Numerical simulation of arterial dissection during balloon angioplasty of atherosclerotic coronary arteries.
Balloon angioplasty is a standard clinical treatment for symptomatic coronary artery disease. In this procedure, controlled damage is applied intraluminally to the wall of a stenotic artery. Dissection of the coronary artery is a commonly observed clinical complication of angioplasty; however, not all dissections can be detected angioscopically. This work focuses on studying the dissection mechanisms triggered during the early stages of angioplasty in an atherosclerotic coronary artery, addressing the problem by means of a parametric study based on a simplified finite element model and cohesive interface modeling. Our results emphasize the presence of several damage mechanisms, at different locations, that are triggered near the very beginning of the process and evolve competitively, depending on both geometry and material properties of the atherosclerotic vessel. Small-scale damage was evidenced, which would not be detectable by angiography or intravascular ultrasound, but could potentially be sufficient to stimulate smooth muscle cell activation, promoting late-onset complications such as restenosis.
Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, CNRS:UMR5307, LGF, F-42023 Saint Etienne, France. Electronic address: badel@emse.fr.
Pierre
P
Badel
Ecole Nationale Supérieure des Mines de Saint-Etienne, CIS-EMSE, CNRS:UMR5307, LGF, F-42023 Saint Etienne, France.
Stéphane
S
Avril
Department of Mechanical Engineering, University of South Carolina, Columbia, South Carolina 29208, USA.
Michael A
MA
Sutton
Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, South Carolina 29208, USA.
Susan M
SM
Lessner
D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000209:etiology*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D020342:Finite Element Analysis; D006801:Humans; D008955:Models, Cardiovascular
Arterial dissection; Balloon angioplasty; Cohesive zone; Coronary artery; Finite element model; Plaque fracture