Relation between coronary artery geometry and the distribution of early sudanophilic lesions

Friedman, Morton H.; Brinkman, Anne M.; Qin, Jay J.; Seed, W. A.

doi:10.1016/0021-9150(93)90128-h

Cited by 76 publications

(42 citation statements)

References 14 publications

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“…The specific effect of branching angles in bifurcations has been studied by several other investigators. [13][14][15][16][17]30,[32][33][34][35] Most studies indicate that large branching angles cause large secondary velocities and consequently complex flow fields. The effect of branching angles on the distribution of atherosclerotic plaques was not conclusive in these studies.…”

Section: Discussionmentioning

confidence: 99%

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Localizing Role of Hemodynamics in Atherosclerosis in Several Human Vertebrobasilar Junction Geometries

Ravensbergen

Krijger

Hillen

et al. 1998

ATVB

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Abstract-Atherosclerosis is a common finding in the vertebrobasilar junction and in the basilar artery. Several theories try to link the process of atherogenesis with the forces exerted by the flowing blood. An attractive relation has been found between the locations in vessels at which atherosclerotic plaques are often present and the locations in models where complicated flow patterns exist. Most of the studies provided data on bifurcations. Finding a similar relation in an arterial confluence would certainly add to the credibility of the (causal) relationship between hemodynamics and atherosclerosis. Further support can be provided if variations of the geometry result in changes of the location of the atherosclerotic lesions, corresponding to the changes of the flow force distribution. In our previous numerical and experimental work, the influence of geometric and hemodynamic parameters, such as asymmetrical inflow, confluence angle, and blunting of the apex, on the flow in vertebrobasilar junction models has been investigated in detail. Recirculation areas and distribution of the wall shear stress have been computed. In this anatomic study, the effect of modulation of these geometric and hemodynamic parameters on the flow pattern is compared with the size and location of plaques in human vertebrobasilar junctions and basilar arteries. In addition, a comparison is made between the preferential areas of atherosclerotic plaques in junctions and bifurcations to demonstrate the localizing role of hemodynamics in atherogenesis. The apex of the vertebrobasilar junction and the lateral walls of the basilar artery appeared to be prone to atherosclerosis. In 43 of 85 vertebrobasilar junctions, a plaque was found at the apex. Furthermore, the summed plaque thickness at both lateral walls differs significantly (paired t test, Pϭ.03) from that at the walls facing the pons and the skull base. In contrast, several authors found that the lateral walls of the mother vessel and the apex in bifurcations are often spared. Modulation of the various parameters in the models changed the size of the regions with low wall shear stress and/or recirculation areas dramatically. A comparable effect was found in the occurrence of plaques in the human vertebrobasilar junction; eg, for an atherosclerotic plaque at the apex, a predicted probability larger than 0.5 was computed for blunted apexes and for sharp-edged apexes with a confluence angle exceeding 90°. Apparently, two geometric risk factors for an atherosclerotic plaque at the apex can be distinguished: a blunted apex and a large confluence angle. (Arterioscler Thromb Vasc Biol. 1998;18:708-716.)

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Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16][17] Moreover, arterial geometry shows considerable variability. Consequently, the hemodynamic phenomena near the blood vessel wall vary between vessels, and this variation will affect the localization of atherosclerotic lesions.…”

mentioning

confidence: 99%

Localizing Role of Hemodynamics in Atherosclerosis in Several Human Vertebrobasilar Junction Geometries

Ravensbergen

Krijger

Hillen

et al. 1998

ATVB

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“…8 These and many other observations in the literature supported the hypothesis of an interaction between systemic and local risk factors able to influence atherogenesis and lesion localization. [12][13][14][15] The importance of local factors, however, remained unexplored. We therefore designed the present study to investigate the contribution of shear stress to the atherosclerotic process in different clinical settings.…”

Section: Stroke February 2004mentioning

confidence: 99%

Wall Shear Stress Is Associated With Intima-Media Thickness and Carotid Atherosclerosis in Subjects at Low Coronary Heart Disease Risk

Irace

Cortese

Fiaschi

et al. 2004

Stroke

109

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Background and Purpose-Systemic and local coronary heart disease (CHD) risk factors participate in atherogenesis. The role of wall shear stress, a major local risk factor, remains to be elucidated. Methods-Two hundred thirty-four subjects were carefully characterized for the presence of hypertension, hyperlipidemia, diabetes mellitus, obesity, and cigarette smoking and were divided into low-and high-risk groups. They underwent echo-Doppler examination of the carotid arteries. Atherosclerotic plaques and stenoses were detected, intima-media thickness (IMT) was measured, and wall shear stress was calculated. Results-One hundred eight subjects were classified as low-risk individuals. The prevalence of carotid atherosclerosis in this group was 18.5%. Wall shear stress was 24.23Ϯ7.21 dyne/cm 2 in individuals without atherosclerosis and 16.89Ϯ5.48 in those with atherosclerosis (PϽ0.000). In multiple regression analyses, wall shear stress, body mass index, and HDL cholesterol were inversely associated and total cholesterol was directly associated with the presence of atherosclerosis; only wall shear stress was associated with IMT. In the high-risk group the prevalence of atherosclerosis was 45.2%. Wall shear stress was 20.44Ϯ6.82 dyne/cm 2 in subjects without atherosclerosis and 17.84Ϯ6.88 dyne/cm

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“…37 Furthermore, the proximal portion of the left anterior descending coronary artery is well known to be the most frequent site of advanced and occlusive lesions in the coronary system. However, the results from the RCA presented here show that lesions follow a consistent pattern of localization in a coronary artery with less complex geometry.…”

Section: Implications For Relationship Of Raised Lesions To Fatty Strmentioning

confidence: 99%

Effects of Coronary Heart Disease Risk Factors on Atherosclerosis of Selected Regions of the Aorta and Right Coronary Artery

McGill

McMahan

Herderick

et al. 2000

ATVB

277

180

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Abstract-We examined topographic distributions of atherosclerosis and their relation to risk factors for adult coronary heart disease in right coronary arteries and abdominal aortas of more than 2000 autopsied persons 15 through 34 years of age. We digitized images of Sudan IV-stained fatty streaks and of manually outlined raised lesions and computed the percent surface area involved by each lesion in each of 6 regions of each artery. In abdominal aortas of 15-to 24-year-old persons, fatty streaks involve an elongated oval area on the dorsolateral intimal surface and another oval area in the middle third of the ventral surface. Raised lesions in 25-to 34-year-old persons involve an oval area in the distal third of the dorsolateral intimal surface. In other areas of the abdominal aortas of older persons, fatty streaks occur but raised lesions are rare. In the right coronary arteries of 15-to 24-year-old persons, fatty streaks are most frequent on the myocardial aspect of the first 2 cm. Raised lesions follow a similar pattern in 25-to 34-year-old persons. High non-HDL cholesterol and low HDL cholesterol concentrations are associated with more extensive fatty streaks and raised lesions in all regions of both arteries. Smoking is associated with more extensive fatty streaks and raised lesions of the abdominal aorta, particularly in the dorsolateral region of the distal third of the abdominal aorta. Hypertension is not associated with fatty streaks in whites or blacks but is associated with more extensive raised lesions in blacks. Risk factor effects on arterial regions that are vulnerable to lesions are Ϸ25% greater than risk factor effects assessed over entire arterial segments. These risk factor effects on vulnerable sites emphasize the need for risk factor control during adolescence and young adulthood to prevent or delay the progression of atherosclerosis. Key Words: atherosclerosis Ⅲ aorta Ⅲ coronary artery Ⅲ topography Ⅲ risk factors A therosclerosis follows a distinctive topographical distribution in the intimal surface of each affected artery. Hypotheses explaining the localization of atherosclerotic lesions include hemodynamic stresses related to arterial geometry [1][2][3][4] ; anatomic, cellular, or biochemical variations in the arterial wall, particularly in endothelium 5 ; smooth muscle cell mutations leading to monoclonal proliferation 6 ; and infectious agents. 7 Most of the established major risk factors for coronary heart disease are associated with the extent of both fatty streaks and raised lesions in the large muscular and elastic arteries of adults 8 and also in arteries of adolescents and young adults. 9 -11 The magnitude of the effect of each risk factor varies among the arterial beds: for example, hypertension selectively augments atherosclerosis of the cerebral arteries, 8 whereas smoking selectively augments atherosclerosis of the abdominal aorta and the iliac and femoral arteries. 12 Although the prevailing opinion is that raised lesions (fibrous plaques and the other advanced lesions of...

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Relation between coronary artery geometry and the distribution of early sudanophilic lesions

Cited by 76 publications

References 14 publications

Localizing Role of Hemodynamics in Atherosclerosis in Several Human Vertebrobasilar Junction Geometries

Localizing Role of Hemodynamics in Atherosclerosis in Several Human Vertebrobasilar Junction Geometries

Wall Shear Stress Is Associated With Intima-Media Thickness and Carotid Atherosclerosis in Subjects at Low Coronary Heart Disease Risk

Effects of Coronary Heart Disease Risk Factors on Atherosclerosis of Selected Regions of the Aorta and Right Coronary Artery

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