title: Image-based quantification of 3D morphology for bifurcations in the left coronary artery: Application to stent design.
abstract: BACKGROUND
  Improved strategies for stent-based treatment of coronary artery disease at bifurcations require a greater understanding of artery morphology.
  
  
  OBJECTIVE
  We developed a workflow to quantify morphology in the left main coronary (LMCA), left anterior descending (LAD), and left circumflex (LCX) artery bifurcations.
  
  
  METHODS
  Computational models of each bifurcation were created for 55 patients using computed tomography images in 3D segmentation software. Metrics including cross-sectional area, length, eccentricity, taper, curvature, planarity, branching law parameters, and bifurcation angles were assessed using open-sources software and custom applications. Geometric characterization was performed by comparison of means, correlation, and linear discriminant analysis (LDA).
  
  
  RESULTS
  Differences between metrics suggest dedicated or multistent approaches should be tailored for each bifurcation. For example, the side branch of the LCX (i.e., obtuse marginal; OM) was longer than that of the LMCA (i.e., LCXprox) and LAD (i.e., first diagonal; D1). Bifurcation metrics for some locations (e.g., LMCA Finet ratio) provide results and confidence intervals agreeing with prior findings, while revised metric values are presented for others (e.g., LAD and LCX). LDA revealed several metrics that differentiate between artery locations (e.g., LMCA vs. D1, LMCA vs. OM, LADprox vs. D1, and LCXprox vs. D1).
  
  
  CONCLUSIONS
  These results provide a foundation for elucidating common parameters from healthy coronary arteries and could be leveraged in the future for treating diseased arteries. Collectively the current results may ultimately be used for design iterations that improve outcomes following implantation of future dedicated bifurcation stents. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, VA.
authors.forename: Laura
authors.initials: L
authors.lastname: Ellwein
authors.affiliation: Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: David S
authors.initials: DS
authors.lastname: Marks
authors.affiliation: Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.|Department of Medicine, VA Health Care System, Phoenix, Arizona.
authors.forename: Raymond Q
authors.initials: RQ
authors.lastname: Migrino
authors.affiliation: Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: W Dennis
authors.initials: WD
authors.lastname: Foley
authors.affiliation: Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, VA.
authors.forename: Sara
authors.initials: S
authors.lastname: Sherman
authors.affiliation: Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, VA.|Department of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.|Biotechnology and Bioengineering Center, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: John F
authors.initials: JF
authors.lastname: LaDisa
mesh_terms: D000072226:Computed Tomography Angiography; D003198:Computer Simulation; D017076:Computer-Aided Design; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000628:therapy*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D016002:Discriminant Analysis; D006801:Humans; D021621:Imaging, Three-Dimensional; D016014:Linear Models; D008955:Models, Cardiovascular; D061330:Multidetector Computed Tomography; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation*; D011237:Predictive Value of Tests; D011474:Prosthesis Design / Q000379:methods*; D011857:Radiographic Image Interpretation, Computer-Assisted; D015607:Stents; D057188:Workflow
keywords: hemodynamics; restenosis; thrombosis