基于有限元分析切割球囊对冠状动脉钙化病变预处理效果

Pretreatment Effects of Cutting Balloon on Coronary Artery Calcification Based on Finite Element Analysis

目的探讨切割球囊在浅部冠状动脉钙化病变预处理中的适用范围,以减少其在钙化病变治疗中严重并发症的发生。方法采用有限元方法,以普通球囊为对照分析切割球囊对不同弧度、厚度和长度钙化斑块的作用效果。将钙化斑块厚度设置为0.3、0.4 mm,长度设置为2、4 mm。并根据血管内超声(intravenous ultrasound,IVUS)钙化严重程度分级,设置钙化弧度为120°、180°、270°和360°,共16种钙化斑块。对钙化斑块使用脆性断裂模块来模拟钙化断裂情况,在预处理仿真的基础上进行支架虚拟植入,使用钙化断裂情况和支架圆形率来评价预处理效果。结果对于浅部钙化病变,在小于120°病变中,球囊无法解除钙化斑块阻碍,支架圆形率为82.75%。在厚度小于0.3 mm的180°钙化病变中,切割球囊在1215.9 kPa下使钙化发生断裂,支架后圆形率为74.42%;普通球囊在安全扩张压力(1418.55 kPa)下无法使钙化发生断裂。在270°小于0.3 mm厚钙化病变,普通球囊在1013.25 kPa下产生3处断裂;切割球囊在1013.25 kPa下产生2处断裂,球囊无法使厚0.3 mm的环状钙化发生断裂。结论推荐在厚度小于0.3 mm的180°左右钙化病变中使用切割球囊,270°钙化斑块使用普通球囊。对于厚度大于0.3 mm的环状病变,不推荐使用球囊预处理方法。

Objective To investigates the applicability of cutting balloon in the pretreatment of superficial coronary artery calcified lesions,so as to decrease the occurrence of serious consequences in the treatment of calcified lesions.Methods The effect of cutting balloon on calcified plaques with different curvatures,thickness,and length was analyzed using the finite element method,with normal balloon as a control.The thickness of calcified plaque was set to 0.3 mm and 0.4 mm,and the length was set to 2 mm and 4 mm.The calcification degree was set to 120°,180°,270°and 360°according to the intravenous ultrasound(IVUS)calcification severity grading,with a total of 16 types of calcified plaques.The brittle fracture module was used to simulate calcification fracture of calcified plaques,and virtual stent implantation was carried out based on pretreatment simulation.The effect of pretreatment was evaluated by calcification fracture condition and stent roundness.Results For superficial calcification lesions,in lesions less than 120°,the balloon could not remove the calcification plaque obstruction,and the stent roundness rate was 82.75%.In 180°calcified lesions with thickness of less than 0.3 mm,the calcification was broken by cutting balloon under 1215.9 kPa expansion pressure,and the post-stent roundness rate was 74.42%;normal balloon could not cause calcification fracture under safe expansion pressure(1418.55 kPa).In 270°calcified lesions with thickness less than 0.3 mm,the normal balloon produced 3 fractures under 1013.25 kPa expansion pressure.The cutting balloon produced 2 fractures under 1013.25 kPa expansion pressure,and the balloon could not fracture the circular calcified lesions with thickness of 0.3 mm.Conclusions Cutting balloon is recommended for 180°calcified lesions with thickness less than 0.3 mm,the normal balloon is recommended for 270°calcified lesions,and balloon pretreatment is not recommended for annular lesions with thickness greater than 0.3 mm.