The influence of vascular anatomy on carotid artery stenting: a parametric study for damage assessment.
Carotid artery stenting is emerging as an alternative technique to surgery for the treatment of symptomatic severe carotid stenosis. Clinical and experimental evidence demonstrates that both plaque morphology and biomechanical changes due to the device implantation can be possible causes of an unsuccessful treatment. In order to gain further insights of the endovascular intervention, a virtual environment based on structural finite element simulations was built to emulate the stenting procedure on generalized atherosclerotic carotid geometries which included a damage model to quantify the injury of the vessel. Five possible lesion scenarios were simulated by changing both material properties and vascular geometrical features to cover both presumed vulnerable and stable plaques. The results were analyzed with respect to lumen gain and wall stresses which are potentially related to the failure of the procedure according to previous studies. Our findings show that an elliptic lumen shape and a thinner fibrous cap with an underlying lipid pool result in higher stenosis reduction, while large calcifications and fibrotic tissue are more prone to recoil. The shielding effect of a thicker fibrous cap helps to reduce local compressive stresses in the soft plaque. The presence of a soft plaque reduces the damage in the healthy vascular structures. Contrarily, the presence of hard plaque promotes less damage volume in the fibrous cap and reduces stress peaks in this region, but they seem to increase stresses in the media-intima layer. Finally the reliability of the achieved results was put into clinical perspective.
IbiTech-bioMMeda, Department of Electronics and Information Systems, iMinds Future Health Department, Ghent University, Belgium. Electronic address: francesco.iannaccone@UGent.be.
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Iannaccone
IbiTech-bioMMeda, Department of Electronics and Information Systems, iMinds Future Health Department, Ghent University, Belgium.
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Debusschere
IbiTech-bioMMeda, Department of Electronics and Information Systems, iMinds Future Health Department, Ghent University, Belgium.
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De Bock
IbiTech-bioMMeda, Department of Electronics and Information Systems, iMinds Future Health Department, Ghent University, Belgium; FEops bvba, Ghent, Belgium.
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De Beule
Centre for X-ray Tomography, Ghent University, Belgium.
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Van Loo
Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
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Vermassen
IbiTech-bioMMeda, Department of Electronics and Information Systems, iMinds Future Health Department, Ghent University, Belgium.
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Segers
IbiTech-bioMMeda, Department of Electronics and Information Systems, iMinds Future Health Department, Ghent University, Belgium; FEops bvba, Ghent, Belgium.
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Verhegghe
D017130:Angioplasty / Q000009:adverse effects / Q000379:methods; D002339:Carotid Arteries / Q000473:pathology; D020212:Carotid Artery Injuries / Q000209:etiology* / Q000473:pathology; D016893:Carotid Stenosis / Q000473:pathology / Q000628:therapy*; D020342:Finite Element Analysis; D006801:Humans; D008955:Models, Cardiovascular; D058226:Plaque, Atherosclerotic / Q000473:pathology / Q000628:therapy*; D015203:Reproducibility of Results; D015607:Stents / Q000009:adverse effects*; D017539:Tunica Intima / Q000473:pathology
Carotid artery stenting; Finite element; Lumen shape; Plaque eccentricity