title: A layer-specific three-dimensional model for the simulation of balloon angioplasty using magnetic resonance imaging and mechanical testing.
abstract: A detailed understanding of the mechanical procedure of balloon angioplasty requires three-dimensional (3D) modeling and efficient numerical simulations. We have developed a 3D model for eight distinct arterial components associated with specific mechanical responses. The 3D geometrical model is based on in vitro magnetic resonance imaging of a human stenotic postmortem artery and is represented by nonuniform rational B-spline surfaces. Mechanical tests of the corresponding vascular tissues provide a fundamental basis for the formulation of large strain constitutive laws, which model the typical anisotropic, highly nonlinear, and inelastic mechanical characteristics under supraphysiological loadings. The 3D finite-element realization considers the balloon-artery interaction and accounts for vessel-specific axial in situ prestretches. 3D stress states of the investigated artery during balloon expansion and stent deployment were analyzed. Furthermore, we studied the changes of the 3D stress state due to model simplifications, which are characterized by neglecting axial in situ prestretch, assuming plane strain states, and isotropic material responses, as commonly utilized in previous works. Since these simplifications lead to maximum stress deviations of up to 600%-where even the stress character may interchange-the associated models are, in general, inappropriate. The proposed approach provides a tool that has the potential (i) to improve procedural protocols and the design of interventional instruments on a lesion-specific basis, and (ii) to determine postangioplasty mechanical environments, which may be correlated with restenosis responses.
authors.affiliation: Institute for Structural Analysis-Computational Biomechanics, Graz University of Technology, Austria. gerhard.holzapfel@biomech.tu-graz.ac.at
authors.forename: Gerhard A
authors.initials: GA
authors.lastname: Holzapfel
authors.forename: Michael
authors.initials: M
authors.lastname: Stadler
authors.forename: Christian A J
authors.initials: CA
authors.lastname: Schulze-Bauer
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D016880:Anisotropy; D003198:Computer Simulation; D003238:Connective Tissue / Q000503:physiopathology / Q000601:surgery; D003251:Constriction, Pathologic / Q000503:physiopathology / Q000601:surgery; D004548:Elasticity; D004730:Endothelium, Vascular / Q000503:physiopathology / Q000601:surgery; D020342:Finite Element Analysis; D006801:Humans; D007083:Iliac Artery / Q000033:anatomy & histology / Q000503:physiopathology* / Q000601:surgery*; D021621:Imaging, Three-Dimensional / Q000379:methods; D066298:In Vitro Techniques; D008279:Magnetic Resonance Imaging; D008297:Male; D008955:Models, Cardiovascular; D017711:Nonlinear Dynamics; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013314:Stress, Mechanical; D013718:Tensile Strength; D017540:Tunica Media / Q000503:physiopathology / Q000601:surgery