Title

Image-based Quantification of 3D Morphology for Bifurcations in the Left Coronary Artery: Application to Stent Design

Document Type

Article

Language

eng

Publication Date

6-2016

Publisher

Wiley

Source Publication

Catheterization and Cardiovascular Interventions

Source ISSN

1522-1946

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.

Comments

Catheterization and Cardiovascular Interventions, Vol. 87, No. 7 (June 2016): 1244-1255. DOI.

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