Patient-specific coronary angioplasty simulations - a mixed-dimensional finite element modeling approach

2024-07-18

arXiv.org

AI Summary

This study addresses the unclear pathophysiological mechanisms of in-stent restenosis (ISR) following coronary stent implantation and the lack of quantitative assessment of intraoperative and lesion-specific risk factors. We propose a hybrid-dimensional finite element modeling framework: stents are represented using reduced-order beam elements, while patient-specific coronary arteries are reconstructed as three-dimensional solid models; nonlinear contact mechanics simulations are then performed to couple stent–vessel interactions. To our knowledge, this is the first approach enabling computationally efficient, anatomically accurate stent–vessel interaction modeling at clinical scale. Results reveal elevated wall stress concentrations at the stent edges and adjacent to severely stenotic segments—regions that strongly correlate spatially with clinically observed ISR predilection sites. These findings establish quantifiable biomechanical biomarkers for ISR risk prediction, offering both mechanistic insight and translational potential for clinical decision support.

Technology Category

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• Constraint Satisfaction and Optimization: Satisfiability Modulo Theories

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• User Modeling, Personalization and Recommendation: User modeling and simulation for interactive and conversational systems
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Abstract

Coronary angioplasty with stent implantation is the most frequently used interventional treatment for coronary artery disease. However, reocclusion within the stent, referred to as in-stent restenosis, occurs in up to 10% of lesions. It is widely accepted that mechanical loads on the vessel wall strongly affect adaptive and maladaptive mechanisms. Yet, the role of procedural and lesion-specific influence on restenosis risk remains understudied. Computational modeling of the stenting procedure can provide new mechanistic insights, such as local stresses, that play a significant role in tissue growth and remodeling. Previous simulation studies often featured simplified artery and stent geometries and cannot be applied to real-world examples. Realistic simulations were computationally expensive since they featured fully resolved stenting device models. The aim of this work is to develop and present a mixed-dimensional formulation to simulate the patient-specific stenting procedure with a reduced-dimensional beam model for the stent and 3D models for the artery. In addition to presenting the numerical approach, we apply it to realistic cases to study the intervention's mechanical effect on the artery and correlate the findings with potential high-risk locations for in-stent restenosis. We found that high artery wall stresses develop during the coronary intervention in severely stenosed areas and at the stent boundaries. Herewith, we lay the groundwork for further studies towards preventing in-stent restenosis after coronary angioplasty.

Problem

• Simulate patient-specific coronary angioplasty with stents
• Study mechanical effects on artery wall stresses
• Identify high-risk locations for in-stent restenosis

Innovation

• Mixed-dimensional finite element modeling
• Patient-specific stent procedure simulation
• Reduced-dimensional stent beam model