title: Biomechanical Modeling to Improve Coronary Artery Bifurcation Stenting: Expert Review Document on Techniques and Clinical Implementation.
abstract: Treatment of coronary bifurcation lesions remains an ongoing challenge for interventional cardiologists. Stenting of coronary bifurcations carries higher risk for in-stent restenosis, stent thrombosis, and recurrent clinical events. This review summarizes the current evidence regarding application and use of biomechanical modeling in the study of stent properties, local flow dynamics, and outcomes after percutaneous coronary interventions in bifurcation lesions. Biomechanical modeling of bifurcation stenting involves computational simulations and in vitro bench testing using subject-specific arterial geometries obtained from in vivo imaging. Biomechanical modeling has the potential to optimize stenting strategies and stent design, thereby reducing adverse outcomes. Large-scale clinical studies are needed to establish the translation of pre-clinical findings to the clinical arena.
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece; Cardiovascular Department, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.
authors: Antonios P
authors: AP
authors: Antoniadis
authors: FEops, Ghent, Belgium; IBiTech-bioMMeda, Ghent University, Ghent, Belgium.
authors: Peter
authors: P
authors: Mortier
authors: California Medical Innovations Institute, San Diego, California.
authors: Ghassan
authors: G
authors: Kassab
authors: Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta," Politecnico di Milano, Milan, Italy.
authors: Gabriele
authors: G
authors: Dubini
authors: National Heart Centre Singapore, Singapore.
authors: Nicolas
authors: N
authors: Foin
authors: Department of Cardiology and Clinical Research Institute, Kyushu Medical Center, Fukuoka, Japan.
authors: Yoshinobu
authors: Y
authors: Murasato
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.
authors: Andreas A
authors: AA
authors: Giannopoulos
authors: Biomedical Instrument Institute, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China.
authors: Shengxian
authors: S
authors: Tu
authors: Graduate School of Advanced Science and Engineering, Waseda University, Tokyo, Japan.
authors: Kiyotaka
authors: K
authors: Iwasaki
authors: Cardiovascular Division, Department of Internal Medicine, Saga University, Saga, Japan.
authors: Yutaka
authors: Y
authors: Hikichi
authors: Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta," Politecnico di Milano, Milan, Italy.
authors: Francesco
authors: F
authors: Migliavacca
authors: Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta," Politecnico di Milano, Milan, Italy; Biomechanics Laboratory, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors: Claudio
authors: C
authors: Chiastra
authors: Biomechanics Laboratory, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors: Jolanda J
authors: JJ
authors: Wentzel
authors: Biomechanics Laboratory, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.
authors: Frank
authors: F
authors: Gijsen
authors: Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
authors: Johan H C
authors: JHC
authors: Reiber
authors: Melbourne Medical School and Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia.
authors: Peter
authors: P
authors: Barlis
authors: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
authors: Patrick W
authors: PW
authors: Serruys
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors: Deepak L
authors: DL
authors: Bhatt
authors: Department of Cardiology, Clinical Center of Serbia, and Medical Faculty, University of Belgrade, Belgrade, Serbia.
authors: Goran
authors: G
authors: Stankovic
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts.
authors: Elazer R
authors: ER
authors: Edelman
authors: Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece.
authors: George D
authors: GD
authors: Giannoglou
authors: Institut Cardiovasculaire Paris Sud, Massy, France.
authors: Yves
authors: Y
authors: Louvard
authors: Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. Electronic address: ychatzizisis@icloud.com.
authors: Yiannis S
authors: YS
authors: Chatzizisis
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D000818:Animals; D001696:Biomechanical Phenomena; D003198:Computer Simulation; D017076:Computer-Aided Design; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D011474:Prosthesis Design; D015607:Stents; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome
keywords: bifurcation; biomechanical stress; coronary artery disease; endothelial shear stress; stent(s)