Influence of Plaque Characteristics on Stent Biomechanical Outcomes - A Case Study on Double Kissing Crush Coronary Stenting

Abstract

Background Double Kissing (DK) Crush is a two-stent technique for complex coronary bifurcation lesions, yet the biomechanical influence of plaque on its performance remains poorly understood. This study developed a computational biomechanical model of the DK-Crush procedure to quantify how plaque presence and composition affect procedural outcomes and the performance of Xience Sierra and Orsiro stents. Methods A population-representative coronary bifurcation was modelled with no plaque, lipid plaque, and fibrous plaque. The complete DK-Crush sequence was simulated using finite element analysis for both stent platforms. Mechanical outcomes included arterial wall stress, malapposition, side branch ostium clearance, and residual stenosis. Post-deployment hemodynamics was assessed using pulsatile computational fluid dynamics, quantifying high shear rate volume and lumen area exposed to low time-averaged endothelial shear stress (TAESS). Results Plaque presence and stiffness reduced lumen restoration, increased arterial wall stress, led to larger high shear rate regions and, for fibrous plaque, increased exposure to low TAESS. Malapposition and ostial clearance depended mainly on stent design. Plaque also altered the relative performance of the two platforms, revealing differences not observed in plaque-free models. Conclusions Plaque characteristics substantially affect DK-Crush biomechanics and modify stent behaviour. Incorporating plaque is therefore essential for realistic computational evaluation of bifurcation stenting.