基於個別病患生理解剖之心導管手術有限元素模擬

Abstract

心血管疾病長年霸榜全球人口死亡主因，通常會透過經皮冠狀動脈介入治療進行緊急處置。分叉病變的治療以及血管支架重疊技術的使用作為常見的多支架治療手法，雖然在所有經皮冠狀動脈介入治療案件中佔有一定比例，然而受限於技術本身存在的缺陷，術後患者發生血管再狹窄或急性狀況的比例也因此高於僅用單一支架進行治療的病患。目前為了幫助評估病患於術後的治療狀況，學界開發了多項有限元素模擬模型幫助分析，然而多數在血管零件上過於理想化，也因此降低了整體結果的參考價值。目前在實務上，對於評估病人術後的恢復狀況，大多僅能依靠醫師經驗以及長期追蹤的研究報告。 本研究使用美國國家衛生研究院提供的公開病人冠狀動脈檔案，進行經皮冠狀動脈介入治療的真實血管模型構建，研究由兩部分組成，分別為分叉病變治療及血管支架重疊技術：在分叉病變模型中，使用兩種不同的商用支架結合兩種不同的治療手法(Simultaneous Kissing Stenting & Crush Technique)，藉此評估模型實施治療技術的能力；而在血管支架重疊技術中，使用幾何定義完善的VYW血管支架，探討單一長支架部屬、雙支架不重疊、雙支架微重疊、雙支架全重疊等四種不同的重疊情況，同時評估模型的極限耐受強度。整個模擬過程透過VDISP子程序大幅降低血管支架定位至病灶處的時間，並以準靜態分析血管支架、氣球導管以及病變血管之間複雜的交互作用問題，所有模擬在最後皆完整地完成分析，且在分析效率上與過往研究相比有一倍以上的提升。在模型結果上，本研究對血管零件設定普通血管及硬化斑塊兩種材料進行對比測試，透過比較不同的血管支架廠牌及治療手法，並評估術後的血管支架塑性應變、整體幾何結構、血管最大應力和管腔增幅，為每種不同的治療方案提供數據及圖像化的參考依據，同時分析其優與劣，找出現有方案中的最佳治療方法，提升整體醫療成效。

Cardiovascular diseases continue to be a leading cause of death worldwide, often requiring emergency percutaneous coronary interventions (PCI) for treatment. Among these procedures, the treatment of bifurcation lesions and the use of stent overlapping techniques in multi-stenting procedures have become common approaches but pose significant challenges. Patients undergoing such procedures have a higher incidence of in-stent restenosis or acute outcomes compared to those treated with a single stent, primarily due to inherent limitations in these techniques. While several finite element simulation models have been developed in academia to aid evaluation, most of them idealize the artery components, reducing the overall reliability of the results. Currently, the assessment of patients' postoperative recovery heavily relies on physician experience and long-term follow-up studies. This study utilized publicly available patient coronary artery datasets provided by the National Institutes of Health to construct realistic patient-specific models for PCI. The research consisted of two parts: treatment of bifurcation lesions and stent overlapping techniques. In the bifurcation lesions models, two different commercial stents were combined with two treatment techniques (Simultaneous Kissing Stenting & Crush Technique) to evaluate the feasibility of implementing these treatment strategies. For the stent overlapping techniques, a well-defined VYW stent was used to investigate four overlapping scenarios: single long stent deployment, non-overlapping double stents, minimally overlapping double stents, and fully overlapping double stents. Additionally, the robustness of the model was tested in this part to assess its ability to withstand extreme conditions. The VDISP subroutine was employed to significantly reduce the time required for stent positioning at the lesion site, and quasi-static analysis was conducted to examine the complex interactions between the stents, balloon catheters, and diseased arteries. All simulations were successfully completed, with analysis efficiency improved by more than twofold compared to previous studies. In terms of the model results, this study conducted comparative tests on two materials: normal artery components and hardened plaques. By comparing different stent brands and treatment techniques, the study evaluated postoperative stent plastic strain, overall geometric structure, maximum vessel stress, and lumen gain. It provided quantitative data and visual references as a basis for each treatment strategy, enabling analysis of their strengths and weaknesses. Through this comprehensive assessment, the study aimed to identify the optimal treatment method among the existing options and enhance overall medical effectiveness.