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<p>Backup force is critical for successful percutaneous coronary intervention (PCI), particularly in complex lesions, yet lacks systematic mechanical understanding and quantitative assessment methods.This study aimed to develop and validate a theoretical model for quantifying backup force in PCI using three-dimensional vascular simulation.We defined pushing force (PF) as force applied to advance balloon catheters and driving force (DF) as transmitted force at the catheter tip, representing true backup force. Using a CT-derived 3D vascular model with pseudo-lesions, we measured PF and DF across guiding catheter (GC) configurations (4 shapes: AL1.0, EBU3.5, JL4.0, JR4.0; 3 sizes: 6Fr, 7Fr, 8Fr), approach sites, and target vessels.Maximum DF varied significantly with GC shape (EBU3.5 451 mN, AL1.0 413 mN, JL4.0 251 mN, JR4.0 141 mN, <i>p</i> &lt; 0.001) and GC size (6Fr 274 mN, 7Fr 319 mN, 8Fr 415 mN, <i>p</i> &lt; 0.001). Multivariate analysis revealed catheter shape and size as primary maximum DF determinants (adjusted R²=0.65). The transmission ratio averaged 28.6%, indicating 71.4% force loss through resistance and deflection. Left coronary interventions showed superior transmission efficiency versus right coronary interventions (32.6% vs. 24.3%, <i>p</i> &lt; 0.001).This study establishes the first quantitative framework for backup force analysis in PCI. Catheter morphology and size are primary determinants of deliverable force, while substantial system inefficiency emphasizes the importance of optimal catheter selection. These findings provide mechanistic rationale for evidence-based GC selection in complex coronary interventions.</p>

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A novel theoretical model and experimental validation of backup force in percutaneous coronary intervention

  • 期刊论文

  • 发表日期：

    2026年3月7日

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  • Satoru Sumitsuji,
  • Yoh Murakami,
  • Fumiaki Ikeno,
  • Kenji Sadamatsu

摘要

Backup force is critical for successful percutaneous coronary intervention (PCI), particularly in complex lesions, yet lacks systematic mechanical understanding and quantitative assessment methods.This study aimed to develop and validate a theoretical model for quantifying backup force in PCI using three-dimensional vascular simulation.We defined pushing force (PF) as force applied to advance balloon catheters and driving force (DF) as transmitted force at the catheter tip, representing true backup force. Using a CT-derived 3D vascular model with pseudo-lesions, we measured PF and DF across guiding catheter (GC) configurations (4 shapes: AL1.0, EBU3.5, JL4.0, JR4.0; 3 sizes: 6Fr, 7Fr, 8Fr), approach sites, and target vessels.Maximum DF varied significantly with GC shape (EBU3.5 451 mN, AL1.0 413 mN, JL4.0 251 mN, JR4.0 141 mN, p < 0.001) and GC size (6Fr 274 mN, 7Fr 319 mN, 8Fr 415 mN, p < 0.001). Multivariate analysis revealed catheter shape and size as primary maximum DF determinants (adjusted R²=0.65). The transmission ratio averaged 28.6%, indicating 71.4% force loss through resistance and deflection. Left coronary interventions showed superior transmission efficiency versus right coronary interventions (32.6% vs. 24.3%, p < 0.001).This study establishes the first quantitative framework for backup force analysis in PCI. Catheter morphology and size are primary determinants of deliverable force, while substantial system inefficiency emphasizes the importance of optimal catheter selection. These findings provide mechanistic rationale for evidence-based GC selection in complex coronary interventions.