Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA.
Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Int J Cardiovasc Imaging. 2021 Sep;37(9):2591-2601. doi: 10.1007/s10554-021-02240-0. Epub 2021 May 16.
Stent implantation in bifurcated coronary lesions is technically challenging so that procedural refinements are continuously investigated. Novel procedure modeling and intracoronary imaging techniques may offer critical insights on stent deformations and stent-wall interactions during bifurcation stenting procedures. Thus, we assessed coronary bifurcation stenting techniques using multimodal imaging and 3D modeling in reanimated swine hearts. Harvested swine hearts were reanimated using Visible Heart® methodologies and (under standard fluoroscopic guidance) used to test 1-stent (provisional and inverted provisional) and 2-stent (culotte, TAP and DK-crush) techniques on bifurcations within various coronary vessels using commercially available devices. Intracoronary angioscopy and frequency-domain optical-coherence-tomography (OCT) were obtained during the procedures. 3D OCT reconstruction and micro-computed tomography 3D modeling (post heart fixations) were used to assess stent deformations and stent-wall interactions. We conducted multiple stenting procedures and collected unique endoscopic and OCT images (and subsequent computational models from micro-CT) to assess stent deformations and device/wall interactions during different steps of bifurcation stenting procedures. Endoscopy, micro-CT and virtual reality processing documented that different 1- and 2-stent techniques, practiced according to experts' recommended steps, achieve optimal post-intervention stent conformation. As compared with intra-procedural endoscopy, software-generated 3D OCT images accurately depicted stent deformations during 1-stent techniques. On the opposite, during more complex 2-stent techniques, some defects were appreciated at 3D OCT reconstruction despite optimal 2D OCT images. This study provided unique insights regarding both stent deformations occurring in the course of bifurcation stenting and the efficacy of OCT to visualize them.
在分叉病变中植入支架具有一定的技术挑战性，因此不断在探索手术改进方法。新型手术建模和冠状动脉内成像技术可能为分叉支架置入术中支架变形和支架壁相互作用提供关键见解。因此，我们使用多模态成像和 3D 建模技术，在复活的猪心脏中评估冠状动脉分叉支架技术。采用 Visible Heart®方法复活收获的猪心，并在标准荧光透视引导下，使用市售器械在各种冠状动脉分叉部位测试 1 支架（临时和倒置临时）和 2 支架（靴型、TAP 和 DK-crush）技术。在手术过程中获得冠状动脉内血管镜检查和频域光学相干断层扫描（OCT）。使用 3D OCT 重建和微计算机断层扫描 3D 建模（心脏固定后）来评估支架变形和支架壁相互作用。我们进行了多次支架置入术，并收集了独特的内镜和 OCT 图像（以及随后来自微 CT 的计算模型），以评估分叉支架置入术不同步骤中的支架变形和器械/壁相互作用。内镜、微 CT 和虚拟现实处理记录了不同的 1 支架和 2 支架技术，根据专家推荐的步骤进行操作，可实现最佳的术后支架形态。与术中内镜相比，软件生成的 3D OCT 图像准确地描述了 1 支架技术中的支架变形。相反，在更复杂的 2 支架技术中，尽管 2D OCT 图像最佳，但在 3D OCT 重建时仍可观察到一些缺陷。本研究提供了关于分叉支架置入术中支架变形的独特见解，以及 OCT 可视化这些支架变形的效果。
