#1 G.S. Kassab Mathematical modeling of coronary arterial tree

Transcription

1 #1 G.S. Kassab Mathematical modeling of coronary arterial tree

2 #1 G.S. Kassab Mathematical modeling of coronary arterial tree HK model is in agreement with measurements of all bifurcations types (e.g., Y and T) and provides high Wall shear stress (WSS) and low oscillatory shear index (OSI). Murray and area-preservation models are not in agreement with experimental measurements. Murray s law provides lower WSS and higher OSI which challenges the previous assumed notion that Murray s bifurcation angle is ideal for optimal hemodynamics. Finet is in agreement for Y bifurcations but not for T-bifurcations where it leads to lower WSS and higher OSI. We have implemented an easy to use rule to determine the 3 rd diameter of bifurcation/trifurcation (if two/three of the segment diameters are known) that can be downloaded to an iphone, BlackBerry: refdiacalculation

3 #1 G.S. Kassab Mathematical modeling of coronary arterial tree HK model is in agreement with measurements of all bifurcations types (e.g., Y and T) and provides high Wall shear stress (WSS) and low oscillatory shear index (OSI). Murray and area-preservation models are not in agreement with experimental measurements. Murray s law provides lower WSS and higher OSI which challenges the previous assumed notion that Murray s bifurcation angle is ideal for optimal hemodynamics. Finet is in agreement for Y bifurcations but not for T-bifurcations where it leads to lower WSS and higher OSI. We have implemented an easy to use rule to determine the 3 rd diameter of bifurcation/trifurcation (if two/three of the segment diameters are known) that can be downloaded to an iphone, BlackBerry: refdiacalculation

4 #2 - J. Ormiston

5 #2 - J. Ormiston CT atlas of bifurcation Approved by local Ethics Commi5ee Wri5en consent Pa9ents with zero calcium score and no stenoses (N=300) à Access to clinical data and CT angiography images

6 #2 - J. Ormiston Atlas to 3D Printing We have created an atlas of the normal coronary anatomy with a focus on à Bifurcation measurements We can 3D print anatomically true bifurcation phantoms based on population models These models can also be used for accurate and representative hemodynamic simulations and realistic bench-testing

7 #3 M. Joner LM anatomy and plaque distribution

8 #3 M. Joner LM anatomy and plaque distribution

9 #3 M. Joner LM anatomy and plaque distribution

10 #3 M. Joner LM anatomy and plaque distribution Important anatomical considerations in LM lesions: ü length of LM is associated with stenosis and calcification ü high percentage of elastic fibers ü predominance of fibrotic and fibrocalcific plaque ü severe luminal narrowing rarely observed Insights into stent healing in LM lesions from pathology: ü Less restenosis in DES compared to BMS ü Greater signs of delayed healing in DES ü Stent thrombosis often associated with incomplete apposition of stent struts

11 #4 C. Tamburino Impact of 3-D angle assessment and plaque distribution classification in LM disease

12 #4 C. Tamburino Impact of 3-D angle assessment and plaque distribution classification in LM disease

13 #4 C. Tamburino Impact of 3-D angle assessment and plaque distribution classification in LM disease

14 #4 C. Tamburino Impact of 3-D angle assessment and plaque distribution classification in LM disease

15 #4 C. Tamburino Impact of 3-D angle assessment and plaque distribution classification in LM disease

16 #4 C. Tamburino Impact of 3-D angle assessment and plaque distribution classification in LM disease

17 #4 C. Tamburino Impact of 3-D angle assessment and plaque distribution classification in LM disease

18 #5 R. Davis Development and need for a dedicated bifurcated stent

19 #5 R. Davis Development and need for a dedicated bifurcated stent

20 #5 R. Davis Development and need for a dedicated bifurcated stent

21 #5 R. Davis Development and need for a dedicated bifurcated stent

22 #5 R. Davis Development and need for a dedicated bifurcated stent

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29 #1 G.S. Kassab Mathematical modeling of coronary arterial tree HK model is in agreement with measurements of all bifurcations types (e.g., Y and T) and provides high WSS and low OSI. Murray and area-preservation models are not in agreement with experimental measurements. Murray s law provides lower WSS and higher OSI which challenges the previous assumed notion that Murray s bifurcation angle is ideal for optimal hemodynamics.

30 #1 G.S. Kassab Mathematical modeling of coronary arterial tree HK model is in agreement with measurements of all bifurcations types (e.g., Y and T) and provides high WSS and low OSI. Murray and area-preservation models are not in agreement with experimental measurements. Murray s law provides lower WSS and higher OSI which challenges the previous assumed notion that Murray s bifurcation angle is ideal for optimal hemodynamics. Finet is in agreement for Y bifurcations but not for T-bifurcations where it leads to lower WSS and higher OSI. We have implemented an easy to use rule to determine the 3 rd diameter of bifurcation/trifurcation (if two/three of the segment diameters are known) that can be downloaded to an iphone, BlackBerry: refdiacalculation

31 #1 G.S. Kassab Mathematical modeling of coronary arterial tree

32 We have created an atlas of the normal coronary anatomy with a focus on à Bifurca9on measurements We can 3D print anatomically true bifurca9on phantoms based on popula9on models These models can also be used for accurate and representa9ve hemodynamic simula9ons and realis9c bench- tes9ng

33 J. Ormiston We have created an atlas of the normal coronary anatomy with a focus on à Bifurcation measurements We can 3D print anatomically true bifurcation phantoms based on population models These models can also be used for accurate and representative hemodynamic simulations and realistic bench-testing

34 J. Ormiston We have created an atlas of the normal coronary anatomy with a focus on à Bifurcation measurements Approved by local Ethics Committee Written consent Patients with zero calcium score and no stenoses (N=300) à Access to clinical data and CT angiography images Demographics: 55 ± 9 years, 64% females Automatic fully three-dimensional measurements

35 Framework Statistical pipeline Bifurcation (per depth) Bifurcation (per patient) Incoming (per depth) 18 Incoming (per patient) Angle (deg) No. of patients CTA Coronary models Atlas Depth (mm) Angle (deg) Mode 2 (16.4 %, N=100) µ -2σ +2σ Printing CAD Atlas lad d1 omb lcx 0 om1 d1b -20 lmb Patient Engineering pipeline Population