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Numerical investigation of blood flow in a deformable coronary bifurcation and non-planar branch.

ABSTRACT: INTRODUCTION: Among cardiovascular diseases, arterials stenosis is recognized more commonly than the others. Hemodynamic characteristics of blood play a key role in the incidence of stenosis. This paper numerically investigates the pulsatile blood flow in a coronary bifurcation with a non-planar branch. To create a more realistic analysis, the wall is assumed to be compliant. Furthermore, the flow is considered to be three-dimensional, incompressible, and laminar. METHODS: The effects of non-Newtonian blood, compliant walls and different angles of bifurcation on hemodynamic characteristics of flow were evaluated. Shear thinning of blood was simulated with the Carreau-Yasuda model. The current research was mainly focused on the flow characteristics in bifurcations since atherosclerosis occurs mostly in bifurcations. Moreover, as the areas with low shear stresses are prone to stenosis, these areas were identified. RESULTS: Our findings indicated that the compliant model of the wall, bifurcation's angle, and other physical properties of flow have an impact on hemodynamics of blood flow. Lower wall shear stress was observed in the compliant wall than that in the rigid wall. The outer wall of bifurcation in all models had lower wall shear stress. In bifurcations with larger angles, wall shear stress was higher in outer walls, and lower in inner walls. CONCLUSION: The non-Newtonian blood vessels and different angles of bifurcation on hemodynamic characteristics of flow evaluation confirmed a lower wall shear stress in the compliant wall than that in the rigid wall, while the wall shear stress was higher in outer walls but lower in inner walls in the bifurcation regions with larger angles.

SUBMITTER: Razavi SE

PROVIDER: S-EPMC4298711 | biostudies-other | 2014

REPOSITORIES: biostudies-other

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Numerical investigation of blood flow in a deformable coronary bifurcation and non-planar branch.

Razavi Seyed Esmail SE Omidi Amir Ali AA Saghafi Zanjani Massoud M

BioImpacts : BI 20141230 4

<h4>Introduction</h4>Among cardiovascular diseases, arterials stenosis is recognized more commonly than the others. Hemodynamic characteristics of blood play a key role in the incidence of stenosis. This paper numerically investigates the pulsatile blood flow in a coronary bifurcation with a non-planar branch. To create a more realistic analysis, the wall is assumed to be compliant. Furthermore, the flow is considered to be three-dimensional, incompressible, and laminar.<h4>Methods</h4>The effec ...[more]

PMID: 25671176

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Project description:BackgroundThe optimal side branch (SB) treatment strategy after simple crossover stenting in bifurcation lesions is still controversial.ObjectivesThe purpose of this study was to compare the long-term outcomes of a 1-stent strategy with simple crossover alone versus with an additional SB-opening procedure in patients with left main (LM) and non-LM coronary bifurcation lesions.MethodsPatients who underwent percutaneous coronary intervention with a 1-stent strategy for bifurcation lesions including LM were selected from the COBIS (Coronary Bifurcation Stenting) III registry and divided into the simple crossover-alone group and SB-opening group. Clinical outcomes were assessed by the 5-year rate of target lesion failure (a composite of cardiac death, target vessel myocardial infarction, and target lesion repeat revascularization).ResultsAmong 2,194 patients who underwent the 1-stent strategy, 1,685 (76.8%) patients were treated with simple crossover alone, and 509 (23.2%) patients were treated with an additional SB-opening procedure. Although the baseline SB angiographic disease was more severe in the SB-opening group, the final lumen diameter of the SB was larger. The 5-year observed target lesion failure rate was similar between the 2 groups (7.0% in the simple crossover vs. 6.7% in SB-opening group; hazard ratio: 0.99; 95% confidence interval: 0.66 to 1.48; p = 0.947), even in the subgroup analyses including LM (9.5% vs. 11.3%; p = 0.442) and true bifurcation (5.3% vs. 7.8%; p = 0.362). The results were not changed after an inverse probability of treatment weighting adjustment. There was no difference in the overall and SB-related target lesion revascularization rate in both groups.ConclusionsThe long-term clinical outcome of the 1-stent strategy with simple crossover alone for coronary bifurcation lesions was acceptable compared to those of additional SB-opening procedures. (Korean Coronary Bifurcation Stenting [COBIS] Registry III [COBIS III]; NCT03068494).

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Numerical investigation of blood flow in a deformable coronary bifurcation and non-planar branch.

Publications

Numerical investigation of blood flow in a deformable coronary bifurcation and non-planar branch.

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