title: A Study of Coronary Bifurcation Shape in a Normal Population.
abstract: During percutaneous coronary intervention, stents are placed in narrowings of the arteries to restore normal blood flow. Despite improvements in stent design, deployment techniques and drug-eluting coatings, restenosis and stent thrombosis remain a significant problem. Population stent design based on statistical shape analysis may improve clinical outcomes. Computed tomographic (CT) coronary angiography scans from 211 patients with a zero calcium score, no stenoses and no intermediate artery, were used to create statistical shape models of 446 major coronary artery bifurcations (left main, first diagonal and obtuse marginal and right coronary crux). Coherent point drift was used for registration. Principal component analysis shape scores were tested against clinical risk factors, quantifying the importance of recognised shape features in intervention including size, angles and curvature. Significant differences were found in (1) vessel size and bifurcation angle between the left main and other bifurcations; (2) inlet and curvature angle between the right coronary crux and other bifurcations; and (3) size and bifurcation angle by sex. Hypertension, smoking history and diabetes did not appear to have an association with shape. Physiological diameter laws were compared, with the Huo-Kassab model having the best fit. Bifurcation coronary anatomy can be partitioned into clinically meaningful modes of variation showing significant shape differences. A computational atlas of normal coronary bifurcation shape, where disease is common, may aid in the design of new stents and deployment techniques, by providing data for bench-top testing and computational modelling of blood flow and vessel wall mechanics.
authors.affiliation: Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand. p.medrano@auckland.ac.nz.
authors.forename: Pau
authors.identifier: http://orcid.org/0000-0002-6255-4864
authors.initials: P
authors.lastname: Medrano-Gracia
authors.affiliation: Auckland Heart Group, Auckland, New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: Ormiston
authors.affiliation: Auckland City Hospital, Auckland, New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Webster
authors.affiliation: Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.
authors.forename: Susann
authors.initials: S
authors.lastname: Beier
authors.affiliation: Auckland Heart Group, Auckland, New Zealand.
authors.forename: Chris
authors.initials: C
authors.lastname: Ellis
authors.affiliation: School of Technology and Health, KTH Royal Institute of Technology, Brinellvägen 8, Stockholm, Sweden.
authors.forename: Chunliang
authors.initials: C
authors.lastname: Wang
authors.affiliation: School of Technology and Health, KTH Royal Institute of Technology, Brinellvägen 8, Stockholm, Sweden.
authors.forename: Örjan
authors.initials: Ö
authors.lastname: Smedby
authors.affiliation: Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.
authors.forename: Alistair
authors.initials: A
authors.lastname: Young
authors.affiliation: Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand.
authors.forename: Brett
authors.initials: B
authors.lastname: Cowan
mesh_terms: D000368:Aged; D000072226:Computed Tomography Angiography; D017076:Computer-Aided Design; D017023:Coronary Angiography / Q000379:methods*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D066230:Patient-Specific Modeling; D062645:Percutaneous Coronary Intervention / Q000295:instrumentation; D011237:Predictive Value of Tests; D025341:Principal Component Analysis; D011474:Prosthesis Design; D011857:Radiographic Image Interpretation, Computer-Assisted; D012016:Reference Values; D015607:Stents
keywords: Atlasing; CT angiography; Coronary bifurcation anatomy