Objective To describe changes that occur in stent morphology and structure after its implantation in coronary bifurcation.Side branch (SB) compromise after stenting of main vessel in coronary bifurcation is a major in...Objective To describe changes that occur in stent morphology and structure after its implantation in coronary bifurcation.Side branch (SB) compromise after stenting of main vessel in coronary bifurcation is a major intraprocedural problem and for the long term,as a place of restenosis.Methods We created an elastic wall model (parent vessel diameter 3.5mm,daughter branches 3.5mm and 2.75mm)with 30,45 and 60 degree distal angulation between branches.After stent implantation,struts to the side branch were opened with 2.0mm and consequently 3.0mm diameter balloons.Subsequent balloon redilatations and kissing balloon inflations (KBI) were performed.All stages of the procedure were photographed with magnification up to 100 times.Results We found that the leading mechanism for side branch compromise was carina displacement,and discovered theoretical description for expected ostial stenosis severity.Based on our model we found that displacement of bifurcation flow divider cause SB stenosis with almost perfect coincidence with our theoretical predictions.Opening of stent cells through the proximal and distal stent struts always increased interslrut distance,but never achieved good apposition to the wall.Balloon diameter increase didn't give proportional enlargement in stent cell diameters.KBI leads to some small better stent positioning,correcting main vessel strut dislodgment from wall,but never gave full strut-wall contact.Distance between struts and wall was minimal only when the stent cell perfectly faced ostium of SB.This was also our observation that the shape of ostium of SB becomed eUiptically-bean shaped after stent implantation and generally kept that shape during consequent stages of experiment.Measured diameter and area stenosis were perfectly fitted and theoretically predicted from our concept Conclusion We have described stent-wall deformations in stent-balloon technique for treatment of coronary bifurcation demonstrating carina displacement as possibly main mechanism of side branch compromise after main vessel stenting.We have shown that KBI could not give full strut-wall contact if there is no perfect facing of stem cell and SB ostium.(J Geroatr Cardool 2008;5(1):43-49)展开更多
为解决传统座舱试验台结构同质化及模块化设计不足等问题,采用亲和图法整理了汽车故障及用户初始需求;采用模糊Kano模型进行需求指标权重计算,并结合质量特性要素进行用户核心需求汇总;通过功能分析系统技术(Function Analysis System T...为解决传统座舱试验台结构同质化及模块化设计不足等问题,采用亲和图法整理了汽车故障及用户初始需求;采用模糊Kano模型进行需求指标权重计算,并结合质量特性要素进行用户核心需求汇总;通过功能分析系统技术(Function Analysis System Technique,FAST)黑箱模型将用户需求转化为功能需求,并引入公理设计(Axiomatic Design,AD)理论与功能-行为-结构(Function-Behavior-Structure,FBS)模型进行逐级映射,最终确定智能座舱柔性试验台的结构设计要素。该设计过程以用户核心需求为导向,通过FAST-AD-FBS集成方法的应用,克服了传统产品概念设计中用户需求与产品功能结构设计间存在矛盾的问题,为提高产品创新设计的完整性及准确性提供了理论参考。展开更多
文摘Objective To describe changes that occur in stent morphology and structure after its implantation in coronary bifurcation.Side branch (SB) compromise after stenting of main vessel in coronary bifurcation is a major intraprocedural problem and for the long term,as a place of restenosis.Methods We created an elastic wall model (parent vessel diameter 3.5mm,daughter branches 3.5mm and 2.75mm)with 30,45 and 60 degree distal angulation between branches.After stent implantation,struts to the side branch were opened with 2.0mm and consequently 3.0mm diameter balloons.Subsequent balloon redilatations and kissing balloon inflations (KBI) were performed.All stages of the procedure were photographed with magnification up to 100 times.Results We found that the leading mechanism for side branch compromise was carina displacement,and discovered theoretical description for expected ostial stenosis severity.Based on our model we found that displacement of bifurcation flow divider cause SB stenosis with almost perfect coincidence with our theoretical predictions.Opening of stent cells through the proximal and distal stent struts always increased interslrut distance,but never achieved good apposition to the wall.Balloon diameter increase didn't give proportional enlargement in stent cell diameters.KBI leads to some small better stent positioning,correcting main vessel strut dislodgment from wall,but never gave full strut-wall contact.Distance between struts and wall was minimal only when the stent cell perfectly faced ostium of SB.This was also our observation that the shape of ostium of SB becomed eUiptically-bean shaped after stent implantation and generally kept that shape during consequent stages of experiment.Measured diameter and area stenosis were perfectly fitted and theoretically predicted from our concept Conclusion We have described stent-wall deformations in stent-balloon technique for treatment of coronary bifurcation demonstrating carina displacement as possibly main mechanism of side branch compromise after main vessel stenting.We have shown that KBI could not give full strut-wall contact if there is no perfect facing of stem cell and SB ostium.(J Geroatr Cardool 2008;5(1):43-49)
文摘为解决传统座舱试验台结构同质化及模块化设计不足等问题,采用亲和图法整理了汽车故障及用户初始需求;采用模糊Kano模型进行需求指标权重计算,并结合质量特性要素进行用户核心需求汇总;通过功能分析系统技术(Function Analysis System Technique,FAST)黑箱模型将用户需求转化为功能需求,并引入公理设计(Axiomatic Design,AD)理论与功能-行为-结构(Function-Behavior-Structure,FBS)模型进行逐级映射,最终确定智能座舱柔性试验台的结构设计要素。该设计过程以用户核心需求为导向,通过FAST-AD-FBS集成方法的应用,克服了传统产品概念设计中用户需求与产品功能结构设计间存在矛盾的问题,为提高产品创新设计的完整性及准确性提供了理论参考。
