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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3592_Библиотеки_им_академика_М_И_Перельмана
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Vascular and Intravascular Imaging Trends, Analysis, and Challenges, Volume 1
https://t.me/medicina_free
Figure 2.20. (a) LAD occlusion after the first diagonal (arrow), (b) vessel opening after predilation with a
2.0/20 mm compliant balloon, (c) BRS 3.0/28 mm and (d) final result.
Figure 2.21. LAD OCT with angiographic co-registration, at 25 months of follow-up. (a) Visible struts/strutlike structures with neointimal coverage, (b) neoatherosclerosis, (c) visible strut free zones, and (d) and (e)
proximal end of the scaffold. Calcium (*); lipid pool (#); diagonal branch (D).
2.6 Conclusions
Coronary artery lesions selected for percutaneous coronary intervention require
more than just plain old balloon angioplasty in order to avoid complications and
maintain long-term vessel patency. Drug-eluting stents are the current preferred
strategy and have proved their efficacy in preventing stent restenosis. However, they
are associated with a permanent caging of the vessel and long-term safety issues such
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Vascular and Intravascular Imaging Trends, Analysis, and Challenges, Volume 1
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Figure 2.22. (a) LAD with a proximal 50% stenosis (QCA), (b) OCT evaluation showed a fibrolipid plaque
with a mean lumen area of 1.79 mm
significant). Lipid accumulation (#).
Figure 2.23. (a) DES implanted in proximal LAD, (b) 3-month-old Absorb, (c)–(d) newly implanted 3.0/25 mm
Magmaris, (e) 15-month-old Absorb and (f)–(h) Magmaris after one year (shadowing is visible but struts are no
longer discernible).
2
and (c) fractional flow reserve evaluation displayed a value of 0.84 (not
as late and very-late stent thrombosis. Bioresorbable platforms are a more recently
developed technology that provide a transient scaffold for the coronary artery, with
potential long-term benefits, namely the return of normal vascular function. Optical
coherence tomography is an essential intravascular imaging method, giving insight
into plaque morphology, optimal landing sites and the need for scaffold
optimization.
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Section II
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Computer modeling and computational fluid
hemodynamics
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IOP Publishing
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Vascular and Intravascular Imaging Trends, Analysis, and
Challenges, Volume 1
Stent applications
Petia Radeva and Jasjit S Suri
Chapter 3
Computer modeling of blood flow and plaque
progression in the stented coronary artery
Nenad Filipovic
In this chapter, nonlinear stent deployment modeling with plaque formation and
progression for specific patients in the coronary arteries is described. First, the
introduction section describes the state-of-the-art in the reported investigations of
blood flow in stented arteries. In the methods section, image segmentation methods
for arteries with stents are briefly described. Blood flow simulation is described using
Navier–Stokes and continuity equations. Blood vessel tissue is modeled with nonlinear
viscoelastic material properties. The governing finite element (FE) equations used in
modeling wall tissue deformation, with emphasis on the implementation of nonlinear
constitutive models, are described. Continuum-based methods for modeling the
evolution of plaque are derived. Low-density lipoprotein (LDL) penetration is defined
by the convection–diffusion equation, while the endothelial permeability is shear stress
dependent. The coupling of fluid dynamics and solute dynamics at the endothelium is
achieved using the Kedem–Katchalsky equations. The inflammatory process is
modeled using three additional reaction–diffusion partial differential equations. The
coupled method is viewed as the motion of the collection of dissipative particle
dynamics (DPD) particles inside a finite element mesh. The motion of each DPD
particle is described by the corresponding Newton’s law. In the results section, examples
of rigid and deformable arterial walls with stented and unstented arteries are presented.
Effective stress analysis results for stent deployment are shown. It can be seen that stents
reduce wall shear stress significantly after deployment, which is caused by opening the
artery and reducing the narrowing. Some results are presented for stent a deployment
model obtained with a solver developed using the PAK software package.
From the results it may be seen that places marked as risky in the baseline showed
varied progression after six months. At the end of the chapter, some results for stent
deployment and plaque formation and development are discussed.
doi:10.1088/2053-2563/ab01fach3 3-1 ª IOP Publishing Ltd 2019
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