Biomechanical Modeling to Improve Coronary Bifurcation Stenting

Antoniadis AP, Mortier P, Kassab G, et al.
Biomechanical Modeling to Improve Coronary Bifurcation Stenting: Expert Review Document on Techniques and Clinical Implementation. JACC Cardiovasc Interv 2015;8:1281-1296.

The following are 10 key points to remember from this review on 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:

  1. The advent of coronary artery stents has ushered a new era in interventional cardiology and revolutionized the therapeutic management of patients with coronary artery disease. However, treatment of coronary bifurcation lesions remains an ongoing challenge for interventional cardiologists.
  2. Biomechanical modeling of bifurcation stenting involves computational simulations and in vitro bench testing using subject-specific arterial geometries obtained from in vivo imaging.
  3. Accurate reproduction of patient-specific coronary anatomy in the complex bifurcation regions is feasible, but currently requires a hybrid imaging approach combining the fusion and combination of multiple modalities.
  4. Biomechanical modeling has the potential to optimize stenting strategies and stent design, aiming to reduce adverse outcomes.
  5. Such modeling techniques may also be applicable to other vascular beds, such as the common carotid artery bifurcation or the aortic bifurcation into common iliac arteries, both of which are common locations of atherosclerosis.
  6. A study in swine coronary arteries highlighted the use of micro–computed tomography (CT) imaging for accurate visualization of stent morphology and 3D configuration in bifurcations regions, and may have important implications in stent design.
  7. Although this technology appears promising, there are several shortcomings that necessitate further consideration:
    • Differences in elasticity between in vitro vascular models and human coronary arteries;
    • Difficulty in the generation of an accurate atherosclerotic coronary model with variable luminal stenosis, plaque burden, and wall calcification;
    • Incomplete representation of the complex 3D structure of coronary bifurcations; and
    • Insufficient representation of the effects of coronary artery motion and deformations during the cardiac cycle on bifurcation models, which precludes the investigation of the temporal strut deformations with increasing inflation pressure.
  8. Furthermore, a widespread application of micro-CT imaging has significant financial and time-related constraints.
  9. Large-scale clinical studies are needed to establish the translation of preclinical findings into the clinical arena.
  10. For percutaneous treatment of bifurcation lesions, modeling and simulation methods may provide the opportunity to translate biomechanical engineering breakthroughs into quantifiable and patient-oriented hard clinical benefits.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Computed Tomography, Nuclear Imaging

Keywords: Atherosclerosis, Constriction, Pathologic, Coronary Artery Disease, Percutaneous Coronary Intervention, Stents, Tomography, X-Ray Computed

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