Key result
Low and oscillatory shear stress at coronary bifurcations promotes atherosclerosis and in-stent restenosis.
Advanced imaging and computational fluid dynamics to assess local endothelial shear stress may improve treatment and prevention strategies for atherosclerosis in coronary bifurcations.
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May warrant shear stress mapping in bifurcation PCI; leaves open prospective outcome validation.
Coronary artery bifurcations are susceptible to atherosclerosis as a result of the unique local flow patterns and the subsequent endothelial shear stress (ESS) environment that are conducive to the development of plaques. Along the lateral walls of the main vessel and side branches, a distinct flow pattern is observed with local low and oscillatory ESS, while high ESS develops at the flow divider (carina). Histopathologic studies have shown that the distribution of plaque at bifurcation regions is related to the local ESS patterns. The local ESS profile also influences the outcome of percutaneous coronary interventions in bifurcation lesions. A variety of invasive and non-invasive imaging modalities have enabled 3D reconstruction of coronary bifurcations and thereby detailed local ESS assessment by computational fluid dynamics. Highly effective strategies for treatment and ultimately prevention of atherosclerosis in coronary bifurcations are anticipated with the use of advanced imaging and computational fluid dynamic techniques.
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Antoniadis et al. (2015) conducted a review in Atherosclerosis in coronary artery bifurcations. Local flow haemodynamics (Endothelial shear stress) was evaluated. Local low and oscillatory endothelial shear stress at the lateral walls of coronary bifurcations promotes the development of atherosclerosis and increases the risk of in-stent restenosis.
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