Stent deformation, physical stress, and drug elution obtained with provisional stenting, conventional culotte and Tryton-based culotte to treat bifurcations: a virtual simulation study
Monday 21st January 2013
Morlacchi, S.; Chiastra, C.; CutrÃ¬, E.; Zunino, P.; Burzotta, F.; Formaggia, L.; Dubini, G.; Migliavacca, F.
Aims: To investigate the possible inﬂuence of diﬀerent bifurcation stenting techniques on stent deformation, physical stress, and drug elution using an implemented virtual tool that comprehends structural, ﬂuid dynamics and drug-eluting numerical models. Methods and results: A virtual bench test based on explicit dynamic modelling was used to simulate procedures on bifurcated coronary vessels performed according to three diﬀerent stenting techniques: provisional side branch stenting, culotte and Tryton-based culotte. Geometrical conﬁgurations obtained after stenting were used to perform ﬂuid dynamics and drug elution analyses. Results show that major diﬀerent pattern of mechanical deformation, shear stress and theoretical drug elution are obtained using diﬀerent techniques. Compared with conventional culotte, the dedicated Tryton seems to facilitate the intervention in terms of improved access to the main branch and lowers its biomechanical inﬂuence on the coronary bifurcation in terms of mechanical and hemodynamic parameters. However, since the Tryton stent is a bare metal stent, the drug elution obtained is lower. Conclusion: Numerical models might successfully complement the information on stenting procedures obtained with traditional approaches as in vitro bench testing or clinical trials. Devices dedicated to bifurcations may facilitate procedure completion and may result in speciﬁc patterns of mechanical stress, regional blood ﬂow and drug elution.