Journal Article

Patient-specific computational simulation of coronary artery bifurcation stenting

Samant S., Sharzehee M., Lefevre T., Dangas G., Lassen J. F., Wu W., Migliavacca F., Makadia J., Brilakis E. S., Zhao S., Zolty D., Chatzizisis Y. S., Watanabe Y., Khan B., Kassab G. S., Bhatt D. L., Chiastra C., Murasato Y., Louvard Y., Panagopoulos A., Stankovic G., Burzotta F., Johnson T. W.

2021

Overview

Patient-specific and lesion-specific computational simulation of bifurcation stenting is an attractive approach to achieve individualized pre-procedural planning that could improve outcomes. The objectives of this work were to describe and validate a novel platform for fully computational patient-specific coronary bifurcation stenting. Our computational stent simulation platform was trained using n = 4 patient-specific bench bifurcation models (n = 17 simulations), and n = 5 clinical bifurcation cases (training group, n = 23 simulations). The platform was blindly tested in n = 5 clinical bifurcation cases (testing group, n = 29 simulations). A variety of stent platforms and stent techniques with 1- or 2-stents was used. Post-stenting imaging with micro-computed tomography (μCT) for bench group and optical coherence tomography (OCT) for clinical groups were used as reference for the training and testing of computational coronary bifurcation stenting. There was a very high agreement for mean lumen diameter (MLD) between stent simulations and post-stenting μCT in bench cases yielding an overall bias of 0.03 (− 0.28 to 0.34) mm. Similarly, there was a high agreement for MLD between stent simulation and OCT in clinical training group [bias 0.08 (− 0.24 to 0.41) mm], and clinical testing group [bias 0.08 (− 0.29 to 0.46) mm]. Quantitatively and qualitatively stent size and shape in computational stenting was in high agreement with clinical cases, yielding an overall bias of < 0.15 mm. Patient-specific computational stenting of coronary bifurcations is a feasible and accurate approach. Future clinical studies are warranted to investigate the ability of computational stenting simulations to guide decision-making in the cardiac catheterization laboratory and improve clinical outcomes.

• Publisher: Springer Science and Business Media LLC,Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
• Subject: 639/166/985 / 692/4019/2776 / Acute coronary syndrome / Bias / bifurcation stenting / Blood Vessel Prosthesis / Blood Vessel Prosthesis Implantation / Blood Vessel Prosthesis Implantation; Coronary Artery Disease; Coronary Vessels; Humans; Preoperative Care; Prosthesis Design; X-Ray Microtomography; Blood Vessel Prosthesis; Computer Simulation; Stents / Catheterization / Computed tomography / Computer applications / Computer Simulation / Coronary artery / coronary artery bifurcation / Coronary Artery Disease / Coronary Artery Disease/diagnostic imaging / Coronary Vessels / Coronary Vessels/diagnostic imaging / Decision making / Humanities and Social Sciences / Humans / Implants / Medicine / multidisciplinary / Patients / Preoperative Care / Preoperative Care/methods / Prosthesis Design / Prosthesis Design/methods / Q / R / Science / Science (multidisciplinary) / Simulation / Stents / Training / X-Ray Microtomography