A review on the use of finite element simulations for structural analyses of coronary stenting: What can we do nowadays and what do we need to move forward?

In silico studies to perform structural analyses of coronary stenting have attracted the attention of many researchers in the last 25 years. As a consequence, the finite element models used to describe the fundamental elements of stenting simulations, namely the delivery system (consisting of stent and balloon), the diseased artery, and the deployment procedure have had considerable development, paving the way for the application of numerical analyses in both manufacturing and clinical contexts. Indeed, in accordance with the logic of the 3Rs (refine, reduce, and replace), simulations can play a fundamental role in developing new devices and as a support tool for training/education and operational planning activities for clinical personnel. However, the application of such numerical methodologies in the aforementioned contexts of use requires an adequate level of credibility of the models with respect to the risk associated to their use in the decision-making process. Within this framework, this paper proposes a review of the modeling approaches available today for in silico stenting of coronary arteries and a discussion of their actual or potential application areas. In particular, the attention is focused on the different levels of credibility required by the presented contexts of use with respect to the validation activities of numerical models developed up to now.