A numerical investigation of the functionality of coronary bifurcation lesions with respect to lesion configuration and stenosis severity.
The intervention of coronary bifurcation lesions is associated with higher rates of peri- and post-procedural clinical events compared to the treatment of isolated lesions. Overall, the factors that influence the dynamics of these types of configurations are still not well understood. A geometric multiscale model, consisting of a 3D representation of the left main coronary artery bifurcation and a 0D representation of the rest of the cardiovascular system, was developed. Computational fluid dynamics simulations of the 3D domain were executed by implementing the multiscale algorithm, in order to characterize the functionality of different multilesional configurations as a function of stenosis severity. The investigation found that coronary branch steal has a significant impact on the functionality of the disease and can render a two-lesion configuration more severe compared to a three-lesion configuration. As a result of the complexity of this phenomenon, it was also suggested that certain lesion configurations could result in false negatives in diagnosis when employing a pullback pressure recording across the tandem lesions. In conclusion, this study showed that coronary bifurcation lesions are subject to intricate haemodynamic interactions which render the characterization of their functionality complex and could have significant clinical implications with regards to their diagnosis and prognosis.
Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West, Montreal, Quebec, Canada H3A 0C3; Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec, Canada H1T 1C8.
Catherine
C
Pagiatakis
Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec, Canada H1T 1C8; Faculty of Medicine, University of Montréal, Pavillon Roger-Gaudry, 2900 Edouard-Montpetit Boulevard, Montreal, Quebec, Canada H3T 1J4.
Jean-Claude
JC
Tardif
Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec, Canada H1T 1C8; Faculty of Medicine, University of Montréal, Pavillon Roger-Gaudry, 2900 Edouard-Montpetit Boulevard, Montreal, Quebec, Canada H3T 1J4.
Philippe L
PL
L'Allier
Department of Mechanical Engineering, McGill University, 817 Sherbrooke Street West, Montreal, Quebec, Canada H3A 0C3; Montreal Heart Institute, 5000 Belanger Street, Montreal, Quebec, Canada H1T 1C8. Electronic address: rosaire.mongrain@mcgill.ca.
Rosaire
R
Mongrain
D023921:Coronary Stenosis / Q000473:pathology* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D057446:Hydrodynamics; D021621:Imaging, Three-Dimensional; D008954:Models, Biological
Atherosclerosis; Computational fluid dynamics; Coronary bifurcation lesions; Fractional flow reserve; Medina classification; Multiscale modelling