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Biomechanical Impact of Wrong Positioning of a Dedicated Stent for Coronary Bifurcations: A Virtual Bench Testing Study

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Abstract

The treatment of coronary bifurcations is challenging for interventional cardiologists. The Tryton stent (Tryton Medical, Inc., USA) is one of the few devices specifically designed for coronary bifurcations that underwent large clinical trials. Although the manufacturer provides specific recommendations to position the stent in the bifurcation side branch (SB) according to four radio-opaque markers under angiographic guidance, wrong device positioning may accidentally occur. In this study, the virtual bench testing approach was used to investigate the impact of wrong positioning of the Tryton stent in coronary bifurcations in terms of geometrical and biomechanical criteria. A finite element model of the left anterior descending/first diagonal coronary bifurcation was created with a 45° distal angle and realistic lumen diameters. A validated model of the Tryton stent mounted on stepped delivery balloon was used. All steps of the Tryton deployment sequence were simulated. Three Tryton positions, namely ‘proximal’, ‘recommended’, and ‘distal’ positions, obtained by progressively implanting the stent more distally in the SB, were compared. The ‘recommended’ case exhibited the lowest ostial area stenosis (44.8 vs. 74.3% (‘proximal’) and 51.5% (‘distal’)), the highest diameter at the SB ostium (2.81 vs. 2.70 mm (‘proximal’) and 2.54 mm (‘distal’)), low stent malapposition (9.9 vs. 16.3% (‘proximal’) and 8.5% (‘distal’)), and the lowest peak wall stress (0.37 vs. 2.20 MPa (‘proximal’) and 0.71 MPa (‘distal’)). In conclusion, the study shows that a ‘recommended’ Tryton stent positioning may be required for optimal clinical results.

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Acknowledgments

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Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The clinical images reported in Fig. 1 were obtained during daily clinical routine (after the Tryton stent has received CE mark). The images used in Fig. 1 were retrieved from existing clinical database. Patients were not subject to additional (imaging) procedures other than clinical routine and thus written informed consent was not obtained. This article does not contain any studies with animals performed by any of the authors.

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Author notes

  1. Claudio Chiastra and Maik J. Grundeken contributed equally.

Authors and Affiliations

  1. Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133, Milan, Italy

    Claudio Chiastra, Wei Wu, Giancarlo Pennati, Gabriele Dubini & Francesco Migliavacca

  2. The Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Maik J. Grundeken, Carlos Collet & Joanna J. Wykrzykowska

  3. Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium

    Carlos Collet

  4. Department of Mechanical Engineering, University of Texas at San Antonio, San Antonio, TX, USA

    Wei Wu

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  1. Claudio Chiastra
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Correspondence to Claudio Chiastra.

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Associate Editors James E. Moore, Jr. and Ajit P. Yoganathan oversaw the review of this article.

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Chiastra, C., Grundeken, M.J., Collet, C. et al. Biomechanical Impact of Wrong Positioning of a Dedicated Stent for Coronary Bifurcations: A Virtual Bench Testing Study. Cardiovasc Eng Tech 9, 415–426 (2018). https://doi.org/10.1007/s13239-018-0359-9

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