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Review Article
Published online: 2020-02-11
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Local fluid dynamics in patients with bifurcated coronary lesions undergoing percutaneous coronary interventions

Lorenzo Genuardi, Yiannis S. Chatzizisis, Claudio Chiastra, Gregory Sgueglia, Habib Samady, Ghassan S. Kassab, Francesco Migliavacca, Carlo Trani, Francesco Burzotta
DOI: 10.5603/CJ.a2020.0024
·
Pubmed: 32052855

open access

Ahead of print
Review articles
Published online: 2020-02-11

Abstract

Although the coronary arteries are uniformly exposed to systemic cardiovascular risk factors, atherosclerosis development has a non-random distribution, which follows the local mechanical stresses including flow-related hemodynamic forces. Among these, wall shear stress plays an essential role and it represents the major flow-related factor affecting the distribution of atherosclerosis in coronary bifurcations. Furthermore, an emerging body of evidence suggests that hemodynamic factors such as low and oscillating wall shear stress may facilitate the development of in-stent restenosis and stent thrombosis after successful drug-eluting stent implantation. Drug-eluting stent implantation represents the gold standard for bifurcation interventions. In this specific setting of interventions on bifurcated lesions, the impact of fluid dynamics is expected to play a major role and constitutes substantial opportunity for future technical improvement. In the present review, available data is summarized regarding the role of local fluid dynamics in the clinical outcome of patients with bifurcated lesions.

Abstract

Although the coronary arteries are uniformly exposed to systemic cardiovascular risk factors, atherosclerosis development has a non-random distribution, which follows the local mechanical stresses including flow-related hemodynamic forces. Among these, wall shear stress plays an essential role and it represents the major flow-related factor affecting the distribution of atherosclerosis in coronary bifurcations. Furthermore, an emerging body of evidence suggests that hemodynamic factors such as low and oscillating wall shear stress may facilitate the development of in-stent restenosis and stent thrombosis after successful drug-eluting stent implantation. Drug-eluting stent implantation represents the gold standard for bifurcation interventions. In this specific setting of interventions on bifurcated lesions, the impact of fluid dynamics is expected to play a major role and constitutes substantial opportunity for future technical improvement. In the present review, available data is summarized regarding the role of local fluid dynamics in the clinical outcome of patients with bifurcated lesions.

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Keywords

fluid dynamics, wall shear stress, coronary bifurcation lesions, percutaneous coronary intervention, bifurcation stenting, in-stent restenosis and thrombosis

About this article
Title

Local fluid dynamics in patients with bifurcated coronary lesions undergoing percutaneous coronary interventions

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Review Article

Published online

2020-02-11

DOI

10.5603/CJ.a2020.0024

Pubmed

32052855

Keywords

fluid dynamics
wall shear stress
coronary bifurcation lesions
percutaneous coronary intervention
bifurcation stenting
in-stent restenosis and thrombosis

Authors

Lorenzo Genuardi
Yiannis S. Chatzizisis
Claudio Chiastra
Gregory Sgueglia
Habib Samady
Ghassan S. Kassab
Francesco Migliavacca
Carlo Trani
Francesco Burzotta

References (41)
  1. Lassen JF, Burzotta F, Banning AP, et al. Percutaneous coronary intervention for the left main stem and other bifurcation lesions: 12th consensus document from the European Bifurcation Club. EuroIntervention. 2018; 13(13): 1540–1553.
  2. Sawaya FJ, Lefèvre T, Chevalier B, et al. Contemporary approach to coronary bifurcation lesion treatment. JACC Cardiovasc Interv. 2016; 9(18): 1861–1878.
  3. Park TK, Park YH, Song YB, et al. Long-Term clinical outcomes of true and non-true bifurcation lesions according to medina classification- results from the COBIS (COronary Bifurcation Stent) II registry. Circ J. 2015; 79(9): 1954–1962.
  4. Antoniadis AP, Mortier P, Kassab G, et al. Biomechanical modeling to improve coronary artery bifurcation stenting: expert review document on techniques and clinical implementation. JACC Cardiovasc Interv. 2015; 8(10): 1281–1296.
  5. Chatzizisis YS, Coskun AU, Jonas M, et al. Role of endothelial shear stress in the natural history of coronary atherosclerosis and vascular remodeling: molecular, cellular, and vascular behavior. J Am Coll Cardiol. 2007; 49(25): 2379–2393.
  6. Morbiducci U, Kok AM, Kwak BR, et al. Atherosclerosis at arterial bifurcations: evidence for the role of haemodynamics and geometry. Thromb Haemost. 2016; 115(3): 484–492.
  7. Yazdani SK, Nakano M, Otsuka F, et al. Atheroma and coronary bifurcations: before and after stenting. EuroIntervention. 2010; 6 Suppl J: J24–J30.
  8. Koskinas KC, Chatzizisis YS, Antoniadis AP, et al. Role of endothelial shear stress in stent restenosis and thrombosis: pathophysiologic mechanisms and implications for clinical translation. J Am Coll Cardiol. 2012; 59(15): 1337–1349.
  9. Malek AM, Alper SL, Izumo S. Hemodynamic shear stress and its role in atherosclerosis. JAMA. 1999; 282(21): 2035–2042.
  10. Finet G, Huo Y, Rioufol G, et al. Structure-function relation in the coronary artery tree: from fluid dynamics to arterial bifurcations. EuroIntervention. 2010; 6 (Suppl J): J10–J15.
  11. Giannoglou GD, Antoniadis AP, Koskinas KC, et al. Flow and atherosclerosis in coronary bifurcations. EuroIntervention. 2010; 6 (Suppl J): J16–J23.
  12. Antoniadis AP, Giannopoulos AA, Wentzel JJ, et al. Impact of local flow haemodynamics on atherosclerosis in coronary artery bifurcations. EuroIntervention. 2015; 11 (Suppl V): V18–V22.
  13. Fukumoto Y, Hiro T, Fujii T, et al. Localized elevation of shear stress is related to coronary plaque rupture: a 3-dimensional intravascular ultrasound study with in-vivo color mapping of shear stress distribution. J Am Coll Cardiol. 2008; 51(6): 645–650.
  14. Huo Y, Finet G, Lefevre T, et al. Which diameter and angle rule provides optimal flow patterns in a coronary bifurcation? J Biomech. 2012; 45(7): 1273–1279.
  15. Otsuka F, Finn AV, Yazdani SK, et al. The importance of the endothelium in atherothrombosis and coronary stenting. Nat Rev Cardiol. 2012; 9(8): 439–453.
  16. Jiménez JM, Prasad V, Yu MD, et al. Macro- and microscale variables regulate stent haemodynamics, fibrin deposition and thrombomodulin expression. J R Soc Interface. 2014; 11(94): 20131079.
  17. Wentzel JJ, Gijsen FJH, Schuurbiers JCH, et al. The influence of shear stress on in-stent restenosis and thrombosis. EuroIntervention. 2008; 4 (Suppl C): C27–C32.
  18. Katritsis DG, Theodorakakos A, Pantos I, et al. Flow patterns at stented coronary bifurcations: computational fluid dynamics analysis. Circ Cardiovasc Interv. 2012; 5(4): 530–539.
  19. Chiastra C, Morlacchi S, Gallo D, et al. Computational fluid dynamic simulations of image-based stented coronary bifurcation models. J R Soc Interface. 2013; 10(84): 20130193.
  20. Chiastra C, Gallo D, Tasso P, et al. Healthy and diseased coronary bifurcation geometries influence near-wall and intravascular flow: A computational exploration of the hemodynamic risk. J Biomech. 2017; 58: 79–88.
  21. Pinto SIS, Campos JB. Numerical study of wall shear stress-based descriptors in the human left coronary artery. Comput Methods Biomech Biomed Engin. 2016; 19(13): 1443–1455.
  22. Martin D, Boyle F. Sequential structural and fluid dynamics analysis of balloon-expandable coronary stents: a multivariable statistical analysis. Cardiovasc Eng Technol. 2015; 6(3): 314–328.
  23. Van der Heiden K, Gijsen FJH, Narracott A, et al. The effects of stenting on shear stress: relevance to endothelial injury and repair. Cardiovasc Res. 2013; 99(2): 269–275.
  24. Richter Y, Groothuis A, Seifert P, et al. Dynamic flow alterations dictate leukocyte adhesion and response to endovascular interventions. J Clin Invest. 2004; 113(11): 1607–1614.
  25. Burzotta F, Talarico GP, Trani C, et al. Frequency-domain optical coherence tomography findings in patients with bifurcated lesions undergoing provisional stenting. Eur Heart J Cardiovasc Imaging. 2014; 15(5): 547–555.
  26. Louvard Y, Thomas M, Dzavik V, et al. Classification of coronary artery bifurcation lesions and treatments: time for a consensus! Catheter Cardiovasc Interv. 2008; 71(2): 175–183.
  27. Migliavacca F, Chiastra C, Chatzizisis YS, et al. Virtual bench testing to study coronary bifurcation stenting. EuroIntervention. 2015; 11 (Suppl V): V31–V34.
  28. Chiastra C, Migliori S, Burzotta F, et al. Patient-Specific modeling of stented coronary arteries reconstructed from optical coherence tomography: towards a widespread clinical use of fluid dynamics analyses. J Cardiovasc Transl Res. 2018; 11(2): 156–172.
  29. Williams AR, Koo BK, Gundert TJ, et al. 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; 109(2): 532–540.
  30. Zhang JJ, Zhang JJ, Chen SL, et al. Contradictory shear stress distribution prevents restenosis after provisional stenting for bifurcation lesions. J Interv Cardiol. 2010; 23(4): 319–329.
  31. Sgueglia GA, Chevalier B. Kissing balloon inflation in percutaneous coronary interventions. JACC Cardiovasc Interv. 2012; 5(8): 803–811.
  32. Burzotta F, Trani C. In bifurcation PCI, as in everyday life, the consequences of kissing may not always be the same. EuroIntervention. 2016; 11(11): e1209–e1213.
  33. Chiastra C, Morlacchi S, Pereira S, et al. Computational fluid dynamics of stented coronary bifurcations studied with a hybrid discretization method. Eur J Mech - B/Fluids. 2012; 35: 76–84.
  34. Morlacchi S, Chiastra C, Gastaldi D, et al. Sequential structural and fluid dynamic numerical simulations of a stented bifurcated coronary artery. J Biomech Eng. 2011; 133(12): 121010.
  35. Katritsis DG, Siontis GCM, Ioannidis JPA. Double versus single stenting for coronary bifurcation lesions: a meta-analysis. Circ Cardiovasc Interv. 2009; 2(5): 409–415.
  36. Chen SL, Zhang JJ, Han Y, et al. Double kissing crush versus provisional stenting for left main distal bifurcation lesions: DKCRUSH-V randomized trial. J Am Coll Cardiol. 2017; 70(21): 2605–2617.
  37. Foin N, Alegria-Barrero E, Torii R, et al. Crush, culotte, T and protrusion: which 2-stent technique for treatment of true bifurcation lesions? - insights from in vitro experiments and micro-computed tomography. Circ J. 2013; 77(1): 73–80.
  38. Raben JS, Morlacchi S, Burzotta F, et al. Local blood flow patterns in stented coronary bifurcations: an experimental and numerical study. J Appl Biomater Funct Mater. 2015; 13(2): e116–e126.
  39. Brindise MC, Chiastra C, Burzotta F, et al. Hemodynamics of Stent Implantation Procedures in Coronary Bifurcations: An In Vitro Study. Ann Biomed Eng. 2017; 45(3): 542–553.
  40. Rigatelli G, Zuin M, Dell'Avvocata F, et al. Evaluation of coronary flow conditions in complex coronary artery bifurcations stenting using computational fluid dynamics: Impact of final proximal optimization technique on different double-stent techniques. Cardiovasc Revasc Med. 2017; 18(4): 233–240.
  41. Chen HY, Koo BK, Kassab GS. Impact of bifurcation dual stenting on endothelial shear stress. J Appl Physiol (1985). 2015; 119(6): 627–632.

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