Gianluca Rigatelli1, Marco Zuin2, Fabio Dell'Avvocata3, Dobrin Vassilev4, Ramesh Daggubati5, Thach Nguyen6, Nguyen Van Viet Thang7, Nicolas Foin8. 1. Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. Electronic address: jackyheart71@yahoo.it. 2. Department of Cardiology, Rovigo General Hospital, Rovigo, Italy; Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy. 3. Section of Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy. 4. Department of Cardiology; Hospital, University School of Medicine, Sofia, Bulgaria. 5. Cardiac Catheterization Laboratories, Winthrop University Hospital, Mineola, NY 11501. 6. Methodist Hospital, Merrillville, IN 46410. 7. Tan Tao University, School of Medicine, Tan Duc eCity, Long An, Vietnam. 8. Medtech Research Theme, National Heart Centre Singapore and Duke-NUS Medical School, Singapore.
Abstract
BACKGROUND/ PURPOSE: Computational fluid dynamics (CFD) have been recently adopted in many fields of cardiovascular medicine and in interventional cardiology. Using CFD analysis we compared the use of different PCI procedures, with and without the utilization of a proximal optimization technique (POT), on a complex coronary artery bifurcation. METHODS/MATERIALS: For the analysis, we considered a hypothetic model of a left anterior descending artery-diagonal Medina 1,1,1 bifurcation type with a diameter of the proximal main branch (MB) and the side branch (SB) set at 3.5mm and 2.5mm, respectively. The bifurcation angle has been set to 50°. For the stent simulation, we reconstructed a third-generation, ultra-thin strut everolimus-eluting stent (ORSIRO stent, Biotronik IC, Bulack, Switzerland). RESULTS: The Nano-crush and the modified T techniques seem able to restore the most physiologic fluid dynamic profile. Conversely, the DK-crush and the culotte demonstrated an intermediate and worst effect, respectively. The addition of a final POT resulted favorably for both Nano-crush and reverse modified T techniques, whereas a neutral and lack of significant effects have been observed for the DK-crush and culotte technique, respectively. CONCLUSION: Different double-stenting techniques (DST) have a different impact on coronary flow physiology. Both Nano-crush and modified T techniques achieved the most physiologic profile. The addition of a final POT appears to be a favourable step for both Nano-crush and modified T.
BACKGROUND/ PURPOSE: Computational fluid dynamics (CFD) have been recently adopted in many fields of cardiovascular medicine and in interventional cardiology. Using CFD analysis we compared the use of different PCI procedures, with and without the utilization of a proximal optimization technique (POT), on a complex coronary artery bifurcation. METHODS/MATERIALS: For the analysis, we considered a hypothetic model of a left anterior descending artery-diagonal Medina 1,1,1 bifurcation type with a diameter of the proximal main branch (MB) and the side branch (SB) set at 3.5mm and 2.5mm, respectively. The bifurcation angle has been set to 50°. For the stent simulation, we reconstructed a third-generation, ultra-thin strut everolimus-eluting stent (ORSIRO stent, Biotronik IC, Bulack, Switzerland). RESULTS: The Nano-crush and the modified T techniques seem able to restore the most physiologic fluid dynamic profile. Conversely, the DK-crush and the culotte demonstrated an intermediate and worst effect, respectively. The addition of a final POT resulted favorably for both Nano-crush and reverse modified T techniques, whereas a neutral and lack of significant effects have been observed for the DK-crush and culotte technique, respectively. CONCLUSION: Different double-stenting techniques (DST) have a different impact on coronary flow physiology. Both Nano-crush and modified T techniques achieved the most physiologic profile. The addition of a final POT appears to be a favourable step for both Nano-crush and modified T.
Authors: Gianluca Rigatelli; Marco Zuin; Tra T Ngo; Hung T Nguyen; Aravinda Nanjundappa; Ernest Talarico; Le Cao Phuong Duy; Thach Nguyen Journal: J Transl Int Med Date: 2019-07-11