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Background and objective: The mutual contribution of each of these in LM bifurcation has not been yet evaluated in a computational model. To investigate the impact and the relationships among bifurcation angles and different left main (LM) stenting techniques using computational fluid dynamic (CFD) analysis. Methods: We reconstructed a LM bifurcation after analyzing 50 consecutive patients (mean age 77.4 ± 4.3, 39 males) with LM distal/bifurcation disease. Consequently, LM bifurcation angles to test were set to: 45°, 60° and 85°. A 90% lesion was added to each vessel obtaining a Medina 1.1.1 LM bifurcation disease. Techniques for LM bifurcation stenting included Nano-crush, DK-crush and Culotte. Results: The Nano-crush obtained the higher averaged WSS in MB and SB at any angle compared to the other two techniques. At the carina the WSS are slightly lower at 45° and highest at 60° and 80° degrees. The DK crush resulted to show the higher values of WSS at the carina at any angles while it achieved the largest lower WSS at MB and SB in particular at 60° degrees. Finally, the Culotte obtained the lower averaged WSS in particular at the carina and SB at 60° degrees and slightly worse compared to the other two techniques at 45° and 80° degrees. Conclusions: The study confirmed the role of angles in LM bifurcation rheology and enhanced the impact of bifurcation angles on double stenting techniques in terms of WSS. *Correspondence to: Gianluca Rigatelli, MD, PhD, EBIR, Cardiovascular Diagnosis and Endoluminal Interventions, Santa Maria della Misericordia Hospital, Viale Tre Martiri 140, 45100 Rovigo, Italy, E-mail: jackyheart@libero.it

journal of integrative cardiology

Left main bifurcation stenting assessed by computational fluid dynamic: The impact on wall shear stress forces depends on both specific techniques and bifurcation angles