title: Drug delivery patterns for different stenting techniques in coronary bifurcations: a comparative computational study.
abstract: The treatment of coronary bifurcation lesions represents a challenge for the interventional cardiologists due to the lower rate of procedural success and the higher risk of restenosis. The advent of drug-eluting stents (DES) has dramatically reduced restenosis and consequently the request for re-intervention. The aim of the present work is to provide further insight about the effectiveness of DES by means of a computational study that combines virtual stent implantation, fluid dynamics and drug release for different stenting protocols currently used in the treatment of a coronary artery bifurcation. An explicit dynamic finite element model is developed in order to obtain realistic configurations of the implanted devices used to perform fluid dynamics analysis by means of a previously developed finite element method coupling the blood flow and the intramural plasma filtration in rigid arteries. To efficiently model the drug release, a multiscale strategy is adopted, ranging from lumped parameter model accounting for drug release to fully 3-D models for drug transport to the artery. Differences in drug delivery to the artery are evaluated with respect to local drug dosage. This model allowed to compare alternative stenting configurations (namely the Provisional Side Branch, the Culotte and the Inverted Culotte techniques), thus suggesting guidelines in the treatment of coronary bifurcation lesions and addressing clinical issues such as the effectiveness of drug delivery to lesions in the side branch, as well as the influence of incomplete strut apposition and overlapping stents.
authors.affiliation: Department of Mathematics, Modelling and Scientific Computing (MOX), Politecnico di Milano, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Cutrì
authors.forename: Paolo
authors.initials: P
authors.lastname: Zunino
authors.forename: Stefano
authors.initials: S
authors.lastname: Morlacchi
authors.forename: Claudio
authors.initials: C
authors.lastname: Chiastra
authors.forename: Francesco
authors.initials: F
authors.lastname: Migliavacca
mesh_terms: D003198:Computer Simulation; D023921:Coronary Stenosis / Q000601:surgery*; D003331:Coronary Vessels / Q000473:pathology; D016503:Drug Delivery Systems; D054855:Drug-Eluting Stents; D006801:Humans; D057446:Hydrodynamics; D019919:Prosthesis Implantation