A Novel Simulation Strategy for Stent Insertion and Deployment in Curved Coronary Bifurcations: Comparison of Three Drug-Eluting Stents
The introduction of drug-eluting stents (DES) has reduced the occurrence of restenosis in coronary arteries. However, restenosis remains a problem in stented coronary bifurcations. This study investigates and compares three different second generation DESs when being implanted in the curved main branch of a coronary bifurcation with the aim of providing better insights into the related changes of the mechanical environment. The 3D bifurcation model is based on patient-specific angiographic data that accurately reproduce the in vivo curvatures of the vessel segments. The layered structure of the arterial wall and its anisotropic mechanical behavior are taken into account by applying a novel algorithm to define the fiber orientations. An innovative simulation strategy considering the insertion of a folded balloon catheter over a guide wire is proposed in order to position the stents within the curved vessel. Straightening occurs after implantation of all stents investigated. The resulting distributions of the wall stresses are strongly dependent on the stent design. Using a parametric modeling approach, two design modifications, which reduce the predicted maximum values of the wall stress, are proposed and analyzed.
KeywordsFinite element analysis Patient-specific bifurcation model Insertion Drug-eluting stents
First author’s research is supported by a BOF-Grant (01D22606) from Ghent University.
- 1.Colombo, A., E. Bramucci, S. Saccà, R. Violini, C. Lettieri, R. Zanini, I. Sheiban, L. Paloscia, E. Grube, J. Schofer, L. Bolognese, M. Orlandi, G. Niccoli, A. Latib, and F. Airoldi. Randomized study of the crush technique versus provisional side-branch stenting in true coronary bifurcations: the CACTUS (Coronary Bifurcations: Application of the Crushing Technique Using Sirolimus-Eluting Stents) Study. Circulation 119:71–78, 2009.CrossRefGoogle Scholar
- 2.De Beule, M. Finite Element Stent Design. PhD thesis, Ghent University, B, 2008.Google Scholar
- 6.Edelman, E. R., and C. Rogers. Pathobiologic responses to stenting. Am. J. Cardiol. 81:4E–6E, 1998.Google Scholar
- 7.Fluent Inc. Gambit Version 2.3 User’s Guide. Lebanon, New Hampshire, 2006.Google Scholar
- 10.Holzapfel, G. A. Nonlinear Solid Mechanics. A Continuum Approach for Engineering. Chichester: John Wiley & Sons, 2000.Google Scholar
- 11.Holzapfel, G. A., and R. W. Ogden, editors. Biomechanical Modelling at the Molecular, Cellular and Tissue Levels. Wien, New York: Springer-Verlag, 2009.Google Scholar
- 12.Holzapfel, G. A., and R. W. Ogden, editors. Mechanics of Biological Tissue. Heidelberg: Springer-Verlag, 2006.Google Scholar
- 13.Holzapfel, G. A., and R. W. Ogden. On planar biaxial tests for anisotropic nonlinearly elasitc solids. A continuum mechanical framework. Math. Mech. Solids, 2008. doi: 10.1177/1081286507084411.
- 22.Laroche, D., S. Delorme, T. Anderson, and R. DiRaddo. Computer prediction of friction in balloon angioplasty and stent implantation. In: Biomedical Simulation, edited by M. Harders and G. Székely. Springer, 2008, pp. 1–8.Google Scholar
- 23.Legrand, V., M. Thomas, M. Zelisko, B. De Bruyne, N. Reifart, T. Steigen, D. Hildick-Smith, R. Albiero, O. Darremont, G. Stankovic, M. Pan, J. Flensted Lassen, Y. Louvard, and T. Lefèvre. Percutaneous coronary intervention of bifurcation lesions: state-of-the-art. Insights from the second meeting of the European Bifurcation Club. EuroInternational 3:44–49, 2007.Google Scholar
- 25.McKelvey, A. L., and R. O. Ritchie. Fatigue-crack growth behavior in the superelastic and shape-memory alloy nitinol. Metall. Mater. Trans. A 32A:731–743, 2001.Google Scholar
- 26.McNeel, R., and Associates. Rhinoceros—NURBS Modeling for Windows, Version 4.0 User’s Guide. Seattle, Washington, 2008.Google Scholar
- 29.Moses, J. W., M. B. Leon, J. J. Popma, P. J. Fitzgerald, D. R. Holmes, C. O’Shaughnessy, R. P. Caputo, D. J. Kereiakes, D. O. Williams, P. S. Teirstein, J. L. Jaeger, and R. E. Kuntz. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N. Engl. J. Med. 349:1315–1323, 2003.CrossRefPubMedGoogle Scholar
- 32.Philips Medical Systems Nederland B. V., Best, The Netherlands. http://www.healthcare.philips.com.
- 33.Poncin, P., and J. Proft. Stent tubing: understanding the desired attributes. In: Proceedings of the Materials and Processes for Medical Devices Conference, Anaheim, USA, 2003.Google Scholar
- 34.pyFormex. http://www.pyformex.org.
- 36.Slager, C. J., J. J. Wentzel, J. C. Schuurbiers, J. A. Oomen, J. Kloet, R. Krams, C. von Birgelen, W. J. van der Giessen, P. W. Serruys, and P. J. de Feyter. True 3-dimensional reconstruction of coronary arteries in patients by fusion of angiography and IVUS (ANGUS) and its quantitative validation. Circulation 102:511–516, 2000.Google Scholar
- 37.Squire, J. C. Dynamics of Endovascular Stent Expansion. PhD thesis, Massachusetts Institute of Technology, US, 2000.Google Scholar