Software for optimized virtual stenting of patient-specific coronary arteries reconstructed from angiography images

Abstract

Detection of clinically relevant stenosis within coronary arteries as well as planning of treatment (stent implantation) are important topics in clinical cardiology. In this study a thorough methodology for virtual stenting assistance is proposed, that includes the 3D reconstruction of a patient-specific coronary artery from X-ray angiography images, hemodynamic simulations of blood flow, computation of a fractional flow reserve (FFR) equivalent, virtual stenting procedure and an optimization of the virtual stenting, by considering not only the value of computed FFR, but also the low and high WSS regions and the state of arterial wall after stenting. The evaluation of the proposed methodology is performed in two ways: the calculated values of FFR are compared with clinically measured values; and the results obtained for automated optimized virtual stenting are compared with virtual stenting performed manually by an expert clinician for the whole considered dataset. The agreement of the results in almost all cases demonstrates the accuracy of the proposed approach, and the small discrepancies only show the capabilities and benefits this approach can offer. The automated optimized virtual stenting technique can provide information about the most optimal stent position that ensures the maximum achievable FFR, while also considering the distribution of WSS and the state of arterial wall. The proposed methodology and developed software can therefore be used as a noninvasive method for planning of optimal patient-specific treatment strategies before invasive procedures and thus help to improve the clinical outcome of interventions and provide better treatment planning adapted to the particular patient.