Impact of lesion preparation-induced calcified plaque defects in vascular intervention for atherosclerotic disease: in silico assessment
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10237_2024_Article_1923.pdf
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Author(s)
Sogbadji, Jonas
Kadry, Karim
Poletti, Gianluca
Berti, Francesca
Edelman, Elazer R.
Nezami, Farhad R.
Date Issued
January 21, 2025
Journal
Biomechanics and Modeling in Mechanobiology
Publisher
Springer Berlin Heidelberg
Citation
Sogbadji, J., Kadry, K., Poletti, G. et al. Impact of lesion preparation-induced calcified plaque defects in vascular intervention for atherosclerotic disease: in silico assessment. Biomech Model Mechanobiol (2025).
Version
Final published version
Abstract
Percutaneous coronary interventions in highly calcified atherosclerotic lesions are challenging due to the high mechanical stiffness that significantly restricts stent expansion. Intravascular lithotripsy (IVL) is a novel vessel preparation technique with the potential to improve interventional outcomes by inducing microscopic and macroscopic cracks to enhance stent expansion. However, the exact mechanism of action for IVL is poorly understood, and it remains unclear whether the improvement in-stent expansion is caused by either the macro-cracks allowing the vessel to open or the micro-cracks altering the bulk material properties. In silico models offer a robust means to examine (a) diverse lesion morphologies, (b) a range of lesion modifications to address these deficiencies, and (c) the correlation between calcium morphology alteration and improved stenting outcomes. These models also help identify which lesions would benefit the most from IVL. In this study, we develop an in silico model of stent expansion to study the effect of macro-crack morphology on interventional outcomes in clinically inspired geometries. Larger IVL-induced defects promote more post-stent lumen gain. IVL seems to induce better stenting outcomes for large calcified lesions. IVL defects that split calcified plaque in two parts are the most beneficial for stenting angioplasty, regardless of the calcified plaque size. Location of the IVL defect does not seem to matter with respect to lumen gain. These findings underscore the potential of IVL to enhance lesion compliance and improve clinical outcomes in PCI. The macroscopic defects induced by IVL seem to have a substantial impact on post-stent outcomes.
MIT Department
Massachusetts Institute of Technology. Institute for Medical Engineering & Science
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DOI of Published Version
https://doi.org/10.1007/s10237-024-01923-6
