In silico modeling for personalized stenting in aortic coarctation

Stent intervention is a recommended therapy to reduce the pressure gradient and restore blood flow for patients with coarctation of the aorta (CoA). A remaining challenge for physician is to select the optimal stent before treatment. Here, we propose a framework for personalized stent intervention in CoA using in silico modeling, combining image-based prediction of the aortic geometry after stent intervention with prediction of the hemodynamics using computational fluid dynamics (CFD). Firstly, the blood flow in the aorta, whose geometry was reconstructed from magnetic resonance imaging (MRI) data, was numerically modeled using the lattice Boltzmann method (LBM). Both large eddy simulation (LES) and direct numerical simulation (DNS) were considered to adequately resolve the turbulent hemodynamics, with boundary conditions extracted from phase-contrast flow MRI. By comparing the results from CFD and 4D-Flow MRI in 3D-printed flow phantoms, we concluded that the LBM-based LES is capable of obtaining accurate aortic flow with acceptable computational cost. In silico stent implantation for a patient with CoA was then performed by predicting the deformed geometry after stent intervention and predicting the blood flow. By evaluating the pressure drop and maximum wall shear stress, an optimal stent is selected.