title: Stent deformation, physical stress, and drug elution obtained with provisional stenting, conventional culotte and Tryton-based culotte to treat bifurcations: a virtual simulation study.
abstract: OBJECTIVE
  This study sought to investigate the possible influence of different bifurcation stenting techniques on stent deformation, physical stress, and drug elution using a virtual tool that includes structural, fluid dynamics and drug-eluting numerical models.
  
  
  RESULTS
  A virtual bench test based on explicit dynamics modelling was used to simulate procedures on bifurcated coronary vessels performed according to three different stenting techniques: provisional side branch stenting, culotte, and Tryton-based culotte. Geometrical configurations obtained after virtual stenting simulations were used to perform fluid dynamics and drug elution analyses. The results showed that substantially different patterns of mechanical deformation, shear stress and theoretical drug elution were obtained using the different techniques. Compared with conventional culotte, the dedicated Tryton seems to facilitate the intervention in terms of improved access to the main branch and to lower its biomechanical influence on the coronary bifurcation in terms of mechanical and haemodynamic parameters. However, since the Tryton stent is a bare metal stent, the drug elution obtained is lower.
  
  
  CONCLUSIONS
  Numerical models might successfully complement the information on stenting procedures obtained with traditional approaches such as in vitro bench testing or clinical trials. Devices dedicated to bifurcations may facilitate procedure completion and may result in specific patterns of mechanical stress, regional blood flow and drug elution.
authors.affiliation: Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Morlacchi
authors.forename: Claudio
authors.initials: C
authors.lastname: Chiastra
authors.forename: Elena
authors.initials: E
authors.lastname: Cutrì
authors.forename: Paolo
authors.initials: P
authors.lastname: Zunino
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Luca
authors.initials: L
authors.lastname: Formaggia
authors.forename: Gabriele
authors.initials: G
authors.lastname: Dubini
authors.forename: Francesco
authors.initials: F
authors.lastname: Migliavacca
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D003198:Computer Simulation; D003324:Coronary Artery Disease / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D054855:Drug-Eluting Stents; D020342:Finite Element Analysis; D006801:Humans; D008422:Materials Testing; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D009716:Numerical Analysis, Computer-Assisted; D011474:Prosthesis Design; D013314:Stress, Mechanical
chemical_list: D002317:Cardiovascular Agents