Modelling of the provisional side-branch stenting approach for the treatment of atherosclerotic coronary bifurcations: effects of stent positioning
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The most common approach to treat atherosclerosis in coronary bifurcations is the provisional side-branch (PSB) stenting, which consists sequentially of the insertion of a stent in the main branch (MB) of the bifurcation and a dilatation of the side branch (SB) passing through the struts of the stent at the bifurcation. This approach can be followed by a redilatation of the MB only or by a Final Kissing Balloon (FKB) inflation, both strategies leading to a minor stent distortion in the MB. The positioning of the stent struts in the bifurcation and the stresses generated in the stent and vessel wall are worthy of investigation for a better understanding of the mechanobiology of the system. For this purpose, a computer model of an atherosclerotic coronary bifurcation based on the finite element method was developed; the effects of performing the final redilatation with the two strategies utilising one or two balloons and those created by a different stent strut positioning around the SB were investigated. Results correlate well with previous experimental tests regarding the deformation following balloon expansion. Furthermore, results confirm firstly that the re-establishment of an optimal spatial configuration of the stent after the PSB approach is achieved with both strategies; secondly, results show that case of stent positioning with one cell placed centrally (with regard to the SB) should be preferred, avoiding the presence of struts inside the vessel lumen, which may reduce hemodynamic disturbances. The central positioning also resulted in a better solution in terms of lower stresses in the stent struts and, more importantly, in the vascular tissues.
KeywordsStent Balloon Arterial tissue Bifurcation Finite element method
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- ABAQUS (2008) Analysis user’s manual, ver. 6.7EFGoogle Scholar
- Loree HM, Tobias BJ, Gibson LJ, Kamm RD, Small DM, Lee RT (1994) Mechanical properties of model atherosclerotic lesion lipid pool. Arterioscler Thromb Vasc Biol 14: 230–234Google Scholar
- Mortier P, Holzapfel GA, De Beule M, Van Loo D, Taeymans Y, Segers P, Verdonck P, Verhegghe B (2009b) A novel simulation strategy for stent insertion and deployment in curved coronary bifurcations: comparison of three drug-eluting stents. Ann Biomed Eng [Epub ahead of print]Google Scholar
- Moses JW, Nikolsky E, Mehran R, Cambier PA, Bachinsky WB, Leya F, Kuntz RE, Popma JJ, Schleckser P, Wang H, Cohen SA, Leon MB (2006) SIRIUS 2.25 investigators. Safety and efficacy of the 2.25- mm sirolimus eluting Bx velocity stent in the treatment of patients with de novo native coronary artery lesions: the SIRIUS 2.25 trial. Am J Cardiol 98: 1455–1460CrossRefGoogle Scholar