Title

Coronary Artery Bifurcation Biomechanics and Implications for Interventional Strategies

Document Type

Article

Language

eng

Format of Original

8 p.

Publication Date

11-15-2010

Publisher

Wiley

Source Publication

Catheterization and Cardiovascular Interventions

Source ISSN

1522-1946

Original Item ID

doi: 10.1002/ccd.22596

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. © 2010 Wiley-Liss, Inc.

Comments

Catheterization and Cardiovascular Interventions, Volume 76, No. 6 (November 2010), DOI: 10.1002/ccd.22596. The definitive version is available at www3.interscience.wiley.com.