding force up to 90 days after implantation. To account for scaffold resorption, it included backbone degradation as well as formation of discontinuities as observed in vivo. The predictions of the model regarding acute recoil and chronic development of the device diameter were in good agreement with the preclinical data, supporting the validity of the model. It was found that after 28 and 90 days, the Magmaris® RMS retained 90 % and 47 % of its initial scaffolding force, respectively. The reduction in scaffolding force was mainly driven by discontinuities in the meandering segments. Finite element analysis combined with preclinical data is a reliable method to characterize the chronic scaffolding force.
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Affiliation(s)
| | | | | | - Daniel Lootz
- Biotronik AG, Ackerstraße 6, 8180 Bülach, Switzerland.
| | - Michael Joner
- German Heart Center Munich, Lazarettstraße 36, 80636 München, Germany.
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2
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Chiastra C, Zuin M, Rigatelli G, D’Ascenzo F, De Ferrari GM, Collet C, Chatzizisis YS, Gallo D, Morbiducci U. Computational fluid dynamics as supporting technology for coronary artery disease diagnosis and treatment: an international survey. Front Cardiovasc Med 2023; 10:1216796. [PMID: 37719972 PMCID: PMC10501454 DOI: 10.3389/fcvm.2023.1216796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Background Computational fluid dynamics (CFD) is emerging as an effective technology able to improve procedural outcomes and enhance clinical decision-making in patients with coronary artery disease (CAD). The present study aims to assess the state of knowledge, use and clinical acceptability of CFD in the diagnosis and treatment of CAD. Methods We realized a 20-questions international, anonymous, cross-sectional survey to cardiologists to test their knowledge and confidence on CFD as a technology applied to patients suffering from CAD. Responses were recorded between May 18, 2022, and June 12, 2022. Results A total of 466 interventional cardiologists (mean age 48.4 ± 8.3 years, males 362), from 42 different countries completed the survey, for a response rate of 45.9%. Of these, 66.6% declared to be familiar with the term CFD, especially for optimization of existing interventional techniques (16.1%) and assessment of hemodynamic quantities related with CAD (13.7%). About 30% of respondents correctly answered to the questions exploring their knowledge on the pathophysiological role of some CFD-derived quantities such as wall shear stress and helical flow in coronary arteries. Among respondents, 85.9% would consider patient-specific CFD-based analysis in daily interventional practice while 94.2% declared to be interested in receiving a brief foundation course on the basic CFD principles. Finally, 87.7% of respondents declared to be interested in a cath-lab software able to conduct affordable CFD-based analyses at the point-of-care. Conclusions Interventional cardiologists reported to be profoundly interested in adopting CFD simulations as a technology supporting decision making in the treatment of CAD in daily practice.
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Affiliation(s)
- Claudio Chiastra
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Interventional Cardiology Unit, Department of Cardiology, Madre Teresa Hospital, Padova, Italy
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Department of Medical Sciences, Città Della Salute e Della Scienza Hospital, Turin, Italy
| | | | - Yiannis S. Chatzizisis
- Division of Cardiovascular Medicine, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Diego Gallo
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
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3
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Rodero C, Baptiste TMG, Barrows RK, Keramati H, Sillett CP, Strocchi M, Lamata P, Niederer SA. A systematic review of cardiac in-silico clinical trials. PROGRESS IN BIOMEDICAL ENGINEERING (BRISTOL, ENGLAND) 2023; 5:032004. [PMID: 37360227 PMCID: PMC10286106 DOI: 10.1088/2516-1091/acdc71] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023]
Abstract
Computational models of the heart are now being used to assess the effectiveness and feasibility of interventions through in-silico clinical trials (ISCTs). As the adoption and acceptance of ISCTs increases, best practices for reporting the methodology and analysing the results will emerge. Focusing in the area of cardiology, we aim to evaluate the types of ISCTs, their analysis methods and their reporting standards. To this end, we conducted a systematic review of cardiac ISCTs over the period of 1 January 2012-1 January 2022, following the preferred reporting items for systematic reviews and meta-analysis (PRISMA). We considered cardiac ISCTs of human patient cohorts, and excluded studies of single individuals and those in which models were used to guide a procedure without comparing against a control group. We identified 36 publications that described cardiac ISCTs, with most of the studies coming from the US and the UK. In 75% of the studies, a validation step was performed, although the specific type of validation varied between the studies. ANSYS FLUENT was the most commonly used software in 19% of ISCTs. The specific software used was not reported in 14% of the studies. Unlike clinical trials, we found a lack of consistent reporting of patient demographics, with 28% of the studies not reporting them. Uncertainty quantification was limited, with sensitivity analysis performed in only 19% of the studies. In 97% of the ISCTs, no link was provided to provide easy access to the data or models used in the study. There was no consistent naming of study types with a wide range of studies that could potentially be considered ISCTs. There is a clear need for community agreement on minimal reporting standards on patient demographics, accepted standards for ISCT cohort quality control, uncertainty quantification, and increased model and data sharing.
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Affiliation(s)
- Cristobal Rodero
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Cardiac Modelling and Imaging Biomarkers (CMIB), Department of Biomedical Engineering and Imaging Sciences Department, King’s College London, London, United Kingdom
| | - Tiffany M G Baptiste
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Rosie K Barrows
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Hamed Keramati
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Cardiac Modelling and Imaging Biomarkers (CMIB), Department of Biomedical Engineering and Imaging Sciences Department, King’s College London, London, United Kingdom
| | - Charles P Sillett
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Marina Strocchi
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Pablo Lamata
- Cardiac Modelling and Imaging Biomarkers (CMIB), Department of Biomedical Engineering and Imaging Sciences Department, King’s College London, London, United Kingdom
| | - Steven A Niederer
- Cardiac Electro-Mechanics Research Group (CEMRG), National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Cardiac Electro-Mechanics Research Group (CEMRG), Department of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Turing Research and Innovation Cluster in Digital Twins (TRIC: DT), The Alan Turing Institute, London, United Kingdom
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Remala A, Reddy KK, Velagapudi P. Advances in Intravascular Ultrasound. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2023. [DOI: 10.25259/ijcdw_2_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Since its inception, intravascular ultrasound (IVUS) and optical coherence tomography (OCT) have played a significant role in evaluating the pathophysiology of coronary artery disease (CAD) guiding the interventional and medical management of CAD improving outcomes in patients. Although the benefits of each of these modalities have been proven, due to some limitations, no single intravascular imaging technique has been proven to provide a detailed and complete evaluation of all CAD lesions. The use of different intravascular imaging modalities sequentially may lead to complications, which are cumbersome, consume time, and add financial burden to the patient. Recently, hybrid imaging catheters that combine OCT and IVUS benefits have been developed to limit these problems. Intravascular imaging techniques we are using currently have some drawbacks that hinder accurate assessment of plaque morphology and pathobiology as demonstrated in many histological studies, causing difficulty in identifying high-risk plaques. To overcome these limitations, great efforts have been put into developing hybrid, dual-probe catheters by combining imaging modalities to get an accurate analysis of plaque characteristics, and high-risk lesions. At present, many dual-probe catheters are available including combined IVUS-OCT, near-infrared spectroscopy-IVUS that is available commercially, the OCT-near infrared fluorescence (NIRF) molecular imaging, IVUS-NIRF, and combined fluorescence lifetime-IVUS imaging. Application of this combined multimodal imaging in clinical practice overcomes the limitations of standalone imaging and helps in providing a comprehensive and accurate visualization of plaque characteristics, composition, and plaque biology. The present article summarizes the advances in hybrid intravascular imaging, analyses the technical hindrances that should be known to have a use in the different clinical circumstances, and the till date shreds of evidence available from their first clinical application aiming to bring these modalities into the limelight and their potential role in the study of CAD.
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5
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Colombo M, Corti A, Gallo D, Colombo A, Antognoli G, Bernini M, McKenna C, Berceli S, Vaughan T, Migliavacca F, Chiastra C. Superficial femoral artery stenting: Impact of stent design and overlapping on the local hemodynamics. Comput Biol Med 2022; 143:105248. [PMID: 35124437 DOI: 10.1016/j.compbiomed.2022.105248] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Superficial femoral arteries (SFAs) treated with self-expanding stents are widely affected by in-stent restenosis (ISR), especially in case of long lesions and multiple overlapping devices. The altered hemodynamics provoked by the stent is considered as a promoting factor of ISR. In this context, this work aims to analyze the impact of stent design and stent overlapping on patient-specific SFA hemodynamics. METHODS Through a morphing technique, single or multiple stents were virtually implanted within two patient-specific, post-operative SFA models reconstructed from computed tomography. The stented domains were used to perform computational fluid dynamics simulations, quantifying wall shear stress (WSS) based descriptors including time-averaged WSS (TAWSS), oscillatory shear index (OSI), transverse WSS (transWSS), and WSS ratio (WSSRATIO). Four stent designs (three laser-cut - EverFlex, Zilver and S.M.A.R.T. - and one prototype braided stent), and three typical clinical scenarios accounting for different order of stent implantation and overlapping length were compared. RESULTS The main hemodynamic differences were found between the two types of stent designs (i.e. laser-cut vs. braided stents). The braided stent presented lower median transWSS and higher median WSSRATIO than the laser-cut stents (p < 0.0001). The laser-cut stents presented comparable WSS-based descriptor values, except for the Zilver, exhibiting a median TAWSS ∼30% higher than the other stents. Stent overlapping provoked an abrupt alteration of the WSS-based descriptors. The overlapping length, rather than the order of stent implantation, highly and negatively impacted the hemodynamics. CONCLUSION The proposed computational workflow compared different SFA stent designs and stent overlapping configurations, highlighting those providing the most favorable hemodynamic conditions.
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Affiliation(s)
- Monika Colombo
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy; Institute for Chemical and Bioengineering, ETH Zurich, Zurich, Switzerland
| | - Anna Corti
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Diego Gallo
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Andrea Colombo
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Giacomo Antognoli
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Martina Bernini
- Biomechanics Research Centre (BioMEC), National University of Ireland Galway, Ireland
| | - Ciara McKenna
- Biomechanics Research Centre (BioMEC), National University of Ireland Galway, Ireland
| | - Scott Berceli
- Department of Surgery, University of Florida, Gainesville, FL, USA; Malcom Randall VAMC, Gainesville, FL, USA
| | - Ted Vaughan
- Biomechanics Research Centre (BioMEC), National University of Ireland Galway, Ireland
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy; PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
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6
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Patient-specific computational simulation of coronary artery bifurcation stenting. Sci Rep 2021; 11:16486. [PMID: 34389748 PMCID: PMC8363606 DOI: 10.1038/s41598-021-95026-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/16/2021] [Indexed: 01/09/2023] Open
Abstract
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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7
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Dong P, Mozafari H, Prabhu D, Bezerra HG, Wilson DL, Gu L. Optical Coherence Tomography-Based Modeling of Stent Deployment in Heavily Calcified Coronary Lesion. J Biomech Eng 2020; 142:051012. [PMID: 31654052 PMCID: PMC7104774 DOI: 10.1115/1.4045285] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/27/2019] [Indexed: 12/12/2022]
Abstract
In this work, a heavily calcified coronary artery model was reconstructed from optical coherence tomography (OCT) images to investigate the impact of calcification characteristics on stenting outcomes. The calcification was quantified at various cross sections in terms of angle, maximum thickness, and area. The stent deployment procedure, including the crimping, expansion, and recoil, was implemented. The influence of calcification characteristics on stent expansion, malapposition, and lesion mechanics was characterized. Results have shown that the minimal lumen area following stenting occurred at the cross section with the greatest calcification angle. The calcification angle constricted the stretchability of the lesion and thus resulted in a small lumen area. The maximum principal strain and von Mises stress distribution patterns in both the fibrotic tissue and artery were consistent with the calcification profiles. The radially projected region of the calcification tends to have less strain and stress. The peak strain and stress of the fibrotic tissue occurred near the interface with the calcification. It is also the region with a high risk of tissue dissection and strut malapposition. In addition, the superficial calcification with a large angle aggregated the malapposition at the middle of the calcification arc. These detailed mechanistic quantifications could be used to provide a fundamental understanding of the role of calcification in stent expansions, as well as to exploit their potential for enhanced pre- and post-stenting strategies.
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Affiliation(s)
- Pengfei Dong
- Department of Mechanical and Materials Engineering,University
of Nebraska-Lincoln,Lincoln, NE 68588
| | - Hozhabr Mozafari
- Department of Mechanical and Materials Engineering,University
of Nebraska-Lincoln,Lincoln, NE 68588
| | - David Prabhu
- Department of Biomedical Engineering,Case Western Reserve
University,Cleveland, OH 44106
| | - Hiram G. Bezerra
- Department of Medicine-Cardiovascular Medicine, Cardiovascular
Imaging Core Laboratory, Harrington Heart & Vascular Institute,
University Hospitals Cleveland Medical Center, Cleveland, OH
44106
| | - David L. Wilson
- Department of Biomedical Engineering,Case Western Reserve
University,Cleveland, OH 44106
| | - Linxia Gu
- Department of Mechanical and Materials Engineering,University
of Nebraska-Lincoln,Lincoln, NE 68588;Department of Biomedical and
Chemical Engineering and Sciences,Florida Institute of
Technology,Melbourne, FL 32901
e-mail:
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Current Advances in the Diagnostic Imaging of Atherosclerosis: Insights into the Pathophysiology of Vulnerable Plaque. Int J Mol Sci 2020; 21:ijms21082992. [PMID: 32340284 PMCID: PMC7216001 DOI: 10.3390/ijms21082992] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/02/2020] [Accepted: 04/15/2020] [Indexed: 12/13/2022] Open
Abstract
Atherosclerosis is a lipoprotein-driven inflammatory disorder leading to a plaque formation at specific sites of the arterial tree. After decades of slow progression, atherosclerotic plaque rupture and formation of thrombi are the major factors responsible for the development of acute coronary syndromes (ACSs). In this regard, the detection of high-risk (vulnerable) plaques is an ultimate goal in the management of atherosclerosis and cardiovascular diseases (CVDs). Vulnerable plaques have specific morphological features that make their detection possible, hence allowing for identification of high-risk patients and the tailoring of therapy. Plaque ruptures predominantly occur amongst lesions characterized as thin-cap fibroatheromas (TCFA). Plaques without a rupture, such as plaque erosions, are also thrombi-forming lesions on the most frequent pathological intimal thickening or fibroatheromas. Many attempts to comprehensively identify vulnerable plaque constituents with different invasive and non-invasive imaging technologies have been made. In this review, advantages and limitations of invasive and non-invasive imaging modalities currently available for the identification of plaque components and morphologic features associated with plaque vulnerability, as well as their clinical diagnostic and prognostic value, were discussed.
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9
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Wei L, Leo HL, Chen Q, Li Z. Structural and Hemodynamic Analyses of Different Stent Structures in Curved and Stenotic Coronary Artery. Front Bioeng Biotechnol 2019; 7:366. [PMID: 31867313 PMCID: PMC6908811 DOI: 10.3389/fbioe.2019.00366] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 11/12/2019] [Indexed: 12/30/2022] Open
Abstract
Coronary artery stenting is commonly used for the treatment of coronary stenosis, and different stent structures indeed have various impacts on the stress distribution within the plaque and artery as well as the local hemodynamic environment. This study aims to evaluate the performance of different stent structures by characterizing the mechanical parameters after coronary stenting. Six stent structures including three commercially-shaped stents (Palmaz-Schatz-shaped, Xience Prime-shaped, and Cypher-shaped) and three author-developed stents (C-Rlink, C-Rcrown, and C-Astrut) implanted into a curved stenotic coronary artery were investigated. Structural analyses of the balloon-stent-plaque-artery system were first performed, and then followed by hemodynamic analyses. The results showed that among the three commercially-shaped stents, the Palmaz-Schatz-shaped had the least stent dogboning and recoiling, corresponding to the greatest maximum plastic strain and the largest diameter change, nevertheless, it induced the highest maximum von Mises stress on plaque, arterial intima and media. From the viewpoint of hemodynamics, the Palmaz-Schatz-shaped displayed smaller areas of adverse low wall shear stress (<0.5 Pa), low time-averaged wall shear stress (<0.5 Pa), and high oscillating shear index (>0.1). Compared to the Cypher-shaped, the C-Rcrown and C-Astrut had smaller recoiling, greater maximum plastic stain and larger diameter change, which indicated the improved mechanical performance of the Cypher-shaped stent. Moreover, both C-Rcrown and C-Astrut exhibited smaller areas of adverse low wall shear stress, and low time-averaged wall shear stress, but only the C-Rcrown displayed a smaller area of adverse high oscillating shear index. The present study evaluated and compared the performance of six different stents deployed inside a curved artery, and could be potentially utilized as a guide for the selection of suitable commercially-shaped stent for clinical application, and to provide an approach to improve the performance of the commercial stents.
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Affiliation(s)
- Lingling Wei
- Biomechanics Laboratory, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China
| | - Hwa Liang Leo
- Department of Biomedical Engineering, National University of Singapore, Singapore, Singapore
| | - Qiang Chen
- Biomechanics Laboratory, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China
| | - Zhiyong Li
- Biomechanics Laboratory, School of Biological Science & Medical Engineering, Southeast University, Nanjing, China.,School of Chemistry, Physics and Mechanical Engineering, Queensland University of Technology, Brisbane, QLD, Australia
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10
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Gosling RC, Morris PD, Lawford PV, Hose DR, Gunn JP. Predictive Physiological Modeling of Percutaneous Coronary Intervention - Is Virtual Treatment Planning the Future? Front Physiol 2018; 9:1107. [PMID: 30154734 PMCID: PMC6103238 DOI: 10.3389/fphys.2018.01107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/23/2018] [Indexed: 01/10/2023] Open
Abstract
Computational modeling has been used routinely in the pre-clinical development of medical devices such as coronary artery stents. The ability to simulate and predict physiological and structural parameters such as flow disturbance, wall shear-stress, and mechanical strain patterns is beneficial to stent manufacturers. These methods are now emerging as useful clinical tools, used by physicians in the assessment and management of patients. Computational models, which can predict the physiological response to intervention, offer clinicians the ability to evaluate a number of different treatment strategies in silico prior to treating the patient in the cardiac catheter laboratory. For the first time clinicians can perform a patient-specific assessment prior to making treatment decisions. This could be advantageous in patients with complex disease patterns where the optimal treatment strategy is not clear. This article reviews the key advances and the potential barriers to clinical adoption and translation of these virtual treatment planning models.
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Affiliation(s)
- Rebecca C. Gosling
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, Sheffield, United Kingdom
- *Correspondence: Rebecca C. Gosling,
| | - Paul D. Morris
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, Sheffield, United Kingdom
- These authors have contributed equally to this work and are joint first authors
| | - Patricia V. Lawford
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, Sheffield, United Kingdom
| | - D. Rodney Hose
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, Sheffield, United Kingdom
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Julian P. Gunn
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom
- Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom
- INSIGNEO Institute for in Silico Medicine, Sheffield, United Kingdom
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11
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Iannaccone F, Chiastra C, Karanasos A, Migliavacca F, Gijsen F, Segers P, Mortier P, Verhegghe B, Dubini G, De Beule M, Regar E, Wentzel J. Impact of plaque type and side branch geometry on side branch compromise after provisional stent implantation: a simulation study. EUROINTERVENTION 2017; 13:e236-e245. [DOI: 10.4244/eij-d-16-00498] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Bourantas CV, Jaffer FA, Gijsen FJ, van Soest G, Madden SP, Courtney BK, Fard AM, Tenekecioglu E, Zeng Y, van der Steen AF, Emelianov S, Muller J, Stone PH, Marcu L, Tearney GJ, Serruys PW. Hybrid intravascular imaging: recent advances, technical considerations, and current applications in the study of plaque pathophysiology. Eur Heart J 2017; 38:400-412. [PMID: 27118197 PMCID: PMC5837589 DOI: 10.1093/eurheartj/ehw097] [Citation(s) in RCA: 129] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 01/31/2016] [Accepted: 02/22/2016] [Indexed: 11/14/2022] Open
Abstract
Cumulative evidence from histology-based studies demonstrate that the currently available intravascular imaging techniques have fundamental limitations that do not allow complete and detailed evaluation of plaque morphology and pathobiology, limiting the ability to accurately identify high-risk plaques. To overcome these drawbacks, new efforts are developing for data fusion methodologies and the design of hybrid, dual-probe catheters to enable accurate assessment of plaque characteristics, and reliable identification of high-risk lesions. Today several dual-probe catheters have been introduced including combined near infrared spectroscopy-intravascular ultrasound (NIRS-IVUS), that is already commercially available, IVUS-optical coherence tomography (OCT), the OCT-NIRS, the OCT-near infrared fluorescence (NIRF) molecular imaging, IVUS-NIRF, IVUS intravascular photoacoustic imaging and combined fluorescence lifetime-IVUS imaging. These multimodal approaches appear able to overcome limitations of standalone imaging and provide comprehensive visualization of plaque composition and plaque biology. The aim of this review article is to summarize the advances in hybrid intravascular imaging, discuss the technical challenges that should be addressed in order to have a use in the clinical arena, and present the evidence from their first applications aiming to highlight their potential value in the study of atherosclerosis.
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Affiliation(s)
| | - Farouc A. Jaffer
- Cardiovascular Research Center and Cardiology Division, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Frank J. Gijsen
- Thorax Center, Erasmus MC, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Gijs van Soest
- Thorax Center, Erasmus MC, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | | | - Brian K. Courtney
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Ali M. Fard
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Erhan Tenekecioglu
- Thorax Center, Erasmus MC, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Yaping Zeng
- Thorax Center, Erasmus MC, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | | | - Stanislav Emelianov
- Department of Biomedical Engineering, University of Texas at Austin, Austin, TX, USA
| | | | - Peter H. Stone
- Cardiovascular Division, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Laura Marcu
- Department of Biomedical Engineering, University of California, CA, USA
| | - Guillermo J. Tearney
- Wellman Center for Photomedicine, Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA
| | - Patrick W. Serruys
- Thorax Center, Erasmus MC, ‘s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
- International Centre for Cardiovascular Health, NHLI, Imperial College London, London, UK
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Ostrowski Z, Melka B, Adamczyk W, Rojczyk M, Golda A, Nowak AJ. CFD analysis of multiphase blood flow within aorta and its thoracic branches of patient with coarctation of aorta using multiphase Euler - Euler approach. ACTA ACUST UNITED AC 2016. [DOI: 10.1088/1742-6596/745/3/032112] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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14
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Behaviour of two typical stents towards a new stent evolution. Med Biol Eng Comput 2016; 55:1019-1037. [PMID: 27669700 DOI: 10.1007/s11517-016-1574-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/15/2016] [Indexed: 11/27/2022]
Abstract
This study explores the analysis of a new stent geometry from two typical stents used to treat the coronary artery disease. Two different finite element methods are applied with different boundary conditions to investigate the stenosis region. Computational fluid dynamics (CFD) models including fluid-structure interaction are used to assess the haemodynamic impact of two types of coronary stents implantation: (1) type 1-based on a strut-link stent geometry and (2) type 2-a continuous helical stent. Using data from a recent clinical stenosis, flow disturbances and consequent shear stress alterations introduced by the stent treatment are investigated. A relationship between stenosis and the induced flow fields for the two types of stent designs is analysed as well as the correlation between haemodynamics and vessel wall biomechanical factors during the initiation and development of stenosis formation in the coronary artery. Both stents exhibit a good performance in reducing the obstruction artery. However, stent type 1 presents higher radial deformation than the type 2. This deformation can be seen as a limitation with a long-term clinical impact.
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15
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Chiastra C, Iannaccone F, Grundeken MJ, Gijsen FJH, Segers P, De Beule M, Serruys PW, Wykrzykowska JJ, van der Steen AFW, Wentzel JJ. Coronary fractional flow reserve measurements of a stenosed side branch: a computational study investigating the influence of the bifurcation angle. Biomed Eng Online 2016; 15:91. [PMID: 27495804 PMCID: PMC4974683 DOI: 10.1186/s12938-016-0211-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 07/20/2016] [Indexed: 12/31/2022] Open
Abstract
Background Coronary hemodynamics and physiology specific for bifurcation lesions was not well understood. To investigate the influence of the bifurcation angle on the intracoronary hemodynamics of side branch (SB) lesions computational fluid dynamics simulations were performed. Methods A parametric model representing a left anterior descending—first diagonal coronary bifurcation lesion was created according to the literature. Diameters obeyed fractal branching laws. Proximal and distal main branch (DMB) stenoses were both set at 60 %. We varied the distal bifurcation angles (40°, 55°, and 70°), the flow splits to the DMB and SB (55 %:45 %, 65 %:35 %, and 75 %:25 %), and the SB stenoses (40, 60, and 80 %), resulting in 27 simulations. Fractional flow reserve, defined as the ratio between the mean distal stenosis and mean aortic pressure during maximal hyperemia, was calculated for the DMB and SB (FFRSB) for all simulations. Results The largest differences in FFRSB comparing the largest and smallest bifurcation angles were 0.02 (in cases with 40 % SB stenosis, irrespective of the assumed flow split) and 0.05 (in cases with 60 % SB stenosis, flow split 55 %:45 %). When the SB stenosis was 80 %, the difference in FFRSB between the largest and smallest bifurcation angle was 0.33 (flow split 55 %:45 %). By describing the ΔPSB−QSB relationship using a quadratic curve for cases with 80 % SB stenosis, we found that the curve was steeper (i.e. higher flow resistance) when bifurcation angle increases (ΔP = 0.451*Q + 0.010*Q2 and ΔP = 0.687*Q + 0.017*Q2 for 40° and 70° bifurcation angle, respectively). Our analyses revealed complex hemodynamics in all cases with evident counter-rotating helical flow structures. Larger bifurcation angles resulted in more pronounced helical flow structures (i.e. higher helicity intensity), when 60 or 80 % SB stenoses were present. A good correlation (R2 = 0.80) between the SB pressure drop and helicity intensity was also found. Conclusions Our analyses showed that, in bifurcation lesions with 60 % MB stenosis and 80 % SB stenosis, SB pressure drop is higher for larger bifurcation angles suggesting higher flow resistance (i.e. curves describing the ΔPSB−QSB relationship being steeper). When the SB stenosis is mild (40 %) or moderate (60 %), SB resistance is minimally influenced by the bifurcation angle, with differences not being clinically meaningful. Our findings also highlighted the complex interplay between anatomy, pressure drops, and blood flow helicity in bifurcations.
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Affiliation(s)
- Claudio Chiastra
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.,Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Francesco Iannaccone
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.,IbiTech-bioMMeda, Department of Electronics and Information Systems iMinds Medical IT, Ghent University, Ghent, Belgium
| | - Maik J Grundeken
- The Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank J H Gijsen
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands
| | - Patrick Segers
- IbiTech-bioMMeda, Department of Electronics and Information Systems iMinds Medical IT, Ghent University, Ghent, Belgium
| | - Matthieu De Beule
- IbiTech-bioMMeda, Department of Electronics and Information Systems iMinds Medical IT, Ghent University, Ghent, Belgium.,FEops bvba, Ghent, Belgium
| | - Patrick W Serruys
- International Centre for Circulatory Health, NHLI, Imperial College London, London, UK
| | - Joanna J Wykrzykowska
- The Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Jolanda J Wentzel
- Department of Cardiology, Biomedical Engineering, Erasmus MC, Rotterdam, The Netherlands.
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Computational replication of the patient-specific stenting procedure for coronary artery bifurcations: From OCT and CT imaging to structural and hemodynamics analyses. J Biomech 2016; 49:2102-2111. [DOI: 10.1016/j.jbiomech.2015.11.024] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 11/21/2015] [Indexed: 01/26/2023]
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17
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[Coronary stent evaluation with cardiac CT: Literature review]. Ann Cardiol Angeiol (Paris) 2015; 64:362-7. [PMID: 26492985 DOI: 10.1016/j.ancard.2015.09.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 09/03/2015] [Indexed: 11/20/2022]
Abstract
Since the introduction of the 64-generation scanners, the accuracy and robustness of the diagnosis of coronary artery disease has progressed. The main advantage of cardiac CT is the exclusion of coronary artery disease by its excellent negative predictive value. Currently, cardiac CT applications extend thanks to innovations both in terms of technological development systems scanner or stents implanted. This is a literature review of stent evaluation with cardiac CT.
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Antoniadis AP, Mortier P, Kassab G, Dubini G, Foin N, Murasato Y, Giannopoulos AA, Tu S, Iwasaki K, Hikichi Y, Migliavacca F, Chiastra C, Wentzel JJ, Gijsen F, Reiber JH, Barlis P, Serruys PW, Bhatt DL, Stankovic G, Edelman ER, Giannoglou GD, Louvard Y, Chatzizisis YS. Biomechanical Modeling to Improve Coronary Artery Bifurcation Stenting. JACC Cardiovasc Interv 2015; 8:1281-1296. [DOI: 10.1016/j.jcin.2015.06.015] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/05/2015] [Accepted: 06/18/2015] [Indexed: 02/04/2023]
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19
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Migliavacca F, Chiastra C, Chatzizisis YS, Dubini G. Virtual bench testing to study coronary bifurcation stenting. EUROINTERVENTION 2015; 11 Suppl V:V31-4. [DOI: 10.4244/eijv11sva7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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