Ragkousis Georgios E, Curzen Nick, Bressloff Neil W
Computational Engineering & Design Group, Engineering & the Environment, University of Southampton, Boldrewood Campus, Southampton, SO16 7QF, UK.
Ann Biomed Eng. 2015 Aug;43(8):1786-802. doi: 10.1007/s10439-014-1237-8. Epub 2015 Jan 10.
Despite the clinical effectiveness of coronary artery stenting, percutaneous coronary intervention or "stenting" is not free of complications. Stent malapposition (SM) is a common feature of "stenting" particularly in challenging anatomy, such as that characterized by long, tortuous and bifurcated segments. SM is an important risk factor for stent thrombosis and recently it has been associated with longitudinal stent deformation. SM is the result of many factors including reference diameter, vessel tapering, the deployment pressure and the eccentric anatomy of the vessel. For the purpose of the present paper, virtual multi-folded balloon models have been developed for simulated deployment in both constant and varying diameter vessels under uniform pressure. The virtual balloons have been compared to available compliance charts to ensure realistic inflation response at nominal pressures. Thereafter, patient-specific simulations of stenting have been conducted aiming to reduce SM. Different scalar indicators, which allow a more global quantitative judgement of the mechanical performance of each delivery system, have been implemented. The results indicate that at constant pressure, the proposed balloon models can increase the minimum stent lumen area and thereby significantly decrease SM.
尽管冠状动脉支架置入术具有临床有效性，但经皮冠状动脉介入治疗（即“支架置入术”）并非没有并发症。支架贴壁不良（SM）是“支架置入术”的常见特征，尤其是在具有挑战性的解剖结构中，例如以长、迂曲和分叉节段为特征的解剖结构。SM是支架血栓形成的重要危险因素，最近它还与支架纵向变形有关。SM是多种因素造成的结果，包括参考直径、血管逐渐变细、释放压力以及血管的偏心解剖结构。出于本文的目的，已开发出虚拟多重折叠球囊模型，用于在均匀压力下模拟在直径恒定和变化的血管中的释放。已将虚拟球囊与现有的顺应性图表进行比较，以确保在标称压力下具有逼真的膨胀反应。此后，进行了针对特定患者的支架置入模拟，旨在减少SM。已实施了不同的标量指标，这些指标可以对每个输送系统的机械性能进行更全面的定量判断。结果表明，在恒定压力下，所提出的球囊模型可以增加最小支架管腔面积，从而显著降低SM。
