A patient-specific study investigating the relation between coronary hemodynamics and neo-intimal thickening after bifurcation stenting with a polymeric bioresorbable scaffold

Susanna Migliori, Rajiv Rampat, Marco Bologna, Eros Montin, Francesco Burzotta, David Hildick-Smith, Gabriele Dubini, Luca Mainardi, Francesco Migliavacca, James Cockburn, Claudio Chiastra

Research output: Contribution to journalArticle

Abstract

We present an application of a validated reconstruction methodology for the comparison between patient-specific hemodynamics and neo-intimal thickening at nine months from the intervention. (1) Background: Coronary bifurcation stenting alters the vessel geometry, influencing the local hemodynamics. The evaluation of wall shear stress (WSS) relies on the application of computational fluid dynamics to model its distribution along the coronary tree. The endothelium actively responds to WSS, which triggers eventual cell proliferation to cover the stent struts. (2) Methods: Baseline optical coherence tomography and angiographic data were combined to reconstruct a patient-specific coronary bifurcation with an implanted bioresorbable scaffold and to simulate the hemodynamics. Results were linked with the neo-intimal thickening after nine months from the intervention. (3) Results: Blood velocity patterns were disrupted at the bifurcation due to the presence of the stent. It was observed that 55.6% of the scaffolded lumen surface was exposed to values of time-averaged WSS lower than 0.4 Pa. Follow-up images showed a luminal narrowing of 19% in the main branch. There was also a complete coverage in 99% of struts. (4) Conclusions: This approach provided valuable complementary information that might improve the clinical outcomes in this subset of coronary diseases.

Original languageEnglish
Article number1510
JournalApplied Sciences (Switzerland)
Volume8
Issue number9
DOIs
Publication statusPublished - Sep 1 2018

Keywords

  • Bioresorbable scaffold
  • Computational fluid dynamics
  • Coronary artery bifurcation
  • Image segmentation
  • Neo-intimal coverage
  • Optical coherence tomography
  • Patient-specific computer modeling
  • Stent
  • Three-dimensional reconstruction
  • Wall shear stress

ASJC Scopus subject areas

  • Materials Science(all)
  • Instrumentation
  • Engineering(all)
  • Process Chemistry and Technology
  • Computer Science Applications
  • Fluid Flow and Transfer Processes

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