Stent deformation, physical stress, and drug elution obtained with provisional stenting, conventional culotte and Tryton-based culotte to treat bifurcations: a virtual simulation study

04/2013

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.; Cutrì, 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.