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Appl. Sci. 2018, 8(9), 1510; https://doi.org/10.3390/app8091510

A Patient-Specific Study Investigating the Relation between Coronary Hemodynamics and Neo-Intimal Thickening after Bifurcation Stenting with a Polymeric Bioresorbable Scaffold

1
Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, 20133 Milan, Italy
2
Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Brighton BN2 5BE, UK
3
Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
4
Center for Advanced Imaging Innovation and Research (CAI2R), and the Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY 10016, USA
5
Institute of Cardiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
First authorship shared.
*
Author to whom correspondence should be addressed.
Received: 17 July 2018 / Revised: 24 August 2018 / Accepted: 29 August 2018 / Published: 1 September 2018
(This article belongs to the Special Issue Optical Coherence Tomography and its Applications)
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Abstract

We present an application of a validated reconstruction methodology for the comparison between patient-specific hemodynamics and neo-intimal thickening at nine months from the intervention. (1) Background: Coronary bifurcation stenting alters the vessel geometry, influencing the local hemodynamics. The evaluation of wall shear stress (WSS) relies on the application of computational fluid dynamics to model its distribution along the coronary tree. The endothelium actively responds to WSS, which triggers eventual cell proliferation to cover the stent struts. (2) Methods: Baseline optical coherence tomography and angiographic data were combined to reconstruct a patient-specific coronary bifurcation with an implanted bioresorbable scaffold and to simulate the hemodynamics. Results were linked with the neo-intimal thickening after nine months from the intervention. (3) Results: Blood velocity patterns were disrupted at the bifurcation due to the presence of the stent. It was observed that 55.6% of the scaffolded lumen surface was exposed to values of time-averaged WSS lower than 0.4 Pa. Follow-up images showed a luminal narrowing of 19% in the main branch. There was also a complete coverage in 99% of struts. (4) Conclusions: This approach provided valuable complementary information that might improve the clinical outcomes in this subset of coronary diseases. View Full-Text
Keywords: coronary artery bifurcation; stent; bioresorbable scaffold; optical coherence tomography; image segmentation; three-dimensional reconstruction; patient-specific computer modeling; computational fluid dynamics; neo-intimal coverage; wall shear stress coronary artery bifurcation; stent; bioresorbable scaffold; optical coherence tomography; image segmentation; three-dimensional reconstruction; patient-specific computer modeling; computational fluid dynamics; neo-intimal coverage; wall shear stress
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).
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Migliori, S.; Rampat, R.; Bologna, M.; Montin, E.; Burzotta, F.; Hildick-Smith, D.; Dubini, G.; Mainardi, L.; Migliavacca, F.; Cockburn, J.; Chiastra, C. A Patient-Specific Study Investigating the Relation between Coronary Hemodynamics and Neo-Intimal Thickening after Bifurcation Stenting with a Polymeric Bioresorbable Scaffold. Appl. Sci. 2018, 8, 1510.

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