Computational replication of the patient-specific stenting procedure for coronary artery bifurcations: From OCT and CT imaging to structural and hemodynamics analyses
Computational replication of the patient-specific stenting procedure for coronary artery bifurcations: From OCT and CT imaging to structural and hemodynamics analyses
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DOI：
10.1016/j.jbiomech.2015.11.024
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发表时间：
2016-07-26
影响因子：
2.4
通讯作者：
LaDisa, John F., Jr.
中科院分区：
文献类型：
--
作者：
Chiastra, Claudio;Wu, Wei;LaDisa, John F., Jr.
冠状动脉分叉的最佳支架技术仍然存在争议。有了更多的进步，计算模拟很快就可以用来比较支架设计或策略，基于验证的结构和血流动力学结果，以便确定每个人的解剖结构的最佳解决方案。在这项研究中，对2例患者进行了支架部署的特定患者模拟，以复制介入心脏科医生进行的完整过程。随后进行计算流体动力学(CFD)分析以量化与再狭窄有关的血流动力学参数。通过CT血管成像和光学相干断层扫描(OCT)重建患者特定的冠状动脉分叉模型。从OCT估计斑块的位置和组成，并将其分配到模型，并在ABAQUS中进行结构模拟。在SolidWorks中创建的Xience Prime或Nobori支架的虚拟支架扩张后的动脉几何形状与OCT和CT的术后几何形状进行了比较，然后被提取并用于在SimVculate中进行CFD模拟。基于体表面积和下游血管阻力和电容的流入边界条件被应用于分支来模拟生理，虚拟扩张后得到的动脉几何形状与根据患者图像重建的动脉几何形状吻合良好。定量比较重建和支架后几何形状之间的距离，发现面积的最大差异为20.4%。在两个患者中，壁切应力的不利指标在较厚的Nobori支架中更为明显。这些发现验证了支架扩张的结构分析，引入了结合固体和流体力学分析软件包的工作流程，并强调了先前理想化研究中的重要支架设计特征。建议的方法最终可能有助于为每个患者确定支架和位置的最佳选择。(C)2015爱思唯尔有限公司。保留所有权利。
The optimal stenting technique for coronary artery bifurcations is still debated. With additional advances computational simulations can soon be used to compare stent designs or strategies based on verified structural and hemodynamics results in order to identify the optimal solution for each individual's anatomy. In this study, patient-specific simulations of stent deployment were performed for 2 cases to replicate the complete procedure conducted by interventional cardiologists. Subsequent computational fluid dynamics (CFD) analyses were conducted to quantify hemodynamic quantities linked to restenosis.Patient-specific pre-operative models of coronary bifurcations were reconstructed from CT angiography and optical coherence tomography (OCT). Plaque location and composition were estimated from OCT and assigned to models, and structural simulations were performed in Abaqus. Artery geometries after virtual stent expansion of Xience Prime or Nobori stents created in SolidWorks were compared to post-operative geometry from OCT and CT before being extracted and used for CFD simulations in SimVascular. Inflow boundary conditions based on body surface area, and downstream vascular resistances and capacitances were applied at branches to mimic physiology.Artery geometries obtained after virtual expansion were in good agreement with those reconstructed from patient images. Quantitative comparison of the distance between reconstructed and post-stent geometries revealed a maximum difference in area of 20.4%. Adverse indices of wall shear stress were more pronounced for thicker Nobori stents in both patients. These findings verify structural analyses of stent expansion, introduce a workflow to combine software packages for solid and fluid mechanics analysis, and underscore important stent design features from prior idealized studies. The proposed approach may ultimately be useful in determining an optimal choice of stent and position for each patient. (C) 2015 Elsevier Ltd. All rights reserved.