北京生物醫(yī)學(xué)工程

冠脈支架與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：劉宇星艾遼元毛琳宋成利

單位：上海理工大學(xué)醫(yī)療器械與食品學(xué)院教育部現(xiàn)代微創(chuàng)醫(yī)療器械及技術(shù)工程研究中心（上海200093）

關(guān)鍵詞：冠脈支架；狹窄；擴(kuò)張；直徑；斑塊；有限元分析

分類(lèi)號(hào)：R318.01

出版年·卷·期（頁(yè)碼）：2019·38·4（331-338）

摘要：

目的研究支架擴(kuò)張直徑以及斑塊硬化程度對(duì)支架與冠脈耦合擴(kuò)張的影響，探究合理的支架擴(kuò)張直徑范圍，以期對(duì)臨床冠脈支架植入術(shù)提供科學(xué)的參考依據(jù)。方法首先采用三維設(shè)計(jì)軟件建立支架和理想狹窄冠狀動(dòng)脈模型，再利用有限元分析軟件，通過(guò)賦予冠脈斑塊三種不同的材料屬性（鈣化、纖維化、脂質(zhì)），參考健康冠脈內(nèi)徑尺寸，模擬分析支架分別擴(kuò)張至冠脈直徑的1.0、1.1、1.2、1.3倍時(shí)，支架和血管的應(yīng)力、支架徑向回彈率、冠脈最小腔徑以及支架的貼壁情況。結(jié)果支架、血管壁和斑塊上的最大應(yīng)力、支架徑向回彈率、冠脈最小腔徑均隨支架擴(kuò)張直徑增加而增加。當(dāng)支架擴(kuò)張至冠脈直徑的1.3倍時(shí)，血管壁及鈣化斑塊上的最大應(yīng)力已處于或超出極限應(yīng)力范圍；當(dāng)支架擴(kuò)張至冠脈直徑的1.0倍時(shí)，支架卸載回彈后會(huì)出現(xiàn)明顯的貼壁不良。相比其他兩種斑塊，鈣化斑塊導(dǎo)致更高的血管應(yīng)力和更小的血管腔徑增長(zhǎng)。結(jié)論冠脈支架擴(kuò)張比例范圍在1.1~1.2倍較為合理；其中，含鈣化斑塊的冠脈，應(yīng)將支架擴(kuò)張比例控制在1.1更為合理。研究結(jié)果可為冠脈支架植入術(shù)中支架擴(kuò)張直徑的選擇提供參考依據(jù)。

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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