北京生物医学工程

冠脉支架与血管耦合作用的有限元分析

Finite element analysis of coupling interaction between coronary stent and artery

作者：刘宇星艾辽元毛琳宋成利

单位：上海理工大学医疗器械与食品学院教育部现代微创医疗器械及技术工程研究中心（上海200093）

关键词：冠脉支架；狭窄；扩张；直径；斑块；有限元分析

分类号：R318.01

出版年·卷·期（页码）：2019·38·4（331-338）

摘要：

目的研究支架扩张直径以及斑块硬化程度对支架与冠脉耦合扩张的影响，探究合理的支架扩张直径范围，以期对临床冠脉支架植入术提供科学的参考依据。方法首先采用三维设计软件建立支架和理想狭窄冠状动脉模型，再利用有限元分析软件，通过赋予冠脉斑块三种不同的材料属性（钙化、纤维化、脂质），参考健康冠脉内径尺寸，模拟分析支架分别扩张至冠脉直径的1.0、1.1、1.2、1.3倍时，支架和血管的应力、支架径向回弹率、冠脉最小腔径以及支架的贴壁情况。结果支架、血管壁和斑块上的最大应力、支架径向回弹率、冠脉最小腔径均随支架扩张直径增加而增加。当支架扩张至冠脉直径的1.3倍时，血管壁及钙化斑块上的最大应力已处于或超出极限应力范围；当支架扩张至冠脉直径的1.0倍时，支架卸载回弹后会出现明显的贴壁不良。相比其他两种斑块，钙化斑块导致更高的血管应力和更小的血管腔径增长。结论冠脉支架扩张比例范围在1.1~1.2倍较为合理；其中，含钙化斑块的冠脉，应将支架扩张比例控制在1.1更为合理。研究结果可为冠脉支架植入术中支架扩张直径的选择提供参考依据。

Objective We studied the influence of stent expansion diameters and plaque sclerosis degrees on the coupling expansion between the stent and coronary artery, so as to obtain a reasonable range of stent expansion diameter and provide scientific references for coronary stent implantation. Methods Firstly, 3D design software was used to establish models of the stent and idealized stenotic coronary artery. Then, finite element analysis software was used for simulation. By attaching three different material properties (calcified, hypocellular, cellular) to the plaque and reading the inner diameter of healthy coronary artery as reference, stent was respectively dilated to 1.0, 1.1, 1.2, 1.3 times of coronary artery diameter. Stresses of the stents and arteries, rebound ratio in radial direction of the stents, minimum lumen diameter of coronary artery and wall apposition of the stents were analyzed. Results Maximum stresses on the stent and stenotic coronary artery, rebound ratio in radial direction of the stents and minimum lumen diameters of coronary artery increased with the increasing expansion diameters of the stents. When the stent was dilated to 1.3 times of the coronary artery diameter, maximum stresses on arterial walls and calcified plaque were in or beyond ultimate stress ranges. When the stent was dilated to 1 time of the coronary artery diameter, stent was not fully attached to the arterial wall after unloading and rebounding, obviously. Calcified plaque led to the higher arterial stresses and lower lumen diameter gain than the others. Conclusions The reasonable range of stent expansion ratio is 1.1 - 1.2, and it is better to be 1.1 for the artery with calcified plaque. These research findings may provide references for coronary stent implantation to choose a reasonable expansion diameter for the stents.

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