title: Numerical study of stenotic side branch hemodynamics in true bifurcation lesions.
abstract: 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.
authors.affiliation: Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada H3A 0C3. Electronic address: jennifer.frattolin@mail.mcgill.ca.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Frattolin
authors.affiliation: Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada H3A 0C3. Electronic address: marjan.molavizarandi@mail.mcgill.ca.
authors.forename: Marjan Molavi
authors.initials: MM
authors.lastname: Zarandi
authors.affiliation: Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada H3A 0C3. Electronic address: catherine.pagiatakis@mail.mcgill.ca.
authors.forename: Catherine
authors.initials: C
authors.lastname: Pagiatakis
authors.affiliation: Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada H3A 0C3; Department of Interventional Cardiology, Québec Heart and Lung Institute, Laval University, Québec City, Québec, Canada G1V 4G5. Electronic address: olivier.bertrand@criucpq.ulaval.ca.
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
authors.affiliation: Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada H3A 0C3; Montreal Heart Institute, Montreal, Quebec, Canada H1T 1C8. Electronic address: rosaire.mongrain@mcgill.ca.
authors.forename: Rosaire
authors.initials: R
authors.lastname: Mongrain
mesh_terms: D001696:Biomechanical Phenomena; D016893:Carotid Stenosis / Q000473:pathology* / Q000503:physiopathology*; D003198:Computer Simulation; D003331:Coronary Vessels / Q000473:pathology* / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D013314:Stress, Mechanical
keywords: Atherosclerosis; Coronary artery disease; Coronary bifurcation; Left main coronary artery; Medina classification; Pulsatile flow; Wall shear stress