Antoniadis Antonios P, Giannopoulos Andreas A, Wentzel Jolanda J, Joner Michael, Giannoglou George D, Virmani Renu, Chatzizisis Yiannis S
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
EuroIntervention. 2015;11 Suppl V:V18-22. doi: 10.4244/EIJV11SVA4.
Coronary artery bifurcations are susceptible to atherosclerosis as a result of the unique local flow patterns and the subsequent endothelial shear stress (ESS) environment that are conducive to the development of plaques. Along the lateral walls of the main vessel and side branches, a distinct flow pattern is observed with local low and oscillatory ESS, while high ESS develops at the flow divider (carina). Histopathologic studies have shown that the distribution of plaque at bifurcation regions is related to the local ESS patterns. The local ESS profile also influences the outcome of percutaneous coronary interventions in bifurcation lesions. A variety of invasive and non-invasive imaging modalities have enabled 3D reconstruction of coronary bifurcations and thereby detailed local ESS assessment by computational fluid dynamics. Highly effective strategies for treatment and ultimately prevention of atherosclerosis in coronary bifurcations are anticipated with the use of advanced imaging and computational fluid dynamic techniques.
由于独特的局部血流模式以及随后有利于斑块形成的内皮剪切应力（ESS）环境，冠状动脉分叉处易患动脉粥样硬化。在主血管和侧支的侧壁上，观察到一种独特的血流模式，局部ESS较低且呈振荡性，而在分流处（隆突）则出现高ESS。组织病理学研究表明，分叉区域斑块的分布与局部ESS模式有关。局部ESS分布还会影响分叉病变经皮冠状动脉介入治疗的结果。多种有创和无创成像方式已能够对冠状动脉分叉进行三维重建，从而通过计算流体动力学对局部ESS进行详细评估。随着先进成像和计算流体动力学技术的应用，有望制定出高效的治疗策略，并最终预防冠状动脉分叉处的动脉粥样硬化。
