Application of an OCT-based 3D reconstruction framework to the hemodynamic assessment of an ulcerated coronary artery plaque. (April 2020)

• Record Type: Journal Article
• Authors: Migliori, Susanna; Chiastra, Claudio; Bologna, Marco; Montin, Eros; Dubini, Gabriele; Genuardi, Lorenzo; Aurigemma, Cristina; Mainardi, Luca; Burzotta, Francesco; Migliavacca, Francesco
• Is Part Of: Medical engineering & physics. Volume 78(2020)
• Page Start: 74
• Page End: 81
• Publication Date: 2020-04
• Subjects: Optical coherence tomography -- Image segmentation -- Coronary artery -- Ulcerated plaque -- Pre-operative assessment -- Patient-specific modelling -- Computational fluid dynamics -- Wall shear stress; CAD Computer-aided design -- CFD Computational fluid dynamics -- DICOM Digital Imaging and COmmunications in Medicine -- MB Main branch -- OCT Optical coherence tomography -- PCI Percutaneous coronary intervention -- 3D-QCA 3D quantitative coronary angiography -- RCA right coronary artery -- SB Side branch -- TAWSS Time-averaged wall shear stress -- WSS Wall shear stress; Biomedical engineering -- Periodicals; Biomedical Engineering -- Periodicals; Physics -- Periodicals; Génie biomédical -- Périodiques; Biomedical engineering; Electronic journals; Periodicals; 610.28
• DOI: 10.1016/j.medengphy.2019.12.006
• Languages: English
• ISSNs: 1350-4533

Abstract

Highlights: Semi-automatic segmentation of pre- and post-operative OCT images. 3D modelling of an ulcerated coronary artery lesion from OCT and angiography. Pre- and post-operative patient-specific CFD model of an ulcerated coronary artery. Abstract: The rupture of a vulnerable plaque, known as ulceration, is the most common cause of myocardial infarction. It can be recognized by angiographic features, such as prolonged intraluminal filling and delayed clearance of the contrast liquid. The diagnosis of such an event is an open challenge due to the limited angiographic resolution and acquisition frequency. The treatment of ulcerated plaques is an open discussion, due to the high heterogeneity and the lack of evidences that support particular strategies. Therefore, the therapeutic decision should follow a detailed investigation with angiography and intravascular imaging, such as optical coherence tomography (OCT), to locate the lesion, besides its geometric features and the lumen occlusion severity. The aim of this study is the application of a framework for the in-silico analysis of the disrupted hemodynamics due to an ulcerated lesion. The study employed a validated OCT-based reconstruction methodology and computational fluid dynamics (CFD) simulations for the computation of local hemodynamic quantities, such as wall shear stress. The reported findings, such as disrupted pre-operative flow conditions, proved the applicability of the developed framework for CFD analyses on complicated patient-specific anatomies that feature ulcerated plaques. The prediction of lesion expansion and the clinical decision making can benefit from a reliable computation of wall shear stress distributions that result from the peculiar anatomy of the lesion. The application of intravascular OCT imaging, high fidelity 3D reconstructions and CFD simulations might guide the treatment of such pathology.