Hemodynamic analysis of coronary circulation in angulated coronary stenosis following stenting.
The present study in angulated coronary stenosis used human in vivo hemodynamic parameters and computed simulation, both qualitatively and qualitatively, to evaluate the influence of flow velocity and wall shear stress (WSS) on coronary atherosclerosis, the changes of hemodynamic indices following coronary stenting, and their effect on evolving in-stent restenosis. Initial and follow-up coronary angiographies in patients with angulated coronary stenosis were performed (n=60). The optimal degree of coronary stenting for angulated coronary stenosis had two models, the less than 50% angle changed group (model 1, n=33) and the more than 50% angle changed group (model 2, n=27). This angle change was based on the percentage change of vascular angle between pre- and post-intracoronary stenting. The flow-velocity wave obtained from in vivo intracoronary Doppler study data was used for in vitro numerical simulation. Spatial and temporal patterns of the flow-velocity vector and recirculation area were drawn throughout the selected segment of coronary models. WSS of pre- and post-intracoronary stenting was calculated from three-dimensional computer simulation. As results, follow-up coronary angiogram demonstrated significant difference in the percentage of diameter stenosis between the two groups (group 1: 40.3 +/- 30.2 vs. group 2: 25.5 +/- 22.5%, p < 0.05). Negative shear area on 3D simulation, which is consistent with the re-circulation area of flow vector, was noted on the inner wall of the post-stenotic area before stenting. The negative WSS disappeared after stenting. High spatial and temporal WSS before stenting fell within the range of physiologic WSS after stenting. This finding was more prominent in model 2 (p < 0.01). The present study suggests that hemodynamic forces exerted by pulsatile coronary circulation, termed WSS, might affect the evolution of atherosclerosis within the angulated vascular curvature. Moreover, geometric characteristics, such as the angular difference between pre- and post- intracoronary stenting might define optimal rheologic properties for vascular repair after stenting.
Lee
Byoung Kwon
BK
Department of Internal Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea.
Lee
Ju Yong
JY
Hong
Bum Kee
BK
Park
Byoung Eun
BE
Kim
Dong Soo
DS
Kim
Dong Yeon
DY
Cho
Yun Hyeong
YH
Yoon
Se Jung
SJ
Yoon
Young Won
YW
Kwon
Hyuck Moon
HM
Roh
Hyung Woon
HW
Kim
Il
I
Park
Hye Won
HW
Han
Seong Min
SM
Cho
Min Tae
MT
Suh
Sang Ho
SH
Kim
Hyun Seung
HS
D000328:Adult; D000368:Aged; D001696:Biomechanical Phenomena; D003326:Coronary Circulation; D023921:Coronary Stenosis / Q000503:physiopathology* / Q000628:therapy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D013314:Stress, Mechanical