Modeling Stented Coronary Arteries: Where We are, Where to Go

Morlacchi, Stefano; Migliavacca, Francesco

doi:10.1007/s10439-012-0681-6

Cited by 66 publications

(27 citation statements)

References 114 publications

(142 reference statements)

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“…The analysis of perturbed blood flow in presence of stents has been investigated by several studies . The present work aims to complement the existing literature with the investigation of the following points: (i) the role of vessel curvature on flow and WSS patterns; and (ii) the combined analysis of blood flow and oxygen transfer.…”

Section: Resultsmentioning

confidence: 99%

Simulation of oxygen transfer in stented arteries and correlation with in‐stent restenosis

Caputo

Chiastra

Cianciolo

et al. 2013

Numer Methods Biomed Eng

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Computational models are used to study the combined effect of biomechanical and biochemical factors on coronary in-stent restenosis, which is a postoperative remodeling and regrowth pathology of the stented arteries. More precisely, we address numerical simulations, on the basis of Navier-Stokes and mass transport equations, to study the role of perturbed wall shear stresses and reduced oxygen concentration in a geometrical model reconstructed from a real porcine artery treated with a stent. Joining in vivo and in silico tools of investigation has multiple benefits in this case. On one hand, the geometry of the arterial wall and of the stent closely correspond to a real implanted configuration. On the other hand, the inspection of histological tissue samples informs us on the location and intensity of in-stent restenosis. As a result, we are able to correlate geometrical factors, such as the axial variation of the artery diameter and its curvature; the numerical quantification of biochemical stimuli, such as wall shear stresses; and the availability of oxygen to the inner layers of the artery, with the appearance of in-stent restenosis. This study shows that the perturbation of the vessel curvature could induce hemodynamic conditions that stimulate undesired arterial remodeling.

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Section: Resultsmentioning

confidence: 99%

Simulation of oxygen transfer in stented arteries and correlation with in‐stent restenosis

Caputo

Chiastra

Cianciolo

et al. 2013

Numer Methods Biomed Eng

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“…In the literature, many reports have focused on the expansion of stents without any textile [11][12][13][14][15][16][17]. And yet, the presence of the textile component onto which stents are sutured is a key aspect that drastically influences the device behavior and requires specific modeling.…”

Section: Introductionmentioning

confidence: 99%

Deployment of stent grafts in curved aneurysmal arteries: toward a predictive numerical tool

Perrin

Demanget

Badel

et al. 2015

Numer Methods Biomed Eng

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The mechanical behavior of aortic stent grafts plays an important role in the success of endovascular surgery for aneurysms. In this study, finite element analysis was carried out to simulate the expansion of five marketed stent graft iliac limbs and to evaluate quantitatively their mechanical performances. The deployment was modeled in a simplified manner according to the following steps: (i) stent graft crimping and insertion in the delivery sheath, (ii) removal of the sheath and stent graft deployment in the aneurysm, and (iii) application of arterial pressure. In the most curved aneurysm and for some devices, a decrease of stent graft cross-sectional area up to 57% was found at the location of some kinks. Apposition defects onto the arterial wall were also clearly evidenced and quantified. Aneurysm inner curve presented significantly more apposition defects than outer curve. The feasibility of finite element analysis to simulate deployment of marketed stent grafts in curved aneurysm models was demonstrated. The study of the influence of aneurysm tortuosity on stent graft mechanical behavior shows that increasing vessel curvature leads to stent graft kinks and inadequate apposition against the arterial wall. Such simulation approach opens a very promising way toward surgical planning tools able to predict intra and/or post-operative short-term stent graft complications.

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“…Such an advancement has been supported by dedicated biomechanical analysis of the artery-device interactions through computational tools, like structural Finite Element Analysis or Computational Fluid Dynamics, which are nowadays extensively used during the device design [Alaimo et al, 2017], for pre-operative planning [Morganti et al, 2016, de Jaegere et al, 2016, or diagnostics [Gasser et al, 2016, Gaur et al, 2017 as discussed in the following, where we deal with the different aspects of simulating tissues and structures in cardiovascular mechanics. In particular, we focus here on the simulation of endovascular treatments of peripheral arteries (e.g., carotid artery) and aortic valve, neglecting coronary stenting, which would deserve a dedicated dissertation as reported in [Morlacchi et al, 2013].…”

Section: Cardiovascular Diseases and Endovascular Treatmentsmentioning

confidence: 99%

Computational Methods in Cardiovascular Mechanics

Auricchio¹,

Conti²,

Lefieux³

et al. 2018

Cardiovascular Mechanics

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Introduction: The Role and the Development of Computational MethodsThe introduction of computational models in cardiovascular sciences has been progressively bringing new and unique tools for the investigation of the physiopathology. Together with the dramatic improvement of imaging and measuring devices on one side, and of computational architectures on the other one, mathematical and numerical models have provided a new -clearly noninvasiveapproach for understanding not only basic mechanisms but also patient-specific conditions, and for supporting the design and the development of new therapeutic options. The terminology in silico is, nowadays, commonly accepted for indicating this new source of knowledge added to traditional in vitro and in vivo investigations. The advantages of in silico methodologies are basically the low cost in terms of infrastructures and facilities, the reduced invasiveness and, in general, the intrinsic predictive capabilities based on the use of mathematical models. The disadvantages are generally identified in the distance between the real cases and their virtual counterpart required by the conceptual modeling that can be detrimental for the reliability of numerical simulations. In this respect, the terrific development of new devices and algorithms for image and data retrieval and processing allowed the migration from (over)simplified idealized descriptions to high-fidelity patient-specific models, in a critical -still ongoingprocess of merging measures and conceptualizations. Meanwhile, the progressive improvement of computational resources provides the infrastructures to perform numerical simulations of complex dynamics in reasonable timelines. All such processes required, in background, the crucial development of novel specific modeling techniques and solvers in the field of computational mechanics, in an exciting process involving mathematics, engineering, computer science, and biomedical knowledge that is now having an impact not only on research but also on clinical practice. As a matter of fact, mathematical and computational modeling has been recognized more than a research tool, a service to be integrated in products for the clinical market, as the example of the company HeartFlow [Taylor et al., 2013] demonstrates.

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Modeling Stented Coronary Arteries: Where We are, Where to Go

Cited by 66 publications

References 114 publications

Simulation of oxygen transfer in stented arteries and correlation with in‐stent restenosis

Simulation of oxygen transfer in stented arteries and correlation with in‐stent restenosis

Deployment of stent grafts in curved aneurysmal arteries: toward a predictive numerical tool

Computational Methods in Cardiovascular Mechanics

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