Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Beijing Key Laboratory of Fundamental Research on Biomechanics in Clinical Application, Beijing, China.
Proc Inst Mech Eng H. 2023 Apr;237(4):443-450. doi: 10.1177/09544119231157853. Epub 2023 Mar 16.
Calcified coronary lesions have been one of the more difficult types of lesion for interventional treatment, and angioplasty is required to break the calcification before stent implantation so that the stent can expand smoothly, however, it remains unclear which type of angioplasty is optimal for different calcified lesions. In this study, a finite element approach was used to model normal balloons, cutting balloons, and AngioSculpt balloons. In addition, calcified lesions of different degrees, thicknesses, and lengths were modeled according to Intravascular ultrasound (IVUS) calcification grade. The above three balloons were used to pretreat calcified lesions, and the brittle fracture module for calcification was used to detect fracture success, to facilitate virtual stent implantation after predilation. The simulation results showed that with a thickness of less than 0.3 mm, balloons were unable to deal with calcified plaques in lesions of less than 120°, for 180° calcified lesions the cutting balloon fractured the calcified material at 1.2 MPa, the AngioSculpt balloon produced multiple fractures at 0.8 MPa for 270° calcified plaques, but was unable to fracture calcified lesions with a thickness of 0.4 mm. Based on these results, we conclude that the length of the lesion did not affect calcification fracture, while the thickness of the lesion did. In calcified lesions of approximately 180°, the cutting balloon showed the best predilation results, while the AngioSculpt balloon was optimal for 270°. In annular calcification, all three balloons were unable to fracture the lesion.
钙化冠状动脉病变一直是介入治疗中较难处理的病变类型之一，需要在支架植入前进行球囊扩张以打破钙化，使支架能够顺利扩张，但对于不同类型的钙化病变，哪种球囊扩张方式最佳仍不清楚。本研究采用有限元方法对普通球囊、切割球囊和 AngioSculpt 球囊进行建模。此外，根据血管内超声（IVUS）钙化分级，对不同程度、厚度和长度的钙化病变进行建模。使用上述三种球囊对钙化病变进行预处理，并使用钙化脆性断裂模块检测断裂是否成功，以方便预扩张后进行虚拟支架植入。模拟结果表明，对于厚度小于 0.3mm 的钙化斑块，球囊无法处理小于 120°的病变中的钙化斑块，对于 180°的钙化病变，切割球囊在 1.2MPa 下使钙化物质断裂，AngioSculpt 球囊在 0.8MPa 下对 270°的钙化斑块产生多个断裂，但无法断裂厚度为 0.4mm 的钙化病变。基于这些结果，我们得出结论，病变的长度不影响钙化断裂，而病变的厚度则有影响。在大约 180°的钙化病变中，切割球囊显示出最佳的预扩张效果，而 AngioSculpt 球囊在 270°时效果最佳。在环状钙化病变中，三种球囊均无法使病变断裂。
