Key result
Insertion of a guidewire in computational models shifts velocity distribution, increases resistance, and amplifies the pressure drop across the stenosis, with a maximum relative error of around 3.0%.
Why the study?
In vivo coronary pressure measurement relies on a guidewire that inevitably alters local hemodynamics, making it necessary to precisely assess the impact of guidewire insertion on measurement accuracy.
Does the presence of a guidewire alter trans-stenotic pressure drop in computational models of coronary artery disease?
Does the presence of a guidewire alter trans-stenotic pressure drop in computational models of coronary artery disease?
Computational modeling demonstrates that guidewire insertion amplifies trans-stenotic pressure drop, and a novel analytical model can correct for this to better align CT-derived FFR with invasive measurements.
Answers are grounded in this paper and cite their sources.
Guidewire effects merit inclusion in computational FFR models; leaves open prospective validation against invasive measurements.
Accurate measurement of trans-stenotic pressure drop is vital for risk stratification in coronary artery disease. Currently, in vivo pressure measurement relies mostly on a pressure guidewire inserted into the artery, which inevitably alters local hemodynamics. To precisely assess the impact of guidewire insertion on the accuracy of pressure measurement, this study conducts numerical simulations with both an idealized straight-tube model and a patient-specific model. Results with and without a guidewire model are compared and analyzed. Results from the idealized model reveal that the insertion of a guidewire shifts velocity distribution, increases resistance, and amplifies the pressure drop across the stenosis. The patient-specific model also demonstrates that the guidewire causes non-negligible flow redistribution among the arterial branches, but the influence on pressure drop remains mostly localized. An analytical model for trans-stenotic pressure drop that takes the guidewire into consideration is also proposed and validated against the 3D simulation results. It is observed that the maximum relative error is around 3.0% in the patient-specific model, indicating the effectiveness of the analytical model in physiologically accurate settings. The proposed model can be used to align computed tomography-derived fractional flow reserve values with clinically recognized FFR standards established through guidewire measurements.
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Wang et al. (2024) studied Coronary artery disease. Guidewire insertion vs. Without a guidewire model was evaluated on Trans-stenotic pressure drop and velocity distribution. Insertion of a guidewire in computational models shifts velocity distribution, increases resistance, and amplifies the pressure drop across the stenosis, with a maximum relative error of around 3.0%.
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