numerical models of single- and double- stenting procedures...welcome to the 8th european...
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![Page 1: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/1.jpg)
Welcome to the 8th
European Bifurcation Club
12-13 October 2012 - Barcelona
Numerical models
of single- and double-
stenting procedures
Stefano Morlacchi
Politecnico di Milano
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Stenting procedures in bifurcations
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Stenting procedures in bifurcations
Lower clinical
outcomes
Technical
complexities
CBL are still an
open challenge
Improvement of the current state-of-the-art
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Numerical methods
Numerical
methods
Advantages:
- Assessment of biomechanical quantities: arterial stress,
wall shear stress, deformations.
- Comparative evaluation of different techniques.
- Optimization of the current devices and design of new
concepts.
![Page 5: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/5.jpg)
Numerical methods
Clinical
studies
In vitro
experiments
Numerical
methods
Advantages:
- Assessment of biomechanical quantities: arterial stress,
wall shear stress, deformations.
- Comparative evaluation of different techniques.
- Optimization of the current devices and design of new
concepts.
![Page 6: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/6.jpg)
Numerical methods
Clinical
studies
In vitro
experiments
Numerical
methods
Advantages:
- Assessment of biomechanical quantities: arterial stress,
wall shear stress, deformations.
- Comparative evaluation of different techniques.
- Optimization of the current devices and design of new
concepts.
![Page 7: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/7.jpg)
Aim of this work
Virtual simulation of
stenting procedures in
coronary bifurcations.
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Aim of this work
Virtual simulation of
stenting procedures in
coronary bifurcations.
Fluid dynamics
model of the
hemodynamic field.
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Structural simulations
Morlacchi et al. “Sequential structural and fluid dynamic numerical
simulations of a stented bifurcated coronary artery”
Journal of Biomechanical Engineering 133(12):121010.
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Structural simulations
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Fluid dynamic simulations
Chiastra C et al. “Computational fluid dynamics of stented coronary bifurcations
studied with a hybrid discretization method”
European Journal of Mechanics - B/Fluids. 2012; 35:76–84.
INLET
OUTLET SB
30%
OUTLET MB
70 %
Flow rate
85 ml/min
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Fluid dynamic simulations
Chiastra C et al. “Computational fluid dynamics
of stented coronary bifurcations studied with a
hybrid discretization method”
European Journal of Mechanics - B/Fluids. 2012;
35:76–84.
INLET
OUTLET SB
30%
OUTLET MB
70 %
Volume flow rate
85 ml/min
![Page 13: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/13.jpg)
Stenting procedures in bifurcations
Provisional SB stenting
0 0.115 0.23
Velocity magnitude [m/s]
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Stenting procedures in bifurcations
Culotte technique Provisional SB stenting
0 0.115 0.23
Velocity magnitude [m/s]
0 0.115 0.23
Velocity magnitude [m/s]
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Stenting procedures in bifurcations
Simultaneous Kissing Stents
0 0.115 0.23
Velocity magnitude [m/s]
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Stenting procedures in bifurcations
Crush technique Simultaneous Kissing Stents
0 0.115 0.23
Velocity magnitude [m/s]
0 0.115 0.23
Velocity magnitude [m/s]
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Stenting procedures in bifurcations
T-stenting
0 0.115 0.23
Velocity magnitude [m/s]
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Stenting procedures in bifurcations
T-stenting with
protrusion
T-stenting
0 0.115 0.23
Velocity magnitude [m/s]
0 0.115 0.23
Velocity magnitude [m/s]
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Stresses in the devices Bulk-flow quantities
Near wall quantities
PSB CULOTTE Low WSS Area
STRUT
MALAPPOSITIONS
0.95
0.83
Arterial stresses and stent
configurations
Biomechanical quantities
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Stresses in the devices Bulk-flow quantities
Near wall quantities
PSB CULOTTE Low WSS Area
STRUT
MALAPPOSITIONS
0.95
0.83
Arterial stresses and stent
configurations
Biomechanical quantities
![Page 21: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/21.jpg)
Stresses in the devices Bulk-flow quantities
Near wall quantities
PSB CULOTTE Low WSS Area
STRUT
MALAPPOSITIONS
0.95
0.83
Arterial stresses and stent
configurations
Biomechanical quantities
![Page 22: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/22.jpg)
Stresses in the devices Bulk-flow quantities
Near wall quantities
PSB CULOTTE Low WSS Area
STRUT
MALAPPOSITIONS
0.95
0.83
Arterial stresses and stent
configurations
Biomechanical quantities
![Page 23: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/23.jpg)
Some examples
Strut malappositions in the SKS tecnhique.
Single- and double- stenting techniques.
Influence of procedural errors: stent protrusion in
the MB within the T-stenting technique.
![Page 24: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/24.jpg)
Some examples
Strut malappositions in the SKS tecnhique.
Single- and double- stenting techniques.
Influence of procedural errors: stent protrusion in
the MB within the T-stenting technique.
![Page 25: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/25.jpg)
Single- and double- procedures
PSB CULOTTE CRUSH
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Single- and double- procedures
PSB CULOTTE CRUSH
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Single- and double- procedures
PSB CULOTTE CRUSH
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Single- and double- procedures
PSB CULOTTE CRUSH
0 0.23
Velocity [m/s]
Low velocities Low velocities
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Single- and double- procedures
0 0.5
WSS [Pa]
PSB CULOTTE CRUSH
0 0.23
Velocity [m/s]
Low WSS Area Low WSS Area
Low velocities Low velocities
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Some examples
Strut malappositions in the SKS tecnhique.
Single- and double- stenting techniques.
Influence of procedural errors: stent protrusion in
the MB within the T-stenting technique.
![Page 31: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/31.jpg)
Effects of stent protrusion
T-stenting
with protrusion
T-stenting
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Effects of stent protrusion
T-stenting
with protrusion
T-stenting
-0.05 0 0.05
Viscous shear stress [Pa]
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Some examples
Strut malappositions in the SKS tecnhique.
Influence of procedural errors: stent protrusion in
the MB within the T-stenting technique.
Single- and double- stenting techniques.
![Page 34: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/34.jpg)
Effects of strut malappositions C
UL
OT
TE
S
KS
0 0.125 0.25
Velocity magnitude [m/s]
0 0.125 0.25
Velocity magnitude [m/s]
LOW FLOW REGION
LOW FLOW REGION
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Effects of strut malappositions C
UL
OT
TE
S
KS
0 0.125 0.25
Velocity magnitude [m/s]
0 0.125 0.25
Velocity magnitude [m/s]
NO STRUTS
NO STRUTS
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Effects of strut malappositions
0 120 240
Max principal stress [kPa]
CU
LO
TT
E
SK
S
0 0.125 0.25
Velocity magnitude [m/s]
0 0.125 0.25
Velocity magnitude [m/s]
HIGH STRESS – ?NO DRUG?
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Conclusions
Implementation of a sequential virtual model of
different stenting procedures for coronary
bifurcation lesions.
Application of the sequential model to assess both
structural and hemodynamic variables.
Comparisons among different single- or double-
stenting techniques.
![Page 38: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/38.jpg)
Conclusions
Implementation of a sequential virtual model of
different stenting procedures for coronary
bifurcation lesions.
Application of the sequential model to assess both
structural and hemodynamic variables.
Comparisons among different single- or double-
stenting techniques.
![Page 39: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/39.jpg)
Conclusions
Implementation of a sequential virtual model of
different stenting procedures for coronary
bifurcation lesions.
Application of the sequential model to assess both
structural and hemodynamic variables.
Comparisons among different single- or double-
stenting techniques.
![Page 40: Numerical models of single- and double- stenting procedures...Welcome to the 8th European Bifurcation Club 12-13 October 2012 - Barcelona Numerical models of single- and double-stenting](https://reader035.vdocuments.us/reader035/viewer/2022081621/612eaeb71ecc51586942f7c3/html5/thumbnails/40.jpg)
Further developments
Image-based simulations of clinical cases.
In collaboration with Universitat Pomepeu Fabra, Barcelona.
CTA + CCA
3D model
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Further developments
Validation of fluid dynamic fields with in-vitro tests.
In collaboration with Dr. Francesco Burzotta, Roma
and Prof. Vlachos, Virginia Tech, Blacksburg, USA.
PIV Imaging Bench test Flow measurement
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Further developments
Drug elution numerical models.
In collaboration with prof. Paolo Zunino, University of Pittsburgh,
and Elena Cutrì, Mox, Politecnico di Milano.
EBC presentation by Prof. Gabriele Dubini.
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Acknowledgements
Politecnico di Milano
Prof. Francesco Migliavacca
Prof. Gabriele Dubini
Dr. Elena Cutrì
Ing. Claudio Chiastra
Ing. Sebastian Colleoni
University of Pittsburgh
Prof. Paolo Zunino
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THANK YOU FOR THE ATTENTION
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Validation of structural results
COMPARISON WITH IN VITRO EXPANSION BY ORMISTON ET AL.
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Validation of structural results
COMPARISON WITH IN VITRO EXPANSION BY SCHULTZ ET AL. 2009
In vitro
expansion Virtual
simulation