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Image-based quantification of 3D morphology for bifurcations in the left coronary artery: Application to stent design. Catheter Cardiovasc Interv 2016 Jun;87(7):1244-55

Date

06/03/2016

Pubmed ID

27251470

Pubmed Central ID

PMC4896847

DOI

10.1002/ccd.26247

Scopus ID

2-s2.0-84975123117   10 Citations

Abstract

BACKGROUND: Improved strategies for stent-based treatment of coronary artery disease at bifurcations require a greater understanding of artery morphology.

OBJECTIVE: We developed a workflow to quantify morphology in the left main coronary (LMCA), left anterior descending (LAD), and left circumflex (LCX) artery bifurcations.

METHODS: Computational models of each bifurcation were created for 55 patients using computed tomography images in 3D segmentation software. Metrics including cross-sectional area, length, eccentricity, taper, curvature, planarity, branching law parameters, and bifurcation angles were assessed using open-sources software and custom applications. Geometric characterization was performed by comparison of means, correlation, and linear discriminant analysis (LDA).

RESULTS: Differences between metrics suggest dedicated or multistent approaches should be tailored for each bifurcation. For example, the side branch of the LCX (i.e., obtuse marginal; OM) was longer than that of the LMCA (i.e., LCXprox) and LAD (i.e., first diagonal; D1). Bifurcation metrics for some locations (e.g., LMCA Finet ratio) provide results and confidence intervals agreeing with prior findings, while revised metric values are presented for others (e.g., LAD and LCX). LDA revealed several metrics that differentiate between artery locations (e.g., LMCA vs. D1, LMCA vs. OM, LADprox vs. D1, and LCXprox vs. D1).

CONCLUSIONS: These results provide a foundation for elucidating common parameters from healthy coronary arteries and could be leveraged in the future for treating diseased arteries. Collectively the current results may ultimately be used for design iterations that improve outcomes following implantation of future dedicated bifurcation stents. © 2015 Wiley Periodicals, Inc.

Author List

Ellwein L, Marks DS, Migrino RQ, Foley WD, Sherman S, LaDisa JF Jr

Authors

John F. LaDisa PhD Professor in the Pediatrics department at Medical College of Wisconsin
David S. Marks MD Vice Chair, Professor in the Medicine department at Medical College of Wisconsin




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

Computed Tomography Angiography
Computer Simulation
Computer-Aided Design
Coronary Angiography
Coronary Artery Disease
Coronary Vessels
Discriminant Analysis
Humans
Imaging, Three-Dimensional
Linear Models
Models, Cardiovascular
Multidetector Computed Tomography
Percutaneous Coronary Intervention
Predictive Value of Tests
Prosthesis Design
Radiographic Image Interpretation, Computer-Assisted
Stents
Workflow