title: Patient-specific simulations of stenting procedures in coronary bifurcations: two clinical cases.
abstract: Computational simulations of stenting procedures in idealized geometries can only provide general guidelines and their use in the patient-specific planning of percutaneous treatments is inadequate. Conversely, image-based patient-specific tools that are able to realistically simulate different interventional options might facilitate clinical decision-making and provide useful insights on the treatment for each individual patient. The aim of this work is the implementation of a patient-specific model that uses image-based reconstructions of coronary bifurcations and is able to replicate real stenting procedures following clinical indications. Two clinical cases are investigated focusing the attention on the open problems of coronary bifurcations and their main treatment, the provisional side branch approach. Image-based reconstructions are created combining the information from conventional coronary angiography and computed tomography angiography while structural finite element models are implemented to replicate the real procedure performed in the patients. First, numerical results show the biomechanical influence of stents deployment in the coronary bifurcations during and after the procedures. In particular, the straightening of the arterial wall and the influence of two overlapping stents on stress fields are investigated here. Results show that a sensible decrease of the vessel tortuosity occurs after stent implantation and that overlapping devices result in an increased stress state of both the artery and the stents. Lastly, the comparison between numerical and image-based post-stenting configurations proved the reliability of such models while replicating stent deployment in coronary arteries.
authors: Laboratory of Biological Structure Mechanics (LaBS), Chemistry, Materials and Chemical Engineering Department Giulio Natta, Politecnico di Milano, Italy. stefano.morlacchi@mail.polimi.it
authors: Stefano
authors: S
authors: Morlacchi
authors: Sebastian George
authors: SG
authors: Colleoni
authors: Rubén
authors: R
authors: Cárdenes
authors: Claudio
authors: C
authors: Chiastra
authors: Jose Luis
authors: JL
authors: Diez
authors: Ignacio
authors: I
authors: Larrabide
authors: Francesco
authors: F
authors: Migliavacca
mesh_terms: D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D020342:Finite Element Analysis; D006801:Humans; D007091:Image Processing, Computer-Assisted; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging; D057285:Precision Medicine; D015607:Stents
keywords: Coronary bifurcations; Finite element model; Image-based reconstruction; Interventional cardiology; Stent