title: Evaluation of coronary flow conditions in complex coronary artery bifurcations stenting using computational fluid dynamics: Impact of final proximal optimization technique on different double-stent techniques.
abstract: OBJECTIVE
  Computational fluid dynamics (CFD) have been recently adopted in many fields of cardiovascular medicine and in interventional cardiology. Using CFD analysis we compared the use of different PCI procedures, with and without the utilization of a proximal optimization technique (POT), on a complex coronary artery bifurcation.
  
  
  METHODS
  For the analysis, we considered a hypothetic model of a left anterior descending artery-diagonal Medina 1,1,1 bifurcation type with a diameter of the proximal main branch (MB) and the side branch (SB) set at 3.5mm and 2.5mm, respectively. The bifurcation angle has been set to 50°. For the stent simulation, we reconstructed a third-generation, ultra-thin strut everolimus-eluting stent (ORSIRO stent, Biotronik IC, Bulack, Switzerland).
  
  
  RESULTS
  The Nano-crush and the modified T techniques seem able to restore the most physiologic fluid dynamic profile. Conversely, the DK-crush and the culotte demonstrated an intermediate and worst effect, respectively. The addition of a final POT resulted favorably for both Nano-crush and reverse modified T techniques, whereas a neutral and lack of significant effects have been observed for the DK-crush and culotte technique, respectively.
  
  
  CONCLUSIONS
  Different double-stenting techniques (DST) have a different impact on coronary flow physiology. Both Nano-crush and modified T techniques achieved the most physiologic profile. The addition of a final POT appears to be a favourable step for both Nano-crush and modified T.
authors.affiliation: Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. Electronic address: jackyheart71@yahoo.it.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Rigatelli
authors.affiliation: Department of Cardiology, Rovigo General Hospital, Rovigo, Italy; Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Zuin
authors.affiliation: Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Dell'Avvocata
authors.affiliation: Department of Cardiology; Hospital, University School of Medicine, Sofia, Bulgaria.
authors.forename: Dobrin
authors.initials: D
authors.lastname: Vassilev
authors.affiliation: Cardiac Catheterization Laboratories, Winthrop University Hospital, Mineola, NY 11501.
authors.forename: Ramesh
authors.initials: R
authors.lastname: Daggubati
authors.affiliation: Methodist Hospital, Merrillville, IN 46410.
authors.forename: Thach
authors.initials: T
authors.lastname: Nguyen
authors.affiliation: Tan Tao University, School of Medicine, Tan Duc eCity, Long An, Vietnam.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Van Viet Thang
authors.affiliation: Medtech Research Theme, National Heart Centre Singapore and Duke-NUS Medical School, Singapore.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Foin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D002317:Cardiovascular Agents / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology*; D054855:Drug-Eluting Stents; D000068338:Everolimus / Q000008:administration & dosage; D005260:Female; D006801:Humans; D057446:Hydrodynamics; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D066230:Patient-Specific Modeling; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D011474:Prosthesis Design; D020127:Recovery of Function; D012039:Regional Blood Flow; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D000068338:Everolimus
keywords: CFD; Coronary artery disease; Coronary bifurcations; Drud eluting stents; Percutaneous coronary intervention (PCI)