TY - JOUR
T1 - Impact of calcium quantifications on stent expansions
AU - Dong, Pengfei
AU - Bezerra, Hiram G.
AU - Wilson, David L.
AU - Gu, Linxia
N1 - Funding Information:
The authors gratefully acknowledge the support from the National Science Foundation CAREER award (CBET-1254095) and NIH grant R01 HL143484. They thank Heidi Brauning for proofreading the manuscript.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - Severely calcified plaque is of great concern when planning and implementing a stenting intervention. In this work, computational models were developed to investigate the influence of calcium characteristics on stenting outcomes. The commonly used clinical measurements of calcium (i.e., the arc angle, maximum thickness, length, and volume) were varied to estimate stenting outcomes in terms of lumen gain, stent underexpansion, strut malapposition, and stress or strain distributions of the stenotic lesion. Results have shown that stenting outcomes were most sensitive to the arc angle of the calcium. A thick calcium with a large arc angle resulted in poor stenting outcomes, such as severe stent underexpansion, D-shaped lumen, increased strut malapposition, and large stresses or strains in the plaque. This was attributed to the circumferential stretch of the tissue. Specifically, the noncalcium component was stretched significantly more than the calcium. The circumferential stretch ratios of calcium and noncalcium component were approximately 1.44 and 2.35, respectively, regardless of calcium characteristics. In addition, the peak stress or strain within the artery and noncalcium component of the plaque occurred at the area adjacent to calcium edges (i.e., the interface between the calcium and the noncalcium component) coincident with the location of peak malapposition. It is worth noting that calcium played a protective role for the artery underneath, which was at the expense of the overstretch and stress concentrations in the other portion of the artery. These detailed mechanistic quantifications could be used to provide a fundamental understanding of the impact of calcium quantifications on stent expansions, as well as to exploit their potential for a better preclinical strategy.
AB - Severely calcified plaque is of great concern when planning and implementing a stenting intervention. In this work, computational models were developed to investigate the influence of calcium characteristics on stenting outcomes. The commonly used clinical measurements of calcium (i.e., the arc angle, maximum thickness, length, and volume) were varied to estimate stenting outcomes in terms of lumen gain, stent underexpansion, strut malapposition, and stress or strain distributions of the stenotic lesion. Results have shown that stenting outcomes were most sensitive to the arc angle of the calcium. A thick calcium with a large arc angle resulted in poor stenting outcomes, such as severe stent underexpansion, D-shaped lumen, increased strut malapposition, and large stresses or strains in the plaque. This was attributed to the circumferential stretch of the tissue. Specifically, the noncalcium component was stretched significantly more than the calcium. The circumferential stretch ratios of calcium and noncalcium component were approximately 1.44 and 2.35, respectively, regardless of calcium characteristics. In addition, the peak stress or strain within the artery and noncalcium component of the plaque occurred at the area adjacent to calcium edges (i.e., the interface between the calcium and the noncalcium component) coincident with the location of peak malapposition. It is worth noting that calcium played a protective role for the artery underneath, which was at the expense of the overstretch and stress concentrations in the other portion of the artery. These detailed mechanistic quantifications could be used to provide a fundamental understanding of the impact of calcium quantifications on stent expansions, as well as to exploit their potential for a better preclinical strategy.
KW - Arc angle
KW - Arterial stress
KW - Calcium
KW - D-shaped lumen
KW - Finite element method
KW - Malapposition
KW - Percutaneous coronary intervention
KW - Stent deployment
KW - Stent underexpansion
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U2 - 10.1115/1.4042013
DO - 10.1115/1.4042013
M3 - Article
C2 - 30453326
AN - SCOPUS:85058482130
VL - 141
JO - Journal of Biomechanical Engineering
JF - Journal of Biomechanical Engineering
SN - 0148-0731
IS - 2
M1 - 021010
ER -