Focus Issue on Bifurcation Intervention
State-of-the-Art Review
Biomechanical Modeling to Improve Coronary Artery Bifurcation Stenting: Expert Review Document on Techniques and Clinical Implementation

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Abstract

Treatment of coronary bifurcation lesions remains an ongoing challenge for interventional cardiologists. Stenting of coronary bifurcations carries higher risk for in-stent restenosis, stent thrombosis, and recurrent clinical events. This review summarizes the current evidence regarding application and use of biomechanical modeling in the study of stent properties, local flow dynamics, and outcomes after percutaneous coronary interventions in bifurcation lesions. Biomechanical modeling of bifurcation stenting involves computational simulations and in vitro bench testing using subject-specific arterial geometries obtained from in vivo imaging. Biomechanical modeling has the potential to optimize stenting strategies and stent design, thereby reducing adverse outcomes. Large-scale clinical studies are needed to establish the translation of pre-clinical findings to the clinical arena.

Key Words

bifurcation
biomechanical stress
coronary artery disease
endothelial shear stress
stent(s)

Abbreviations and Acronyms

3D
3-dimensional
CFD
computational fluid dynamics
CT
computed tomography
ESS
endothelial shear stress
ISR
in-stent restenosis
KBI
kissing balloon inflation

Cited by (0)

Supported by Behrakis Foundation, and European Commission, Framework Program 7, Marie Curie International Reintegration Grant, Project: SMILE (249303). Dr. Mortier is a founder and shareholder of FEops. Dr. Tu has received a research grant from Medis. Dr. Reiber is the chief executive officer of and has equity in Medis Medical Imaging Systems. Dr. Bhatt serves on the advisory boards of Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; serves on the boards of directors of Boston VA Research Institute, Society of Cardiovascular Patient Care; chairs the American Heart Association Get With The Guidelines Steering Committee; serves on the data monitoring committees of Duke Clinical Research Institute, Harvard Clinical Research Institute, Mayo Clinic, Population Health Research Institute; receives honoraria from American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees), Harvard Clinical Research Institute (clinical trial steering committee), HMP Communications (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Associate Editor; Section Editor, Pharmacology), Population Health Research Institute (clinical trial steering committee), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), WebMD (continuing medical education steering committees), Clinical Cardiology (Deputy Editor); receives research funding from Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company; and participates in unfunded research for FlowCo, PLx Pharma, and Takeda. Dr. Louvard has received honoraria for workshop participation from Terumo, Abbott, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.