Patient-specific finite element simulation of peripheral artery percutaneous transluminal angioplasty to evaluate the procedure outcome without stent implantation

Abstract

The purpose of this work is to present a patient-specific (PS) modeling approach for simulating percutaneous transluminal angioplasty (PTA) endovascular treatment and assessing the balloon sizing influence on short-term outcomes in peripheral arteries, i.e. without stent implantation. Two 3D PS stenosed femoral artery models, one with a dominant calcified atherosclerosis while the other with a lipidic plaque, were generated from pre-operative computed tomography angiography images. Elastoplastic constitutive laws were implemented within the plaque and artery models. Implicit finite element method (FEM) was used to simulate the balloon inflation and deflation for different sizings. Besides vessel strains, results were mainly evaluated in terms of the elastic recoil ratio (ERR) and lumen gain ratio (LGR) attained immediately after PTA. Higher LGR values were shown within the stenosed region of the lipidic patient. Simulated results also showed a direct and quantified correlation between balloon sizing and LGR and ERR for both patients after PTA, with a more significant influence on the lumen gain. The max principal strain values in the outer arterial wall increased at higher balloon sizes during inflation as well, with higher rates of increase when the plaque was calcified. Results show that our model could serve in finding a compromise for each stenosis type: maximizing the achieved lumen gain after PTA, but at the same time without damaging the arterial tissue. The proposed methodology can serve as a step toward a clinical decision support system to improve angioplasty balloon sizing selection prior to the surgery.

Keywords: acute post-procedural outcomes; atherosclerosis; balloon sizing; finite element analysis; patient-specific model; percutaneous transluminal angioplasty; peripheral artery.