Hemodynamic performance of different stent strategies for coronary bifurcations. Evaluation with a mathematical model

Purpose: Best percutaneous treatment strategy for lesions in coronary bifurcations is an ongoing subject of debate. There is limited data that analyses the effect of the different bifurcation strategies on coronary flow. Our aim is to evaluate the influence of different bifurcation stenting strategies on hemodynamic parameters, both in the main vessel (MV) and side branch (SB).

Pulsatile flow in coronary bifurcations for different stenting techniques

The objective of this work is to analyze the local hem odynamic changes caused in a coronary bifurcation by three different stenting techniques: simple stenting of the main vessel, simple stenting of the main vessel with kissing balloon in the side branch and culotte. To carry out this study an idealized geometry of a coronary bifurcation is used, and two bifurcation angles, 45º and 90º, are chosen as representative of the wide variety of re al configurations. In order to quantify the influence of the stenting technique on the local blood flow, both numeri- cal simulations and experimental measurements are performed. First, steady simulations are carried out with the commercial code ANSYS-Fluent, and then, experimental measurements with PIV (Particle Image Velocimetry) obtained in the laboratory are used to validate the numerical simulation. The steady computational simulations show a good overall agreement with the experimental data. Second, pulsatile flow is considered to take into account the tran- sient effects. The time averaged wall shear stress, scillatory shear index and pressure drop obtained numerically are used to compare the behavior of the stenting techniques.