Towards a Digital Twin of Coronary Stenting: A Suitable and Validated Image-Based Approach for Mimicking Patient-Specific Coronary Arteries

Gianluca Poletti,Giancarlo Pennati,Michail I Papafaklis,Dimitrios I Fotiadis,Panagiota Tsompou,Luca Antonini,Georgia S Karanasiou,Lampros K Michalis,Lorenza Petrini,Lorenzo Mandelli

doi:10.3390/electronics11030502

Gianluca Poletti, Giancarlo Pennati + Show 8 more

Open Access

https://doi.org/10.3390/electronics11030502

Copy DOI

Abstract

Considering the field of application involving stent deployment simulations, the exploitation of a digital twin of coronary stenting that can reliably mimic the patient-specific clinical reality could lead to improvements in individual treatments. A starting step to pursue this goal is the development of simple, but at the same time, robust and effective computational methods to obtain a good compromise between the accuracy of the description of physical phenomena and computational costs. Specifically, this work proposes an approach for the development of a patient-specific artery model to be used in stenting simulations. The finite element model was generated through a 3D reconstruction based on the clinical imaging (coronary Optical Coherence Tomography (OCT) and angiography) acquired on the pre-treatment patient. From a mechanical point of view, the coronary wall was described with a suitable phenomenological model, which is consistent with more complex constitutive approaches and accounts for the in vivo pressurization and axial pre-stretch. The effectiveness of this artery modeling method was tested by reproducing in silico the stenting procedures of two clinical cases and comparing the computational results with the in vivo lumen area of the stented vessel.

Highlights

Coronary artery disease is the leading cause of death among cardiovascular pathologies, with stenting being the most common treatment [1]
The post-treatment area derived from optical coherence tomography (OCT) images appears to be adequately estimated by Finite element analysis (FEA): a good fit between the graph curves can be seen along the whole stented region
For Case B, starting from the 3D artery geometry at the end of treatment (Figure 8b), the area values estimated with FEA were compared with the clinical data

Summary

Introduction

Coronary artery disease is the leading cause of death among cardiovascular pathologies, with stenting being the most common treatment [1]. Several stent types and clinical procedures were evaluated in the last decades, leading to the current gold standard of drug-eluting stent implantation. There still remain risks of treatment failure due to in-stent restenosis and stent thrombosis. The occurrence of these adverse events is mainly correlated to the presence of arterial injury during treatment and stent malapposition at the end of the surgical procedure [2]. Both phenomena are related to the mechanical interaction between the device and the patient-specific arteries in the acute phase of treatment

Objectives

Methods

Results

Discussion

Conclusion