Department of Cardiology, Athens Euroclinic, Athens, Greece.
Phys Med Biol. 2010 Mar 7;55(5):1395-411. doi: 10.1088/0031-9155/55/5/009. Epub 2010 Feb 11.
Flow patterns may affect the potential of thrombus formation following plaque rupture. Computational fluid dynamics (CFD) were employed to assess hemodynamic conditions, and particularly flow recirculation and vortex formation in reconstructed arterial models associated with ST-elevation myocardial infraction (STEMI) or stable coronary stenosis (SCS) in the left anterior descending coronary artery (LAD). Results indicate that in the arterial models associated with STEMI, a 50% diameter stenosis immediately before or after a bifurcation creates a recirculation zone and vortex formation at the orifice of the bifurcation branch, for most of the cardiac cycle, thus allowing the creation of stagnating flow. These flow patterns are not seen in the SCS model with an identical stenosis. Post-stenotic recirculation in the presence of a 90% stenosis was evident at both the STEMI and SCS models. The presence of 90% diameter stenosis resulted in flow reduction in the LAD of 51.5% and 35.9% in the STEMI models and 37.6% in the SCS model, for a 10 mmHg pressure drop. CFD simulations in a reconstructed model of stenotic LAD segments indicate that specific anatomic characteristics create zones of vortices and flow recirculation that promote thrombus formation and potentially myocardial infarction.
血流模式可能会影响斑块破裂后血栓形成的潜力。计算流体动力学（CFD）被用于评估血流动力学条件，特别是在左前降支（LAD）中与 ST 段抬高型心肌梗死（STEMI）或稳定型冠状动脉狭窄（SCS）相关的重建动脉模型中的血流再循环和涡流形成。结果表明，在与 STEMI 相关的动脉模型中，在分支前或分支后 50%直径狭窄处会在分支口处产生一个再循环区和涡流形成，在大部分心动周期内，从而允许形成停滞流动。在具有相同狭窄程度的 SCS 模型中不会出现这些流动模式。在 STEMI 和 SCS 模型中，在存在 90%狭窄的情况下，狭窄后再循环明显。在 STEMI 模型中，90%直径狭窄导致 LAD 中的血流减少 51.5%和 35.9%，而在 SCS 模型中，血流减少 37.6%，压差为 10mmHg。在狭窄的 LAD 节段的重建模型中的 CFD 模拟表明，特定的解剖特征会产生涡流和血流再循环区，从而促进血栓形成和潜在的心肌梗死。
