Questions on the Genesis and Growth of Coronary Lesions and their Answers Based on Fluid Mechanics Engineering: A New Dynamic Angiography Analysis

Abstract

In the continuing debate regarding the mechanism of atherosclerotic plaque formation in arteries, one question remains unanswered: While all arteries in a patient are exposed to the same systemic risk factors (hypertension, diabetes, aging, nicotine of cigarettes, etc.), why do plaques frequently present in the coronary arteries, and to a lesser extent in the arteries of the lower extremities, and still less in the carotid or renal arteries? Over the past five years, in order to find an answer to the above question, there has been a radical shift in our research strategy: The principles of fluid dynamics in industrial and domestic pipes/pipelines were employed to decipher changes in the cardiovascular system. The types of flow under investigation included laminar, entrance, turbulent, and helical flows in systole and diastole, as well as the interface between antegrade and retrograde flows resulting in water hammer shock and cavitation phenomena. We aim to highlight the similarities and differences among flow types in arteries and pipes and apply the same methodologies to study the formation, growth, and rupture of coronary plaques leading to inactive and active clinical syndromes and the beneficial mechanism of percutaneous coronary interventions (PCI). In this article, we list the questions and the answers based on the primary data of several completed studies and the preliminary results of ongoing projects from a fluid mechanics perspective. The angiographic coronary images of recirculation flow, vortex formation, collision, hammer water shock, and cavitation will be showcased in detail, and their videos in slow motion are uploaded in the addendum for further in-depth review.

Introducing a Novel Innovative Technique for the Recording and Interpretation of Dynamic Coronary Angiography

“…If so, does laminar flow also inhibit plaque growth and sustain a patient’s stable angina (SA) condition? These questions were examined in the following study [ 22 , 23 ].…”

“…In contrast, 83% of patients with baseline turbulent flow across a moderate-sized lesion developed ACS within six months. This pilot study suggests the protective effect of laminar flow and an increased risk of plaque rupture due to turbulent flow [ 23 ]. Large randomized studies are needed to confirm these observations.…”

“…A vortex may be formed if the flow speed is high enough, and turbulent flow may follow (arrow). These abnormal flows may damage the intima and start the atherosclerotic process [ 10 ].…”

“…( B ) The blood converges from a large main branch and one smaller side branch (The yellow arrows point to the retrograde direction of the blood flow). Because of differences in velocity, the flow at the inner curve recirculates and starts a slow atherosclerotic process [ 10 ].…”

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“…This is the original version of the method section from the article titled "Questions on the Genesis and Growth of Coronary Lesions and their Answers Based on Fluid Mechanics Engineering: A New Dynamic Angiography Analysis" (Figure 3) [17].…”