Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, 20133 Milan, Italy.
Department of Surgery, University of Florida, Gainesville, FL 32608, USA.
J R Soc Interface. 2023 Apr;20(201):20220876. doi: 10.1098/rsif.2022.0876. Epub 2023 Apr 5.
In-stent restenosis in superficial femoral arteries (SFAs) is a complex, multi-factorial and multiscale vascular adaptation process whose thorough understanding is still lacking. Multiscale computational agent-based modelling has recently emerged as a promising approach to decipher mechanobiological mechanisms driving the arterial response to the endovascular intervention. However, the long-term arterial response has never been investigated with this approach, although being of fundamental relevance. In this context, this study investigates the 1-year post-operative arterial wall remodelling in three patient-specific stented SFA lesions through a fully coupled multiscale agent-based modelling framework. The framework integrates the effects of local haemodynamics and monocyte gene expression data on cellular dynamics through a bi-directional coupling of computational fluid dynamics simulations with an agent-based model of cellular activities. The framework was calibrated on the follow-up data at 1 month and 6 months of one stented SFA lesion and then applied to the other two lesions. The calibrated framework successfully captured (i) the high lumen area reduction occurring within the first post-operative month and (ii) the stabilization of the median lumen area from 1-month to 1-year follow-ups in all the stented lesions, demonstrating the potentialities of the proposed approach for investigating patient-specific short- and long-term responses to endovascular interventions.
股浅动脉（SFAs）内支架再狭窄是一个复杂的、多因素和多尺度的血管适应过程，其机制仍未完全阐明。多尺度计算基于代理的建模方法最近作为一种有前途的方法出现，用于解析驱动动脉对血管内介入反应的力学生物学机制。然而，尽管这一方法具有根本的重要性，但从未用这种方法研究过长期的动脉反应。在这种情况下，本研究通过一个完全耦合的多尺度基于代理的建模框架，研究了三个特定于患者的支架置入 SFA 病变 1 年后的动脉壁重塑。该框架通过计算流体动力学模拟与细胞活动的基于代理的模型之间的双向耦合，将局部血液动力学和单核细胞基因表达数据的影响纳入到细胞动力学中。该框架在一个支架置入 SFA 病变的 1 个月和 6 个月的随访数据上进行了校准，然后应用于另外两个病变。校准后的框架成功地捕捉到了：（i）术后第一个月内发生的高管腔面积减少；（ii）所有支架置入病变中从 1 个月到 1 年随访期间的管腔面积中位数的稳定化，证明了该方法用于研究特定于患者的血管内介入短期和长期反应的潜力。
