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Atherosclerotic risk burden assessment according as bifurcation angle using computerized tomogram and fluid dynamics
연세대학교 의과대학 강남세브란스병원 심장내과¹ , 연세대학교 의과대학 강남세브란스병원 진단영상의학과² , IVAY Co.³ , Cybermed Co.⁴
이병권¹, 박종관¹ , 이성주¹ , 박상민¹ , 김종윤¹ , 민필기¹ , 윤영원¹ , 홍범기¹ , 임세중¹ , 권혁문¹ , 이상민² , 김태훈² , 노형운³ , 곽효승⁴, 정철영⁴
Background: While recent advances in percutaneous coronary interventions with drug-eluting stents, treatment of coronary bifurcation lesions represents a challenging area in interventional cardiology. Restenosis at the ostium of the side branch (SB) remains a problem. Vascular stenosis due to atherosclerosis might be affected by hemodynamic factors, such as flow separation and oscillatory shear stress. The purpose of this study is investigating the flow characteristics and distributions of the hemodynamic wall parameters (HWP) in the coronary bifurcation between left anterior descending artery and first diagonal branch according as different angle. Methods: HWP, such as time averaged wall shear stress (TAWSS), oscillating shear index (OSI), and wall shear stress (WSS) distributions in coronary bifurcation model were calculated under different bifurcation angle condition (30, 45, 60, and 90o). Coronary bifurcation models were made from geometric data of computed tomogram (CT). Atheroma volume was analyzed with CT according as bifurcation angle (BA) in patients with stable angina. Results: The bigger the BA, the lower TAWSS and the higher OSI at SB [TAWSS(Pa): 0.133, 0.020, 0.045, 0.060, OSI: 0.309, 0.472, 0.442, 0.469 at 30, 45, 60, and 90o, respectively](figure). The low shear zone was widening when the BA increasing. The mean volume of side branch in small BA (n= 12, <45o) was significantly smaller than large BA (n=15, >45o) (12.5±6.2 mm3 vs. 25.6±10.7 mm3), p = 0.035). Conclusion: Over 45 degree of BA might be more atherogenic and have restenosis risk of SB after main branch intervention. We suggest that small BA might be more likely treated with just one stent in main vessel when there is no flow limitation.
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