EBC - ON DEMAND
Stent strut malapposition: Insights from simulations and oct imaging
European Bifurcation Club 2014, EBC 2014 – Bordeaux, France
BIFURCATION STENTING: LEARNING FROM BENCH AND SIMULATION
Stent strut malapposition: insights from flow simulations and OCT imaging
Author: Nicolas Foin, MD, PhD, National Heart Centre Singapore, Duke-NUS
- How are blood flow patterns and shear rate affected by different degree of stent malapposition?
- How does baseline flow around ISA strut affect coverage at FU
- High shear and delayed coverage: are both contributing factors to thrombogenicity observed with ISA?
- Computer Model of different strut-wall malapposition distances, flow patterns and shear rates evaluated by CFD
- In-vivo:ISA and strut coverage (% uncovered, thickness) assessed sequentially in-vivo by OCT at both baseline and FU
- Comparison of shear patterns with OCT FU coverage response
- Strut-wall malapposition distances affect flow disturbances and shear rate in a dose-dependent relation.
- OCT sequential study revealed that baseline ISA is mostly resolved and covered at FU for strut ISA distance < 300 um
- More severe malapposition (ISA distance > 300 um) create higher shear disturbance with significantly higher rate of persitent malapposition and uncovered strut at FU.
- Strut thickness influence re-endothelialisation as well as shear rate disturbance: for minimal shear rate, thinner strut is better.
- Further in-vivo studies are required to evaluate the impact of flow on neointimal healing and adverse events.