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Biomechanics and Modeling in Mechanobiology

, Volume 9, Issue 5, pp 551–561 | Cite as

Modelling of the provisional side-branch stenting approach for the treatment of atherosclerotic coronary bifurcations: effects of stent positioning

  • Dario Gastaldi
  • Stefano Morlacchi
  • Roberto Nichetti
  • Claudio Capelli
  • Gabriele Dubini
  • Lorenza Petrini
  • Francesco MigliavaccaEmail author
Original Paper

Abstract

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.

Keywords

Stent Balloon Arterial tissue Bifurcation Finite element method 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Dario Gastaldi
    • 1
  • Stefano Morlacchi
    • 1
  • Roberto Nichetti
    • 1
  • Claudio Capelli
    • 2
  • Gabriele Dubini
    • 1
  • Lorenza Petrini
    • 1
  • Francesco Migliavacca
    • 1
    Email author
  1. 1.Laboratory of Biological Structure Mechanics, Structural Engineering DepartmentPolitecnico di MilanoMilanoItaly
  2. 2.Cardiac Unit, Institute of Child Health and Great Ormond Street HospitalUniversity College of LondonLondonUK

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