TY - JOUR
T1 - Mechanical performances of balloon post-dilation for improving stent expansion in calcified coronary artery
T2 - Computational and experimental investigations
AU - Dong, Pengfei
AU - Mozafari, Hozhabr
AU - Lee, Juhwan
AU - Gharaibeh, Yazan
AU - Zimin, Vladislav N.
AU - Dallan, Luis A.P.
AU - Bezerra, Hiram G.
AU - Wilson, David L.
AU - Gu, Linxia
N1 - Funding Information:
This project was supported by the National Heart, Lung, and Blood Institute through grant R01 HL143484-01 . The grant was obtained via collaboration between Case Western Reserve University , University Hospitals of Cleveland, and Florida Institute of Technology . The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work made use of the High-Performance Computing Resource in the Core Facility for Advanced Research Computing at Florida Institute of Technology. The authors gratefully acknowledge Huan Huan Cai for proofreading the manuscript.
Funding Information:
This project was supported by the National Heart, Lung, and Blood Institute through grant R01 HL143484-01. The grant was obtained via collaboration between Case Western Reserve University, University Hospitals of Cleveland, and Florida Institute of Technology. The content of this report is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This work made use of the High-Performance Computing Resource in the Core Facility for Advanced Research Computing at Florida Institute of Technology. The authors gratefully acknowledge Huan Huan Cai for proofreading the manuscript.
Publisher Copyright:
© 2021 Elsevier Ltd
PY - 2021/9
Y1 - 2021/9
N2 - Stent deployment in a calcified coronary artery is often associated with suboptimal outcomes such as stent underexpansion and malapposition. Post-dilation after stent deployment is commonly used for optimal stent implantation. There is no guideline for choosing the post-dilation balloon diameter and inflation pressure. In this work, ex-vivo/in-silico experiments were performed to investigate the efficacy of post-dilation balloon diameter and inflation pressure in improving the stent expansion in a calcified lesion. Post-dilations with three balloon diameters (3 mm, 3.5 mm, and 4 mm) were performed. For each balloon diameter, three inflation pressures (10 atm, 20 atm, and 30 atm) were sequentially applied. In ex-vivo experiments, optical coherence tomography images were acquired during the stenting procedure, i.e., pre- and post-deployment of 3 mm diameter stent, as well as after each post-dilation. The results from in-silico experiments were compared with ex-vivo experiments in terms of lumen area. In addition, stretch ratio analysis was developed to predict the stent-induced lumen area, along with the strain analysis and the in-silico experiments. Results have shown that target lumen area could be achieved with an oversized nominal balloon diameter of +0.5 mm (i.e., 0.5 mm greater than reference lumen diameter) at an inflation pressure of 20 atm. After each post-dilation, fibrotic tissue demonstrated a larger strain, contributing to improved lumen gain. However, minimal changes were observed in calcification. Moreover, a strong correlation (R2 = 0.95) between the stretch ratio of fibrotic tissue and lumen area after each post-dilation was observed. This indicated that the morphology of the fibrotic tissue could be a potential marker to predict the lumen gain. The detailed mechanistic quantifications of a single lesion cannot be generalized to all clinical cases. However, this work could be used to provide a fundamental understanding of the post-dilations, to develop experimental protocols for producing generalized guidelines, and to exploit their potential for optimal pre- and post-stent strategies.
AB - Stent deployment in a calcified coronary artery is often associated with suboptimal outcomes such as stent underexpansion and malapposition. Post-dilation after stent deployment is commonly used for optimal stent implantation. There is no guideline for choosing the post-dilation balloon diameter and inflation pressure. In this work, ex-vivo/in-silico experiments were performed to investigate the efficacy of post-dilation balloon diameter and inflation pressure in improving the stent expansion in a calcified lesion. Post-dilations with three balloon diameters (3 mm, 3.5 mm, and 4 mm) were performed. For each balloon diameter, three inflation pressures (10 atm, 20 atm, and 30 atm) were sequentially applied. In ex-vivo experiments, optical coherence tomography images were acquired during the stenting procedure, i.e., pre- and post-deployment of 3 mm diameter stent, as well as after each post-dilation. The results from in-silico experiments were compared with ex-vivo experiments in terms of lumen area. In addition, stretch ratio analysis was developed to predict the stent-induced lumen area, along with the strain analysis and the in-silico experiments. Results have shown that target lumen area could be achieved with an oversized nominal balloon diameter of +0.5 mm (i.e., 0.5 mm greater than reference lumen diameter) at an inflation pressure of 20 atm. After each post-dilation, fibrotic tissue demonstrated a larger strain, contributing to improved lumen gain. However, minimal changes were observed in calcification. Moreover, a strong correlation (R2 = 0.95) between the stretch ratio of fibrotic tissue and lumen area after each post-dilation was observed. This indicated that the morphology of the fibrotic tissue could be a potential marker to predict the lumen gain. The detailed mechanistic quantifications of a single lesion cannot be generalized to all clinical cases. However, this work could be used to provide a fundamental understanding of the post-dilations, to develop experimental protocols for producing generalized guidelines, and to exploit their potential for optimal pre- and post-stent strategies.
KW - Balloon diameter
KW - Cadaver
KW - Calcification
KW - Finite element method (FEM)
KW - Inflation pressure
KW - Optical coherence tomography (OCT)
KW - Percutaneous coronary intervention (PCI)
KW - Post-dilation
KW - Stent expansion
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U2 - 10.1016/j.jmbbm.2021.104609
DO - 10.1016/j.jmbbm.2021.104609
M3 - Article
C2 - 34082181
AN - SCOPUS:85107074166
VL - 121
JO - Journal of the Mechanical Behavior of Biomedical Materials
JF - Journal of the Mechanical Behavior of Biomedical Materials
SN - 1751-6161
M1 - 104609
ER -