title: Feasibility of a priori numerical assessment of plaque scaffolding after carotid artery stenting in clinical routine: proof of concept.
abstract: OBJECTIVE
  Carotid artery stenting (CAS) is an alternative procedure for the treatment of severely stenosed carotid artery lesions in high-risk patients. Appropriate patient selection and stent design are paramount to achieve a low stroke and death rate in these complex high-risk procedures. This study introduces and evaluates a novel virtual, patient-specific, pre-operative environment to quantify scaffolding parameters based on routine imaging techniques.
  
  
  METHODS
  Two patients who underwent CAS with two different sizes of the Acculink stent (Abbott Vascular, Santa Clara, CA, USA) were studied. Pre-operative data were used to build the numerical models for the virtual procedure. Numerical results were validated with post-operative angiography. Using novel virtual geometrical tools, incomplete stent apposition, free cell area and largest fitting sphere in the stent cell were evaluated in situ as quantitative measures of successful stent placement and to assess potential risk factors for CAS complications.
  
  
  RESULTS
  A quantitative validation of the numerical outcome with post-operative images noted differences in lumen diameter of 5.31 ± 8.05% and 4.12 ± 9.84%, demonstrating the reliability of the proposed methodology. The quantitative measurements of the scaffolding parameters on the virtually deployed stent geometry highlight the variability of the device behavior in relation to the target lesion. The free cell area depends on the target diameter and oversizing, while the largest fitting spheres and apposition values are influenced by the local concavity and convexity of the vessel.
  
  
  CONCLUSIONS
  The proposed virtual environment may be an additional tool for endovascular specialists especially in complex anatomical cases where stent design and positioning may have a higher impact on procedural success and outcome.
authors.affiliation: 1 IBiTech-bioMMeda, Ghent University, Ghent - Belgium.
authors.forename: Francesco
authors.initials: F
authors.lastname: Iannaccone
authors.forename: Sander
authors.initials: S
authors.lastname: De Bock
authors.forename: Matthieu
authors.initials: M
authors.lastname: De Beule
authors.forename: Frank
authors.initials: F
authors.lastname: Vermassen
authors.forename: Isabelle
authors.initials: I
authors.lastname: Van Herzeele
authors.forename: Pascal
authors.initials: P
authors.lastname: Verdonck
authors.forename: Patrick
authors.initials: P
authors.lastname: Segers
authors.forename: Benedict
authors.initials: B
authors.lastname: Verhegghe
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000295:instrumentation*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003198:Computer Simulation; D005240:Feasibility Studies; D020342:Finite Element Analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D009716:Numerical Analysis, Computer-Assisted; D018579:Patient Selection; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D015607:Stents; D013813:Therapy, Computer-Assisted; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome