Patient-Specific Coronary Artery 3D Printing Based on Intravascular Optical Coherence Tomography and Coronary Angiography

Despite the new ideas were inspired in medical treatment by the rapid advancement of three-dimensional (3D) printing technology, there is still rare research work reported on 3D printing of coronary arteries being documented in the literature. In this work, the application value of 3D printing technology in the treatment of cardiovascular diseases has been explored via comparison study between the 3D printed vascular solid model and the computer aided design (CAD) model. In this paper, a new framework is proposed to achieve a 3D printing vascular model with high simulation. The patient-specific 3D reconstruction of the coronary arteries is performed by the detailed morphological information abstracted from the contour of the vessel lumen. In the process of reconstruction which has 5 steps, the morphological details of the contour view of the vessel lumen are merged along with the curvature and length information provided by the coronary angiography. After comparing with the diameter of the narrow section and the diameter of the normal section in CAD models and 3D printing model, it can be concluded that there is a high correlation between the diameter of vascular stenosis measured in 3D printing models and computer aided design models. The 3D printing model has high-modeling ability and high precision, which can represent the original coronary artery appearance accurately. It can be adapted for prevascularization planning to support doctors in determining the surgical procedures

Translation of Intravascular Optical Ultrasound Imaging

ances in the field of intravascular imaging have provided clinicians with power ful tools to aid in the assessment and treatment of vascular pathology. Optical Ultra sound (OpUS) is an emerging modality with the potential to offer significant bene fits over existing commercial technologies such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT). With this paradigm ultrasound (US) is generated using pulsed or modulated light and received by a miniaturised fibre-optic hydrophone (FOH). The US generation is facilitated through the use of engineered optically-absorbing nanocomposite materials. To date pre-clinical benchtop stud ies of OpUS have shown significant promise however further study is needed to facilitate clinical translation. The overall aim of this PhD was to develop a pathway to clinical translation of OpUS, enabled by the development of a catheter-based device capable of high resolution vascular tissue imaging during an in-vivo setting. A forward-viewing OpUS imaging probe was developed using a 400 µm mul timode optical fibre, dip-coated in a multi-walled carbon nanotube-PDMS com posite, paired with a FOH comprising a 125 µm single mode fibre tipped with a Fabry-Perot cavity. With this high US pressures were generated (21.5 MPa at the transducer surface) and broad corresponding bandwidths were achieved (−6 dB of 39.8MHz). Using this probe, OpUS imaging was performed of an ex-vivo human coronary artery. The results demonstrated excellent correspondence, in the detec tion of calcification and lipid infiltration, with IVUS, OCT and histological analysis. A side-viewing OpUS imaging probe, employing a reflective 45 °angle at the dis tal fibre surface, was used to demonstrate rotational B-mode imaging of a vascular structure for the first time. This provided high-resolution imaging (54 µm axial resolution) with deep depth penetration (>10.5 mm). Finally the clinical utility of this technology was demonstrated during an in-vivo endovascular procedure. An OpUS imaging probe, incorporated into an interventional device, allowed guidance of in-situ fenestration of an endograft during a complex abdominal aortic aneurysm repair. Through this work the potential clinical utility of OpUS, to assess pathology and guide vascular intervention, has been demonstrated. These results pave the way for translation of this technology and a first in man study

Pressure drop and recovery in cases of cardiovascular disease: a computational study

The presence of disease in the cardiovascular system results in changes in flow and pressure patterns. Increased resistance to the flow observed in cases of aortic valve and coronary artery disease can have as a consequence abnormally high pressure gradients, which may lead to overexertion of the heart muscle, limited tissue perfusion and tissue damage. In the past, computational fluid dynamics (CFD) methods have been used coupled with medical imaging data to study haemodynamics, and it has been shown that CFD has great potential as a way to study patient-specific cases of cardiovascular disease in vivo, non-invasively, in great detail and at low cost. CFD can be particularly useful in evaluating the effectiveness of new diagnostic and treatment techniques, especially at early ‘concept’ stages. The main aim of this thesis is to use CFD to investigate the relationship between pressure and flow in cases of disease in the coronary arteries and the aortic valve, with the purpose of helping improve diagnosis and treatment, respectively. A transitional flow CFD model is used to investigate the phenomenon of pressure recovery in idealised models of aortic valve stenosis. Energy lost as turbulence in the wake of a diseased valve hinders pressure recovery, which occurs naturally when no energy losses are observed. A “concept” study testing the potential of a device that could maximise pressure recovery to reduce the pressure load on the heart muscle was conducted. The results indicate that, under certain conditions, such a device could prove useful. Fully patient-specific CFD studies of the coronary arteries are fewer than studies in larger vessels, mostly due to past limitations in the imaging and velocity data quality. A new method to reconstruct coronary anatomy from optical coherence tomography (OCT) data is presented in the thesis. The resulting models were combined with invasively acquired pressure and flow velocity data in transient CFD simulations, in order to test the ability of CFD to match the invasively measured pressure drop. A positive correlation and no bias were found between the calculated and measured results. The use of lower resolution reconstruction methods resulted in no correlation between the calculated and measured results, highlighting the importance of anatomical accuracy in the effectiveness of the CFD model. However, it was considered imperative that the limitations of CFD in predicting pressure gradients be further explored. It was found that the CFD-derived pressure drop is sensitive to changes in the volumetric flow rate, while bench-top experiments showed that the estimation of volumetric flow rate from invasively measured velocity data is subject to errors and uncertainties that may have a random effect on the CFD pressure result. This study demonstrated that the relationship between geometry, pressure and flow can be used to evaluate new diagnostic and treatment methods. In the case of aortic stenosis, further experimental work is required to turn the concept of a pressure recovery device into a potential clinical tool. In the coronary study it was shown that, though CFD has great power as a study tool, its limitations, especially those pertaining to the volumetric flow rate boundary condition, must be further studied and become fully understood before CFD can be reliably used to aid diagnosis in clinical practice.Open Acces

A nine months follow-up study of hemodynamic effect on bioabsorbable coronary stent implantation

Coronary artery disease has emerged as one of the major diseases causing death worldwide. Coronary stent has great effect to improve blood flow to the myocardium subtended by that artery, in which bioresorbable vascular scaffolds are new-generation stents used by people. However, Coronary stents implantation has a risk of restenosis, which is relative to hemodynamic parameters. Most of existing literatures studied in this issue have not taken into account such important factors as the strut thickness and lumen profile, and has yet to analyze the time effects among hemodynamic parameters over a certain period of time based on individual models. In this research, we proposed a framework to assess the chronic impact of hemodynamic on coronary stent implantation. In the framework, the optical coherence tomography (OCT) is combined with angiography to reconstruct patient-specific models of bioresorbable vascular scaffolds. Then, the hemodynamics parameters are extracted through the simulated 3D models, obtaining the distribution of wall shear stress (WSS), relative residence time (RRT) and oscillatory shear index (OSI). Finally, the changes of these parameters representing the effectiveness of hemodynamics exerted on the implanted stent can be assessed to estimate the chronic impacts. By a 9-month follow-up case study, it is observed that the difference of hemodynamic parameters are not significance. Both at baseline and 9-month follow-up experiments show that the hemodynamic parameters remain normal and similar, proving that the coronary stent implantation nowadays appears to have a robust and everlasting curative effect