title: A novel simulation strategy for stent insertion and deployment in curved coronary bifurcations: comparison of three drug-eluting stents.
abstract: The introduction of drug-eluting stents (DES) has reduced the occurrence of restenosis in coronary arteries. However, restenosis remains a problem in stented coronary bifurcations. This study investigates and compares three different second generation DESs when being implanted in the curved main branch of a coronary bifurcation with the aim of providing better insights into the related changes of the mechanical environment. The 3D bifurcation model is based on patient-specific angiographic data that accurately reproduce the in vivo curvatures of the vessel segments. The layered structure of the arterial wall and its anisotropic mechanical behavior are taken into account by applying a novel algorithm to define the fiber orientations. An innovative simulation strategy considering the insertion of a folded balloon catheter over a guide wire is proposed in order to position the stents within the curved vessel. Straightening occurs after implantation of all stents investigated. The resulting distributions of the wall stresses are strongly dependent on the stent design. Using a parametric modeling approach, two design modifications, which reduce the predicted maximum values of the wall stress, are proposed and analyzed.
authors.affiliation: IBiTech, Ghent University, Ghent, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Mortier
authors.forename: Gerhard A
authors.initials: GA
authors.lastname: Holzapfel
authors.forename: Matthieu
authors.initials: M
authors.lastname: De Beule
authors.forename: Denis
authors.initials: D
authors.lastname: Van Loo
authors.forename: Yves
authors.initials: Y
authors.lastname: Taeymans
authors.forename: Patrick
authors.initials: P
authors.lastname: Segers
authors.forename: Pascal
authors.initials: P
authors.lastname: Verdonck
authors.forename: Benedict
authors.initials: B
authors.lastname: Verhegghe
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D003198:Computer Simulation; D017023:Coronary Angiography / Q000379:methods; D003331:Coronary Vessels / Q000473:pathology* / Q000503:physiopathology; D054855:Drug-Eluting Stents; D006083:Graft Occlusion, Vascular / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D008955:Models, Cardiovascular