Abstract:

John Doe, an 81-year-old patient with a significant distal left main (LM) stenosis, was treated using a provisional stenting approach. As part of a European Bifurcation Club (EBC) project, the complete stenting procedure was repeated using computational modelling.

First, a tailored three-dimensional (3D) reconstruction of the bifurcation anatomy was created by fusion of multi-slice computed tomography (CT) imaging and intra- vascular ultrasound.

Second, finite element analysis was employed to deploy and post-dilate the stent virtually within the generated patient-specific anatomical bifurcation model.

Finally, blood flow was modelled using computational fluid dynamics.

This proof-of-concept study demonstrated the feasibility of such patient-specific simulations for bifurcation stenting and has provided unique insights into the bifurcation anatomy, the technical aspects of LM bifurcation stenting, and the positive impact of adequate post-dilatation on blood flow patterns.

Potential clinical applications such as virtual trials and preoperative planning seem feasible but require a thorough clinical validation of the predictive power of these computer simulations.