Denis Van Loo

A Novel Simulation Strategy for Stent Insertion and Deployment in Curved Coronary Bifurcations: Comparison of Three Drug-Eluting Stents

The introduction of drug-eluting stents (DES) has reduced the occurrence of restenosis in coronary arteries. However, restenosis remains a problem in stented coronary bifurcations. This study investigates and compares three different second generation DESs when being implanted in the curved main branch of a coronary bifurcation with the aim of providing better insights into the related changes of the mechanical environment. The 3D bifurcation model is based on patient-specific angiographic data that accurately reproduce the in vivo curvatures of the vessel segments. The layered structure of the arterial wall and its anisotropic mechanical behavior are taken into account by applying a novel algorithm to define the fiber orientations. An innovative simulation strategy considering the insertion of a folded balloon catheter over a guide wire is proposed in order to position the stents within the curved vessel. Straightening occurs after implantation of all stents investigated. The resulting distributions of the wall stresses are strongly dependent on the stent design. Using a parametric modeling approach, two design modifications, which reduce the predicted maximum values of the wall stress, are proposed and analyzed.

Plant structure visualization by high-resolution X-ray computed tomography

New developments in high-resolution X-ray computed tomography (HRXCT) are promising for the broader application of this non-destructive imaging method in plant sciences. Here, we demonstrate how detailed three-dimensional morphological traits can be extracted rapidly from in vivoArabidopsis thaliana seedlings without sample manipulation. Furthermore, ex vivo scanning at sub-micron resolution allows the quantification and visualization of the cellular organization of plant tissue samples, making HRXCT a desired tool in developmental plant biology.

HECTOR : a 240kV micro-CT setup optimized for research

X-ray micro-CT has become a very powerful and common tool for non-destructive three-dimensional (3D) visualization and analysis of objects. Many systems are commercially available, but they are typically limited in terms of operational freedom both from a mechanical point of view as well as for acquisition routines. HECTOR is the latest system developed by the Ghent University Centre for X-ray Tomography (http://www.ugct.ugent.be) in collaboration with X-Ray Engineering (XRE bvba, Ghent, Belgium). It consists of a mechanical setup with nine motorized axes and a modular acquisition software package and combines a microfocus directional target X-ray source up to 240 kV with a large flat-panel detector. Provisions are made to install a line-detector for a maximal operational range. The system can accommodate samples up to 80 kg, 1 m long and 80 cm in diameter while it is also suited for high resolution (down to 4 μm) tomography. The bi-directional detector tiling is suited for large samples while the variable source-detector distance optimizes the signal to noise ratio (SNR) for every type of sample, even with peripheral equipment such as compression stages or climate chambers. The large vertical travel of 1 m can be used for helical scanning and a vertical detector rotation axis allows laminography experiments. The setup is installed in a large concrete bunker to allow accommodation of peripheral equipment such as pumps, chillers, etc., which can be integrated in the modular acquisition software to obtain a maximal correlation between the environmental control and the CT data taken. The acquisition software does not only allow good coupling with the peripheral equipment but its scripting feature is also particularly interesting for testing new and exotic acquisition routines.

Impact of competitive flow on wall shear stress in coronary surgery: computational fluid dynamics of a LIMA–LAD model

AIMS Competitive flow from native coronary vessels is considered a major factor in the failure of coronary bypass grafts. However, the pathophysiological effects are not fully understood. Low and oscillatory wall shear stress (WSS) is known to induce endothelial dysfunction and vascular disease, like atherosclerosis and intimal hyperplasia. The aim was to investigate the impact of competitive flow on WSS in mammary artery bypass grafts. METHODS AND RESULTS Using computational fluid dynamics, WSS was calculated in a left internal mammary artery (LIMA) graft to the left anterior descending artery in a three-dimensional in vivo porcine coronary artery bypass graft model. The following conditions were investigated: high competitive flow (non-significant coronary lesion), partial competitive flow (significant coronary lesion), and no competitive flow (totally occluded coronary vessel). Time-averaged WSS of LIMA at high, partial, and no competitive flow were 0.3-0.6, 0.6-3.0, and 0.9-3.0 Pa, respectively. Further, oscillatory WSS quantified as the oscillatory shear index (OSI) ranged from (maximum OSI = 0.5 equals zero net WSS) 0.15 to 0.35, <0.05, and <0.05, respectively. Thus, high competitive flow resulted in substantial oscillatory and low WSS. Moderate competitive flow resulted in WSS and OSI similar to the no competitive flow condition. CONCLUSION Graft flow is highly dependent on the degree of competitive flow. High competitive flow was found to produce unfavourable WSS consistent with endothelial dysfunction and subsequent graft narrowing and failure. Partial competitive flow, however, may be better tolerated as it was found to be similar to the ideal condition of no competitive flow.

From Vascular Corrosion Cast to Electrical Analog Model for the Study of Human Liver Hemodynamics and Perfusion

Hypothermic machine perfusion (HMP) is experiencing a revival in organ preservation due to the limitations of static cold storage and the need for better preservation of expanded criteria donor organs. For livers, perfusion protocols are still poorly defined, and damage of sinusoidal endothelial cells and heterogeneous perfusion are concerns. In this study, an electrical model of the human liver blood circulation is developed to enlighten internal pressure and flow distributions during HMP. Detailed vascular data on two human livers, obtained by combining vascular corrosion casting, micro-CT-imaging and image processing, were used to set up the electrical model. Anatomical data could be measured up to 5-6 vessel generations in each tree and showed exponential trend lines, used to predict data for higher generations. Simulated flow and pressure were in accordance with literature data. The model was able to simulate effects of pressure-driven HMP on liver hemodynamics and reproduced observations such as flow competition between the hepatic artery and portal vein. Our simulations further indicate that, from a pure biomechanical (shear stress) standpoint, HMP with low pressures should not result in organ damage, and that fluid viscosity has no effect on the shear stress experienced by the liver microcirculation in pressure-driven HMP.

Virtual optimization of self-expandable braided wire stents

At present, the deployment of self-expandable braided stents has become a common and widely used minimally invasive treatment for stenotic lesions in the cardiovascular, gastrointestinal and respiratory system. To improve these revascularization procedures (e.g. increase the positioning accuracy) the optimal strategy lies in the further development of the stent design. In the context of optimizing braided stent designs, computational models can provide an excellent research tool complementary to analytical models. In this study, a finite element based modelling strategy is proposed to investigate and optimize the mechanics of braided stents. First a geometrical and finite element model of a braided Urolume endoprosthesis was built with the open source pyFormex design tool. The results of the reference simulation of the Urolume stent are in close agreement with both analytical and experimental data. Subsequently, a simplex-based design optimization algorithm automatically adjusts the reference Urolume geometry to facilitate precise positioning by reducing the foreshortening with 20% while maintaining the radial stiffness. Therefore, the proposed modelling strategy appears to be a promising optimization methodology in braided stent design.

Comparison of drug-eluting stent cell size using micro-CT: important data for bifurcation stent selection

AIMS The size of stent cells is an important design parameter influencing the resulting wall coverage and strut positioning of several bifurcation stenting techniques. Therefore, we report accurate geometrical information on stent cell size of five different stents with the key purpose to assist with stent selection for bifurcation lesions. METHODS AND RESULTS We developed an innovative technique to assess cell size with high accuracy based on micro-CT images. In addition, the size of the ostium was calculated for several idealised bifurcations with a cylindrical main and side branch. The cell circumferences of the investigated stents vary substantially, with values between 9.5 and 19.8 mm (or an equivalent maximal cell diameter between 3.0 and 6.3 mm). Comparison of these cell circumferences with the calculated ostium circumferences shows which stents should preferably be used for which bifurcations, as these stents have cells that can be sufficiently enlarged by dilating through the side. CONCLUSIONS The cell sizes of the investigated stents differ considerably. This should be taken into account when applying a particular bifurcation stenting technique. The risk on limited main or side branch patency due to obstructing stent struts can be minimised by using the reported data for stent selection.

Finite element analysis of side branch access during bifurcation stenting.

Stent implantation has become a widely accepted endovascular intervention for the treatment of stenosed arteries. This minimally invasive technique has shown excellent results in unbranched arteries. However, stenting bifurcation lesions remains a challenge in coronary intervention as it is associated with a lower success rate. Many different techniques have been proposed in medical practice but all the suggested methodologies have specific limitations. Numerical simulations may help to understand and eliminate the shortcomings of current clinical techniques and devices. In this study, one of the currently applied techniques is analysed which involves the implantation of a stent in the main branch, followed by subsequent inflation of a balloon through the side of the stent. This improves the side branch patency and provides access to the side branch for later stent implantations. The impact of using different balloon sizes and stent designs was investigated. The stent cell through which the balloon is inflated increases considerably and as intuitively expected, using a larger balloon results in a larger opening. Furthermore, it was observed that this procedure may compromise the downstream main branch lumen. These observations correspond well with previously reported results, which were based on in vitro studies. The added value of the proposed numerical model is the ability to study many different techniques/stents, without the need for various expensive stent samples.

Perfusion characteristics of the human hepatic microcirculation based on three-dimensional reconstructions and computational fluid dynamic analysis

The perfusion of the liver microcirculation is often analyzed in terms of idealized functional units (hexagonal liver lobules) based on a porous medium approach. More elaborate research is essential to assess the validity of this approach and to provide a more adequate and quantitative characterization of the liver microcirculation. To this end, we modeled the perfusion of the liver microcirculation using an image-based three-dimensional (3D) reconstruction of human liver sinusoids and computational fluid dynamics techniques. After vascular corrosion casting, a microvascular sample (±0.134 mm(3)) representing three liver lobules, was dissected from a human liver vascular replica and scanned using a high resolution (2.6 μm) micro-CT scanner. Following image processing, a cube (0.15 × 0.15 × 0.15 mm(3)) representing a sample of intertwined and interconnected sinusoids, was isolated from the 3D reconstructed dataset to define the fluid domain. Three models were studied to simulate flow along three orthogonal directions (i.e., parallel to the central vein and in the radial and circumferential directions of the lobule). Inflow and outflow guidances were added to facilitate solution convergence, and good quality volume meshes were obtained using approximately 9 × 10(6) tetrahedral cells. Subsequently, three computational fluid dynamics models were generated and solved assuming Newtonian liquid properties (viscosity 3.5 mPa s). Post-processing allowed to visualize and quantify the microvascular flow characteristics, to calculate the permeability tensor and corresponding principal permeability axes, as well as the 3D porosity. The computational fluid dynamics simulations provided data on pressure differences, preferential flow pathways and wall shear stresses. Notably, the pressure difference resulting from the flow simulation parallel to the central vein (0-100 Pa) was clearly smaller than the difference from the radial (0-170 Pa) and circumferential (0-180 Pa) flow directions. This resulted in a higher permeability along the central vein direction (k(d,33) = 3.64 × 10(-14) m(2)) in comparison with the radial (k(d,11) = 1.56 × 10(-14) m(2)) and circumferential (k(d,22) = 1.75 × 10(-14) m(2)) permeabilities which were approximately equal. The mean 3D porosity was 14.3. Our data indicate that the human hepatic microcirculation is characterized by a higher permeability along the central vein direction, and an about two times lower permeability along the radial and circumferential directions of a lobule. Since the permeability coefficients depend on the flow direction, (porous medium) liver microcirculation models should take into account sinusoidal anisotropy.

Influence of Pore Structure on the Effectiveness of a Biogenic Carbonate Surface Treatment for Limestone Conservation

ABSTRACT A ureolytic biodeposition treatment was applied to five types of limestone in order to investigate the effect of pore structure on the protective performance of a biogenic carbonate surface treatment. Protective performance was assessed by means of transport and degradation processes, and the penetration depth of the treatment was visualized by microtomography. Pore size governs bacterial adsorption and hence the location and amount of carbonate precipitated. This study indicated that in macroporous stone, biogenic carbonate formation occurred to a larger extent and at greater depths than in microporous stone. As a consequence, the biodeposition treatment exhibited the greatest protective performance on macroporous stone. While precipitation was limited to the outer surface of microporous stone, biogenic carbonate formation occurred at depths of greater than 2 mm for Savonnières and Euville. For Savonnières, the presence of biogenic carbonate resulted in a 20-fold decreased rate of water absorption, which resulted in increased resistance to sodium sulfate attack and to freezing and thawing. While untreated samples were completely degraded after 15 cycles of salt attack, no damage was observed in biodeposition-treated Savonnières. From this study, it is clear that biodeposition is very effective and more feasible for macroporous stones than for microporous stones.