Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Cardiovascular Engineering and Atherosclerosis Laboratory, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece; Cardiovascular Department, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom.
FEops, Ghent, Belgium; IBiTech-bioMMeda, Ghent University, Ghent, Belgium.
JACC Cardiovasc Interv. 2015 Aug 24;8(10):1281-1296. doi: 10.1016/j.jcin.2015.06.015.
Treatment of coronary bifurcation lesions remains an ongoing challenge for interventional cardiologists. Stenting of coronary bifurcations carries higher risk for in-stent restenosis, stent thrombosis, and recurrent clinical events. This review summarizes the current evidence regarding application and use of biomechanical modeling in the study of stent properties, local flow dynamics, and outcomes after percutaneous coronary interventions in bifurcation lesions. Biomechanical modeling of bifurcation stenting involves computational simulations and in vitro bench testing using subject-specific arterial geometries obtained from in vivo imaging. Biomechanical modeling has the potential to optimize stenting strategies and stent design, thereby reducing adverse outcomes. Large-scale clinical studies are needed to establish the translation of pre-clinical findings to the clinical arena.
治疗冠状动脉分叉病变仍然是介入心脏病学家面临的一个持续挑战。冠状动脉分叉处支架置入术存在更高的支架内再狭窄、支架内血栓形成和临床事件复发的风险。本文综述了目前关于生物力学模型在支架特性、局部血流动力学以及经皮冠状动脉介入治疗分叉病变后结局研究中的应用和使用的证据。分叉支架的生物力学建模包括使用从体内成像获得的特定于患者的动脉几何形状进行计算模拟和体外台架测试。生物力学建模有可能优化支架置入策略和支架设计，从而减少不良结局。需要进行大规模的临床研究，以将临床前研究结果转化为临床领域。
