Abstract
Coronary artery bifurcations are susceptible to atherosclerotic plaque formation and progression. This is likely because of the unique local hemodynamic patterns and the subsequent impaired endothelial shear stress (ESS) environment that are conducive to the development of plaques. Distinct flow patterns are generated in bifurcation regions: Low and oscillatory ESS occurs along the lateral walls of the main vessel and side branches, while high ESS develops at the flow-divider (carina). The histologic distribution of plaque at bifurcation regions relates to these local ESS patterns. The local ESS profile also influences the outcome of percutaneous coronary interventions in coronary bifurcations. Several invasive and noninvasive imaging modalities have facilitated the 3D reconstruction of coronary bifurcations and subsequent detailed local ESS assessment by computational fluid dynamics. Further understanding of the role of ESS in atherosclerosis in coronary bifurcations, utilizing advanced imaging and computational fluid dynamic techniques, is expected to lead to more targeted and effective strategies for the prevention and treatment of atherosclerosis.
Published Version
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