Faculty Collaboration Database

Local hemodynamic changes caused by main branch stent implantation and subsequent virtual side branch balloon angioplasty in a representative coronary bifurcation. J Appl Physiol (1985) 2010 Aug;109(2):532-40

Date

05/29/2010

Pubmed ID

20507966

DOI

10.1152/japplphysiol.00086.2010

Scopus ID

2-s2.0-77955605944 (requires institutional sign-in at Scopus site)   78 Citations

Abstract

Abnormal blood flow patterns promoting inflammation, cellular proliferation, and thrombosis may be established by local changes in vessel geometry after stent implantation in bifurcation lesions. Our objective was to quantify altered hemodynamics due to main vessel (MV) stenting and subsequent virtual side branch (SB) angioplasty in a coronary bifurcation by using computational fluid dynamics (CFD) analysis. CFD models were generated from representative vascular dimensions and intravascular ultrasound images. Time-averaged wall shear stress (TAWSS), oscillatory shear index (OSI), and fractional flow reserve (FFR) were quantified. None of the luminal surface was exposed to low TAWSS (<4 dyn/cm(2)) in the nondiseased bifurcation model. MV stenting introduced eccentric areas of low TAWSS along the lateral wall of the MV. Virtual SB angioplasty resulted in a more concentric region of low TAWSS in the MV distal to the carina and along the lateral wall of the SB. The luminal surface exposed to low TAWSS was similar before and after virtual SB angioplasty (rest: 43% vs. 41%; hyperemia: 18% vs. 21%) and primarily due to stent-induced flow alterations. Sites of elevated OSI (>0.1) were minimal but more impacted by general vessel geometry established after MV stenting. FFR measured at a jailed SB was within the normal range despite angiographic stenosis of 54%. These findings indicate that the most commonly used percutaneous interventional strategy for a bifurcation lesion causes abnormal local hemodynamic conditions. These results may partially explain the high clinical event rates in bifurcation lesions.

Author List

Williams AR, Koo BK, Gundert TJ, Fitzgerald PJ, 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
Blood Flow Velocity
Computer Simulation
Coronary Circulation
Coronary Stenosis
Coronary Vessels
Finite Element Analysis
Fractional Flow Reserve, Myocardial
Hemodynamics
Humans
Models, Cardiovascular
Severity of Illness Index
Stents
Stress, Mechanical
Ultrasonography, Interventional