Patient-specific modelling of stent overlap: Lumen gain, tissue damage and in-stent restenosis
Patient-specific modelling of stent overlap: Lumen gain, tissue damage and in-stent restenosis
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DOI：
10.1016/j.jmbbm.2020.103836
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发表时间：
2020-09-01
影响因子：
3.9
通讯作者：
Vogt, F.
中科院分区：
文献类型：
--
作者：
He, R.;Zhao, L. G.;Vogt, F.
本文用有限元方法研究了多个支架，有无重叠，对特定患者冠状动脉内支架置入的结果的影响。具体地说，本研究的目的是揭示在经皮冠状动脉介入治疗中支架重叠对管腔增加、组织损伤和支架内再狭窄的影响。在活体光学相干断层成像的基础上，利用MIMICS建立了特定患者冠状动脉的三维模型，包括中层和外膜两层和斑块。具有损伤的超弹性模型被用来描述动脉层和斑块的应力-拉伸响应，并与实验结果进行了验证。使用ABAQUS CAE建立了Resolute Integrity(TM)药物洗脱支架和三折叠膨胀球囊的模型。结果显示，支架置入后，重叠支架较单一支架管腔增大，但中层损伤较大，支架内再狭窄率较高。同时，非重叠支架的管腔增益小于重叠支架，这是由于后坐效应增加所致。与重叠支架相比，非重叠支架对组织的损伤更大，支架内再狭窄的发生率更高。就长期临床结果而言，该研究建议在可能的情况下使用单个支架或重叠最小的多个支架来治疗长时间或成角度的病变。
This paper investigates the effects of multiple stents, with and without overlap, on the outcome of stent deployment in a patient-specific coronary artery using the finite element method. Specifically, the objective of this study is to reveal the effect of stent overlap on lumen gain, tissue damage and in-stent restenosis in percutaneous coronary intervention. Based on intravital optical coherency tomography imaging, threedimensional model of a specific patient's coronary artery was developed, with two constituent layers (media and adventitia) and plaque, using Mimics. Hyperelastic models with damage, verified against experimental results, were used to describe stress-stretch responses of arterial layers and plaque. Abaqus CAE was used to create the models for Resolute Integrity (TM) drug-eluting stents and tri-folded expansion balloons. The results showed that lumen gain was improved by the overlapping stents than a single stent after deployment; however, damage to the media layer was greater, promoting a higher rate of in-stent restenosis. Meanwhile, the lumen gain achieved with the non-overlapping stents was smaller than that with the overlapping ones, due to an increased recoiling effect. Also, non-overlapping stents induced more tissue damage and higher rate of in-stent restenosis than overlapping stents. With respect to long-term clinical outcomes, the study recommended the use of a single stent where possible or multiple stents with minimal overlaps to treat long or angulated lesions.