Restenosis Investigation of Two-Stent Placement in the Artery Bifurcation with Different Stenting Techniques Using Computational Fluid Dynamics Analysis

The in-stent restenosis may still occur in patients with a coronary bifurcation stenting. The purpose of this study is to investigate the restenosis effect in the relationships between the bifurcation angles of the coronary artery and three types of stenting techniques (T-stenting, Culotte, and Kissing techniques), for comparing two kinds of arterial shapes using computational fluid dynamics (CFD) analysis. The finite element models of two types of the coronary arteries were reconstructed using stereolithography (STL) data of an artificial artery from reverse engineering laser scanning, and then each artery was further modified to add three kinds of the bifurcation angles, including 80°, 113°, and 142°. The low TAWSS of the two arteries were mainly concentrated at the LCX branch; a more essential discovery was that the low TAWSS area ration was in proportion to the bifurcation angle. The smallest low TAWSS of the T-stenting and Kissing techniques was detected in the arteries A and B, respectively. Both Culotte and Kissing techniques always showed a higher OSI than the T-stenting, and a high OSI was meaningfully located at the LCX branch. The CFD study concluded that the large bifurcation angle of an artery using a long stent at the LCX side branch with the T-stenting technique has a high risk of stenting restenosis.