Development of a general method for designing microvascular networks using distribution of wall shear stress

Cathet Cardio Intervent

Yin

et al. 2015

Section: Discussionmentioning

confidence: 99%

How bifurcation angle impacts the fate of side branch after main vessel stenting: A retrospective analysis of 1,200 consecutive bifurcation lesions in a single center

Cathet Cardio Intervent

Yin

et al. 2015

“…[ 25 ] In our study, a wide bifurcation angle predicted SB occlusion after MV stenting. Part of the explanation was that bifurcations with smaller bifurcation angle was easier for flow diversion into SB and too large bifurcation angle might increase the pressure drop and flow resistance,[ 26 ] thus increasing the SB occlusion risk. Another potential explanation was that increasing bifurcation angle decreased wall shear stress and increases oscillatory shear index significantly around the carina,[ 27 ] which might induce plaque proliferation at the bifurcation region.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Angiographic Predictors of Major Side Branch Occlusion after Main Vessel Stenting in Coronary Bifurcation Lesions

Chinese Medical Journal

Yin

et al. 2015

Background:Major side branch (SB) occlusion is one of the most serious complications during percutaneous coronary intervention (PCI) for bifurcation lesions. We aimed to characterize the incidence and predictors of major SB occlusion during coronary bifurcation intervention.Methods:We selected consecutive patients undergoing PCI (using one stent or provisional two stent strategy) for bifurcation lesions with major SB. All clinical characteristics, coronary angiography findings, PCI procedural factors and quantitative coronary angiographic analysis data were collected. Multivariate logistic regression analysis was performed to identify independent predictors of SB occlusion. SB occlusion after main vessel (MV) stenting was defined as no blood flow or any thrombolysis in myocardial infarction (TIMI) flow grade decrease in SB after MV stenting.Results:Among all 652 bifurcation lesions, 32 (4.91%) SBs occluded. No blood flow occurred in 18 lesions and TIMI flow grade decreasing occurred in 14 lesions. In multivariate analysis, diameter ratio between MV/SB (odds ratio [OR]: 7.71, 95% confidence interval [CI]: 1.53–38.85, P = 0.01), bifurcation angle (OR: 1.03, 95% CI: 1.02–1.05, P < 0.01), diameter stenosis of SB before MV stenting (OR: 1.05, 95% CI: 1.03–1.07, P < 0.01), TIMI flow grade of SB before MV stenting (OR: 3.59, 95% CI: 1.48–8.72, P < 0.01) and left ventricular eject fraction (LVEF) (OR: 1.06, 95% CI: 1.02–1.11, P < 0.01) were independent predictors of SB occlusion.Conclusions:Among clinical and angiographic findings, diameter ratio between MV/SB, bifurcation angle, diameter stenosis of SB before MV stenting, TIMI flow grade of SB before MV stenting and LVEF were predictive of major SB occlusion after MV stenting.

“…BA could impact the hemodynamic parameters and geometrical characteristics directly (Fig. ): (1) Increasing angle B decreased wall shear stress and increased oscillatory shear index significantly; (2) smaller angle B was easier for flow diversion into side branch and too large angle B might increase the pressure drop and flow resistance; (3) for side branches with identical reference diameter, ostium length of side branch decreased as the angle B became wider and thus led to smaller ostial length and lumen area of side branch ostium …”

Section: Introductionmentioning

confidence: 99%

Coronary Bifurcation Intervention: What Role Do Bifurcation Angles Play?

Dou

2015

J Interven Cardiology

Bifurcation angles play an important role in coronary bifurcation intervention. Bifurcation angles affect the coronary bifurcation intervention from many aspects: (1) impact the atherosclerosis proliferation via affecting the hemodynamic parameters at bifurcation regions; (2) impact side branch compromise after main vessel stenting via hemodynamics, atherosclerosis proliferation, geometric characteristics, and plaque/carina shift; (3) affect the long-term clinical outcome after coronary bifurcation stenting. Bifurcation angles are key factors to formulate the intervention strategy of stenting procedure and can also be modified by different bifurcation stenting strategies. In the last few years, significant improvements have occurred in understanding the role of bifurcation angles. However, there are still questions remain to be clarified: (1) How to measure the bifurcation angles accurately and comprehensively? (2) How do bifurcation angles impact the immediate and long term outcome of PCI? (3) Why the results of previous studies remain controversial? The exact influence of bifurcation angles on post-PCI effect like side branch compromise and clinical outcome has not been fully elucidated. In this review, we highlight the current knowledge of bifurcation angles, summarize the questions remained to be clarified, and discuss the implications for clinical practice and future studies.