Cataloguing the geometry of the human coronary arteries: A potential tool for predicting risk of coronary artery disease

Abstract

Background-The nonuniform distribution of atherosclerosis in the human vasculature suggests that local fluid dynamics or wall mechanics may be involved in atherogenesis. Thus certain aspects of vascular geometry, which mediates both fluid dynamics and wall mechanics, might be risk factors for coronary atherosclerosis. Cataloguing the geometry of normal human coronary arteries and its variability is a first step toward identifying specific geometric features that increase vascular susceptibility to the disease.Methods-Images of angiographically normal coronary arteries, including 32 left anterior descending (LAD) and 35 right coronary arteries (RCA), were acquired by clinical biplane cineangiography from 52 patients. The vessel axes in end diastole were reconstructed and geometric parameters that included measures of curvature, torsion and tortuosity were quantified for the proximal, middle and distal segments of the arteries.Results-Statistical analysis shows that (1) in the LAD, curvature, torsion and tortuosity are generally highest in the distal portion, (2) in the RCA, these parameters are smallest in the middle segment, (3) the LAD exhibits significant higher torsion than the RCA (P<0.005), and (4) >80% of the variability of coronary arterial geometry can be expressed in terms of two factors, one dominated by the curvature measures and tortuosity, and the other emphasizing the torsion parameters.Conclusions-This study has comprehensively documented the normal arterial geometry of the LAD and RCA in end diastole. This information may be used to guide the identification of geometric features that might be atherogenic risk factors.

Coronary tortuosity and its role in myocardial ischemia in patients with no coronary obstructions

“…28 A case of quadruplets, whose parents were blood relatives, with the syndrome, suggests that it is an autosomal recessive disease. 29 …”

Design and Optimization of a Blood Vessel Mimic Bioreactor System for the Evaluation of Intravascular Devices in Simple and Complex Vessel Geometries

“…They run along the surface of the heart and are curved, bent, and angulated (Smith, et al 2001). In addition, it has been observed that plaque accumulation is related to vessel curvature, with plaque accumulating more rapidly in angulated vessels where wall shear stress is low (Wahle, et al 2006;Zhu, et al 2008). As a result, stents are most often placed in curved positions within the coronary arteries and remain in a bent position throughout their lifetime (Fournier, et al 2005;Smith, et al 2001).…”

“…From single and multiple vessel disease to bifurcated, angulated and long lesions, the variation and complexity of coronary artery disease and the advanced capabilities to detect and determine the extent and severity has led to an increased interest in intravascular device innovation (Zhu, et al 2008;Kini 2006). A variety of stent designs currently exist and continuous efforts are being made to improve both stent design and placement procedures (Kandzari, Tcheng and Zidar 2002;Kraitzer, Kloog and Zilberman 2008).…”

“…The anatomical characteristics of coronary arteries vary considerably, ranging from straight simple geometries to extremely angulated bends and curves as well as bifurcations and long lesions (Ellis, et al 1990;Zhu, et al 2008;Smith, et al 2001). Depending on the individual, the anatomical structure of the coronary arteries can include all or some of the characteristics identified above.…”

“…Implanted stents can alter coronary flow and induce significant changes in flow hemodynamics, especially in bifurcated and angulated geometries where flow is already disturbed and shear stress is low (Zhu, et al 2008;Wahle, et al 2006;Benard, et al 2003). These changes result in local modification of the mechanical stress exerted on the endothelial cells lining the vessel wall and several studies have demonstrated that endothelial cell proliferation increases significantly when subjected to weak shear stress and non-laminar flow (Ridger, et al 2008;Scott 2006).…”