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ARUP; ISBN: 978-0-9562121-5-3 - CMBBE 2012 - Cardiff University

ARUP; ISBN: 978-0-9562121-5-3 - CMBBE 2012 - Cardiff University

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DRUG RELEASE IN CORONARY BIFURCATION STENTING.<br />

Elena Cutrì 1 , Paolo Zunino 1 , Stefano Morlacchi 2,3 , Claudio Chiastra 2,3 , Francesco<br />

Migliavacca 2<br />

1. ABSTRACT<br />

The treatment of coronary bifurcation lesions represents a challenge for the<br />

interventional cardiologists due to the lower rate of procedural success and the higher<br />

rate of restenosis. The advent of drug eluting stents (DES) has dramatically reduced<br />

restenosis and consequently the request for re-intervention [1]. The aim of the present<br />

work is to provide further insight about the effectiveness of DES by means of<br />

computational analysis that combine virtual stent implantation, fluid dynamics and drug<br />

release for different stenting protocols used in the treatment of a coronary artery<br />

bifurcation. An explicit dynamic finite element model is developed in order to provide<br />

realistic configurations of the implanted device used to perform fluid dynamics analysis<br />

by means of a previously developed [2,3] finite element method coupling the blood<br />

flow and intramural plasma filtration in rigid arteries. To efficiently model the drug<br />

release, a multiscale strategy is adopted, ranging from lumped parameter model<br />

accounting for drug release, to fully 3-D models for drug transport to the artery [4].<br />

Differences in drug delivery to the artery are evaluated with respect to local drug<br />

dosage. The model allowed to compare alternative stenting configurations thus<br />

suggesting guidelines in the treatment of coronary bifurcations lesions and addressing<br />

clinical issues such as the effectiveness of drug delivery to lesions in the side branch, as<br />

well as the influence of incomplete strut apposition and overlapping stents.<br />

2. INTRODUCTION<br />

The treatment of coronary bifurcation lesions by means of drug eluting stents (DESs)<br />

represents an open issue for the cardiologists since the need for standard guidelines on<br />

the choice of the optimal stenting procedure has not been fulfilled. In particular,<br />

atherosclerotic coronary bifurcations are currently treated by means of either single-or<br />

double-stenting procedures. The former procedure is easier to be performed but might<br />

not be able to adequately deliver drug to the SB and lead to partial coverage of the SB<br />

origin. On the other hand, the conventional double stenting procedures might lead to<br />

stent under-expansion at the SB ostium, stent overlap, incomplete stent apposition and a<br />

high density of metal at the carina [5]. Computational models [6] represent a valuable<br />

1<br />

Modelling and Scientific Computing (MOX), Department of Mathematics, Politecnico di Milano, Milan,<br />

Italy<br />

2Laboratory of Biological Structure Mechanics (LaBS), Structural Engineering Department, Politecnico di<br />

Milano, Milan, Italy<br />

3Bioengineering Department, Politecnico di Milano, Milan, Italy

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