CompBioMed – Newsletter Issue No. 6 January 2019

Prof. Peter V. Coveney
Introduction

"We are pleased to be able to describe the work of LifeTec Group, an SME in the Netherlands and partner in CompBioMed that is looking into numerical models for planning surgical procedures. They are making important steps to allow personalised medicine to be used in the clinic." 

Prof. Peter V. Coveney

Principal Investigator & CompBioMed Coordinator

LifeTec Group | AngioSupport

What's in it for you?

For patients with coronary artery disease, there is a huge difference of impact between a Percutaneous Coronary Intervention (PCI) or a Coronary Artery Bypass Graft (CABG). While CABG has better long-term patency, it is a dangerous surgery due to the required opening of the patient’s chest. PCI on the other hand is much less invasive and usually allows the patient to go home the same day. However, it has a higher change on restenosis. Therefore, AngioSupport allows the cardiac team to make a well-made choice, suited for each specific patient.

Citing:

CompBioMed – Newsletter Issue No. 6 January 2019

AngioSupport - Numerical Simulations in the assessment of Coronary Artery Disease

The cardiac team at the Catharina Hospital Eindhoven have a meeting every day to assess the severity of coronary artery disease from approximately 15 patients based on their coronary angiogram and Fractional Flow Reserve (FFR). The FFR is the ratio between the pressure distal (Pd) to the stenosis and the aortic pressure (Pa)(FFR=Pd/Pa ). 

As a rule of thumb, an FFR < 0.8 is assumed to lead to ischemia in the myocardial tissue downstream of the stenosis and an intervention should then be performed. The cardiac team decides on a treatment plan for these patients which may consist of Percutaneous Coronary Intervention (PCI) or Coronary Artery Bypass Graft (CABG).

LifeTec Group | AngioSupport
"defining a treatment plan is challenging"

For patients with multiple stenoses, a complex coronary geometry or diffuse coronary artery disease, it is hard to predict the outcome of the different treatments. Therefore, defining a treatment plan for these patients is challenging. 

This is a typical example of where computer simulations may assist clinicians in their daily work, and in this particular case it was the origin of a collaboration between the cardiac team and LifeTec Group.

"predicting the FFR..."

Within the scope of CompBioMed, LifeTec Group is developing an interactive tool - called AngioSupport - to support coronary interventions by predicting the FFR after the intervention (post-FFR). 

AngioSupport is a toolchain comprising of a segmentation tool and a 1D wave propagation model. The patient geometry is captured from a bi-planar angiogram by segmentation (Coronary Angiographic Analysis Systems, Pie Medical Imaging:) 

LifeTec Group | AngioSupport

An existing 1D wave propagation model of the human vascular system was simplified and extended with the coronary system, as developed at the Eindhoven University of Technology. To simulate the pressure and flow propagation, by feeding the model with patient specific clinical measures such as patient length, weight, heart rate and aortic blood pressure, the pre-op FFR is calculated throughout the patient’s system. Subsequently, the clinician can select standard stent sizes and deploy them in the area they deem affected by disease. Alternatively, they can simulate the CABG option by selecting the location of the anastomosis on the coronary tree. 

In practice, the clinician will only have to load the coronary angiogram and, subsequently, perform multiple interventions. The post-FFR is computed in real-time and can be compared between the different interventions. This allows AngioSupport to be used during the cardiac team meetings, where patient treatment plans are determined in a short time span. By allowing clinicians access to the numerical models through the straightforward AngioSupport user interface, clinicians will have an extra tool to support this difficult but vital decision. 

Besides coronary applications, the individual tools are also valuable in other areas. 1D models are also employed in hemodynamic simulations of the vasculature in the brain, as part of CompBioMed research at the Sheffield University, where they are developing OpenBF. This shows the flexibility of 1D modelling for describing complex vasculatures. Moreover, 1D models of the whole human vascular system can serve to provide essential boundary conditions for localized 3D simulations of hemodynamics in and around cardiac or vascular devices.

The challenge for CompBioMed to bring simulation support to the community is on! 

Head of MedTech Innovation

Marco Stijnen

Junior R&D Engineer

Tim van den Boom

Junior R&D Engineer

Bettine van Willigen

Relevant links and background information:

  • Please do not hesitate to contact Bettine van Willigen, Tim van den Boom or Marco stijnen if you require any further information: Phone; +31 40 298 93 93 | email; info (at) lifetecgroup.com

 

  • CompBioMed - link to newsletter [link]
  • Pie Medical Imaging - link to website [link]
  • Catharina Hospital - link to website [link]
  • Eindhoven Technical University - link to website [link]

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