Relationship between Coronary Arterial Geometry and the Presence and Extend of Atherosclerotic Plaque Burden: A Review Discussing Methodology and Findings in the Era of Cardiac Computed Tomography Angiography

Abstract

Coronary artery disease (CAD) represents a modern pandemic associated with significant morbidity and mortality. The multi-faceted pathogenesis of this entity has long been investigated, highlighting the contribution of systemic factors such as hyperlipidemia and hypertension. Nevertheless, recent research has drawn attention to the importance of geometrical features of coronary vasculature on the complexity and vulnerability of coronary atherosclerosis. Various parameters have been investigated so far, including vessel-length, coronary artery volume index, cross-sectional area, curvature, and tortuosity, using primarily invasive coronary angiography (ICA) and recently non-invasive cardiac computed tomography angiography (CCTA). It is clear that there is correlation between geometrical parameters and both the haemodynamic alterations augmenting the atherosclerosis-prone environment and the extent of plaque burden. The purpose of this review is to discuss the currently available literature regarding this issue and propose a potential non-invasive imaging biomarker, the geometric risk score, which could be of importance to allow the early detection of individuals at increased risk of developing CAD.

Lessons from autopsy: Topographical variability of atherosclerosis plaques

“… 17 This discrepancy is partially attributed to the distinctive geometry of coronary arteries, which influences the architecture and cellular composition of coronary plaques compared to those in other vascular districts. 8 According to this hypothesis, plaques in peripheral arteries are expected to exhibit more fibroproliferative structure, characterized by a thicker fibrous cap, a smaller lipid-rich necrotic core, lower macrophage infiltration, fewer lymphocytes or plasma cells, a higher content of vascular smooth muscle cells, a lower density of vasa vasorum, infrequent intra-plaque hemorrhages, a high incidence of medial calcification, low levels of foam cells, and rare erosions. This differs from plaques observed in coronary arteries.…”

“…This selective vulnerability remains puzzling and suggests a range of genetic, environmental, and lifestyle factors, including fetal programing, which interact in ways that are not fully understood yet. [8][9][10][11] Continued investigation into these complexities is crucial for developing better therapeutic and preventive strategies for atherosclerosis.…”

Pan-vascular disease: what we have done in the past and what we can do in the future?

“…Hypertension affects coronary and cerebral arteries and provokes atherosclerosis by increasing arterial wall tension which could disrupt vascular repair mechanisms. Atherosclerosis often occurs in areas of altered blood flow like bends and branches in coronary arteries, where low shear stress impairs endothelial cell function and reduces the release of protective nitric oxide [16][17][18][19] .…”

Correlation between Coronary Artery Disease with Other Arterial Systems: Similar, Albeit Separate, Underlying Pathophysiologic Mechanisms

“…However, the fact that atherosclerotic plaques tend to impact specific locations of the arterial tree heightened the significance of local features in the onset and progression of atherosclerosis. The association between coronary artery tree topology and atherosclerotic disease has generated interest in recent years, with several studies looking into various aspects of this interaction [2]. Patients with multiple vascular diseases such as myocardial infarction, stroke, or established peripheral artery disease (PAD) have double the risk of further cardiovascular death, myocardial infarction, or stroke versus patients with either prior myocardial infarction, prior stroke, or established PAD alone [3].…”