Relationship between left coronary artery bifurcation angle and restenosis after stenting of the proximal left anterior descending artery

Konishi, Takao; Yamamoto, Tadashi; Funayama, Naohiro; Nishihara, Hiroshi; Hotta, Daisuke

doi:10.1097/mca.0000000000000381

Cited by 16 publications

(18 citation statements)

References 45 publications

(38 reference statements)

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“…Using coronary CTA, the mean LM-LAD arteries angle measured by Kawasaki et al was 37±13° [ 24 ], and that by Cui et al was 34.2±13.4° [ 6 ]. In a previous analysis of coronary angiographies, we measured an average LM-LAD arteries angle of 34.1°±18.5° [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Relationship between left main and left anterior descending arteries bifurcation angle and coronary artery calcium score in chronic kidney disease: A 3-dimensional analysis of coronary computed tomography

et al. 2018

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BackgroundA high coronary artery calcium score (CACS) predicts a poor prognosis in patients with coronary artery disease. We examined the relationship between the bifurcation angle and the CACS of the left main (LM) and left anterior descending (LAD) arteries in patients suffering from chronic kidney disease (CKD).MethodsWe analyzed the data of 121 patients who underwent coronary computed tomography between October 2014 and June 2015 and whose estimated glomerular filtration rate (eGFR) was <60 ml/min/1.73 m2. The LM-LAD bifurcation angle was measured by 3-dimensional coronary computed tomography. The CACS of the LM-LAD arteries was also calculated. We excluded stent recipients and patient who had undergone coronary artery bypass graft surgery.ResultsIn the overall sample, the mean ± standard deviation (range) LM-LAD bifurcation angle was 35.9 ± 11.4° (6.8–79.4°) and mean CACS was 227 ± 351 (0 to 1,695). The mean LM-LAD arteries angle was 40.3° ± 10.0° in 39 patients whose CACS was ≥200, versus 33.8° ± 11.6° in 82 patients with CACS <200 (p = 0.003). A weak, but positive correlation (r = 0.269, p = 0.003) was observed between the LM-LAD arteries angle and CACS of the LM-LAD arteries. By multiple variable analysis, hemoglobin A1c, triglycerides, eGFR and the LM-LAD arteries angle were independent predictors of a high CACS of the LM-LAD arteries.ConclusionIn patients with CKD, a wide LM-LAD arteries angle was associated with a high CACS of the LM-LAD arteries. The prognostic value of this observation warrants further evaluation.

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Section: Discussionmentioning

confidence: 99%

Relationship between left main and left anterior descending arteries bifurcation angle and coronary artery calcium score in chronic kidney disease: A 3-dimensional analysis of coronary computed tomography

et al. 2018

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“…However, the presence of significant and non-significant stenosis of the LAD and LCX should be a more critical issue than the arterial diameter. Second, the LCBA values on angiograms were not measured for comparison; however, since CCA had been shown to have limitations (such as foreshortening and out-of-plane magnification), coronary CTA has been demonstrated to be an accurate tool to measure the LCBA 14 , 17 . Three-dimensional quantitative coronary angiography may help to resolve this problem, but the availability is limited.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Left Main Coronary Bifurcating Angle among Patients with Normal, Non-significantly and Significantly Stenosed Left Coronary Arteries

Juan

Tsay

Yeh

et al. 2017

Sci Rep

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We evaluated the correlation of the left main coronary bifurcating angle (LCBA) with the severity of coronary atherosclerosis, risk factors of coronary artery disease (CAD) and the feasibility of measuring the LBCA using the axial plane. Coronary Computed tomography angiographies (CTAs) of 313 patients between Nov. 2006 and Oct. 2013 were reviewed and separated into three groups. Group I (211 patients) had significant stenosis (≥50%) of the left anterior descending coronary artery (LAD) and/or left circumflex coronary artery (LCX). Group II (62 subjects) had atherosclerosis without significant stenosis. Group III (40 subjects) had unremarkable coronary CTAs. Both Group I and II patients received conventional catheter angiography to confirm the severities of coronary stenoses. Significant differences were found among the groups with respect to risk factors, such as male gender, hypertension and body mass index. Axial plane measurement was feasible in most patients (82.1%), without significant differences among the groups. The mean LCBA was 84.7° among all patients, and significantly differed among groups I, II and III (87.34°, 81.16° and 75.53°, P < 0.001). The LCBA of group I was significantly higher than group III (P < 0.001) in univariate analysis, but insignificant in multivariate analysis (P = 0.064).During the past decade, coronary computed tomography angiography (coronary CTA) has been accepted as a highly reliable and less invasive modality for CAD diagnosis owing to its high spatial and temporal resolution and excellent diagnostic accuracy [1][2][3][4][5] . Coronary CTA allows the visualization of coronary artery anatomy and the associated atherosclerotic plaques 6-8 . This is represented in the ability of coronary CTA to identify the coronary anatomy as well as the location, distribution, characteristics and composition of plaques in the coronary arteries 6,7,9 .The evaluation of the left main coronary bifurcation angle (LCBA) has gained increasing clinical concern and research interest because the angulation of the LCBA has been shown to have a hemodynamic effect on shear stress, flow turbulence formation and the consequent development of plaques at the bifurcating regions; thus, measurements of the bifurcation angles will provide an insight into demonstrating the relationship among the plaques, CAD and coronary angles 4-6, 8, 10-17 . In previous studies, a wider bifurcation angle has been hypothesized as related to higher turbulence and low shear stress, which might induce plaque proliferation at the bifurcated regions, whereas a narrow angle might be more prone to present laminar flow and less likely to induce plaque formation 4-6, 8, 10-18 . Despite the evidence of a direct correlation between the LCBA and the formation of plaques 4 , to the best of the authors' knowledge, this is the first study to investigate the correlation between the LCBA

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“…Harrison and Marshall found no significant difference between the bifurcation angles of normal patients vs. those with stenosis, 20 but the important role of branch angle has been suggested in several studies. [45][46][47] Moreover, as shown in Table 3, there was a significant difference in the ECA/CCA diameter ratio (5.64±12.751% vs. −3.59±8.697%, P=0.047) between crotches. Regions with low TAWSS and high OSI appeared on the sinus, which was consistent with the location of neointima.…”

Section: Synthetic Models: Univariate and Multivariate Analysesmentioning

confidence: 80%

Carotid Geometry as a Predictor of In-Stent Neointimal Hyperplasia　― A Computational Fluid Dynamics Study ―

Yao

Dai

Zhang

et al. 2019

Circ J

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Background: Carotid angioplasty and stenting (CAS) is emerging as an alternative treatment for carotid stenosis, but neointimal hyperplasia (NIH) remains a drawback of this treatment strategy. This study aimed to evaluate the effect of variations of carotid bifurcation geometry on local hemodynamics and NIH. Methods and Results: Hemodynamic and geometric effects on NIH were compared between 2 groups, by performing computational fluid dynamics (CFD) simulations both on synthetic models and patient-specific models. In the idealized models, multiple regression analysis revealed a significant negative relationship between internal carotid artery (ICA) angle and the local hemodynamics. In the patient-derived models, which were reconstructed from digital subtraction angiography (DSA) of 25 patients with bilateral CAS, a low time-average wall shear stress (TAWSS) and a high oscillatory shear index (OSI) were often found at the location of NIH. Larger difference values of the OSI percentage area (10.56±20.798% vs. −5.87±18.259%, P=0.048) and ECA/CCA diameter ratio (5.64±12.751% vs. −3.59±8.697%, P=0.047) were detected in the NIH-asymmetric group than in the NIH-symmetric group. Conclusions: Changes in carotid bifurcation geometry can make apparent differences in hemodynamic distribution and lead to bilateral NIH asymmetry. It may therefore be reasonable to consider certain geometric variations as potential local risk factors for NIH.

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Relationship between left coronary artery bifurcation angle and restenosis after stenting of the proximal left anterior descending artery

Abstract: Supplemental Digital Content is available in the text.

Cited by 16 publications

References 45 publications

Relationship between left main and left anterior descending arteries bifurcation angle and coronary artery calcium score in chronic kidney disease: A 3-dimensional analysis of coronary computed tomography

Relationship between left main and left anterior descending arteries bifurcation angle and coronary artery calcium score in chronic kidney disease: A 3-dimensional analysis of coronary computed tomography

Comparison of the Left Main Coronary Bifurcating Angle among Patients with Normal, Non-significantly and Significantly Stenosed Left Coronary Arteries

Carotid Geometry as a Predictor of In-Stent Neointimal Hyperplasia　― A Computational Fluid Dynamics Study ―

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Relationship between left coronary artery bifurcation angle and restenosis after stenting of the proximal left anterior descending artery

Abstract: Supplemental Digital Content is available in the text.

Cited by 16 publications

References 45 publications

Relationship between left main and left anterior descending arteries bifurcation angle and coronary artery calcium score in chronic kidney disease: A 3-dimensional analysis of coronary computed tomography

Relationship between left main and left anterior descending arteries bifurcation angle and coronary artery calcium score in chronic kidney disease: A 3-dimensional analysis of coronary computed tomography

Comparison of the Left Main Coronary Bifurcating Angle among Patients with Normal, Non-significantly and Significantly Stenosed Left Coronary Arteries

Carotid Geometry as a Predictor of In-Stent Neointimal Hyperplasia ― A Computational Fluid Dynamics Study ―

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Carotid Geometry as a Predictor of In-Stent Neointimal Hyperplasia　― A Computational Fluid Dynamics Study ―