An agent-based model of the response to angioplasty and bare-metal stent deployment in an atherosclerotic blood vessel

Purpose: While animal models are widely used to investigate the development of restenosis in blood vessels following an intervention, computational models offer another means for investigating this phenomenon. A computational model of the response of a treated vessel would allow investigators to assess the effects of altering certain vessel- and stent-related variables. The authors aimed to develop a novel computational model of restenosis development following an angioplasty and bare-metal stent implantation in an atherosclerotic vessel using agent-based modeling techniques. The presented model is intended to demonstrate the body's response to the intervention and to explore how different vessel geometries or stent arrangements may affect restenosis development. Methods: The model was created on a two-dimensional grid space. It utilizes the post-procedural vessel lumen diameter and stent information as its input parameters. The simulation starting point of the model is an atherosclerotic vessel after an angioplasty and stent implantation procedure. The model subsequently generates the final lumen diameter, percent change in lumen cross-sectional area, time to lumen diameter stabilization, and local concentrations of inflammatory cytokines upon simulation completion. Simulation results were directly compared with the results from serial imaging studies and cytokine levels studies in atherosclerotic patients from the relevant literature. Results: The final lumen diameter results were all within one standard deviation of the mean lumen diameters reported in the comparison studies. The overlapping-stent simulations yielded results that matched published trends. The cytokine levels remained within the range of physiological levels throughout the simulations. Conclusion: We developed a novel computational model that successfully simulated the development of restenosis in a blood vessel following an angioplasty and bare-metal stent deployment based on the characteristics of the vessel crosssection and stent. A further development of this model could ultimately be used as a predictive tool to depict patient outcomes and inform treatment options. © 2014 Curtin, Zhou

Syndromes associated with the deep veins: phlegmasia cerulean dolens, May-Thurner syndrome, and nutcracker syndrome.

Although phlegmasia cerulea dolens, May-Thurner syndrome, and nutcracker syndrome are rare entities, knowledge of these syndromes associated with the deep veins is essential. This study presents current management of these disorders, including diagnostic and interventional strategies. Endovascular techniques have evolved and now play a significant role in the treatment of both phlegmasia cerulea dolens and May-Thurner syndrome. However, endovascular therapy for nutcracker syndrome remains untested. © The Author(s) 2010.http://deepblue.lib.umich.edu/bitstream/2027.42/175818/2/Syndromes Associated with the Deep Veins.pdfPublished versionDescription of Syndromes Associated with the Deep Veins.pdf : Published versio

Between a Rock and a Hard Place: Anticipating Poor Surgical Outcomes while Honoring Patient Autonomy

http://deepblue.lib.umich.edu/bitstream/2027.42/175716/2/Between a Rock and a Hard Place Chapter.pdfPublished versionDescription of Between a Rock and a Hard Place Chapter.pdf : Published versio