Influence of coronary plaque morphology on local mechanical states and associated in-stent restenosis

In-stent restenosis after percutaneous coronary intervention is a multifactorial process. Specific morphological lesion characteristics were observed to contribute to the occurrence of in-stent restenosis. Local mechanical factors, such as stresses and strains, are known to influence tissue adaptation after stent implantation. However, the influence of morphological features on those local mechanical states and, hence, on the occurrence of in-stent restenosis remains understudied. This work investigates the correlation between local mechanical quantities and in-stent restenosis by evaluating the stress distributions in the artery wall during and after stent implantation for informative lesion morphologies. We perform computational simulations of the stenting procedure with physics-based patient-specific coronary artery models. Different morphologies are assessed using the spatial plaque composition information from high-resolution coronary computed tomography angiography data. We quantify the correlation between in-stent restenosis and local tensional stresses. We found that specific morphological characteristics like circumferential or asymmetric block calcifications result in higher stresses in the surrounding tissue. This study concludes that local stresses are critical for assessing the individual in-stent restenosis risk.