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Research Papers

Computational Modeling and Comparative Tissue Damage Analysis of Angioplasty and Orbital Atherectomy Interventional Procedures

[+] Author and Article Information
Rohit R. Deokar

Department of Mechanical Engineering,
University of Minnesota—Twin Cities,
111 Church Street SE,
Minneapolis, MN 55455
e-mail: deoka002@umn.edu

Barney E. Klamecki

Department of Mechanical Engineering,
University of Minnesota—Twin Cities,
111 Church Street SE,
Minneapolis, MN 55455
e-mail: klamecki@umn.edu

Manuscript received June 30, 2016; final manuscript received March 14, 2017; published online May 3, 2017. Assoc. Editor: Marc Horner.

J. Med. Devices 11(2), 021006 (May 03, 2017) (15 pages) Paper No: MED-16-1256; doi: 10.1115/1.4036299 History: Received June 30, 2016; Revised March 14, 2017

This research was directed toward quantitatively characterizing the effects of arterial mechanical treatment procedures on the stress and strain energy states of the artery wall. Finite element simulations of percutaneous transluminal angioplasty (PTA) and orbital atherectomy (OA) were performed on arterial lesion models with various extents and types of plaque. Stress fields in the artery were calculated and strain energy density was used as an explicit description of potential damage to the artery. The research also included numerical simulations of changes in arterial compliance due to orbital atherectomy. The angioplasty simulations show that the damage energy fields in the media and adventitia are predominant in regions of the lesion that are not protected by a layer of calcification. In addition, it was observed that softening the plaque components leads to a lower peak stress and therefore lesser damage energy in the media and adventitia under the action of a semicompliant balloon. Orbital atherectomy simulations revealed that the major portion of strain energy dissipated is concentrated in the plaque components in contact with the spinning tool. The damage and peak stress fields in the media and adventitia components of the vessel were significantly less. This observation suggests less mechanically induced trauma during a localized procedure like orbital atherectomy. Artery compliance was calculated pre- and post-treatment and an increase was observed after the orbital atherectomy procedure. The localized plaque disruption produced in atherectomy suggests that the undesirable stress states in angioplasty can be mitigated by a combination of procedures such as atherectomy followed by angioplasty.

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Figures

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Fig. 1

Mullin's effect in a material under uniaxial loading and unloading

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Fig. 2

Experimental primary hyperelastic response of calcified, echolucent, and mixed plaque types reported by Maher et al. [16]

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Fig. 3

Plaque stress–strain models developed from experimental results of Maher et al. [16] fit to a third order Ogden function with Mullins effect

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Fig. 4

Material data reported by Lawlor et al. [21] for average representative hard, mixed, and soft plaques

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Fig. 5

(a) Combined compressive and tensile material data for echolucent plaque and (b) for calcified plaque

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Fig. 6

Final material model of calcified plaque for (a) angioplasty and (b) orbital atherectomy simulations

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Fig. 7

Final material model of echolucent/soft plaque for (a) angioplasty and (b) orbital atherectomy simulations

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Fig. 8

Comparison of cyclic loading response of the experimental [13] and FEA results for human thoracic aorta tissue

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Fig. 9

Histology image of superficial femoral artery used to model the 3D vessel. (Image provided by Cardiovascular Systems Inc., St Paul, MN)

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Fig. 10

Cross-sectional and axial section views of (a) and (b) SFA model and (c) and (d) idealized SFA model with 90 deg calcification

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Fig. 11

Tri-folded balloon configuration used in angioplasty simulations (a)–(c), cross-sectional view of three stages of balloon deployment (not to scale) (d) and (e) balloon in initial and deployed states

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Fig. 12

(a) von Mises stress (kPa) and (b) damage energy density (J/m3), in artery–plaque structure for plaque extending over 90 deg of internal artery surface

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Fig. 13

Axial section views of von Mises stress (MPa) in (a) media, (b) calcification, (c) adventitia, and (d) soft plaque

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Fig. 14

Von Mises stress (kPa) in lesion for calcification extending over (a) 180 deg and (b) 270 deg of internal artery surface

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Fig. 15

Axial section views of von Mises stress (MPa) in the media for calcification over (a) 90 deg, (c) 180 deg, and (e) 270 deg and in the adventitia with (b) 90 deg, (d) 180 deg, and (f) 270 deg calcification

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Fig. 16

Medial stress for 180 deg plaque with (a) plaque of initial stiffness, (b) plaque component with 50% of original stiffness, and (c) plaque component with 20% of original stiffness

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Fig. 17

Overview of orbital atherectomy simulations with (a) the crown in (b) a longitudinal section of an artery with (c) calcification extending over varying portions of artery cross sections

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Fig. 18

von Mises stress (MPa) in calcified plaque region of artery in (a) longitudinal section and (b) cross section of artery with plaque extending over 90 deg of artery

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Fig. 19

von Mises stress (MPa) in calcified plaque region of artery in (a) longitudinal section and (b) cross section of artery calculated in simulation including permanent set

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Fig. 20

Lumen area-applied pressure simulation results used to calculate compliance of untreated and OA treated arteries

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