Faculty Collaboration Database

Coronary artery bifurcation biomechanics and implications for interventional strategies. Catheter Cardiovasc Interv 2010 Nov 15;76(6):836-43

Date

05/28/2010

Pubmed ID

20506509

DOI

10.1002/ccd.22596

Scopus ID

2-s2.0-78649637726 (requires institutional sign-in at Scopus site)   29 Citations

Abstract

The treatment of atherosclerotic plaques near and involving coronary bifurcations is especially challenging for interventional procedures. Optimization of these treatment strategies should begin with an understanding of how disease came to be localized to these regions, followed by careful design of the interventional tools and implanted devices. This manuscript reviews the basic biomechanics of coronary bifurcations, stented arteries, and the complex biomechanical challenges associated with bifurcation stenting. Flow patterns in bifurcations are inherently complex, including vortex formation and creation of zones of low and oscillating wall shear stress that coincide with early intimal thickening. Bifurcation geometry (in particular, the angle between the side branches), is of paramount importance in creating these proatherogenic conditions. This predilection for disease formation leads to a large number of bifurcation lesions presenting for clinical intervention. Therefore, several strategies have developed for treating these challenging lesions, including both dedicated devices and creative adaptation of single vessel lesion technologies. The biomechanical implications of these strategies are likely important in short and long term clinical outcomes. While the biomechanical environment in a stented coronary bifurcation is extremely challenging to model, computational methods have been deployed recently to better understand these implications. Enhancement of clinical success will be best achieved through the collaborative efforts of clinicians, biomechanicians, and device manufacturers.

Author List

Moore JE Jr, Timmins LH, Ladisa JF Jr

Author

John F. LaDisa PhD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Angioplasty, Balloon, Coronary
Animals
Biomechanical Phenomena
Computer Simulation
Coronary Artery Disease
Coronary Circulation
Coronary Vessels
Hemodynamics
Humans
Mechanotransduction, Cellular
Models, Cardiovascular
Stents
Stress, Mechanical
Treatment Outcome