Prediction of Post-stenting Lumen Dimensions Using High-Definition Intravascular Ultrasound

Accurate prediction of stent-plaque interaction is crucial for optimizing lesion preparation strategies and improving percutaneous coronary intervention outcomes. High-definition intravascular ultrasound (HD IVUS) provides detailed imaging of plaque composition and vessel dimensions, enabling computational modeling to predict post-stenting lumen dimensions.

The purpose of this study was to develop and validate a patient-specific HD IVUS-based computational framework for the characterization of coronary plaque components and prediction of post-stenting lumen dimensions.

Nine patients underwent HD IVUS and coronary angiography before and after stenting. Using pre-stenting HD IVUS images, plaque components (fibrolipid, fibrous, and calcified tissue) were segmented and reconstructed in 3 dimensions. All procedural steps were simulated computationally, and post-simulation lumen dimensions were compared with the actual post-stenting HD IVUS lumen dimensions.

Predicted and actual lumen dimensions post-stenting demonstrated high agreement. The mean lumen diameter difference was 0.17 mm (+5.5% error), with 95% limits of agreement ranging from -0.26 to 0.60 mm. Agreement was also strong for minimal lumen diameter and minimal in-stent cross-sectional area, with differences of -0.02 mm (95% limits of agreement -0.23 to 0.19 mm) and -0.11 mm² (95% limits of agreement -0.93 to 0.72 mm²), respectively. Predicted stent geometry assessed by eccentricity showed high agreement with HD IVUS-derived stent shape (bias 0.06; 95% limits of agreement -0.10 to 0.21). Stent apposition was accurately predicted by the computational simulations.

We presented and validated a patient-specific computational simulation framework that uses high-resolution intracoronary imaging of plaque components to precisely predict the lumen dimensions post-stenting.