冠脉重叠支架虚拟置入的有限元分析

doi:10.3969/j.issn.0258-8021.2018.05.009

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Abstract In the percutaneous coronary intervention (PCI), overlapping stents are often used to treat diffuse coronary lesions. There are many clinical studies on overlapping stents, which provide the clinical effect and efficacy of the stents. However, the interactions between stents and stents, stents and blood vessels have not been demonstrated by direct observations. The aim of this study was to investigate the changes of stent, vessel morphology and stress during stenting by analyzing the coronary stents with superimposed stents. A real diffuse lesion model of right coronary artery (RCA) was reconstructed by computed tomography angiography (CTA). The finite element method was used to simulate long-term implantation of overlapping resolute drug-eluting stent (DES). The overlap length was 3 mm. The entire procedure included the grasping and delivery of the stent, the placement of the distal stent and the proximal stent. During the virtual placement of the scaffold, the interaction between the stent and the stent, the stent and the blood vessel was analyzed by observing the changes of the stent and the vascular morphology and stress. The lumen cross-sectional area increased from the initial 1.4 mm² to 6.5 mm² after stenting, and the stenosis of blood vessels was well treated. In the stent overlap area, the distal stent located in the outer layer was more stressed than the proximal stent due to over-expansion. The stress of tube wall at overlap (0.64～0.81 MPa) was larger than that of non-overlap region (0.32-0.56 MPa). Over-dilatation of blood vessels in the overlap caused the lumen cross-sectional area not to be influenced by overlapping stent. The study shows that overlapping stents can make blood vessels unobstructed; and there were greater stress in the overlapping parts between the stent and vessel.

Key words： coronary artery diffuse long lesions overlapped stent finite element analysis

Received: 29 December 2017

PACS:

R318

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http://cjbme.csbme.org/EN/10.3969/j.issn.0258-8021.2018.05.009 OR http://cjbme.csbme.org/EN/Y2018/V37/I5/576

[1] 王辛, 李学奇, 夏洪远, 等. 冠状动脉内重叠支架置入术的临床研究进展[J]. 现代生物医学进展, 2015 (30): 5970-5973.
[2] 肖瑞, 李学生, 刘志强. 重叠药物洗脱支架治疗弥漫长病变62例分析[J]. 中国误诊学杂志, 2009, 9(12):2945-2946.
[3] Blachutzik F, Boeder N, Wiebe J, et al. Overlapping implantation of bioresorbable novolimus-eluting scaffolds: an observational optical coherence tomography study[J]. Heart and Vessels, 2017, 32(7): 781-789.
[4] Ortega-Paz L, Capodanno D, Giacchi G, et al. Impact of overlapping on 1-year clinical outcomes in patients undergoing everolimus-eluting bioresorbable scaffolds implantation in routine clinical practice: Insights from the European multicenter GHOST-EU registry[J]. Catheterization and Cardiovascular Interventions, 2017, 89(5): 812-818.
[5] Tarantini G, Mojoli M, Masiero G, et al. Clinical outcomes of overlapping versus non-overlapping everolimus-eluting absorb bioresorbable vascular scaffolds: An analysis from the multicentre prospective RAI registry (Clinical Trials. gov identifier: NCT02298413)[J]. Catheterization and Cardiovascular Interventions, 2018, 91(1): E1-E16.
[6] Nakazawa G, Finn AV, Vorpahl M, et al. Incidence and predictors of drug-eluting stent fracture in human coronary artery: a pathologic analysis[J]. Journal of the American College of Cardiology, 2009, 54(21): 1924-1931.
[7] Xu Jiang, Yang Jie, Sohrabi S, et al. Finite element analysis of the implantation process of overlapping stents[J]. Journal of Medical Devices, 2017, 11(2): 0210101-0210109.
[8] Rikhtegar F, Wyss C, Stok KS, et al. Hemodynamics in coronary arteries with overlapping stents[J]. Journal of Biomechanics, 2014, 47(2): 505-511.
[9] Rigatelli G, Zuin M, Dell′Avvocata F, et al. Evaluation of potential substrates for restenosis and thrombosis in overlapped versus edge-to-edge juxtaposed bioabsorbable scaffolds: Insights from a computed fluid dynamic study[J]. Cardiovascular Revascularization Medicine, 2018, 19(3): 273-278.
[10] Spencer JH, Sundaram CC, Iaizzo PA. The relative anatomy of the coronary arterial and venous systems[J]. Clinical Anatomy, 2014, 27(7): 1023-1029.
[11] Torii R, Wood NB, Hadjiloizou N, et al. Fluid-structure interaction analysis of a patient-specific right coronary artery with physiological velocity and pressure waveforms[J]. International Journal for Numerical Methods in Biomedical Engineering, 2009, 25(5): 565-580.
[12] Holzapfel GA, Sommer G, Gasser CT, et al. Determination of layer-specific mechanical properties of human coronary arteries with nonatherosclerotic intimal thickening and related constitutive modeling[J]. American Journal of Physiology-Heart and Circulatory Physiology, 2005, 289(5): H2048-H2058.
[13] 何玉娜, 徐创业, 刘修健, 等. 球囊配置对冠状动脉支架扩张和回弹行为的影响[J]. 中国生物医学工程学报, 2016, 35(2): 177-183.
[14] Poncin P, Proft J. Stent tubing: understanding the desired attributes[C]//Medical Device Materials: Proceedings of the Materials & Processes for Medical Devices Conference. Materials Park:ASM International, 2004: 253-259.
[15] Colleoni SG. Patient specific modeling of a stenting procedure in coronary bifurcations: a finite element study[EB/OL]. http://hdl.handle.net/10589/45561,2012-04-23/2017-12-20.
[16] Timmins LH, Miller MW, Clubb Jr CF, et al. Increased artery wall stress post-stenting leads to greater intimal thickening[J]. Laboratory Investigation, 2011, 91(6):955-967.