A Patient-Specific Study Investigating the Relation between Coronary Hemodynamics and Neo-Intimal Thickening after Bifurcation Stenting with a Polymeric Bioresorbable Scaffold

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.

Automatic segmentation of optical coherence tomography pullbacks of coronary arteries treated with bioresorbable vascular scaffolds: Application to hemodynamics modeling

“…Unlike all the other phases of lumen segmentation, the struts-based lumen correction is optional. While this correction is mandatory when baseline OCT images are analyzed, in case of follow-up OCT images, where the stent struts are covered by the neointimal, the segmentation algorithm can either be used without correction to detect the follow-up lumen or with correction to identify the baseline lumen contour [ 16 ].…”

Advancements and Opportunities in Characterizing Patient-Specific Wall Shear Stress Imposed by Coronary Artery Stenting

“…Their approach pays particular attention to the inclusion of side branches that are likely to impact the local flow field. A similar approach was employed for BVS by Migliori et al, who further quantified restenosis and neointimal thickening [76]. Gogas et al developed a similar process that is highlighted via a BVS case study [77,78].…”

“…Other approaches in the combination of conventional extravascular and high-resolution intravascular imaging data to reconstruct the stented flow domain are also presented with varying degrees of detail in the literature [70,[76][77][78][79]. Recently, Li and colleagues described their process using 3D angiography and OCT imaging, which was featured for diseased coronary artery data sets [80] as well as those obtained after bioresorbable vascular scaffold (BVS) implantation [58].…”

Application of an OCT-based 3D reconstruction framework to the hemodynamic assessment of an ulcerated coronary artery plaque

“…The employed 3D reconstruction methodology was performed in a MATLAB environment (Mathworks, Natick, MA, USA) and comprised two phases: (i) image elaboration for the detection of the lumen contour and stent struts, (ii) alignment and orientation of the detected components with the vessel centerline, obtained from angiography. The implemented methodology is described in detail elsewhere [8][9][10]. A brief description of the main reconstruction steps is presented below.…”