EBC - ON DEMAND
Learnings From the Bench and a Thrombogenicity Model
European Bifurcation Club 2019, EBC 2019 – Barcelona, Spain
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Learnings From the Bench and a Thrombogenicity Model
Author: Nicolas Foin, MSc, PhD, National Heart Research Institute Singapore; Philips Healthcare, Belgium
LEARNINGS FROM THE BENCH
- Bench models allow to study questions in controlled and reproducible experimental environments
- Make use tools such as Micro-CT, Radial & Longitudinal Strength tes;ng, 3D printing, Perfusion test, Histology, SEM Microscopy.
LIMITATIONS
- It can only provide a partial model to investigate a question and cannot mimic the entire tissue /plaque characteristics and in-vivo biological response.
- Results can not always be transposed directly to in-vivo situations and should be interpreted with caution.
- Bench models complement, but do not replace clinical/imaging studies
SUMMARY
- Stent underexpansion and stent malapposition distances affect flow disturbances and shear rate in a dose-dependent relation.
- Severe malapposition (ISA distance > 300 um) create higher shear rate with persitent malapposition + uncovered strut at follow-up.
- In-vitro experiments with perfused blood suggest that large malapposed stent segment create potential sites for platelet adhesion and clot development.
- Stent optimisation (expansion and apposition) with appropriate sizing, post-dilatation and imaging can improve local hemodynamic environment and reduce area of high shear disturbance.