Patient-Specific Multiscale Modeling of Restenosis Following Percutaneous Transluminal Angioplasty
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Recently, multiscale agent-based modeling frameworks have shown promise in mechanobiological modeling of restenosis following percutaneous transluminal angioplasty (PTA) by capturing the intricate interplay between biomechanical forces, cellular behavior, and molecular pathways. Despite their potential, applications have primarily been confined to idealized scenarios [1]. This study introduces a multiscale agent-based modeling framework for investigating restenosis after PTA in the patient-specific superficial femoral artery (SFA). The framework simulates the 2-month arterial wall remodeling response to PTA-induced injury and altered hemodynamics. It integrates 3 modules: (i) the PTA module, which provides arterial wall damage and post-intervention configuration, through a finite element analysis of PTA; this module incorporates anisotropic hyperelastic material models, a damage formulation for fibrous soft tissue and an element deletion strategy; (ii) the hemodynamics module, which computes post-intervention hemodynamics using computational fluid dynamics simulations; (iii) the tissue remodeling module, based on an agent-based model of cellular behaviors. The framework successfully captured PTA-induced arterial tissue lacerations and subsequent arterial wall remodeling. The remodeling process was characterized by cellular migration to PTA-damaged regions, increased cell proliferation and extracellular matrix production, resulting in lumen area reduction up to the 1-month follow-up. After this initial reduction, growth stabilized due to the resolution of the inflammatory state and hemodynamic changes. The consistency of the results with clinical observations in treated SFAs [2] suggests the framework’s potential in capturing patient-specific mechanobiological events following PTA.
