Giulia Luraghi

Politecnico di Milano | Polimi · Department of Chemistry, Materials and Chemical Engineering "Giulio Natta"

Numerical models are increasingly used in the cardiovascular field to reproduce, study and improve devices and clinical treatments. The recent literature involves a number of patient-specific models replicating the transcatheter aortic valve implantation procedure, a minimally invasive treatment for high-risk patients with aortic diseases. The repr...

Introduction Increasing applications of transcatheter aortic valve replacement (TAVR) to treat high- or medium-risk patients with aortic diseases have been proposed in recent years. Despite its increasing use, many influential factors are still to be understood. Furthermore, innovative applications of TAVR such as in bicuspid aortic valves or in lo...

The bicuspid aortic valve (BAV) is a common and heterogeneous congenital heart abnormality that is often complicated by aortic stenosis. Although initially developed for tricuspid aortic valves (TAV), transcatheter aortic valve replacement (TAVR) devices are increasingly applied to the treatment of BAV stenosis. It is known that patient-device rela...

Intra-arterial thrombectomy is a minimally invasive procedure in which an obstructing thrombus (clot) is removed using a minimally-invasive device: a stent-retriever. The stent-retriever is first deployed, and then the thrombus is removed during stent-retriever retraction. This procedure can be simulated using a detailed computational model. Howeve...

Thoracic Endovascular Aortic Repair (TEVAR) is the preferred treatment option for thoracic aortic pathologies and consists of inserting a self-expandable stent-graft into the pathological region to restore the lumen. Computational models play a significant role in procedural planning and must be reliable. For this reason, in this work, high-fidelit...

Introduction: Glaucoma, a leading cause of blindness worldwide, is primarily caused by elevated intraocular pressure (IOP). Accurate and reliable IOP measurements are the key to diagnose the pathology in time and to provide for effective treatment strategies. The currently available methods for measuring IOP include contact and non contact tonomete...

Tissue-engineered heart valves can grow, repair, and remodel after implantation, presenting a more favorable long-term solution compared to mechanical and porcine valves. Achieving functional engineered valve tissue requires the maturation of human cells seeded onto valve scaffolds under favorable growth conditions in bioreactors. The mechanical st...

Purpose Structural Valve Deterioration (SVD) is the main limiting factor to the long-term durability of bioprosthetic valves, which are used for Transcatheter Aortic Valve Implantation (TAVI). The aim of this study is to perform a patient-specific computational analysis of post-TAVI blood dynamics to identify hemodynamic indices that correlate with...

Introduction: In-vitro evaluation (analysis in a bench top flow model) is the gold standard for pre-clinical investigation of devices being developed for endovascular thrombectomy (EVT). In-silico evaluation (computer simulated analysis in a virtual stroke model) has the potential to test and optimize large number of stent-retriever design variatio...

Tissue engineered heart valves can grow, repair, and remodel after implantation, presenting a more favorable long-term solution compared to mechanical and porcine valves. Achieving functional engineered valve tissue requires the maturation of human cells seeded onto valve scaffolds under favorable growth conditions in bioreactors. The mechanical st...

Transcatheter aortic valve implantation (TAVI) and thoracic endovascular aortic repair (TEVAR) are minimally invasive procedures for treating aortic valves and diseases. Finite element simulations have proven to be valuable tools in predicting device-related complications. In the literature, the inclusion of aortic pre-stress has not been widely in...

Introduction In‐vitro evaluation (analysis in a bench top flow model) is the gold standard and a regulatory requirement for pre‐clinical investigation of devices being developed for endovascular thrombectomy (EVT). In‐silico evaluation (computer simulated analysis in a virtual stroke model) has the potential to test and optimize large number of ste...

The development of in silico trials based on high-fidelity simulations of clinical procedures requires the availability of large cohorts of three-dimensional (3D) patient-specific anatomy models, which are often hard to collect due to limited availability and/or accessibility and imaging quality. Statistical shape modeling (SSM) allows one to ident...

Measuring Intraocular Pressure (IOP) is a critical field of research in ophthalmology. This work presents and energetic approach to study the Non Contact Tonometry based on the results of a Fluid Structure Interaction simulation. Then, combining these results with clinical images, a new method to estimate the IOP is proposed.

Numerical simulations of thoracic endovascular aortic repair (TEVAR) may be implemented in the preoperative workflow if credible and reliable. We present the application of a TEVAR simulation methodology to an 82-year-old woman with a penetrating atherosclerotic ulcer in the left hemiarch, that underwent a left common carotid artery to left subclav...

Objective: Preprocedural planning of thoracic endovascular aortic repair (TEVAR) may implement computational adjuncts to predict technical and clinical outcomes. The aim of this scoping review is to explore the currently available TEVAR procedure and stent graft modelling options. Data sources: PubMed (MEDLINE), Scopus, and Web of Science were syst...

Background and objective: Mechanical thrombectomy is a minimally invasive procedure that aims at removing the occluding thrombus from the vasculature of acute ischemic stroke patients. Thrombectomy success and failure can be studied using in-silico thrombectomy models. Such models require realistic modeling steps to be effective. We here present a...

Thoracic Endovascular Aortic Repair (TEVAR) is a minimally invasive technique to treat thoracic aorta pathologies and consists of placing a self-expandable stent-graft into the pathological region to restore the vessel lumen and recreate a more physiological condition. Exhaustive computational models can be implemented to reproduce the clinical pro...

Background and objective: In silico trials aim to speed up the introduction of new devices in clinical practice by testing device design and performance in different patient scenarios and improving patient stratification for optimizing clinical trials. In this paper, we demonstrate an in silico trial framework for thrombectomy treatment of acute i...

Background Intra-arterial thrombectomy is the main treatment for acute ischemic stroke due to large vessel occlusions and can consist in mechanically removing the thrombus with a stent-retriever. A cause of failure of the procedure is the fragmentation of the thrombus and formation of micro-emboli, difficult to remove. This work proposes a methodol...

Background and objective In the last 30 years, a growing interest has involved the study of zebrafish thanks to its physiological characteristics similar to those of humans. The aim of the following work is to create an electrophysiological computational model of the zebrafish heart and lay the foundation for the development of an in-silico model o...

Understanding the corneal mechanical properties has great importance in the study of corneal pathologies and the prediction of refractive surgery outcomes. Non-Contact Tonometry (NCT) is a non-invasive diagnostic tool intended to characterize the corneal tissue response in vivo by applying a defined air-pulse. The biomarkers inferred from this test...

Mechanical thrombectomy (MT) treatment of acute ischemic stroke (AIS) patients typically involves use of stent retrievers or aspiration catheters alone or in combination. For in silico trials of AIS patients, it is crucial to incorporate the possibility of thrombus fragmentation during the intervention. This study focuses on two aspects of the thro...

Non-Contact Tonometry (NCT) is a diagnostic tool intended to characterize corneal biomechanics in vivo. In order to analyze the response of the corneal tissue behavior, a numerical model could be of great help. This work aims to validate an in-silico NCT by comparing the clinical biomarkers of four patients to the numerical results of the same pati...

Medical image segmentation, especially for biological soft tissues, is an issue of great interest. The aim of this study is to evaluate the segmentation performance of a commercial and an open-source software, to segment aortic root and coronary arteries. 3D printing stereolithography technology was used to generate ground truth models, which were...

Background The performance of self-expandable stents is being increasingly studied by means of finite-element analysis. As for peripheral stents, transcatheter valves and stent-grafts, there are numerous computational studies for setting up a proper model, this information is missing for stent-retrievers used in the procedure of thrombus removal in...

Background and Objective Transcatheter aortic valve implantation (TAVI) has become the standard treatment for a wide range of patients with aortic stenosis. Although some of the TAVI post-operative complications are addressed in newer designs, other complications and lack of long-term and durability data on the performance of these prostheses are l...

The current interest of those dealing with medical research is the preparation of digital twins. In this frame, the first step to accomplish is the preparation of reliable numerical models. This is a challenging task since it is not common to know the exact device geometry and material properties unless in studies performed in collaboration with th...

Development of in silico models of patient-specific cerebral artery networks presents several significant technical challenges: (i) The resolution and smoothness of medical CT images are much lower than the required element/cell length for FEA/CFD/FSI models; (ii) contact between vessels, and indeed self contact of high tortuosity vessel segments a...

Non Contact Tonometry is a clinical tool that records the displacement of the corneal surface caused by the application of an airflow. The measurements are not true representatives of corneal properties, but they are related. The proposed analysis simulates the test on an eye model to isolate the mechanical properties and establish clinical decisio...

In recent years there has been a growing interest in the zebrafish thanks to its physiological characteristics similar to humans’. The following work aims to create a full electrophysiological computational model of the zebrafish heart with the ultimate purpose of assessing the influence of pathologies and drug administration. The model considers a...

There is a discrepancy between successful recanalization and good clinical outcome after endovascular treatment (EVT) in acute ischemic stroke patients. During removal of a thrombus, a shower of microemboli may release and lodge to the distal circulation. The objective of this study was to determine the extent of damage on brain tissue caused by mi...

The aim of this work is to propose a methodology for identifying relationships between morphological features of the cerebral vasculature and the outcome of in silico simulations of thrombectomy, the mechanical treatment for acute ischemic stroke. Fourteen patient-specific cerebral vasculature segmentations were collected and used for geometric cha...

Acute ischemic stroke occurs when a thrombus obstructs a cerebral artery, leading to sub-optimal blood perfusion to brain tissue. A recently developed, preventive treatment is the endovascular stroke treatment (EVT), which is a minimally invasive procedure, involving the use of stent-retrievers and/or aspiration catheters. Despite its increasing us...

An in silico trial simulates a disease and its corresponding therapies on a cohort of virtual patients to support the development and evaluation of medical devices, drugs and treatment. in silico trials have the potential to refine, reduce cost, and partially replace current in vivo studies, namely clinical trials and animal testing. We present the...

Treatment of acute ischemic stroke has been recently improved with the introduction of endovascular mechanical thrombectomy, a minimally invasive procedure able to remove a clot using aspiration devices and/or stent-retrievers. Despite the promising and encouraging results, improvements to the procedure and to the stent design are the focus of the...

Development of in silico models of patient-specific cerebral artery networks presents several significant technical challenges: (i) The resolution and smoothness of medical CT images is much lower than the required element/cell length for FEA/CFD/FSI models; (ii) contact between vessels, and indeed self contact of high tortuosity vessel segments ar...

An acute ischaemic stroke appears when a blood clot blocks the blood flow in a cerebral artery. Intra-arterial thrombectomy, a mini-invasive procedure based on stent technology, is a mechanical available treatment to extract the clot and restore the blood circulation. After stent deployment, the clot, trapped in the stent struts, is pulled along wi...

Transcatheter aortic valve replacement (TAVR) strongly depends on the calcification patterns, which may lead to a malapposition of the stented valve and complication onsets in terms of structure kinematics and paravalvular leakage (PVL). From one anatomical-resembling model of the aortic root, six configurations with different calcific deposits wer...

Femoropopliteal arteries (FPAs) are subjected to a wide range of deformations, mainly determined by leg movement. FPAs are often affected by atherosclerotic plaque development, presumably influenced by the biomechanics of surrounding tissues. Although abnormal hemodynamics in FPAs appears to be an important factor in driving plaque development, to...

Total Artificial Heart (TAH) represents the only valid alternative to heart transplantation, which number is continuously increasing in recent years. The Carmat‐TAH, example of a modern generation of TAH, is a biventricular pulsatile, electrically powered, hydraulically actuated flow pump with all components embodied in a single device. One of the...

The Carmat bioprosthetic total artificial heart (C-TAH) is a biventricular pump developed to minimize drawbacks of current mechanical assist devices and improve quality of life during support. This study aims to evaluate the safety of the hybrid membrane, which plays a pivotal role in this artificial heart. We investigated in particular its blood-c...

Femoropopliteal artery (FPA), characterized by a unique extension and curvature, is often affected by atherosclerotic occlusive diseases, such as peripheral artery disease (PAD). The clinical trend for the treatment of the FPA has shown that none of the endovascular nor surgical treatments typically adopted for other vascular regions, including car...

Purpose Transcatheter aortic valve replacement (TAVR) is a minimally invasive treatment for high-risk patients with aortic diseases. Despite its increasing use, many influential factors are still to be understood and require continuous investigation. The best numerical approach capable of reproducing both the valves mechanics and the hemodynamics i...

Heart failure is a progressive and often fatal pathology among the main causes of death in the world. An implantable total artificial heart (TAH) is an alternative to heart transplantation. Blood damage quantification is imperative to assess the behavior of an artificial ventricle and is strictly related to the hemodynamics, which can be investigat...

Purpose The performance of heart valves, either native or artificial, can be evaluated by means of finite element analyses, either from a structural or a fluid–structure interaction (FSI) point of view. The latter captures the coupling between the valve leaflets and the blood in a more realistic way. The selection of the appropriate finite elements...

Introduction The Carmat bioprosthetic Total Artificial Heart (C-TAH) is a mechanical circulatory support device providing an alternative to the heart transplant for patients in advanced heart failure. Objectives One of the most original components of the C-TAH is its biocompatible hybrid membrane made of bovine pericardial tissue and polyurethane...

Bio-inspired polymeric heart valves (PHVs) are excellent candidates to mimic the structural and the fluid dynamic features of the native valve. PHVs can be implanted as prosthetic alternative to currently clin- ically used mechanical and biological valves or as potential candidate for a minimally invasive treatment, like the transcatheter aortic va...