Flow Patterns at Stented Coronary Bifurcations Computational Fluid Dynamics Analysis
Flow Patterns at Stented Coronary Bifurcations Computational Fluid Dynamics Analysis
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DOI：
10.1161/circinterventions.112.968347
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发表时间：
2012-08-01
影响因子：
5.6
通讯作者：
Efstathopoulos, Efstathios P.
中科院分区：
文献类型：
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作者：
Katritsis, Demosthenes G.;Theodorakakos, Andreas;Efstathopoulos, Efstathios P.
背景-理想的分叉支架技术尚未建立，关于支架分叉处血流动力学特性的数据有限。方法和结果-我们使用计算流体动力学分析来评估在使用各种单支架和双支架技术后影响冠状动脉分叉处再狭窄和血栓形成风险的血流动力学参数。我们评估了时间平均壁面剪应力(TAWSS)、振荡剪切指数(OSI)和相对停留时间(t(R))的分布和表面积分。未行侧支血管成形术或支架置入术的单支主干支架的血流动力学效果最好(TAWSS=4.13.10(-4)N，OSI=7.52.10(-6)m(2)，t(R)=5.57.10(-4)m(2)/pa)，分叉面积分别为0.36 mm(2)、0.04 mm(2)和0 mm(2)。T-支架置入后，根据这些OSI值扩展的分叉区分别为0.61 mm(2)、0.18 mm(2)和0.02 mm(2)。在考虑的双支架技术中，粉碎支架(TAWSS=1.18.10(-4)N，OSI=7.75.10(-6)m(2)，t(R)=6.16.10(-4)m(2)/pa)与T-支架(TAWSS=0.78.10(-4)N，OSI=10.40.10(-6)m(2)，t(R)=6.87.10(-4)m(2)/pa)或球囊技术(TAWSS=1.30.10(-4)N，t(R)=6.87.10(-4)m(2)/pa)相比具有最有利的结果。OSI=9.87.10(-6)m(2)，t(R)=8.78.10(-4)m(2)/pa。结论：在所研究的计算机模拟模型中，非球囊侧支支架置入术较双支架置入术具有更好的血流动力学优势。当考虑双支架置入术时，使用薄支撑支架的挤压技术可能比Cuotte或T型支架更能改善即刻血流动力学。(中国保监会心脏科协2012；5：530-539。)
Background-The ideal bifurcation stenting technique is not established, and data on the hemodynamic characteristics at stented bifurcations are limited.Methods and Results-We used computational fluid dynamics analysis to assess hemodynamic parameters known affect the risk of restenosis and thrombosis at coronary bifurcations after the use of various single-and double-stenting techniques. We assessed the distributions and surface integrals of the time averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and relative residence time (t(r)). Single main branch stenting without side branch balloon angioplasty or stenting provided the most favorable hemodynamic results (integrated values of TAWSS=4.13.10(-4) N, OSI=7.52.10(-6) m(2), t(r)=5.57.10(-4) m(2)/Pa) with bifurcational area subjected to OSI values >0.25, >0.35, and >0.45 calculated as 0.36 mm(2), 0.04 mm(2), and 0 mm(2), respectively. Extended bifurcation areas subjected to these OSI values were seen after T-stenting: 0.61 mm(2), 0.18 mm(2), and 0.02 mm(2), respectively. Among the considered double-stenting techniques, crush stenting (integrated values of TAWSS=1.18.10(-4) N, OSI=7.75.10(-6) m(2), t(r)=6.16.10(-4) m(2)/Pa) gave the most favorable results compared with T-stenting (TAWSS=0.78.10(-4) N, OSI=10.40.10(-6) m(2), t(r)=6.87.10(-4) m(2)/Pa) or the culotte technique (TAWSS=1.30.10(-4) N, OSI=9.87.10(-6) m(2), t(r)=8.78.10(-4) m(2)/Pa).Conclusions-In the studied models of computer simulations, stenting of the main branch with our without balloon angioplasty of the side branch offers hemodynamic advantages over double stenting. When double stenting is considered, the crush technique with the use of a thin-strut stent may result in improved immediate hemodynamics compared with culotte or T-stenting. (Circ Cardiovasc Interv. 2012; 5:530-539.)