Comput. Biol. Med. - Numerical study of stenotic side branch hemodynamics in true bifurcation lesions.

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Resumo

Coronary bifurcation lesions are complex. Whether a critical condition exists in the stenotic side branch (SB) of bifurcation lesions, according to the Medina classification, is unassessed. Computational models of coronary bifurcations were developed with different stenosis severities and locations, in order to study the flow distribution and wall shear stress (WSS) in the SB. It was found that bifurcation lesion type (1,0,1) had a flow ratio of 0.25, much less than the corresponding normal ratio of 0.47, and the 0.46 and 0.39 ratios computed for lesion types (0,1,1) and (1,1,1), respectively. Bifurcation type (1,0,1) was associated with a 47% reduction from normal coronary flow, resulting in coronary branch steal. Blood flow to the SB decreased as the stenosis severity increased and approached the carina, in the proximal, distal, and side branches. Similarly, WSS values decreased with increasing stenosis severity. Bifurcation type (1,0,1) had the lowest WSS values in the SB, and were below the 0.5Pa threshold for atherosclerotic growth. In conclusion, the results suggest that lesion type (1,0,1) is at the greatest risk of coronary branch steal, leading to potential ischemia, as well as further atherosclerotic growth. This is counterintuitive to the Medina classification, where bifurcation type (1,1,1) is usually considered the most severe.

Resumo Limpo

coronari bifurc lesion complex whether critic condit exist stenot side branch sb bifurc lesion accord medina classif unassess comput model coronari bifurc develop differ stenosi sever locat order studi flow distribut wall shear stress wss sb found bifurc lesion type flow ratio much less correspond normal ratio ratio comput lesion type respect bifurc type associ reduct normal coronari flow result coronari branch steal blood flow sb decreas stenosi sever increas approach carina proxim distal side branch similar wss valu decreas increas stenosi sever bifurc type lowest wss valu sb pa threshold atherosclerot growth conclus result suggest lesion type greatest risk coronari branch steal lead potenti ischemia well atherosclerot growth counterintuit medina classif bifurc type usual consid sever

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